22 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
-EZ
Dear EZ: Until the umbilical cord is cut, it can continue to provide oxygenated blood to the baby's circulation. Once the baby takes a breath and expands the lungs, circulation through the lungs increases and circulation through the placenta decreases. Of course, clamping of the cord stops circulation through the placenta. Placental circulation cannot continue for a prolonged time after birth since the placental will separate from the womb and be delivered.
Sincerely,
Dr. Warren
Thank you for you time.
-SH
Dear SH: A person who is on the pill regularly is not likely to ovulate and become pregnant by taking the pill 12 hours late on one day. If you take the pill but miss doses regularly it will be unreliable. With the added precaution of a condom, pregnancy is even less likely. Finally, it is unlikely that you would continue to menstruate during a pregnancy even if you continued the pill. Adding these things together, it becomes highly unlikely that you are pregnant, but by 5 months, you should be able to feel the top of the uterus just above your pubic bone. If you think you feel it or have any lingering doubts, see a doctor or take the test. If you are pregnant, avoiding the issue won't make it go away.
Sincerely,
Dr. Warren
-BK
Dear BK: Providing enough fat in a child's diet is rarely a problem since most protein foods including meat, chicken, eggs, yogurt, and cheese have fat in them. In addition, many baked items such as crackers have fat in them. Since your daughter is not overweight and eats a low fat diet, continuing low fat milk instead of switching to skim would be fine. It is likely that as her repertoire of foods increases there will be additional sources of fat in her diet, and so, for the sake of her future cardiovascular health, it would be a good idea for her to get used to skim milk before adolescence.
Sincerely,
Dr. Warren
I appreciate you taking the time to respond. Thanks.
-AM
Dear AM: Labial adhesions usually open on their own with puberty. Labial adhesions are common before the age of 6. Physical activity has nothing to do with opening these adhesions. Rarely, adhesions may become thick enough to require surgical division. The primary problem with adhesions is that they may cause pooling of urine in the vagina which may contribute to continued inflammation in the area and urinary tract infection. Spreading of the labia and nightly application of an antibiotic ointment like Bacitracin or A&D ointment is often successful at opening the adhesions. Estrogen creams like Premarin are helpful in those cases which don't respond to treatment with bland ointments. Premarin should not be used for more than 2 weeks. Those cases which are asymptomatic (no urinary problems) may be left alone.
Sincerely,
Dr. Warren
-G
Dear G: Most infants spit because they do have some degree of gastroesophageal reflux. Reflux becomes a problem when it causes poor weight gain, irritability, or coughing and wheezing. The amount of spitting you describe sounds minimal. The fact that it continues for several hours after a feeding does not make it worrisome.
There are medication which are useful for treating symptomatic reflux, but it sounds like your baby has only the usual amount of spitting. Since all medications have potential side effects, I wouldn't opt for any intervention. Spitting up stops when the baby spends more time upright. Toddlers don't walk around spitting up.
Unless I'm missing some details of your concerns, you've described normal infant spitting up which is nothing more than a nuisance. You should stop worrying about it.
Sincerely,
Dr. Warren
Thank You.
-Tamara
Dear Tamara: Fingers can peel for a variety of reasons:
Sincerely,
Dr. Warren
-S
Dear S: You are describing a retractile testicle. The testicles are surrounded by a thin muscle which can contract to pull the testicles up and relax to let the testicles down. When a boy is feverish, his scrotum becomes pendulous and his testicles will hang further from his body to avoid the heat. When a boy is chilled, the scrotum will become tight, pulling the testicles close to the body. You and your son can observe the cremasteric reflex by gently stroking the inside of his thigh near the scrotum with your fingernail. The testicle will move upward in the scrotum and then move back down.
Sometimes the testicle can retract into the skin above the scrotum. If your son feels for the testicle when it is "missing" he will probably feel it right against his body in the groin. I cannot give you much of a reason as to why your son's testicle retracts during sleep and would suggest that perhaps his retractile testicle comes down during the day because of gravity.
If the testicle spends most of the time in the scrotum, a retractile testicle is nothing to worry about, but if the testicle disappears completely, you may want your pediatrician to double check and be sure there isn't a hernia on that side.
Sincerely,
Dr. Warren
Sincerely,
-A Very Terrified Mom
Dear Very Terrified Mom: The adenoids are lymphoid tissue similar to tonsils and lymph nodes. They participate in the body's fight against infection. Because of their location, they become inflamed in the fight against upper respiratory infection. Inflammation is part of the mechanism through which the body guards against infection, however, when the inflammatory response produces excessive symptoms or tissue enlargement, as is the case with enlarged adenoids, it becomes more of a liability than a benefit.
Even though the adenoids participate in the fight against upper respiratory infection, there is enough lymphoid tissue in the upper respiratory tract that removal of the adenoids will not leave a child more prone to infection. In fact, if the adenoids are chronically infected, the child will tend to be sicker with the adenoids than without them. The adenoids may shrink down on their own without surgery, but given the frequency with which young children get colds and other respiratory infections they are likely to remain enlarged for the duration of childhood. Because of their location, enlarged adenoids can obstruct the eustachian tubes and the sinuses contributing to chronic or recurrent ear infections and sinusitis.
The main risk of an adenoidectomy is the same risk for putting in tubes, namely, general anesthesia. While that risk is small, it is a real risk. It is not related to age or weight. Small infants who require life saving cardiac surgery and other complex surgeries often undergo prolonged general anesthesia and do well. Unfortunately, nobody can promise you zero risk with anesthesia, and while it's rare, deaths do occur and are not always related to the complexity or the duration of the surgery. Adenoidectomy adds a small additional risk of bleeding, but that risk is so small that if I were committed to taking the risk of anesthesia for putting in tubes, I would certainly recommend removing the adenoids as well in a child with significantly enlarged adenoids. Removing the adenoids may even eliminate the need for tubes. Putting in tubes will not help the upper airway obstruction and recurrent sinusitis associated with adenoid enlargement.
Unfortunately life has no guarantees. I have one patient who had his adenoids out twice and still can't breathe through his nose. The ENTs we have consulted don't seem to have an answer. But from what you've described to me, adenoidectomy sounds like the best course of action.
I don't think there is any relationship between your daughter's current situation and her squashed nose at birth, but even if there were some obscure reason they were related, it wouldn't alter the decision you are faced with now.
Sincerely,
Dr. Warren
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