27 September 2004

1. When You Need to Ask Your Doctor Instead of Asking Dr. Warren
2. Adolescent Gynecomastia
3. Congenital Hydronephrosis
4. Hole in Tonsil
5. White Hairs at 18
6. Benign External Hydrocephalus
7. Maximum Height
8. Rash Called ?"Skifs"?
9. Disclaimer

• Read Questions & Answers in Another Column

When You Need to Ask Your Doctor Instead of Asking Dr. Warren

-L

Dear L: This is, unfortunately, a perfect example of a situation where the best way to get the information you need is to insist that the treating doctor provide the information. That doctor already knows what the diagnosis is, and I don't. In addition, he is a specialist. Therefore he is the best person to provide information. You need to ask him the following:

• Diagnosis: If he doesn't have a diagnosis, he should honestly tell you the possibilities and of what importance making an exact diagnosis is to formulating a treatment plan. If you contact me with a diagnosis, then I could try to provide more information.
• Prognosis: The doctor needs to explain the natural course of the child's condition: The likely outcome, the best possible result, and the worst case scenario.
• Treatment options: This includes not only the treating doctor's recommendations, but also other possible treatments, the risks and benefits of each treatment, and the risks of not treating at all.

Sincerely,
Dr. Warren

Thank you very much.

-Billy

Dear Billy: You're describing adolescent gynecomastia. It's a normal part of body development in some teenage boys as their bodies go through the changes of puberty. Your testicles produce testosterone, the male hormone, but they also produce estrogen, the female hormone. In early to mid puberty, when the testosterone levels have not yet peaked, the increased estrogen produced during puberty may cause some breast development. This makes the nipples swell and may cause a lump on the chest which is actually breast tissue. Many boys become so self conscious about it they think everyone else notices it, when in fact, most people really don't.

As puberty progresses and your body reaches it's adult status the breast tissue usually shrinks away. If it does not go away or is large enough to cause you distress, then you could consult a plastic surgeon about it.

Sincerely,
Dr. Warren

The surgeon removed his stent a few months ago, and after having his latest mag 3 scan, the surgeon didn't sound too pleased with the outcome. He wants to keep an eye on the baby who is 12 months old. Could you advise what possible outcome we could have if the kidney isn't functioning as well as it should be. Is it likely that it would need to be removed? or could they do another pyloplasty? I am very worried about him as the area around his penis has always been swollen, do you think this is normal? I wonder if it's the excess fluid that's causing this and the rather puffy look on his face. I would love to hear your response. Many thanks.

-Joanne

Dear Joanne: To fully answer your question, I'd need to know why the surgeon seemed displeased, which is something you really should ask him. An obstructed and nonfunctional kidney may need to be removed since it may be at risk for infection and doesn't serve any purpose. A diseased and scarred kidney may cause high blood pressure later in life. If the kidney is functional; however, even if it the obstruction has not been relieved as much as the surgeon hoped, it may be reasonable to do additional surgery after the period of observation to see if the function improves. You would have to ask your surgeon if his concerns are related to continued obstruction or unsatisfactory kidney function in spite of successful surgery to know if additional surgery might be the answer.

Assuming that your son's right kidney is perfectly normal, your baby should not have any immediate ill effects from his diseased kidney. One kidney can do the job quite well so your baby should not be edematous (swollen). You may be simply looking at the normal pubic fat pad around your son's penis, but since I haven't seen him, I cannot say. If you believe your baby looks puffy, he should be checked by his pediatrician.

Sincerely,
Dr. Warren

The right side of my tonsil I have a small hole in it. Some times there is stuff caught in it and I take it out with a Q-tip. Now I think that the stuff that gets caught in it might be food but it doesn't look like food because it is the same color every time I take it out. It is like a beige color. I went to the doctor once and he said that he has never seen or heard anything like this before and sense I'm not having any series pain I shouldn't be concerned. That was years ago. But, the other day I went to take that stuff out of the hole and I was very gentle wail doing it but when I pulled the Q-tip out there was blood on it. There wasn't just blood coming from the hole but it was all over my tonsil. It didn't hurt though. Some times I can't get the stuff out of the hole because the stuff is so deep in the hole and so large. But, I have to get it out because I gag on it if I don't.

My question is: Have you ever heard of anything like this before and should I go see the doctor about it again. Also, this last year I have had strep throat about 3 times and one time I had some kind of throat infection and they ran test but they couldn't figure out what it was.Please Email me back.

Thank you.

-Angela

Dear Angela: Your description sounds like an enlarged tonsillar follicle. The tonsils are lymphoid tissue similar to lymph nodes. They swell in response to infection to help fight the invading organism. Sometimes, if a tonsil has been inflamed, one or more of the follicle may remain overactive even after the infection is gone. This produces the whitish debris that looks like a ball on the tonsil. If it touches the back of the tongue, it may make you gag. The debris is dead tissue rather than food. When it falls off, you may swallow it. If you spit it out, it looks and feels like a spit ball (wet paper). Since the material is tissue attached to your tonsil, it is no surprise that you get bleeding if you poke at it and pull it off prematurely. When the follicle discharges, it will leave a crater behind.

The enlarged tonsillar follicle is not dangerous but can be a nuisance. Constant recurrence could suggest that your tonsils are inflamed. If it keeps bothering you, consult an ENT surgeon.

Sincerely,
Dr. Warren

I thank you in advance for your help. I apologize if my question seems a bit 'absurd.' I am a bit worried about this. Please take your time answering this.

