24 April 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
-ER
Dear ER: A child who is ill may exhibit the behavior you described without being hypoglycemic. If your child was up during the night because of wheezing that could add to his fatigue. Being ill and not eating could also cause your child to be hypoglycemic. The GTT does not support the diagnosis of hypoglycemia.
As regards your son's diet, sugar is not a source of protein. Whether or not a child becomes hypoglycemic children should have their intake of sugar limited. They should get 60% of their calories from complex carbohydrates which includes cereals, grains, vegetables, fruits, and pastas. Protein is an essential building block. In a milk allergic child it can be provided by meat, eggs, soy protein such as tofu, and a combination of beans with other vegetables.
Sincerely,
Dr. Warren
Thanks.
-AM
Dear AM: The condition you are describing in which skin folds rub together and become inflamed is called intertrigo. The inflammation can usually be controlled by regular application of hydrocortisone 1% cream. If you are already using hydrocortisone 1% or a stronger steroid cream without benefit, then you should consult a dermatologist.
Sincerely,
Dr. Warren
Thanks
-KS
Dear KS: Blueness around the mouth can be seen in a child who is chilled. It could be an indication of a cardiac or respiratory problem. It could be nothing, but it could be significant. That can only be determined by an examination. Share you concerns with the infant's pediatrician.
Sincerely,
Dr. Warren
-Gina
Dear Gina: Cough variant asthma is called that because the only symptom the patient gets is coughing. Even though the patient does not have episodes of shortness of breath, the cough symptoms are caused by inflammation and constriction of the airways, so it is a form of asthma. Since it is a form of asthma it responds to treatment for asthma. If your daughter did not respond to singulair but does improve with a steroid like prelone, your doctor should try her on a combination of an inhaled steroid like flovent and a long acting bronchodilator such as serevent. These medications are available as sprays which a young child can learn to take using a spacer or powders which can be inhaled directly even by a young child. For more information read my five part series on asthma:
Sincerely,
Dr. Warren
Dear Readers: Use of long acting bronchodilators like Serevent is currently being reevaluated due to an apparent higher incidence of asthma deaths in patients who use them. No cause and effect relationship has been found. Serevent is rarely prescribed since it comes in combination with an inhaled steroid in a medication called Advair, and use of Serevent alone is not a recommended treatment. For those patients who require a long acting bronchodilator, it is recommended to try to wean them down to an inhaled steroid alone when their symptoms improve.
One additonal thought for this patient. Perhaps the Singulair would have kept her symptoms under control if it was started when her symptoms were already under control after a course of Prelone.Sincerely,
Dr. Warren
-Gina
Dear Gina: The first thing you must do is to stop beating yourself up about your baby's condition. Most people need so much to feel in control of their lives they lose sight of the fact that so many things happen for no apparent reason. By taking care of yourself during your pregnancy you gave your baby the best chance. There were many potential problems you avoided. Your baby's thyroid condition was not one of them. It had nothing to do with you. You could not have prevented it. When you consider all the things that can go wrong, the real miracle is that most babies are completely healthy.
I can understand your desire for your baby not to have to endure pain. Unfortunately, many medical procedures are painful. But let's put it in perspective. Your child's condition was diagnosed early and is entirely treatable with medication. As long as she takes the right amount of medication, she can lead a completely normal life. Your daughter may not be able to appreciate it now, but the pain of periodic blood tests is a small price to pay for a normal life. Believe it or not, there are plenty of parents whose children have worse diseases without the promise of a normal life who would be very happy to trade places with you.
I can tell you from my experience drawing blood on many infants that many of them cry for the whole procedure (holding the arm, applying the tourniquet, drawing the blood) even though they are not in pain the whole time. And occasionally, I have an infant who just sits and watches me do it without making a peep. The actual procedure has to feel the same to all the babies even though their reactions differ. For this reason, I'm not sure how much of a difference using a local anesthetic would make to a young infant, but since your baby has to have blood drawn regularly, you should ask you doctor about applying EMLA cream to the area 1 or more hours prior to the blood drawing.
Sincerely,
Dr. Warren
Now my 7 year old son has it on his bottom. We are very protective of our son and know that he is not having contact with any one that could be abusing him.
Can you confirm how this virus is transmitted. Have you come across any similar cases?
Many Thanks.
-GW
Dear GW: Molluscum contagiosum is a kind of wart and is fairly common in children. Your doctor has made an assumption that yours were sexually acquired because they were on your penis, but these kinds of warts occur quite regularly without any kind of sexual contact. Common warts and mollusca are caused by viruses. The virus must contact the skin in order to cause warts. Most people who develop warts cannot say who they caught if from. They are not so contagious that I ever have to worry about getting warts just because I touch a patient's wart.
A man may get mollusca on his penis the same way he gets poison ivy on his penis. There are many things that won't affect the thick callused skin on the palmar surface of the hand, so that you can get poison ivy resin or the virus of the wart on your hand without necessarily developing the rash. But when you touch your penis, if you haven't washed first (most people wash after using the bathroom), you can get the poison ivy resin or the wart virus on your penis.
Sincerely,
Dr. Warren
Thanks for any advice you can give me.
-CT
Dear CT: There isn't any way to get a 10 month old to stop doing something unless you are willing to make an issue of it or distract him from it (as the pacifier does). Your baby is enjoying the noise and sensation he gets playing with his new teeth. He will eventually stop grinding his teeth and move on to other new experiences. Ignore it.
Sincerely,
Dr. Warren
-J
Dear J: The reason certain diseases are primarily sexually transmitted is that the organisms (bacteria, viruses) which cause the diseases do not remain viable for prolonged periods outside the body and so must be passed directly from one body to another. This does not mean that all these germs die immediately when they are outside the body, but even if they remain viable on a surface for a short period of time there is little likelihood of these organisms going from a surface to a part of your body where it can cause a sexually transmitted disease (STD).
Organisms such as herpes do remain viable on surfaces for a short period of time and can be transmitted without sexual contact. Fever blisters are caused by the same herpes virus as genital herpes. The virus can be spread by kissing or even drinking out of the same glass as someone with fever blisters. The virus can spread from a person's mouth to his eyes or genitals on his hands. Therefore, if you have concerns about someone living with you who may have an STD, make sure glasses and utensils are washed before using them; wash your hands before eating AND BEFORE as well as after going to the bathroom; don't share towels, bedding, or clothing (unless you wash them first). Reasonable hygiene and appropriate protection during sex can prevent the spread of STDs. Living with someone who has one should not be a risk.
Sincerely,
Dr. Warren
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