11 February 2002
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
-CH
Dear CH: There is no way not to overreact once you consider a serious diagnosis and have to await consultation and test results to know if your worries are realized or over. Unfortunately, there is no way to be sure how worried you should be until your daughter has been evaluated. Certainly viruses can cause swollen glands, fever, cough, low white blood cell count, and low platelet count. Other blood disorders besides leukemia could cause your daughter's blood picture. When you throw in 6 months of weight loss, it becomes even more worrisome unless your daughter has been trying to lose weight or increased activity can account for the weight loss.
On the reassuring side, aside from the fact that your daughter's condition could be from something less serious than leukemia, treatments available today for leukemia have a pretty good success record. If your daughter does have any kind of cancer, you should seek treatment at a university center where they treat a large number of cancer patients. If you are in the New York area, there are many excellent institutions, but the tops for cancer has to be Memorial Sloan Kettering.
Please let me know how things turn out for you and your daughter.
Sincerely,
Dr. Warren
-Very Concerned
Dear Very Concerned: Without examining your child or even knowing where in her stomach she has pain, since there are so many possibilities, I can't be sure what might be causing your daughter's abdominal pain. The most common causes of abdominal pain in children are:
Sincerely,
Dr. Warren
Sincerely,
-A Frustrated and Concerned Mother.
Dear Frustrated: One of the reasons I advise against letting children sleep in their parents' bed is that once the children get used to it, they come to depend on it for nighttime comfort. There isn't necessarily an age at which the children will just decide they've had enough. Or at least, that time doesn't come soon enough for most parents. After spending 6 years in your bed, your daughter will continue to join you every night unless you tell her she can't and enforce it. I don't mean to be brutal. Comfort her and try to help her fall back to sleep in her own bed, but don't let her back in yours, not even once.
Please read my article, Helping Your Child to Sleep Through the Night.
Sincerely,
Dr. Warren
Sincerely,
-Lilly
Dear Lilly: Unless you are out of the house all day, every day, you need not be concerned that your son will develop an infection waiting to use the bathroom at home. As he gets older, he will probably be able to tolerate rest rooms outside your house. When you are out, you should let him see some of the restrooms without pressuring him to use them so that he can see that they are not all flooded.
Sincerely,
Dr. Warren
thanks
-EI
Dear EI: If your breast enlargement began during adulthood, I would advise that you should have an endocrine evaluation to check for hormone problems. Breast enlargement which occurs during puberty is called gynecomastia. It is fairly common and usually resolves as puberty progresses; however, not all adolescent gynecomastia resolves.
The larger the amount of breast tissue, the greater the likelihood that some will persist, and the more distressing it is to the young men. If you haven't had a complete physical, you should. Until then, you should at least do a testicular self exam to check for lumps since gynecomastia can sometimes be caused by testicular tumors. That is unlikely since you've had the breast swelling for over 10 years and are in good health, but if you don't check, you don't know.
Gynecomastia which is large, persists more than two to three years, persists into or past late puberty, or causes a great deal of distress socially or emotionally, can be treated with breast reduction surgery. This is generally done by a plastic surgeon.
Sincerely,
Dr. Warren
My question is: his breasts are quite enlarged (have been for about two and a half years) and he is becoming more and more self-conscious about it. Other boys that are his size don't seem to have this problem. Is there anything we can do about this?
Thank you.
-B
Dear B: Your son may have gynecomastia, swelling of the breasts related to puberty. Severe gynecomastia that has persisted more than two years can be treated with breast reduction surgery. If the young man is very distressed by his breast size and it is affecting him socially and emotionally, the surgical option should be explored, but first he needs a physical by his pediatrician to determine if that's what's going on.
Sincerely,
Dr. Warren
Please can you help?
-Julie
Dear Julie: Recurrent fainting spells of the type you describe require evaluation by a cardiologist. He will do a tilt table test to see if your blood pressure responses and heart rate are responsible for your fainting episodes. You may require medication to prevent these spells.
Hypoglycemia (low blood sugar) could cause faintness, but not generally to the degree you describe. Eating sugar does not prevent hypoglycemia. It may even aggravate it. To prevent hypoglycemia you need protein and complex carbohydrates which your body can burn for energy. Theoretically, sugar may cause a larger rise in the blood sugar than protein and complex carbohydrates, and it is metabolized more quickly, so that the blood sugar may fall more quickly after a sugar meal which does not have protein or starch.
Dehydration may also contribute to dizziness. Drinking adequate fluids is important, but if you drink large quantities of fluids that have no salts, you may lower your blood sodium and increase your chance of fainting. Active people lose more than fluid when they sweat. They also lose salt. That's why sports drinks like Gatorade have salt in them. Increasing salt intake has sometimes been the only treatment necessary to eliminate fainting spells.
Sincerely,
Dr. Warren
Thank you for taking the time to read this any help is greatly appreciated.
Thank you.
-A Concerned Stepmother
Dear Concerned Stepmother: Use a moisturizer such as Eucerin on the dried, peeling areas of skin. The severity of the scarlet fever rash may be due to the particular strain of strep that your stepdaughter had. I can't say that treating her before 3 to 4 days would have made the rash less severe. Three days is not too long to wait before seeing a doctor about a sore throat if a child is not very sick. Muscle aches can be seen as part of many infectious illnesses. They are often worse as the fever goes up, but may be present as a symptom even in the absence of fever.
Antibiotics do not have any long term protective effect on the body. They work by killing germs. After the course of treatment is over, the patient can still catch any illness he is exposed to. If a person is exposed to an infection that is resistant to an antibiotic he is on, he can catch it while on antibiotics. Virus infections, which include colds, do not respond to antibiotic treatment. You can catch colds or flu even while you are taking a broad spectrum antibiotic. Ear infections may sometimes develop while on an antibiotic because, until the ear becomes inflamed, the antibiotic doesn't achieve very high concentrations in the middle ear.
Scarlet fever does not get worse each time you get it. While two strep infections is more than anyone wants in a year, it is not an extraordinary or dangerous frequency of infection. Since she didn't go on antibiotics immediately the second time, she may even develop an increased immunity to strep.
Sincerely,
Dr. Warren
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