2 August 2004
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
-(unsigned)
Dear Mother of 3: At nap time, put your child into his crib awake and try to soothe him to sleep. Avoid taking him out unless you absolutely have to. If you do take him out put him back as quickly as possible, preferably drowsy but awake. The aim is for your baby to learn to fall asleep in his crib. Try to follow the same routine at approximately the same time each day so your son gets used to it. When you are out of the house, if possible, arrange for a place for your son to take his naps, but don't be surprised if the change in environment is enough to disrupt his routine, even if it's nap time and there is a crib available. When the routine must be disrupted, go back to it as soon as possible. Please read my article, Helping Your Child to Sleep Through the Night.
Sincerely,
Dr. Warren
-Leslie
Dear Leslie: I think you get the award for the most unusual question ever asked of Dr. Warren. I can't claim to be an expert on the matter, but since I have seen dead birds that weren't hit by cars I can assure you that when birds die in flight or in trees they fall to the ground. Most animals hide when they don't feel well. Even those animal which have adapted to coexisting with human civilization won't stay out in the open in areas inhabited by people. When birds sense that something is wrong they most likely go to wooded areas or to nests they have built on high structures. If you want to ask someone who really knows, try contacting the Audubon Society.
Sincerely,
Dr. Warren
Yours faithfully,
-Jane.
Dear Jane: I cannot be sure what you are feeling since I don't know exactly where you are feeling it or your knowledge and experience with female anatomy. The urethra, the tube which comes from the bladder would not normally be palpable inside the vagina. The cervix (the entrance to the womb) can be felt deep inside the vagina along the front wall. It is approximately the diameter of a quarter. If you feel along the side of it you can probably feel the neck of the cervix going up to the uterus. This may be what you are describing.
If in doubt, see a doctor.
Sincerely,
Dr. Warren
-JH
Dear JH: Persistent coughing and wheezing after bronchiolitis could be a result of asthma. There are many treatments which can help asthma, but before this can be undertaken, the diagnosis has to be made. Therefore you will need to see the pulmonologist unless your pediatrician wants to start some other medications besides albuterol by nebulizer. For more information about asthma follow the links on the list of articles I have written to the articles about asthma.
Asthma alone should not result in poor weight gain, but if the symptoms are not controlled, continued wheezing and coughing could result in poor appetite as well as caloric loss from vomiting associated with coughing. Other, less likely conditions which could cause poor weight gain and respiratory symptoms include cystic fibrosis and congenital heart disease. Gastroesophageal reflux could also cause vomiting, wheezing, and poor appetite. Determining the cause of the symptoms will require a medical evaluation looking for these possibilities. The pulmonologist is a good place to start. Once a diagnosis is made, a treatment regimen can begin.
Sincerely,
Dr. Warren
I have two questions for you. First, is it uncommon to take that long (Sunday AM to Thursday PM) to discover a problem like this? Secondly, on average for a very fit and healthy 11 year old girl, how quickly can we expect a full recovery? We have been planning a family trip of a lifetime overseas, how soon is travel possible?
Thank you for your reply. I hope to hear from you soon.
Sincerely,
-Kristina
Dear Kristina: Acute appendicitis generally develops typical signs and symptoms within 24 hours, but when it does not follow a typical course so that the diagnosis is not made prior to rupture of the appendix, the diagnosis of ruptured appendix could be made days later depending on how sick the patient is and what the findings are on examination. So my answer is that this is exactly what doctors want to avoid by making the diagnosis of appendicitis before the appendix ruptures. In your sister's case, her appendix may have been ruptured by the time she saw the doctor, and without localized findings, the examination was not typical for appendicitis.
The surgeon who is treating your sister would be the best person to predict how long recovery may take. If she does well, she should be up and around within a couple weeks. You need to review your travel plans with your sister's surgeon.
Sincerely,
Dr. Warren
There is bound to be some reason for this rash. I've not changed soaps or detergents. She is breastfed. She has a little rice cereal once a day, but no real solids yet.
-CP
Dear CP: There is no doubt that if a child has a rash, there must be a reason. Nonetheless, many rashes are transient and cause no other symptoms, and so don't warrant a great deal of investigation. As a general rule, if a child is not sick and the rash is not bothering the child, once the doctor has determined that it doesn't look like any of the rashes associated with serious illnesses, I think it's worth waiting a few days to see what happens.
Since I haven't seen the rash and your description does not ring any bells for me, I won't try to guess what the rash is. If it does not resolve or gets worse, ask your pediatrician to refer you to a dermatologist.
Sincerely,
Dr. Warren
Please help.
Thanks.
-CC
Dear CC: Benzoyl peroxide, which is used for treating acne, also dries the skin and may help relieve your oily skin condition.. If not, I'd suggest you consult a dermatologist.
Sincerely,
Dr. Warren
Sincerely,
-Tabitha
Dear Tabitha: Since the hormones in birth control pills don't cause bleeding from the nipples in the women who take them, you wouldn't expect any hormonal effect from the pills to cause a nursing baby's nipple to discharge blood. As a general rule, birth control pills are safe to take while nursing, although, those pills with a higher estrogen content may decrease the milk supply.
Check the baby's nipple for any rash or irritation which may account for a speck of blood. If there is no obvious source for the bleeding or if there is any reason to be concerned about the appearance of the breast, have her pediatrician check it.
Sincerely,
Dr. Warren
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