7 March 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
PLease let me know, thanks in advance.
-Tim
Dear Tim: You're so embarrassed by your situation, you haven't accurately explained to me what you saw. Did you see blood in the toilet bowl, or did you have a bloody bowel movement (blood mixed into the stool), or did you see blood streaked on a hard bowel movement? You could be talking about a bleeding hemorrhoid or an anal fissure, neither of which is serious. If you're seeing dark blood and are feeling poorly, you could be talking about intestinal bleeding. I understand that you're embarrassed, but doctors examine embarrassing body parts all the time. Nobody chooses to have rectal bleeding, so there's no reason to be embarrassed to have it checked by your doctor. If the bleeding continues, for the sake of your health as well as your peace of mind, you need to have it checked.
Sincerely,
Dr. Warren
-Mr. & Mrs. C
Dear Mr. & Mrs. C: Unfortunately, colic is one of those problems of infancy that improves around 4 months of age regardless of what remedies one tries. Often parents resort to trying different formulas in case the baby's pains are gas caused by formula sensitivity. Nursing mothers may look at their own diets to see if any spices or other foods they are eating are causing a problem, or they may eliminate cow's milk from their diets to see if that will help. Such things as gripe water and chamomile tea are popular remedies which may enjoy limited success. In extreme cases, a review of the situation by the pediatrician may be warranted to rule out gastroesophageal reflux or another source of pain.
Colic tends to be an on and off problem all day long. An infant who cries for two hours each day at approximately the same time every day is probably not crying because of colic. In the case of the nursing mother, it pays to review the ingredients in the meal preceding the crying episodes, but most babies who cry for a few hours each day at the same time each day are experiencing their fussy period. It's just part of how the central nervous system organizes itself. It's best dealt with by remaining calm while you soothe or walk with the baby. The knowledge that it generally lasts just a few hours and that the baby is okay should help most parents remain calm. As with colic, these fussy periods will become a faded memory once the baby gets older.
Sincerely,
Dr. Warren
This is regarding my son, who now is almost 1 yr old. He was suspected to have lowered muscle tone on his 9 month check up and we were advised by the neurologist that we should have an MRI done to rule out the possibility of hydrocephelus. The MRI was done, and it turned out to be normal.
Since his 9 month check up, my son has made steady progress in his mobility, in terms of sitting up and crawling. But as yet he does not prefer to pull up to a stand; I say prefer because sometimes when there is an object of his interest, he does attempt it and is able to pull himself up, but otherwise he prefers not to do it. When we make him stand with the support of furniture e.g. bed or sofa, he holds that position for a long time, but he does not cruise.
We are concerned about his mobility and wanted to know what we should do next. He seems to be very normal in all other respects and is gaining height and weight quite normally, although he is on the taller side (33 inches). Also we do not have any genetic abnormalities on both sides of the family, that we know of.
Please advise.
-PG
Dear PG: While most children at 1 year are cruising along furniture, some perfectly normal children are not. In general, children do things when they are ready as long as they have the opportunity. If the neurologist still feels that your child has low muscle tone which may interfere with motor development, then he should refer you to the appropriate early intervention programs in your area for physical therapy and occupational therapy if warranted.
Sincerely,
Dr. Warren
-JT
Dear JT: The condition in which the head does not grow properly because of premature closure of the growth lines (sutures) is called craniosynostosis. Since it would be unusual for all of the sutures to close prematurely, head growth usually continues along the open sutures resulting in a misshapen head. Craniosynostosis must be treated surgically since inadequate head growth puts pressure on the brain.
The surgery for craniosynostosis is major surgery and is not risk free. Since the covering of the brain must be opened, meningitis is a potential risk; however, the brain does not have to be entered during the surgery. A shunt may be required to prevent hydrocephalus. Surgery for craniosynostosis is essential. The benefits certainly outweigh the risks.
Craniosynostosis does happen, but it is not a common occurrence. It cannot be considered normal as there are no "normal" conditions which require surgery. Small heads on the basis of family growth patterns are more common. An evaluation including x-rays or a CT scan of the skull should establish whether or not there is any craniosynostosis.
By the way, a head circumference of 42.2 cm. at 6 months is above the 10th percentile and so is still within the normal range. If the baby's head circumference continues to grow along this percentile, even though it fell from a higher percentile at birth, it would still represent normal growth. The fact that your pediatrician does not feel an open anterior fontanelle has probably increased his concern (appropriately) about your son's head growth.
Sincerely,
Dr. Warren
-CE
Dear CE: Over the counter wart removal medications are safe and are generally effective. They may result in local irritation which could be more problematic if the wart is right on a joint which is frequently moving. Warts may sometimes disappear without intervention, but they may also spread. Most people prefer to get rid of them. It's easier to get rid of one than many.
If an OTC wart remover does not work, you will need to consult a dermatologist. If the dermatologist needs to remove the wart, he will use local anesthesia to minimize the pain.
Sincerely,
Dr. Warren
-S
Dear S: The lump you describe is probably a normal part of the epididymis (the tubules which collect sperm from the testicle) or possibly a cyst of the epididymis and therefore is probably not dangerous. All questionable lumps should be examined by a doctor for proper diagnosis. At 16, your experience with lumps is limited so essentially any lump you find should be checked by a doctor. You should not assume the doctor will find it at your checkup. What a patient tells the doctor (the medical history) is every bit as important in finding things and making a diagnosis as the examination. Make sure you tell the doctor about your concern and show him where you feel a lump. That is the only way you can be sure the doctor has examined what concerns you.
Sincerely,
Dr. Warren
-Becky
Dear Becky: Since you did not tell me what you consider frequent stools it is hard for me to put your concerns in perspective. It is not unusual for bowel habits to change with environmental and dietary changes. Some infants do experience frequent stools with teething.
If your son's bowel movements number 4 or less per day and are not watery, and your son appears well with a good appetite, no fever, no vomiting, and no cramps, I see no cause for concern. Even if the stools are more frequent, if he has a good fluid intake and is not vomiting, there is no risk of dehydration. Medication is not the answer since diarrhea medicines simply provide symptomatic relief which is useful for older children and adults. These medicines do not prevent dehydration or alter the course of any illness or condition which causes diarrhea.
For a more detailed discussion, read my article, Managing Gastroenteritis.
Sincerely,
Dr. Warren
-N
Dear N: There are no medicines, creams, or non-surgical procedures which can shrink a nose. The nose often grows and changes shape in puberty. Young teens often find their noses appearing large for their faces after being used to their childhood noses. As the face fills out somewhat in the later teens, the nose may not appear so large.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
