17 July 2000

1. Teen Distressed by the Absence of Underarm Hair
2. Newborn Jaundice & Speech Delay?
3. Low Muscle Tone
4. Relapse of Glandular Fever
5. Few Drops of Blood in Infant's Stool
6. Piles, an Embarrassing Problem
7. Recurrent UTI
8. Fractured Toe
9. Disclaimer

• Read Questions & Answers in Another Column

Teen Distressed by the Absence of Underarm Hair

Is their medicine or hormone pills I can drink. Please HELP me, I need this help URGENTLY!!

I hope there is nothing wrong with me and that this problem will soon be overcome!!

Help me please and save me from embarrassment!!

Thank you very much and God Bless You.

-H

Dear H: By now you should have received my response to your previous e-mail. Just in case you didn't it said:

Puberty (the change from being a boy to a man) progresses in a stepwise fashion. First the testicles (balls) enlarge. Then hair develops around the penis. Then the penis enlarges and the hair becomes darker, coarser, curlier, and more abundant. After that more body hair and hair under the arms develops. Some boys start puberty later than others. If you first started when you were 16, and you now have pubic hair and adult size genitals, you can expect the rest of the body hair to develop, and your development is normal. If you have not had any changes of puberty, you must see your doctor for a complete evaluation.

The other thing you must consider is that body hair is genetic. If your father or mother don't have much body hair, you may not either. I know it is difficult at 17-1/2 when you think you are different from everyone else and you think there is something wrong, but if your body is developing normally, you must be patient.

Everyone is self conscious at your age. While you're worrying about your underarm hair, another boy is worrying that he has pimples, and another one is afraid that someone will notice if he has an erection. If anyone says anything to you about your body you should reply, "Why are you so interested in my body that you would notice where I have hair? I'm not looking under your arms to see what you have."

As far as I know, testosterone, the male hormone, is only available as an injection. I'm not sure that a month of injections would change your body hair in time for your camp. I'm also not sure that hormones would be a good idea if you're developing normally. But if you have concerns about these things, you should se your doctor, or perhaps an endocrinologist.

I understand your distress, but you are focused on your underarm hair because you are worried about it. Do you really think that the other boys will have any interest in looking under your arms? If any of them do, I would question why they are so interested. I can't promise that nobody will tease you because sometimes people do, but you only give them power if you are overly sensitive to it. You need to know and have faith that you are developing normally. Make friends and allies by being a friend and a helpful, fun person to be with. If you do that, the others will not want to tease you.

Sincerely,
Dr. Warren

PLEASE HELP ME !!!!!

Thank you.

-H

Dear H: This is the third time I am answering this question for you. Pay attention to the answer. I am sorry you are so distressed about not having hair under your arms, but since the rest of your body is developing normally, I suggest you be patient and let your body finish maturing. You can't rush nature. Believe me, nobody is interested in the appearance of your underarms except you.

Since your body already has testosterone circulating causing you to develop adult male secondary sex characteristics, I do not think additional hormones would speed things up. It takes time for hair to develop in an area. Hormones have side effects and I don't think it would be beneficial for you to take any. But if there's a chance that a hormone would help you, you would need it to be prescribed. You can't just walk into a store and ask for hormones to grow hair under your arms. Since you think this is so important and don't wish to heed my previous advice, why don't you make an appointment to see an endocrinologist for evaluation. He will tell you if it is reasonable to do anything and prescribe medication if it's appropriate.

Sincerely,
Dr. Warren

-DC

Dear DC: An extremely elevated bilirubin in the newborn period can cause brain damage. The condition is known as kernicterus. It can cause deafness and cerebral palsy. The usual elevations of bilirubin seen in the newborn period do not cause kernicterus. Usually the bilirubin level would have to be well over 20 mg/dl to cause kernicterus. Unless the speech therapist is aware of such a circumstance, I'm not sure what the basis for her statement is.

Sincerely,
Dr. Warren

-DW

Dear DW: A baby may have low muscle tone due to neurological reasons or related to certain muscle conditions. An experienced neurologist should be able to judge if the baby is low tone just by feeling the muscles and the movement of the limbs. Even if a baby isn't floppy, if you can pull the arm across the chest so that the elbow goes past the midline, you can be pretty sure the baby has low muscle tone. Because of the decreased strength associated with low muscle tone, these children often have motor developmental delays, but there is no implication that intellect or the social and language development is affected, although sometimes speech may be delayed if the muscles of the mouth and tongue are affected.

I see no harm in getting physical therapy. It wouldn't be putting the baby through anything. An experienced physical therapist can give you a second opinion about your baby's muscle tone. The therapy that is given to exercise an strengthen the muscles is not painful an may be enjoyable for an infant.

