5 August 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
Most of the time, she is happy and heathy. She doesn't shiver when this happens and we make sure her room is kept very warm and she sleeps in footed pajamas and under a blanket. These "blue"spells began when she was about 10 months old.
She has seen a pediatric cardiologist. It was discovered that she has an innocent murmur. He said the cold spells were not heart related. No doctor seems to have an answer, although a nurse said I might have her thyroid checked out. Do you have any ideas?
-KP
Dear KP: Hypothyroidism as a cause for hypothermia due to a low metabolic rate is not a bad thought, but hypothyroidism generally causes poor growth in children so that a child who is clinically hypothyroid would usually be diagnosed while evaluating short stature. A person with insufficient body fat may have difficulty maintaining body temperature, but the hypothermia should still provoke shivering. The absence of shivering suggests a primary problem with thermoregulation. Thermoregulation is controlled by the hypothalamus in the brain.
The following is a partial list of some of the things that can cause hypothermia:
CNS (central nervous system) lesions, debility and exhaustion, encephalopathy, complications of diabetes, hypoglycemia, hypoadrenalism, hypopituitarism, malnutrition, myxedema (uncontrolled hypothyroidism), drugs and alcohol.Most of these would cause other symptoms or findings besides a low body temperature. There are obviously things on this list that don't apply to your daughter. Your pediatrician would be the best person to tell you if any of these possibly could.
Sincerely,
Dr. Warren
Well we hate the brace, and think she does too. It makes it difficult to snuggle with her, and is constantly getting soiled (due to diaper blowouts). The Dr. had suggested that we avoid even taking it off to bath her.
Since getting the brace, we have talked to several other people who have had children with similar hip problems. My brother-in-law, for example, has a 4-year old daughter who had a dislocatable hip. She was merely tripple-diapered for several months. We certainly would prefer that to the brace. What are the risks, and why might there be a difference between brace and diaper treatments?
-Walt
Dear Walt: If an infant has a truly dislocatable hip, I would never recommend triple diapers as sufficient treatment. Infants who have dislocatable hips have shallow hip sockets. The brace holds the leg end of the hip joint in the socket so that the socket develops properly around it. It's a simple treatment which can prevent a lifelong arthritis of the hip. Triple diapers are only intended to be a temporary measure until a diagnosis is made.
I have never heard that the child should not be taken out of the brace for bathing. Brief periods out of the brace should not interfere with the proper development of the hip socket which occurs while the joint is held in proper alignment.
Your situation is different. According to the ultrasound study, your daughter's hips were normal. If your doctor isn't comfortable making a commitment to the diagnosis of no disease on that basis but isn't convinced that your daughter has congenital hip dysplasia, get another opinion from a pediatric orthopedist. If necessary, repeat the ultrasound to clarify the situation.
Sincerely,
Dr. Warren
-RG
Dear RG: Ritalin is a good medication for treating Attention Deficit Disorder, but it is not something you can just decide to try. It's a controlled drug and requires a prescription. Before embarking on any treatment, your daughter needs a diagnostic evaluation. Most of the evaluation is psychological testing which can be done by her school.
From your description, your daughter may have attention deficit disorder, but it is also possible that she is bored because the work is not challenging to her.
Sincerely,
Dr. Warren
-P
Dear P: Often parents believe that they hear or feel wheezing in their child's chest because they sense the vibrations caused by air that passes through mucus in the upper airways. If, on the other hand, your child has had wheezing, especially recurrent wheezing, it is not too early to make the diagnosis of asthma. Any child who has had the diagnosis of bronchitis on several occasions may very well be an asthmatic. The diagnosis is important because there are many good medicines for controlling and even preventing the symptoms of asthma. For more information read my article, What Is Asthma?.
It is unlikely that the meconium caused any permanent damage to your son's lungs. If it had, there should be evidence on x-ray of chronic changes. With recurrent pneumonia in the newborn period and chronic cough there are other diagnoses to consider. Your son should have a sweat test to rule out cystic fibrosis. Less likely possibilities which must at least be considered are heart abnormalities causing overcirculation to the lungs or an H type TE fistula.
