16 May 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
If you would kindly e-mail me back with a definition and reason why this would occur I would greatly appreciate it.
Thanking you in advance.
-TM
Dear TM: Bell's Palsy is a paralysis of facial muscles controlled by the facial nerve. In most cases the cause is unknown. Recovery is usually complete although some facial asymmetry may result. In recent years we have become aware that it can be caused by Lyme disease, so Sean should be tested for Lyme. A consultation with a neurologist may put your mind at ease and assure that it has been appropriately evaluated.
Sincerely,
Dr. Warren
-BD
Dear BD: There is no time like the present to talk to your son about these things. First, I think it's best for kids to know about these things before they happen. Second, it's likely that your son is already hearing about sexual matters from other kids, so it's best to balance that by making sure he has the correct information. Whether or not Mom or Dad should talk to sonny boy about these things is dependent on who will be most comfortable presenting the information and whom your son will be most comfortable hearing it from. You could even do it together.
Sometimes the hardest part of such a discussion is getting started. I suggest a book called "Where Did I Come From?" by Peter Mayle, published by Lyle Stuart, Inc. (ISBN 0-8184-0253-9). It is illustrated cartoon style and is written in simple, matter of fact language, but is quite explicit. They also have a video. Review it first and then read it or watch it with your son. Then talk about it during or afterward.
Sincerely,
Dr. Warren
-DB
Dear DB: Both chicken pox and measles can cause swollen glands. Since the immunizations for these diseases are done with live viruses, after the incubation period the vaccine recipients can get a variety of the symptoms caused by the actual diseases including swollen glands and fever. Vaccine reactions are milder than the real disease, but can make a person sick. Once glands swell, they may persist a considerable time and may never disappear completely.
The doctor's treatment with Augmentin suggests he thinks there is a bacterial infection. I don't know why he thinks that, so you'd have to discuss it with him. If the swollen glands are from the vaccines, the Augmentin will not make any difference.
Sincerely,
Dr. Warren
Thanks
K
I became a proud father on x/x/xx Daughter S. She has a problem called conginetal adhrenal hyperplesia result the genitle organ is slightly ambigues. I have taken a couple of tests & talked to 3/4 doctors. is it possible that I can send the details / reports to you & you can refer to a pediatric Endocrinologist in your city to find out wheather we are going in a right direction. The treatment is already started & the doc has advised us to do a surgery by this month end. The doc has told us that even after the surgery She will have to take medicine throughout her life. If this enquiry is possible then we can send you all the reports taken, by tomorrow & if their advise is favourable we can come there for treatment / surgery. Right now I am mailing you from a cyber cafe & this is my first attempt to email. The time here is 12 night closing time of the cyber cafe, Plz reply at your earliest & guide.V
-K
Dear K: Your friend is describing adrenogenital syndrome caused by congenital adrenal hyperplasia. As a result of an enzyme deficiency, the adrenal gland is unable to produce cortisol, which is the adrenal gland's main function. Since the mechanism that regulates cortisol production detects no cortisol the pituitary gland keeps producing the hormone to stimulate the adrenal gland to produce more cortisol. As a result the adrenal gland enlarges (hyperplasia) and, since it can't complete the production of cortisol, it floods the body with hormones which it produces as an intermediate step toward the production of cortisol. If not for the enzyme deficiency, the adrenal gland would be converting these hormones to cortisol. Unfortunately, these intermediate hormones are not inactive. They have properties similar to testosterone, the male hormone. As a result, not only does the body have the problem of not having enough cortisol, but also, the intermediate hormones cause virilization, which in girls results in ambiguous genitalia with a large clitoris and even labial fusion (closure of the vaginal opening.)
The treatment involves giving the cortisol that the adrenal gland would normally produce so that the adrenal gland is no longer stimulated to produce hormones. This must continue for the patients entire life and should be monitored and treated by an endocrinologist. Some of the patients may have abnormal salt and water metabolism and require treatment with other kinds of adrenal hormones as well. Surgical revision of the ambiguous genitalia is usually done between 6 and 12 months.
Since treatment will continue for the child's lifetime, at this point the parents should find a pediatric endocrinologist near where they live. This should be possible at any university hospital center that treats children. If your friends are not from the USA and desire an initial consultation with a pediatric endocrinologist they should be able to find one in any major city in Europe or the USA. Surgery should be done by a surgeon experienced in genital reconstruction which also should be available at any children's hospital affiliated with a medical school.
Sincerely,
Dr. Warren
She has blood and slight protein in the urine, platelets are ok, sed rate is high. She has had these Purpura spots on her lower half of her body for 12 weeks now without them going completely away. Today these spots with the same appearance started appearing on her arms and torso area. She is on 1200 mg of Ibuprofen a day instead of giving her steroids. She goes through episodes of the severe abdomen pain but the pain is not consistent. It will come on, last for approx. 4 days.
