24 January 2005

1. Antibiotics to Prevent Lyme After Tick Bite?
2. Sensitive to Noise
3. Purpose of Shoes
4. Secretin and Autism
5. Evaluate Persistent Pain
6. Minimal Brain Damage
7. Finger Injury
8. Saccharin and Aspartame
9. Disclaimer

• Read Questions & Answers in Another Column

Antibiotics to Prevent Lyme After Tick Bite?

-M

Dear M: A mother is never wrong to want to protect her child and I fully understand your concerns. At the present time medical research does not support the idea of treating for Lyme disease on the basis of exposure, and in this instance we're talking about possible exposure since you don't know if the tick was carrying Lyme. When our knowledge of Lyme was new, institutions like Stonybrook where Lyme was being researched used to test ticks from patients. They no longer do that because they found even that was not warranted.

Treating every patient who might be exposed to Lyme would be akin to treating every person who was exposed to strep throat with penicillin. You're going through the same thing that people go through in a school or community when they hear about a case of meningitis. Everybody wants to be protected by going on antibiotics. Few people consider there to be any risk to taking antibiotics, so they weigh only the risk of contracting the disease, and no matter how minuscule it is, would rather take the medicine.

In your child's situation where you believe the attachment was at least 12 hours and are certain the tick is a deer tick, if the tick is infected, it would carry some real risk that your son could get Lyme. Antibiotics may protect him and certainly would give you some peace of mind. Your son may not suffer any adverse events from the antibiotic, but if we were to start treating every patient in your situation, a significant percentage would suffer adverse reactions and we would all pay the price of increasing the load of antibiotic resistant bacteria in our environment. The studies have shown that very few people would benefit from this approach. Your doctor is following the current recommendations which look at the big picture, as he should. But since the small picture is your son, I fully understand your focus there.

You can find questions about Lyme in my 1997 and 1998 columns. You can also find information on the net simply using the keyword "Lyme." My favorite sites for information are

• Healthatoz - The Search Engine for Health and Medicine at http://www.HealthAtoZ.com/
• Alphabetic List of Specific Diseases/Disorders at http://www.mic.ki.se/Diseases/alphalist.html
• America's Health Network - Health, Medical, Anatomy, and Hospital Information at http://www.ahn.com/
• Boston University Medical Center: Community Outreach Health Information System ( COHIS ) at http://web.bu.edu/COHIS/ (but finding their Lyme disease link at http://www.bu.edu/cohis/infxns/bacteria/lyme.htm took a little work)
• Med Help International - Virtual Medical Center at http://www.medhelp.org/
• NOAH Home Page at http://www.noah.cuny.edu/
  and the
• National Organization for Rare Disorders at http://www.rarediseases.org/.
  You can also find information at the
• Lyme Disease Network at http://www.lymenet.org/.

The rash of Lyme can occur as early as a few weeks after the tick attachment and typically forms a rapidly expanding red bullseye around the tick bite. At this point blood tests for Lyme are generally negative and treatment can prevent later manifestations. The rash occurs in about 60% of infected people meaning 40% won't be diagnosed until other symptoms develop. These include flu-like symptoms with severe headache and generalized aches and pains, including joint pains. Arthritis, with joint pain and swelling is a later manifestation. Because of the treatment your son received, regardless of whether or not it was warranted, your son should not develop disease.

Sincerely,
Dr. Warren

I have taken him to a child psychologist. I thought he might be ADHD. She was a Dr. in her field and has been practicing for over a decade. She doubted it was ADHD. So now I am thinking there is something wrong with his hearing, because the only time he acts up, throws fits, or gets violent is when he is around too many people.

Do you think I should have his hearing tested because he hears too much........?

-L

Dear L: I don't believe there is any standard on a hearing test which could determine if someone's hearing is hypersensitive. You might get your son's ears checked by an ENT doctor, and if he feels hearing testing is warranted proceed with testing.

Hypersensitivity to sound may be associated with Pervasive Developmental Disorder and Autism. If the psychologist has found your son to be developmentally and socially within normal limits, that possibility is eliminated.

It may help to clarify if the volume of sound causes your son discomfort or frightens him. If it frightens him you may be able to help him by talking through his fears. If loud sound simply makes him uncomfortable, sound reducing ear plugs may help. Your ENT may be able to direct you toward a program for desensitizing your son to loud sound, or you may be able to work on it yourself with music and headphones in which your son can control the volume and increase it himself in an effort to get used to louder sounds.