Sincerely,
Dr. Warren

-TB

Dear TB: I believe that glandular fever is what we call mononucleosis in the USA. Mononucleosis is caused by Epstein-Barr Virus (EBV). Theoretically, once a person has had an EBV infection he is immune for life. Since most people have inapparent EBV infections, most adults are immune to mononucleosis. The issue of whether or not there is such a thing as chronic or recurrent mononucleosis remains controversial, just as the question of whether or not there is any relationship between EBV and chronic fatigue syndrome remains controversial. EBV is a herpes type virus, and we do know that other herpes viruses cause recurrences - Herpes simplex in the form of fever blisters or recurrent genital herpes, chicken pox in the form of shingles. And since I've mentioned chicken pox, to draw a parallel to your question, chicken pox causes life long immunity, but there are situations where patients have had documented cases of chicken pox more than once, but that is rare.

So, in answer to your question, it may be possible to have mononucleosis more than once, or to have a relapse, but it is probably uncommon. It is also possible to have another illness with similar symptoms since many viruses can cause swollen glands and fatigue, although most do not result in as prolonged an illness as EBV.

Sincerely,
Dr. Warren

We have done blood test, urine tests and excrement tests and they are all OK.

We are looking forward to hearing from you ASAP.

Yours faithfully,
-Family K

Dear K Family: For starters, I'm not sure what "baby tea" is. I'm not sure that a 3 month old needs 100 ml. of any kind of tea daily, but I'm especially concerned about whether there are any active ingredients in the tea. That, of course, does not mean that I think the tea is in any way related to the blood in the stool, but I can't be sure.

If you see only a few drops of red blood in the stool, it suggests that the blood is coming from low in the intestinal tract. That could be seen with an anal fissure. Polyps can also cause bleeding. Formula sensitivity can sometimes cause blood in the stool, so if an infant is very sensitive to cows milk, a nursing mother may have to discontinue all cow's milk products while nursing.

If the bleeding continues, you should see a pediatric gastroenterologist for evaluation to determine the cause.

Sincerely,
Dr. Warren

Recently inside of my bottom has felt a bit sore, so I decided to use a mirror to look at it myself. I have found a small clump of small lumps that look quite sore. I asked my mother about it as we are close and can talk about personal things, she said it may be piles but I have never had piles before and don't know what to look for.

I am too embarrassed to go to my own Doctor but at the same time I am VERY worried.

I really hope you reply to me as I am very concerned, I don't want to go to my Doctor and I am afraid of what might happen if I leave it.

I hope you can help me.

-Embarrassed

Dear Embarrassed: The other term for piles is hemorrhoids. Hemorrhoids are varicose veins in the anus and rectum. They appear bluish and swollen. If they are inflamed they will be tender to touch. It is possible, from your description, that you are talking about piles, but I cannot be sure. When in doubt, the best thing to do is see a doctor, even when the problem is embarrassing.

Sincerely,
Dr. Warren

My question to you is this... what can I do in terms of behavior modification to help her with wetting? The pediatrician is labelling this as a case of disfunctional voiding, but there are definitely some mental control isssues here as well. I would like to get her "on track" as soon as possible as I am afraid that she is repeatedly damaging her body. I also don't like to continually use antibiotics. She is taking cranberry supplements and Primadophilus. What else can I do?

Please write me back with any information you might have or suggestions where or who I might look to for help. Thank you for your attention to this matter.

Most sincerely,
DK

Dear DK: If you have difficulty getting your daughter to void regularly each day, eliminate the fuss about it by making it a regularly scheduled event. Schedule trips to the bathroom every 2 hours. Plan it so as not to be disruptive to your daughter's usual schedule. There are enough pauses between activities to plan a schedule that does not interrupt things. Be consistent about enforcing the schedule, including stopping any activity so that there will not be anything for your daughter to miss. You cannot make your daughter urinate, but you can make her go sit on the toilet. Once she gets used to the fact that the bathroom schedule will continue regardless of whether or not she urinates, it is likely she will become more cooperative about urinating.

It is less likely that your daughter is at risk for kidney damage from an infection since she doesn't have reflux; however, given your daughter's history, any time she has an unexplained fever she should have a urine culture rather than waiting to see if the fever persists. She should also have a culture every month for 3 months after an infection, followed by a culture every 3 months for the remainder of a year.

Sugar in the diet has nothing to do with wetting or urinary tract infections. Sugar is only significant to urinary symptoms in someone with diabetes mellitus.

Dysfunctional voiding may be a result of physical problems even in the absence of reflux. Your daughter should have her urinary tract evaluated by a urologist.

Sincerely,
Dr. Warren

-TRB

Dear TRB: A digit, finger or toe, which is swollen and discolored (bruised) is generally fractured. A broken toe can often be treated just by taping it to the toe next to it. If multiple toes are broken or bones in the foot are broken casting may be necessary. If a digit is distorted, the fracture is usually displaced and must be reduced (properly adjusted) before being set. A fractured toe should not be serious, but if you are not able to make the judgment as to whether or not anything needs to be done, then your child needs to see a doctor.

Sincerely,
Dr. Warren

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