I would like to know if there is another disorder that can mimic these symptoms that her doctor is not looking for. Your answer is greatly appreciated. Thank you.
-Tamara
Dear Tamara: According to Behrman: Nelson Textbook of Pediatrics, 15th ed., Copyright 1996 W. B. Saunders Company
The full-blown picture of rash, arthritis, and gastrointestinal and renal manifestations is characteristic. Diagnostic confusion may result when one symptom predominates or multiple system involvement is not recognized. The rash may suggest a hemorrhagic diathesis or septicemia; platelet counts, blood clotting tests, and cultures can exclude these possibilities. The patient with septicemia usually appears more acutely ill. When gastrointestinal manifestations predominate, the syndrome may suggest a number of intra-abdominal emergencies or inflammatory bowel disease. The possibility of Henoch-Schonlein purpura should be considered in any child with acute abdominal pain, and inquiry made for associated rash, angioedema, arthritis, or nephritis. With prominent renal findings, acute glomerulonephritis may be suggested; other manifestations of Henoch-Schonlein vasculitis should allow differentiation. In children with chronic renal disease, a history of acute Henoch-Schonlein vasculitis should be sought. Differentiation from other rheumatic diseases is rarely difficult. In polyarteritis nodosa, peripheral neurologic changes and cardiac manifestations are more common, but differentiating the clinical manifestations from those of Henoch-Schonlein purpura may be difficult.Your daughter's symptoms sound like Henoch-Schonlein purpura. At this time, there isn't another disorder known to cause all these symptoms. It is a clinical diagnosis since there is no test which specifically confirms the diagnosis.
Sincerely,
Dr. Warren
-T
Dear T: I'm not sure there is any problem at all. Infants vary in their need for sleep. Normal newborns may sleep as much as 22 hours in a 24 hour period and as little as 12 hours in a 24 hour period. If your baby is happy and healthy during those wakeful hours then there's nothing to worry about. If your infant is constantly crying, he needs an examination by his pediatrician to determine whether anything is keeping him awake and making him cry. He may also benefit from a change in diet. If he is awake and happy, don't do anything about it.
Sincerely,
Dr. Warren
Why does she do that? Also she gets very sweaty and thirsty all the time. She is small for her age and weighs 31 pounds which she has been at this weight for a year and half. In your opinion should I have any test done on her?
Your reply would be greatly appreciated. Thank you
-[unsigned]
Dear (no name): Lethargy after a head injury is a result of the head injury and indicates that the child needs to be carefully evaluated and observed for signs of more serious head injury. If you're asking why she falls - one time she tripped. Why she fell off the bench, I have no idea. If you're asking why she hits her head, once a child loses his balance, since the head is heavy, unless the child breaks her fall with his hands, she is likely to land on her head.
Thirsty and no weight gain could be symptoms of diabetes. Sweaty and no weight gain could be seen with hyperthyroidism. Lack of weight gain for 1½ years in a young child is potentially serious and demands evaluation. There isn't any test you should be asking for. Your daughter needs a complete physical with tests to be determined by the doctor. You should inform the doctor of your daughter's symptoms and your concerns about her growth.
Sincerely,
Dr. Warren
Now a friend's 8 month old daughter has been diagnosed with hand, mouth, & foot disease by a different pediatrician group. Seeing her, she did have the spots on her feet & hands as well as her mouth, but the places were almost exactly what my daughter had on her earlier. They have had some contact.
Was my daughter mis-diagnosed?
Is it possible to have a mild case of hand, mouth & foot disease and it not spread to your hands & feet?
My daughter was given Zovirax for the places. Due to testing not being done with children, I have read that it is not a good idea to administer this to children unless really necessary. Since I had a waiting period for the medicine with my insurance, 1½ days, I did not give her the medicine. The places had already cleared up.
Please let me know your opinion on the above matter. Your prompt response is appreciated. Thank you for your time and consideration in this matter.
-Kelly
Dear Kelly: Coxsackie virus can cause sores in the mouth without causing any spots on the hands and feet; however, it does not cause sores on the outside of the mouth. If your daughter had canker sores in her throat and on her tongue with no involvement of the gums, it could have been herpangina caused by coxsackie virus. The same illness with blisters on the palms and soles is called hand, foot, and mouth disease.
Zovirax is used for treating herpes infections. If your daughter should have recurrent fever blisters, then you can conclude she might have had a herpes infection this time. A primary herpes infection involving the mouth usually lasts 1 to 2 weeks. The recurrent fever blisters which result from that may only last a few days. Zovirax can be used in children, and in fact, is used in newborns with herpes infections; however it is not indicated for the treatment of herpes gingivostomatitis (the initial mouth infection) or recurrent fever blisters. So far, the only official recommended uses for Zovirax are the treatment of shingles, chicken pox in adults, and genital herpes.
Sincerely,
Dr. Warren
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