20 January 2003
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
-LP
Dear LP: The most likely thing to make the abdomen large and tense is intestinal gas. Constipation with an intestine full of stool may also do it. If the abdomen seems large but is soft, your child's belly may just hang because of weak abdominal muscles.
Sincerely,
Dr. Warren
-CS
Dear CS: I have sent you a copy of a girls' growth chart for age 2-18 years as an attachment to this e-mail. As you can see by looking at the chart, the rate of linear growth (the slope of the curve) is about the same from 6 to 10 years. Since each inch of height weighs more than the previous inch (we grow wider as we grow taller) the rate of weight gain is greater at 10 years than at 6 years.
Sincerely,
Dr. Warren
My son is 14. Two weeks ago he slipped on some ice on the driveway. He cut himself quite severely. My wife and I used peroxide, which stopped the bleeding. we then covered it with gauze Now, two weeks later, his elbow is leaking a yellow colored pus. We put some bacitracin on it and we covered it. It still is swollen and tender to the touch, but seems a tad better. Should I be getting him to the ER and getting him antibiotics. What do you recommend?..thank you for your time .
-RS
Dear RS: Without seeing your son's wound it is difficult to be sure. If the wound was a large abrasion but was not deep, it may have been leaking a lot of tissue fluid. This can become congealed on gauze bandages which are not changed frequently and become very messy. This may be what you are seeing, but I have to say that a wound which is swollen, tender, possibly full of pus, and hasn't healed in two weeks deserves medical attention. After waiting this long to see a doctor, why not make an appointment for an urgent visit with your son's doctor rather than running to a crowded emergency room.
Sincerely,
Dr. Warren
Thank you
-MB
Dear MB: Black tongue may be caused by growth of bacteria or fungi on the tongue, or by debris collecting on the tongue. It is treated by improving oral hygiene (cleaning the tongue). It may have been more evident in your granddaughter if she was not drinking and was slightly dehydrated. Medicines containing bismuth such as Pepto Bismol also turn the tongue black.
Sincerely,
Dr. Warren
I read your article about behavior, is it too early to train him to sleep by himself and let him cry? I still feed him every 2-3 hours at night, is it too often?
Thanks for reading my questions. I appreciate very much for your help.
-AS
Dear AS: Constipation refers to hard stools which are difficult to pass. Generally constipation is associated with less frequent bowel movement, but on occasion, a constipated person may pass frequent, very small, hard stools without successfully emptying the rectum.
Newborns generally have very soft stools. A nursing 4 week old should still have very soft stools. By 4 weeks, many nursing babies have BMs as infrequently as once every 4 to 5 days; however, the stool remains soft and the baby feeds well and is happy. All babies may fuss for a while before they have a bowel movement. The need to have a bowel movement and the process may cause discomfort. If the amount of time a baby spends being distressed by the need to have a bowel movement is a good part of his day, then an effort should be made to see if something can be changed. A baby who fusses 15 minutes to an hour before having a BM needs no special intervention.
A nursing 4 week old should still be fed every 2-3 hours including through the night. It is too early to work on sleep habits. It is reasonable to begin that gently around 4 months of age by getting the baby used to going into his crib awake.
Sincerely,
Dr. Warren
-T
Dear T: Please read my articles Potty Training, and Fecal Soiling. From what you've told me, I suspect you have already tried all the advice you will find in those articles with the guidance of your pediatrician. If that is the case and the problem is getting worse, it's time to consult a pediatric gastroenterologist since they deal with this problem all the time.
Sincerely,
Dr. Warren
-Mr. & Mrs. K
Dear Mr. & Mrs. K: If a full examination by your pediatrician and a pediatric gastroenterologist along with a review of your daughter's symptoms has concluded that your daughter's symptoms result form stool withholding there is no need to do x-ray studies unless a complication is suspected. Your doctors' reassurances (I hope not lack of caring) are due to the fact that much as this problem is unpleasant it poses no danger.
Lactulose is a complex sugar which is poorly digested and absorbed. As a result, it pulls water into the stool. It is not a stimulant laxative. It does not alter normal intestinal function and is not habit forming. It may be used long-term, which is certainly better than increasing constipation.
Unfortunately, this is a physical/functional problem with a large behavioral component. No matter how bright your daughter is, she has not experienced easy, pain-free bowel movements. In the absence of that experience, it is her firm belief (in baby logic) that the best thing to do is prevent these uncomfortable poops from coming out. The only thing you can do to counter that is to make her stool softer and harder to hold in, but the longer she hold it in, the more it negates the medical steps you take to soften her stool. That's why the behavioral management is such an important part of it. Reread my article and review the behavioral management of stool withholding with your pediatrician or gastroenterologist. Dealing with this problem requires full time effort.
Sincerely,
Dr. Warren
-Walter
Dear Walter: Varicocoeles do not affect sexual performance or erections. A varicocoele may decrease fertility (the ability to make babies) by lowering the sperm count. A varicocoele may also cause pain. Small varicocoele may not affect fertility or cause any symptoms. The only way to know if your fertility is affected by a varicocoele is to have a semen analysis (sperm count). The surgery is safe, but it is only necessary if you have a varicocoele that is causing pain, has affected the growth of the testicle on that side, or affects your sperm count. Since you're not even sur if you have a varicocoele, I would say that if you feel something that worries you or have some discomfort, you need to see a doctor. The "jelly" appearance of your ejaculate is normal.
Sincerely,
Dr. Warren
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