14 October 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
-SY
Dear SY: There are many causes for headaches. Muscle tension headaches may be provoked by physical stresses such as fatigue, physical activity, dehydration, and heat, as well as emotional stress. Migraines often run in families. Caffeine addiction with withdrawal can cause headache. If the pain is severe or frequent, see a neurologist for further evaluation.
Sincerely,
Dr. Warren
-D
Dear D: Since the child is your nephew, it would be undesirable to keep him out of your house; however, it is clear that the boys should not be left together unsupervised for even brief periods of time. Therefore, you will have to set and enforce rules about where they are to be during the entire time your nephew is in your house.
I am a bit surprised that you did nothing when your son first told you about your nephew's request to see his penis rather than waiting until your son was accused of doing something "funny." It is imperative that both boys be told the rules about sex play, and it is essential that you talk to your son about not keeping any secrets from you even (especially) if someone threatens him. Make sure you do this in such a way as to make your son feel safe talking to you rather than feeling threatened by you if he doesn't talk.
Sexual curiosity is perfectly normal in a 6 or 8 year old, but looking for or talking about sexual stimulation such as putting a mouth on a penis suggests that the child has been told about or had a sexual experience with someone older. There is a possibility that your nephew has been sexually abused.
Sincerely,
Dr. Warren
Three months ago she had a runny nose that lasted over a month. Thinking it was allergies, I allergy proofed her room and used a vaporizer. It then turned into a cold. Her runny nose then stopped after four days and I assumed her cold was gone, but she developed a cough. After using Infant's Robitussin for over a week, I took her to our family doctor because the cough would not go away. He recommended an antibiotic:Trimox (something like that). After the ten days that it took to finish this antibiotic, her cough lessened but recurred at night. I administered more over the counter cough medicine for about two weeks to help her sleep uninterrupted by the cough, but not on a daily basis. Now it is three months later and she still gets very congested at night, her breathing is extremely loud, and lately it has gotten so bad that she tosses and turns constantly at night. I know she is not getting the rest she needs because her afternoon nap has increased from 45 minutes to 2 hours. Nevertheless, it is a challenging nap for her. She is awakened by not being able to breath from her nose. I sometimes manage to get her to breathe from her mouth, and she sleeps for a maximum of 25 minutes as I rock her in my arms. But she really doesn't know how to sleep with her mouth open to facilitate breathing.
Please enlighten me on why she could be so congested that: her breathing is extremely loud, she coughs about three times a day to clear the congestion, her sleep is being interrupted, and antibiotics as well as over the counter allergy medication, cold medication, and decongestants are not helping the problem go away.
I have given her so many different types of over the counter medication but nothing helps. I never give her any symptom-relief medication for more than a week since the bottle suggests not to. I am scared to give her any more. I am also scared to take her to the doctor for fear that he'll only prescribe more antibiotics and more symptom-relief medication.
Help, if you can. I anxiously await a response from you. Thank you for your time.
-Mrs. L
Dear Mrs. L: If you child cannot breathe through her nose and has not responded to antibiotic treatment, allergy medications, or decongestants, she may have enlarged adenoids. An ENT surgeon would be the best physician to see for evaluation.
Persistent coughing which has not responded to antibiotics may be a sign of asthma. For the doctor to tell if your child is wheezing she must be kept quiet and calm during the examination, and he may have to squeeze on her chest as the air comes out in order to elicit a wheeze. If she is wheezing, there are many medications which can relieve her symptoms.
Sincerely,
Dr. Warren
-AB
Dear AB: The surgery for removal of a testicle is called and orchiectomy or an orchidectomy. The reason you give sounds a little far fetched, so it would be useful if you could get more information. If the testicle had been undescended and was atrophic (underdeveloped) there is a higher risk of cancer, and so removal might be done. A torsion (twisting) of the testicle would cut off it's blood supply resulting in the death of the testicle. If a torsion is not treated in time to save the testicle, the testicle would be removed. The only other reason I can think of to remove a child's testicle is cancer. Perhaps my surgical colleagues might think of other reasons.
Sincerely,
Dr. Warren
Thank you for your assistance.
-LBS
Dear LBS: Certain connective tissue disorders such as Marfan's Syndrome and Ehlers Danlos syndrome have a higher risk of aneurysm. These syndromes are recognized by other clinical features. One study suggests that an autosomal recessive predisposition exists for late-onset abdominal aneurysms. This is not likely to be a concern during childhood.
An ultrasound study is the best and safest way to screen for an abdominal aortic aneurysm.
Sincerely,
Dr. Warren
-SC
Dear SC: Cafe au lait spots are seen as part of neurofibromatosis, also known as von Recklinghausen's disease. Neruofibromatosis is a genetic disease, so you may find a family history if you look. Neurofibromas are benign tumors. The symptoms they cause depend primarily on where they grow. Since neurofibromatosis is primarily a neurological disorder, even though it is inherited genetically, and your pediatrician has found other neurological "things," your child should be seen by a pediatric neurologist.
Sincerely,
Dr. Warren
-SS
Dear SS: Shingles is caused by reactivation of chicken pox virus which lies dormant in nerve roots. The blisters have live virus in them, but unlike chicken pox, the virus is not present in the respiratory tract so it is only contagious by direct contact. If the lesions are covered and your daughter does not touch them the risk of contagion is nil. Nonetheless, patients with active shingles should not be around newborns or people with reduced immunity.
Shingles is not serious, but it can be quite painful. It resolves on its own usually within 2 weeks. Treatment with Zovirax (acyclovir), an antiviral agent, has been shown to decrease the length of time of viral shedding, pain, and time to resolution if started within 72 hours. The benefits of Zovirax are greatest in adults older than 50. Medication is generally not used for children except when they have decreased immunity or a severe outbreak.
When the blisters are fully scabbed and there are no new ones your daughter will no longer be contagious. If she were in an upper grade, I would recommend covering the lesions so she could return to school early, but at 5 years of age, it would be best for her to stay home until the lesions are scabbed, about 1 week.
Sincerely,
Dr. Warren
Note to my readers: Recent studies suggest that early treatment can minimize or prevent post-herpetic neuralgia (prolonged pain after shingles).
-JC
Dear JC: One of the best known centers for lung disease in the country is the National Jewish Medical and Research Center, 1400 Jackson Street, Denver, Colorado 80206 (303)388-4461 (800)222-LUNG, whose web site can be found at http://www.njc.org/. Perhaps they can direct you.
Sincerely,
Dr. Warren
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