24 July 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
-MC
Dear MC: The primary concerns in a child who has episodes of turning blue are cardiac problems and respiratory problems. Does your pediatrician think it's nothing because he's observed one of these episodes or because your son has an entirely normal cardiac and respiratory exam?
Unfortunately there is no good way for me to know just how concerned you should be since I haven't examined your child. If the cyanotic episodes (turning blue) are convincing (not questionable) I'd suggest consulting a pediatric cardiologist.
Sincerely,
Dr. Warren
Sincerely
-Lisa
Dear Lisa: Only a doctor who has examined your son can tell you if a tonsillectomy is necessary. Given your concerns you should definitely get a second opinion from another ENT.
Once the tonsils are removed, a person cannot get tonsillitis, but he can still get strep throat. Strep is a contagious illness which is contracted by exposure to someone else who has the germs in his nose or throat. There is a big difference between having a few strep throats a year and having constant relapses. If a child keeps getting strep back as soon as he comes off the medication and his tonsils are chronically inflamed, it may not be possible to eradicate the chronic infection without removing the tonsils.
Strep is a bacterial infection. It can be treated with antibiotics but could rarely result in serious complications such as pneumonia or meningitis. The main reason for treating strep is that untreated strep can cause rheumatic fever and damage the heart. Strep can also cause glomerulonephritis, a kidney disorder.
The main risks with tonsillectomy are infection and bleeding at the surgical site and reactions to anesthesia. Serious problem with anesthesia are rare, but nobody can tell you it's risk free. I had my tonsils out 53 years ago under ether drip anesthesia and I'm fine. Today's anesthesia is a lot safer than it was back then.
Sincerely,
Dr. Warren
-MS
Dear MS: You are talking about Osgood Schlatter disease. It is a condition seen in growing, active children, primarily preteens and young teens, in which the tibial tubercle becomes inflamed. The tibial tubercle is the site of attachment of the knee cap to the bone of the lower part of the leg. This attachment is under considerable stress as the knee moves during activity. Osgood Schlatter disease is a self limiting condition. It usually responds to ice, anti-inflammatories like ibuprofen, and limitation of activity. In more extreme cases the knee may have to be temporarily immobilized with a brace.
Sincerely,
Dr. Warren
Thanks for your help.
-K
Dear K: Intermittent grunting noises are not necessarily significant; however, grunting can be seen with each breath in infants who are having difficulty breathing or who are ill. The best way to know if the grunting is a concern is for it to be witnessed by the baby's pediatrician. If it never happens at the time of the baby's checkups it is unlikely to be a cause for concern. If that is the case, you could try videotaping the baby while he is grunting so the pediatrician can see what you're concerned about.
Sincerely,
Dr. Warren
-MH
Dear MH: Ritalin should not have any effect on the symptoms or management of a child's asthma.
Sincerely,
Dr. Warren
When I received the handbook relating to the subject and read the symptoms it reminded me of my first son, who is now 21. When he was born, there was no routine testing for this complaint. During his infancy and childhood he developed an umbilical hernia and depigmentation, although, admittedly minimal, and some others. He appears normal now, although he has never been as active as to me would appear normal, nor doing as well educationally as I would have hoped. At the time I put this down to domestic problems, but I am now starting to think again.
Would you advise letting sleeping dogs lie, or suggest he has a check-up?
Yours sincerely,
-PC
Dear PC: A person who has been hypothyroid all his life would most likely be mentally retarded and short since thyroid hormone affects both growth and brain development. Newborn screening tests check for hypothyroidism because it is important to make the diagnosis and treat early in infancy in order to prevent mental retardation.
Testing for hypothyroidism is simple. All that's involved is a blood test. Hypothyroidism is not desirable at any age even though it is most damaging in infancy. If there is any reason to suspect your son is hypothyroid, he should be tested. Hypothyroidism is treatable with medication.
Sincerely,
Dr. Warren
Thank you for your time and advice.
With best regards,
-RD
Dear RD: The ABR is the same thing as a BAER (brainstem auditory evoked response) and is most likely what you are referring to as the BERA. The test is a reliable way to see if there is any hearing loss since it measures the brain's response to a sound stimulus presented to the ears. The test does not require any active participation of the infant being tested. If a hearing problem is identified, the infant should be evaluated by an ENT to be sure there is no treatable cause of hearing loss such as middle ear fluid. If the baby has sensorineural hearing loss the baby would require hearing aids, early intervention aimed at teaching the hearing impaired, and evaluation to determine in the infant is a candidate for a cochlear implant.
Sincerely,
Dr. Warren
1.- What is Bronchitis (inflammation of the Lungs and tubes??)Thankyou.
2.- Is this something that stays with the person as a life time disease?
3.-What and how will this affect his growing years and adulthood?
4.- What should we as parents do?
-a concerned parent
Dear Concerned Parent: The term bronchitis means inflammation of the breathing tubes, but in most instances if the doctor does not say "chronic bronchitis" or some other kind of bronchitis, he usually means an acute infection in the bronchial tree. These are often caused by seasonal viruses which may result in secondary bacterial infection or may be caused by bacteria. For this reason doctors treat bronchitis with antibiotics.
One such episode does not imply anything about a patient's future. Children who have recurrent episodes of bronchitis most often have asthma. The implications for a child's future depends on the severity of symptoms, but asthma is certainly treatable. For more information about asthma check the list of articles I have written at http://www.mindspring.com/~drwarren/ and click on the links for articles about asthma.
At this point, you need to follow your doctor's advice regarding treatment. If the symptoms are recurrent your doctor will probably discuss other evaluation and management options. If he does not, you must question him about the possibility of asthma.
Sincerely,
Dr. Warren
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