Sincerely,
Dr. Warren

Thanks...

-K

Dear K: The purpose of shoes is to protect the feet. Children do not need shoes to support their feet or ankles in order to walk. The issue of support comes from the fact that a shoe is a foreign object attached to the foot, and if it doesn't hold the foot well, a person can fall over it. When children first start walking they should not wear sandals or shoes with soft backs which could allow the heel to slip off the sole of the shoe, but unless a child has an ankle or foot condition that requires orthopedic treatment with a special shoe or brace, he does not have to wear shoes to walk.

Sincerely,
Dr. Warren

Thank you.

-T & I

Dear T &: I: Secretin is a gastrointestinal regulating hormone which is used by gastroenterologists in doing certain tests. It was discovered serendipitously that some autistic children had a significant improvement in function after the secretin. It is unknown whether or not all autistic children would benefit, or how long the benefits last, or if there is any adverse effects associated with long term administration.

The drug is now under study. In order for your child to receive secretin, I believe you would have to enroll in a place which is studying it. It is not a medicine you can pick up with a prescription and administer at home. It is given by IV infusion.

Regimentation and routine are extremely important to autistic children.

Sincerely,
Dr. Warren

Thanks for your time.

By the way -- I am 21 years old if that makes a difference in diagnosis.

-BJ

Dear BJ: Your symptoms are not necessarily serious, but any persistent pain whose cause is unknown deserves investigation. Make an appointment with your doctor. It's okay to see a doctor and find out everything is all right.

Sincerely,
Dr. Warren

Could explain this pathology? signs and symptoms, pathophysiology, treaments, and future? Thank you!

-FO

Dear FO: The brevity of writing style of your question makes it unclear.

Minimal brain dysfunction is one of the older terminologies which refers to what is now known as attention deficit disorder. It is generally but not always associated with learning disabilities. The cause is unknown, but there appears to be some genetic/familial factors.

The diagnosis is often suspected in a child who does not perform up to academic potential, is disorganized, and has difficulty concentrating on tasks. Theses children often flit from one thing to another, can't sit still, are clumsy, have difficulty fitting in, and may have behaviors which disturb other children or the whole class. Hyperactivity may be seen as a major component of attention deficit disorder, but need not be present. Those children who are not hyperactive often go undiagnosed until they have significant academic failure simply because they don't disturb the class.

Treatment is generally accomplished with stimulant medications which improve attention, behavior modification programs for difficult behaviors if they do not improve with medication alone, and special educational programs or resource room to deal with specific learning disabilities.

Most children do well with treatment. With maturity, many teens and adults can manage without medication but may still have difficulties with focusing, attention, and organization. We must keep in mind that any behavior problems associated with attention deficit disorder do not occur in a vacuum. Even if medication improves a child's attention and ability to cope, his self esteem and coping style may have been significantly affected by his experiences before diagnosis and treatment.

Sincerely,
Dr. Warren

Thank you for your time!

-(unsigned)

Dear 12 Year Old: Without seeing your injury it is difficult for me to be sure how it will be treated. If you have a dislocation of a joint, the doctor may be able to pop it back into the correct position. This will hurt, but it will be very brief. If the procedure is more complicated, the doctor will numb your finger with an injection before he does anything, or if necessary, you will be treated in an operating room under anesthesia.

Sincerely,
Dr. Warren

Thank you so much for you time. If you could nothing else, direct me to some studies and such would be fine.

-LB

Dear LB: Saccharin was associated some time ago with bladder cancer in some studies; however it was not taken off the market. Products with saccharin do have a health warning on them. The evidence was not compelling and has recently come under question. While it is useful to study possible associations with cancer by giving drugs to mice, one has to be careful about the conclusions drawn when they are given doses way beyond the amount normally consumed. In general, it's a good idea for kids to stay away from saccharin since there may be some risk, but very few soft drinks are made with saccharin since most people prefer the taste of aspartame.

I would consider it reasonable for kids to not get used to having a daily diet of soft drinks of any sort, but I have no problem with aspartame use in children. There is no evidence that it can cause any harm except to children with a rare metabolic disorder called phenylketonuria.

Sincerely,
Dr. Warren

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

ask Dr. Warren a question?!?