8 November 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
Please help answer some questions for me.
-M
Dear M: Your e-mail arrived starting in the middle of a sentence which makes me wonder if I'm missing any vital information. From what you told me, it sounds like your infant may have had a more complex heart condition than a simple VSD, perhaps a Tetralogy of Fallot. The baby may have suddenly decompensated due to closure of a blood vessel known as a ductus arteriosis. The ductus connects the aorta to the pulmonary vessels. This is present during fetal life because blood is oxygenated by the placenta before birth and there is very little blood flow to the lungs. After a baby is born, the placenta is no longer part of the circuit and the lungs expand so that circulation changes. In the case of a child with a VSD and aortic stenosis, blood can cross from the left side of the heart to the right, exit the heart through the pulmonary vessels, and cross to the bodies main artery, the aorta, through the ductus. If the ductus closes, the heart suddenly has to work harder to get blood to the aorta through the tight aortic valve.
Sometimes large abnormalities in the heart don't cause audible murmurs because blood flow across large openings, even abnormal ones, may not be turbulent. If there is no murmur and the baby is pink, there may be nothing on the examination to suggest heart disease until the baby develops congestive heart failure. The symptoms of CHF include rapid breathing, enlargement of the liver and spleen, poor feeding, and perspiration and fatigue from even minor effort like feeding. Cyanosis (turning blue), or poor blood flow resulting in a pale or gray color would also be a tip off. If the baby had a very tight aortic valve and the ductus closed as I described above, the baby could have had a rapid, unexpected, downhill course.
Even complex cardiac anomalies can often be treated successfully, but unfortunately, not all infants will be diagnosed or treated successfully. I have explained a scenario which could explain your baby's death, but I cannot know if your doctor missed something and if the diagnosis should have been made at one of the baby's checkups. I am sorry for your loss.
Sincerely,
Dr. Warren
-P & M
Dear P & M: The pharmacist is qualified to tell you about medication, but he is not licensed to practice medicine and has no business advising you to not follow your doctor's instructions. If he felt there was a problem with the medication he should have called your doctor. A hemoglobin of 9.1 is low. You should follow your doctor's instructions.
Sincerely,
Dr. Warren
Thank you for your concern and help!
-LM
Dear LM: From your pediatrician's comments and your description, I would guess that your son had an epithelial inclusion or pearl in his skin. This is just a leftover from the formation of the skin and generally disappears without leaving any marks.
Sincerely,
Dr. Warren
I should inform you that all this time (since the first swell) I study for my exams (could stress be the reason?). In addition I work out at the gym (hard enough I must say)
Some friends told me a couple of days ago that I look tired (But I think I got over that by taking some multi-vitamins)
What could the problem be?
Thank you!
-F
Dear F: Recurrence of a swollen lymph node can certainly be something as simple as a swollen glands with a virus infection, but of course, I cannot tell you for sure without examining you. If you're worried that you may have cancer, do yourself a favor and see a doctor so that you can put an end to your worries.
Sincerely,
Dr. Warren
She's full of energy and alert, though lately she's begun suddenly sitting down, then lying down on her back wherever she is--at home, in a store, or most frighteningly, in the path of rollerbladers on the promenade at Battery Park City. Yikes. She's a little short too, but so is our side of the family. New baby due any day, and though her parents, who are brand new to the city and don't have a ped yet are on it, I'm worried she might not get the attention she needs.
Hope you can help.
-SP
Dear SP: Sometimes normal stool can be very light in color. White is abnormal. Light is not. It's difficult for me to tell from the information you have given me if there is anything wrong at all. If she's excessively fatigued it could be related to adjusting to being in a new home and the stress and excitement surrounding the imminent birth of a new baby. As to lying down in strange places, she's 19 months old and may have adopted this unusual behavior for reasons you may never know. The only thing I can suggest is that persistent vague symptoms require evaluation. If her mother is due to have a baby, she will need a pediatrician, so now would be the perfect time to contact one.
Sincerely,
Dr. Warren
Help!
-C
Dear C: A heavy pubic fat pad is normal in infancy and may persist beyond infancy in pudgy kids. The only significance to a large pubic fat pad is that the penis gets buried in it causing parents to worry that the penis is abnormal or small, or that the circumcision (if one was done) was not successful. A large pubic fat pad is normal, which is why you haven't been able to find much information about it. No intervention is necessary.
Sincerely,
Dr. Warren
Do you have any suggestions on how we can quiet him during his feedings ?
- Jamie
Dear Jamie: While it's a good idea to burp babies often enough to prevent gas pains and excess spitting, if your baby is so hungry that he screams while you're burping him, he'll swallow more air from the crying than you'll get up with the burp. You really don't accomplish anything that way. My advice is to burp him less frequently. If you'll follow his lead, you should be able to figure out the best time to burp him. If his feeding slows and he begins to squirm, he's probably needs a burp.
Sincerely,
Dr. Warren
-(unsigned)
Dear Worried Mother: I hope by now you've seen your pediatrician and your daughter's problem is relatively resolved. Unfortunately, my schedule does not allow me to answer most e-mail on an emergent basis.
The uvula cannot grow into the tonsils, but certainly the tissues could be touching each other if they are swollen and inflamed. While it may have looked worse than other sore throats you've seen, sore throats are still basically common pediatric problems. If you don't feel you can trust your pediatrician with management of a sore throat, you either need to find another pediatrician, or talk to him about the issues which prevent you from fully trusting him.
Sincerely,
Dr. Warren
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