19 February 2007
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
-ML
Dear ML: Coxsackie virus is a member of the enteroviruses which includes ECHO viruses, Coxsackie viruses, and other enteroviruses. Hand foot and mouth disease is caused by Coxsackie A virus. The virus spreads from the respiratory tract and stool of an infected person. It can live long enough on surfaces to spread without direct contact with the infected person (including surfaces touched by the infected person and swimming pools) and may be spread by people who are asymptomatic. The virus may continue to be shed in the stool for up to 3 weeks after the illness.
The incubation period is 3 to 6 days after exposure. Symptoms may include headache, fever, sore throat, cankers in the throat, and blisters on the palms and soles. The best preventive measure is careful hand washing, especially after using the bathroom or changing diapers.
Sincerely,
Dr. Warren
-O
Dear O: The pill works by preventing ovulation. It begins to work right away but there is a risk of pregnancy until a woman has completed one full menstrual cycle on the pill. Therefore, you must continue to use other forms of birth control after starting the pill until after having the first period on the pill and starting the next month's supply.
Sincerely,
Dr. Warren
Any info is appreciated! Thank you!
-A
Dear A: If, when you say your granddaughter has no vaginal opening, you mean that the labia re fused together, this is known a labial adhesions. While it is not "normal" it is a common condition and not a cause for alarm. As long as the urethral opening is not obstructed it should not cause any problems and will probably resolve with the onset of puberty. Your pediatrician can determine if there is a need for treatment with Premarin cream or surgical lysis of the adhesions.
I presume you do not mean that there is no normal vaginal structure. I'm sure the pediatrician would have noticed and deemed an evaluation necessary. Certainly absence of a vagina could not be considered normal. All anatomic structures present in normal adults must be present at birth.
Sincerely,
Dr. Warren
-S
Dear S: Unfortunately, nobody can tell you that anesthesia is 100% safe, but it is pretty safe, and is no more dangerous for a 6 month old than for an older child. There is no association between anesthesia and SIDS. There are younger infants and newborns undergoing much more prolonged anesthesia every day at Boston Children's Hospital for complex, dangerous, and life saving procedures. The vast majority do just fine. At least your child does not have any health problems which would increase his risk.
The laparoscopy is not a dangerous procedure. The surgeon would be the best person to present you with all the known risks of the procedure.
It is hard not to be anxious about anesthesia. When I had my own surgery my whole family was anxious.
Sincerely,
Dr. Warren
-Alana
PS: If you haven't noticed, i hate typing!Dear Alana: It isn't that I'm concerned about giving my address to you. It says right on my Web page that I practice in Lynbrook, NY. Anyone with a phone book or internet access can find my listing. However, "Ask Dr. Warren" is a web/e-mail enterprise. I am not inclined to answer questions any other way than specified on my web site. That provides me the control I need to keep this free and voluntary service from overwhelming my life.
Any question you have can be sent to me by e-mail as easily as snail mail. Unless your typos are incomprehensible, there's a greater risk I'll have trouble with your handwriting than your typing. E-mails sent to me are seen only by me. Mail sent to my office is opened by my secretary. Your privacy is assured by e-mail. If you do not have your own e-mail account, you should set one up to assure the privacy of your response.
Please follow the instructions on my web site for submitting your question. If I am away next week you will have to submit your question in two weeks.
Sincerely,
Dr. Warren
Another quick question; Jack had tubes put in his ears 2 wks ago. Prior to them he had thick fluid built up for 6 months, but a hearing test showed he was hearing pretty well. Since the tubes, he definately is "talking" more and hears well, but the way the speech sounds is comparable to the way a deaf person talks. Is it possible that he was hearing everything muffled and that is the way he is going to speak at first ? Just to clarify, he only says 3-4 words, but he babbles a lot and that is what sounds strange to me. Thank you again,
-Staci
Dear Staci: In the absence of other signs of illness, