21 February 2005
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
-SH
Dear SH: It is possible that your granddaughter's broad bridge to her nose is related to her hemangioma. This may result in the appearance to which you're referring. Many babies don't crawl by 9 months and plenty of normal infants love to rock. Most important, infants with Down's Syndrome are floppy rather than rigid. Unfortunately, I don't have enough information to rule that diagnosis in or out.
Whether or not to discuss your concerns with your son depends on your relationship with him. I'm a firm believer in parents not meddling in their adult children's lives, but I'm also a firm believer in open, honest communication with those we care about. It's a matter of how you present it and how your son is likely to take it that will determine your best course of action. Perhaps you can mention it casually in the course of conversation by telling him what your friends said. Your son may be perfectly happy to reassure you that everything is fine.
Sincerely,
Dr. Warren
Thank You
-EC
Dear EC: It is highly unlikely that your son has any medical condition causing him to soil his pants; however, at your next pediatrician visit his pediatrician can check for a normal anal wink reflex and do a digital exam to check sphincter tone.
Has your son ever successfully had bowel movements in a toilet or potty? If not, he may simply be fearful of that with which he has no experience. In his mind it may be better for you to be angry and him to be dirty than to try to deal with having his BM on a toilet. Please read my article on Fecal Soiling for a full discussion of this problem.
If there are no emotional stresses contributing to the problem, you should start your son on a regular program of sitting on the toilet after each meal to attempt a bowel movement. Try to keep it matter of fact rather than a battle. Even if he doesn't have a bowel movement his cooperation needs to be praised.
If there might be emotional issues contributing to the problem, the program remains the same, but you need to address those issues first.
Sincerely,
Dr. Warren
Sincerely,
-Worried Aunt
Dear Worried Aunt: The relationship between asthma and bronchiolitis (wheezing caused by RSV) remains unclear. Does RSV cause asthma or predispose a child to develop asthma, or are the children who have the most trouble with RSV the ones who have a predisposition to wheeze or develop asthma? While one RSV infection does not confer lifelong immunity, those children who have recurrent wheezing generally have asthma. If the diagnosis of bronchiolitis is made without testing for RSV, the diagnosis could be in error. The source of confusion comes from the fact that most infants with asthma wheeze when they have upper respiratory infections (URIs). As a result, clinically they look the same as children with bronchiolitis. The treatment of the wheezing is the same, so initially it's not crucial to distinguish the two; however, in children with recurrent wheezing from asthma, steroids can be very helpful. Steroids are not useful or recommended in the management of bronchiolitis.
I have never heard that Chihuahuas provide any benefit to asthmatics. I cannot imagine any reason why it would help an asthmatic to have a Chihuahua. Allergies can significantly aggravate a patient's asthma. Allergies to dogs can certainly be a problem for asthmatics; however, most infants with asthma have their symptoms primarily with URIs.
I have written a number of articles for parents about asthma which may provide you some useful information. You can find the articles at http://www.mindspring.com/~drwarren/. The primary treatments available to infants include nebulizer treatments with cromolyn as a preventative and albuterol to treat wheezing. In more extreme cases a steroid for the nebulizer can be imported from Canada since it is not yet available in the USA. Avoidance of smoke and exposure to people with colds is of utmost importance. Careful hand washing goes a long way to help prevent spreading URIs.
Sincerely,
Dr. Warren
Sincerely,Dear Readers: Some studies now suggest a benefit to using steroids in the management of bronchiolitis.
Pulmicort, an inhaled steroid, is now available for the nebulizer in the United States.
Dr. Warren
Thank you!
-S
Dear S: The normal heart rate for a 13 year old ranges from 60 to 120 beats per minute with a mean of 85 beats per minute. Runners and athletes who do a lot of aerobic exercises tend to have lower heart rates. A resting heart rate of 95 is not a cause for concern.
Sincerely,
Dr. Warren
-Ms. T
Dear Ms. T: Offering prune juice (not just any fruit juice) regularly may help with constipation. Besides prune juice, it is important to increase the amount of fiber in the child's diet and avoid white rice and bananas. If the child is withholding stool, mineral oil may be helpful. A mild laxative like Senokot may also be helpful. At 22 months you should still be seeing your pediatrician fairly regularly. Since your child has had a problem with constipation since infancy, it's important to embark on a course of treatment under the advice of your pediatrician. He may even recommend an evaluation by a pediatric gastroenterologist to be sure there isn't any underlying problem.
Sincerely,
Dr. Warren
-Richard
Dear Richard: There are some benefits to having a relative as your doctor, but unfortunately, you pay a price in lack of privacy. Since your father is a doctor, and you have no reason to suspect a sexually transmitted disease, there really should be no problem in having your father check your lumps. But if this is a problem for you, then it's time to discuss having a doctor of your own.
I cannot tell you what your lumps are without seeing them, but from the description, I suspect they are simply hair follicles. The hair follicles on the shaft of the penis tend to stand out like gooseflesh.
Sincerely,
Dr. Warren
-T
Dear T: Platelets are necessary for blood clotting. If your daughter's platelet count is 95,000, it isn't likely that she would run into a problem. Any abnormal test should be repeated because, among other things, it could be a laboratory error. One common reason for a low platelet count is platelet clumping or clotting of the specimen before it is well mixed with the anti-coagulant.
Platelet counts can be low in response to certain virus infections. They can also be low in certain blood diseases. If your doctor thought there was a cause to be concerned, he would most likely have repeated the count much sooner than a month. There is nothing you should be doing except following up with your doctor. Should you note any easy bruising or bleeding you should contact your doctor immediately.
Sincerely,
Dr. Warren
-E
Dear E: There are a number of reasons why a baby might be breathing rapidly. Rapid breathing can be a symptom of heart disease, respiratory disease, transient tachypnea of the newborn, infection. I cannot understand why the baby was discharged from the hospital at 48 hours if there was any question as to what was going on. The baby requires close medical follow up and should be seen immediately by his pediatrician who, after a thorough examination, should explain to you what is going on. No baby should ever be discharged from a hospital without talking to the doctor when there is a potential problem. The nurse should not have been put in that position.
Sincerely,
Dr. Warren
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