I can't recommend any home remedies other than a vaporizer. If your child is wheezing he needs prescription medications.
Sincerely,
Dr. Warren
Is this common? Thanks a lot for your time.
-Sheri, worried mom
Dear Sheri: The situation you describe is not at all common. Unfortunately, diagnoses cannot be made by e-mail where the doctor has no lab results and has not examined the patient. Very often people tell me all tests were normal without telling me what tests. So with regard to the stool tests, you could mean stool culture, but did that include all possible pathogens? Or was a test for parasites done?
Since your eight month old can't talk, I'm not sure how you know he has a sore throat or body aches. I might have a different impression if I had details of symptoms and were able to examine to see where he actually had pain.
If your baby isn't crawling or standing because he has lost the ability to do so, it would be appropriate to see a pediatric neurologist now. If he isn't doing those things because he is in pain, you should see a pediatric rheumatologist. But if he is clearly getting better, it may be reasonable to wait, even though you may never have a complete answer as to what happened.
Sincerely,
Dr. Warren
Thankyou.
-TD
Dear TD: I'm not sure what conditions in American Samoa make it common for people to get boils. Most boils are caused by Staph infections in the skin. In order to set up an infection, the Staph has to get into the skin. Since Staph is a microscopic organism, it can enter through microscopic openings. The best way to avoid boils is with good skin care. If the skin isn't inflamed, it's less likely for the Staph to be able to get in. In dry environments, that usually means using moisturizers on the skin and keeping a humidifier going. In humid environments, use of powder to absorb sweat can help to prevent heat rash. Even in humid environments skin can dry out because the sweat removes skin oil; therefore, while it's advisable to wash the skin with an antibacterial soap, applying a moisturizer after bathing to prevent the skin from drying out may help.
Your doctor might consider giving you a prescription for Bactroban (Mupirocin) ointment to apply to any inflamed hair follicles before they develop into boils. Your son should keep his hands washed with an antibacterial soap since germs can often be spread and introduced into the skin by mild scratching. Many people carry Staph in their noses, so he should especially avoid putting his fingers to his nose and then scratching.
If your son's frequency of boils is significantly higher than most other people's in your area, your pediatrician might want to consider checking his white blood count when he has a boil to be sure that it isn't low and his blood sugar to be sure it isn't high. The situation you describe does not sound like it is related to any problems with immunity since the boils remain localized and he is not ill.
Sincerely,
Dr. Warren
Thank you for your anticipated help and have a wonderful holiday!
-Y
Dear Y: I apologize for the long delay in answering your question. If your web browser updates pages properly when you clicked on my e-mail link you should have seen the notice explaining that I'm not available to answer questions at this time; however, since your e-mail did get through and I have a free minute, I'm answering your question now.
Usually holes in the eardrum heal with time. In addition, they generally do not have a significant effect on hearing. Recurrent ear infections and persistent middle ear fluid are treated by placing ventilation tubs through the drum, essentially creating a hole surgically. If your son has a hearing problem which is getting worse or an ear problem that your pediatrician is not able to treat, you should see an ENT.
You and your husband have upper respiratory infections. These are very common. Of course the baby can catch it, but that does not mean he will experience the same ear problems your older son has. Antibiotics are not useful for treating viral upper respiratory infections, but sore throats and ear infections may require antibiotics. You will need to see a doctor to determine if there is a need for medication.
Sincerely,
Dr. Warren
-Peter
Dear Peter: It is perfectly normal for one testicle to hang lower than the other. Usually the left is lower than the right. A varicocoele is a varicose vein around a testicle. It feels like a bag of worms or spaghetti in the scrotum. If both of your testicles are the same size and you have no pain there is no reason to be worried.
I wonder what standard you are using to conclude that the volume of your semen is small. Most young men have nothing to compare to unless they have masturbated with friends and seen their friends ejaculate. Infertility is related to sperm count rather than the amount of semen. Low sperm counts are often associated with higher volumes of semen.
What you have described to me does not sound like you have a problem.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
