18 September 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
Thank you.
-Emily
Dear Emily: Did you have any tests done besides imaging test?. The association of your severe pain with diarrhea would make me consider testing for parasites like giardia or food intolerance such as lactose intolerance.
Sincerely,
Dr. Warren
I am in the Army, and we took him to our pediatrician, and she sent us to an orthopedic specialist. He thought it might have been caused by the healing after a head bump or bruise, and said it would probably go away. The problem is that it has multiplied. There are now about four small hard lumps in a cluster.
Could these be calcium deposits? Would the first lump break up into several?
Thanks in advance for your help.
-BR
Dear BR: A hematoma under the skin (large bruise, bleeding under the skin causing a lump) could turn hard and as it goes toward resolution, break up. If the 4 small lumps occupy the same location as the original lump, that's possibly what you're dealing with. If you're finding new lumps at a distance from the original area that would require further evaluation, perhaps even a biopsy. A biopsy can be used to make a diagnosis. Its use does not imply a search for malignancy.
Sincerely,
Dr. Warren
Thank-you for your time!!!
-DD
Dear DD: The white material you are removing is smegma. It is a secretion normally produced by the glands surrounding the head of the penis. It is not washing away when you bathe your son because it is stuck under the adhesions between the foreskin remnant and the glans penis (head of the penis). If the adhesions are light, you can pull them apart like you did a year ago. If the connection between the foreskin and the penile head is thick, it should be done by a doctor. You may need to see a urologist. Once the head of the penis is separated from the skin, you can prevent adhesions from forming again (keep them separated) by gently pulling the skin back every time you bathe your son and applying a thin layer of Vaseline around the rim of the head of the penis.
Sincerely,
Dr. Warren
-NM
Dear NM: It is normal for little boys to play dress up. It's part of how they experiment with roles. At 3 years of age a child identifies strongly with his mother, so even boys often want to dress as females. It is okay to allow it as play, but you are right to make sure he understands that he wears boy's clothes for everything else. It is important for him to develop a strong relationship with his father or some adult male. It is also important that the relationship with a man does NOT focus on his wearing girl's clothes. It's okay if Dad or any other male role model disapproves, but it should not become a major issue in their relationship. The child needs to feel a friendship or kinship with a man rather than disapproval.
One additional aspect of playing dress up which may help is to be sure that your son has an adequate supply of male costumes to play with. He already knows what it's like to wear his clothes. He wants to play at being someone else. For this he could use some of Dad's work clothes, a uniform, cowboy outfit, traditional male religious costumes, Dad's hat and tie, etc.
Sincerely,
Dr. Warren
This problem seems to come and go but, there seems to be no contributing factors since I have kept a food diary, school (tests or whatever), no stress at home...
These episodes have been very painful for him as well as us (his parents). I am fearful there may be a real problem and that without finding out the cause of this that permenant damage may be done to his health. He has also been to one of the top pediatric gastroenterologist in our area.
Also another symtom is that when I take him to the doctor and they do an x-ray they show me and tell me his intestine is impacted with stool and then they have me use laxatives to clean him out which is not pleasent for him or me.
I know that your time is very valuable but, I would appreciate any information you could provide me as to maybe a test that has not been preformed as of yet. Also I tried keeping him off dairy products for the last 3 months and that does not seem to have helped at all.
Please respond ASAP.. as you may save a child from unnessary suffering.
Thank you for your time and any information you can provide
-ST
Dear ST: The fact that your son has painful bowel movements and his x-rays show his intestines to be full of stool tells you that he has a problem with constipation. The fact that the stools are sometimes soft does not go against that conclusion. Frequent stools can also be seen with constipation. Some constipated children will have small hard stools multiple times per day, but they do not effectively empty their bowels. Having an intestine full of stool often causes recurrent and persistent abdominal pain and a loss of appetite. Constipation is a chronic problem. You can use an enema or laxative to empty the constipated child out, but once he is empty, it's necessary to use stool softeners, lubricants, and/or a high fiber diet or fiber supplement in order to keep the child moving his bowels regularly.
One thing that concerns me is that you say pus was found in the stool. That suggests inflammation or infection. I would expect that something would have been seen on the colonoscopy if that's the case, unless the colonoscopy was performed at a time when your son had no symptoms or pus in the stool. If this occurs again, it may be necessary to repeat the evaluation when he is symptomatic. One possible explanation could be that he is a constipated child who, on at least one occasion, had an intestinal infection when his stool was evaluated. If he has pus in his stool he should have a stool culture, test for parasites, and a blood test (CBC and ESR).
If your gastroenterologist has made recommendations for treating your son's constipation, it is important to stick with the treatment, not only if it doesn't provide immediate relief, but also when your son is pain free. Stopping the treatment for constipation when a child has no pain may cause his intestines to become impacted again resulting in a recurrence of the pain.
Sincerely,
Dr. Warren
If you could e-mail me with some ideas of what this lump could be it would be greatl appreciated.
Thanks.
-Vanessa
Dear Vanessa: A tender lump (I assume it's tender because you say it feels like a bruise) which grows rapidly could be a boil or abscess. You should see your doctor.
Sincerely,
Dr. Warren
Thanks.
-L
Dear L: If your doctor is considering a diagnosis of Zollinger -Ellison Syndrome he would want to get blood for a gastrin level. He would also want to check your serum chloride and calcium to clarify the diagnosis. It is likely that your doctor hasn't considered that diagnosis because it is virtually unheard of in kids and because you must meet certain clinical criteria for the diagnosis to be made. Z-E is a triad of markedly elevated gastric acid secretion, peptic ulcer disease, and a gastrin producing tumor. The gastrin causes the high acid production which causes the symptoms including ulcers. Since you don't have ulcers, there is no reason to look for Z-E.
As well as the GI evaluation you've had, I presume your doctor has checked blood chemistries including liver function tests and done a urinalysis. It might even be worth doing a urine culture. While it's reasonable to fully evaluate the GI tract when searching for causes of nausea, it's equally important to evaluate other systems to be sure the cause doesn't lie elsewhere.
Since you've had a thorough GI evaluation, it may help your doctor for you to keep a diary of when you have your symptoms: what you were doing when the nausea started and what you ate before the nausea started. You should also pay attention to whether or not you have dizziness, double vision, loss of balance, or headache which could suggest a neurological problem. Headache and nausea could also be symptoms of migraine. Nausea and vertigo with or without ringing in the ear could suggest an ear problem.
Sincerely,
Dr. Warren
-From a Worried Mom
Dear Worried Mom: Going into an office visit with worrisome symptoms not knowing the diagnosis, the main questions to ask are what the possible causes of the symptoms are, what steps need to be taken to make a diagnosis (what tests must be done), what risks there are to the recommended diagnostic procedures, how serious the patient's current condition is and whether or not any urgent intervention is needed.
I don't have enough of an idea what's going on here to give you more specific questions for this situation. With the small amount of information you've given me, it's unclear to me whether or not your son's symptoms are secondary to extreme weight loss or if the weight loss is another symptom of a disease. Even though anorexia nervosa is rare in boys, if your son has lost an excessive amount of weight intentionally and believes he is overweight, that would be the likely diagnosis. The bruising and cold hands could be secondary to malnutrition.
Any gastrointestinal condition which could cause malnutrition or chronic disease affecting appetite could cause what you describe. The clues would be what other symptoms your son has. Even diabetes could cause profound weight loss and after taking its toll on the body result in the other symptoms. Unfortunately malignant diseases must also be considered as a cause of weight loss and bruising.
Your son needs a thorough evaluation as soon as possible.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