-Nadia

Dear Nadia: The age at which white hairs appear is governed primarily by genetics. Some families have white or gray hair much younger than others. Since white or gray hair is associated with old age, people tend to assume that premature graying is associated with ill health, but it is not. Ask you parents about the age at which family members began to turn gray, and I'm sure you'll find others who started early. If you only found a few white hairs, it may not even portend the likelihood of early graying.

Sincerely,
Dr. Warren

He is 10 months old now and although he is making some progress, in moving forward on his belly, he still does not attempt to pull himself up, holding onto furniture. A week back he had started sitting up on his own, and he did that for 2 days and now he does not attempt to do it. When we make him sit, he holds that position for a long time and whenever he goes down, he uses his hands to come back to the sitting position. He is able to sit and keep his hands off the ground to hold toys. Sometimes he attempts to go on all fours with his belly off the ground, but he moves backwards. He is currently teething, and got four teeth in about a months time.

Question:

1. Do infants stop repeating some activity, after doing it for 1-2 days (Our son stopped trying to sit up on his own after doing it for 2 days) ? We did not notice that with our daughter.
2. Do infants tend to reduce their activity, while teething ?
3. We went to the neurologist, who suspects "benign external hydrocephelus" and she has ordered an MRI. We understand that "hydrocephelus" could impact motor development skills, but is the above behaviour indicative of hydrocephelus. In all other ways, our son looks behaves very normally, and although his head size is on the larger side, it has been so since birth and it does not look disproportional to his body. His forehead too does not bulge outward as seen in typical hydrocephelus infants.

-P

Dear P: Infants may stop doing a newly learned activity for a while and then come back to it at a later date.

Some infants may be less active or more irritable when teething. Other infants may not be affected at all by teething.

Hydrocephalus refers to excess fluid on the brain. The fluid causes the head to grown abnormally large quickly and puts pressure on the brain. If not diagnosed and treated in a timely fashion, hydrocephalus can cause brain damage. The neurologists impression that it is "benign external hydrocephalus" suggests that she thinks your son simply has a large head and anticipates extra fluid in order to fill the extra volume. When the fluid is not under pressure and is not the cause for the enlargement of the head, it does not do any damage and does not cause any symptoms. Your son does not exhibit any specific symptoms associated with hydrocephalus. The MRI will clarify if any intervention for hydrocephalus is indicated.

Sincerely,
Dr. Warren

Thank you very much!

-Billy

Dear Billy: Your adult height is determined by four things:

1. Genetics - The maximum height you can expect to achieve is determined by what you inherit from your parents. If both your parents are short, there is little likelihood you will be tall, but if there are some tall relatives, the combination of genes you receive may result in your being significantly taller than your parents. You cannot do anything to change what you've inherited.

2. Puberty - Adolescents have their maximum growth in the middle of puberty. Once their bodies are fully mature, growth ceases. To a large extent, the timing of puberty is controlled by genetics. Those who enter puberty later usually finish growing later so that they may initially be shorter than their peers but ultimately end up taller because they grow for a longer time before they reach their final height. The rapidity of body changes also plays a role. A teen who progresses through the body changes of puberty more quickly will reach his final height more quickly. These things cannot be controlled.

3. Health - Chronic disease and certain growth disorders can interfere with growth and prevent a person from growing to his maximum height.

4. Nutrition - This is related to health since a person who is malnourished is more likely to become ill. A well balanced diet which provides adequate protein will allow a person to achieve his maximum growth. The American diet is quite high in protein (meat, milk, fish, eggs, yogurt) so that it is likely your protein needs are more than adequately met. Good balance requires that you eat foods from all categories including cereals and grains, fruits and vegetables, as well as protein foods. You should look at the food pyramid in order to get an idea of what a balanced diet is. A vitamin and mineral supplement can help if your diet is not balanced, but there are no vitamins, minerals, foods, or other substances which will make you grow more than your genetic potential. Basically, if you live your life and eat your healthy meals the way your mother, no doubt, tells you to, you will get to be as tall as you can. Unfortunately, there are no tricks which will make you taller.

Sincerely,
Dr. Warren

Now I have another question.

The child of a co-worker recently developed a skin rash. As I have always heard "skin rashes are common and a dime a dozen" there was no real concern throughout the office. However, yesterday, the 'Dad' called in sick saying the doctor told him that aside from it being uncomfortable, it is very contagious. We are concerned as we work in close proximity to one another in a very closed area. 'Dad' said the name or condition is called 'Skifs' or 'sifts'. I've found nothing on the internet yet, probably because of spelling.

Any clue what condition 'Dad' is referring to?

-DR

Dear DR: Only two possibilities come to mind for a rash that sounds like "skifs." There may be others that I haven't thought of.

Scabies is a mite infestation. It causes a very itchy eczematous rash especially at the waist, groin, underarms, wrist, and finger webs.

Fifth disease is caused by parvovirus-19 and causes bright red cheeks with a lacy rash on the part of the arms and legs nearest to the body. Sometimes the rash occurs on the trunk. The rash is photosensitive and may keep recurring with sun exposure. The rash may persist up to six weeks. Most patients have no symptoms except the rash, although the period before the rash comes out may be associated with some flu like symptoms with headache and joint pains. Parvovirus may cause miscarriages even at full term so that it is a risk for pregnant.

Sincerely,
Dr. Warren

If your questions haven't been answered here, perhaps you would like to

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