13 February 2006
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
Thanks.
-Jessi
Dear Jessi: The tear ducts can be massaged by pressing gently along the area where the corner of the eye meets the nose, massaging in a downward motion from the top of the nose toward the bottom. This may help. In addition, the narrowing or blockage of the tear ducts may resolve on its own. If this does not help, you should consult a pediatric ophthalmologist. The consultation does not obligate you to consent to surgery. The ophthalmologist should explain all your treatment options including the risks and benefits and alternatives including the risk of not treating.
Sincerely,
Dr. Warren
-Kammie
Dear Kammie: It is safe to go on a weight loss diet while nursing as long as the diet is nutritious and not extreme. You cannot expect to lose weight quickly while nursing. Using a nutritious liquid diet meal as part of your weigh loss plan should be okay, but the overall diet must provide adequate nutrients and fiber and the total caloric intake cannot be drastically below your normal maintenance diet.
Sincerely,
Dr. Warren
-Jason
Dear Jason: Swelling and tenderness of the testicle with redness of the scrotum could indicate a significant problem. If there is bleeding inside the capsule of the testicle, the pressure can damage the testicle. Severe tenderness, swelling and redness can be seen with a testicular torsion, a condition where the testicle twists around cutting off its own blood supply. Testicular torsion is a surgical emergency since the testicular tissue will die resulting in loss of the testicle if it isn't treated quickly. Since your son had an injury and you don't say he has excruciating pain, I don't suspect a torsion, but I do suggest you get your son evaluated quickly if you haven't done so yet and if his symptoms have not resolved by the time you read this response.
Sincerely,
Dr. Warren
My main concern which is also my question is could this be cancer and if it is a possibility what is the likelihood of a child getting lung cancer and what things can they do to stop it.
Thank you.
-AM
Dear AM: Children can get cancer which can show up in the lungs. While lung cancer would be extraordinarily unlikely in a child, a lymphoma could show up in the lungs as could other metastatic cancers. If the shadow you are concerned about is indeed the same as in a previous x-ray, if it is solitary and has not grown, and your son has been well for the past year, it is highly unlikely that it is a cancer. Nonetheless, your son needs some appropriate follow up studies to determine if anything further needs to be done. He should have a repeat x-ray within a few weeks to determine if the shadow has resolved. If the doctors believe it is the same shadow as last year, or if a follow up x-ray does not show resolution, he should have a CT scan or MRI to further evaluate the shadow. If the matter cannot be resolved by imaging studies, he should see a pediatric pulmonologist and may require additional tests including a biopsy by bronchoscopy or an open biopsy. If a determination is made that your son has any form of cancer, his treatment will have to be managed by a pediatric oncologist.
Sincerely,
Dr. Warren
Thank you so much for your help it is hard to find literature on this matter.
-GL
Dear GL: There is some evidence that circumcision decreases the incidence of urinary tract infections in boys during the first year of life. Given that urinary tract infections are uncommon in boys, that is a very small benefit. Many of the other arguments in favor of circumcision have been disproved. Medically speaking there is not a big reason to consider circumcision. On the other hand, if you live in the USA where circumcision is very common, there may be psychological considerations. Since the boy's father is circumcised, the boy may be upset not to look like his father as well as not looking like the majority of boys (depending on where you live). Unfortunately, life has no absolutes to help your decision. When your son grows up, if the pendulum has swung to make circumcision less common or he feels based on what he hears on the subject that he would have preferred to not be circumcised, he may regret the irreversible decision to circumcise him in infancy.
If you should decide to go ahead with circumcision, you should be aware that there is an increasing trend to provide local anesthesia and some form of analgesia for the procedure. Given your husband's concerns regarding the pain, it would be wise to investigate your doctor's attitude and approach in advance. If you should decide against circumcision, you can feel confident that circumcision is not a medically necessary procedure.
Sincerely,
Dr. Warren
-CR
Dear CR: A few days of dizziness could be caused by a variety of infectious illnesses, the most common ones in children being mononucleosis and influenza. Mononucleosis can be diagnosed by blood testing. If your daughter has no other signs of illness, she could have an inner ear problem (you mentioned 2 episodes of ear pain without infection) causing dizziness. A consultation with an ENT surgeon could elucidate that possibility. Dizziness could also be neurological. If there is nothing in your daughter's ears causing the problem a neurological evaluation would help.
Sincerely,
Dr. Warren
This worked splendidly with this child who after one and a half year suddenly could feel when he was full, and now can leave even cakes at the plate, and has stopped gaining weight while growing taller (=getting slimmer), without having the feeling he has ever been "big". Could this method work with the same child and his soiling (as he doesīt feel it coming)?
Could this be a good way to handle the problem? (This child doesnīt resist going to the toilet and he does get it out now and then, and he says he does want to get control of it but he doesnīt feel it coming. He doesnīt seem embaressed about it and he has not been teased, but he is aware itīs a bit problematic (with the overeating he didnīt connect the treatment with any problem in his body as he will with this). His soiling is not of a very extensive character but much enough not to be ignored. He seems harmonic and is well performing in school, popular among friends and loving (and loved) by his family. His family had a really tough period last year but he has not been neglected, even if he might not have gotten as much attention as usual during that period. Could this play a part, and should it just simply be talked about all together, (and maybe about him being yelled at, because of the soiling, before the awareness of the seriousity of this problem (one-two years ago)?)).
Could allergy has something to do with it? Milk?Bread?Other?
Iīm most thankful for a quick answer, as this is of great concern , and it would be good to get on to the right track before the problem gets out of hand and heīll get a complex about it. Please donīt put my name on the net, as this is still is a rather delicate question, and I donīt want anybody to find out about this problem. Thanx :))
-Most Concerned
Dear Most Concerned: Any treatment approach for a chronic problem like soiling or overeating should emphasize the positive and avoid labeling the child as part of the problem. Children should never be made to feel that they will not be loved if they don't succeed. They should be helped to see how success will benefit them. The visualization approach you suggest may aid some children to focus on the mechanics of success without any negative emotional content.
Treatment of soiling does require a medical evaluation to determine the cause. Stool withholding is the most common cause and is appropriately treated with lubricants, laxatives, scheduled toileting, and behavior modification techniques which could include your visualization technique. Determining if stool withholding is the cause could even be helpful in modifying your approach, i.e., for stool withholding add to the visualization, "When you push, push the stool out rather than back in."
To the best of my knowledge, allergy is not related to soiling, but any treatment should be undertaken under the watchful eye of a physician experienced in dealing with such problems.
Sincerely,
Dr. Warren
-V & T
Dear V & T: If your son's allergic reaction is so extreme as to cover most of his body and make him uncomfortable in spite of treatment with an antihistamine such as Benadryl, you should stay in close contact with your physician. In the event of a progression which includes swelling of lips or tongue, voice change, difficulty swallowing, fever, swollen joints, coughing or wheezing, or rash inside the mouth, your son will require more vigorous treatment with steroids; however, since these are potent medications, they should not be started prematurely. Unfortunately there is no other intervention which will provide symptomatic relief. Cool compresses or ice on itchy areas may provide some temporary relief, but will not alter the overall picture.
Sincerely,
Dr. Warren
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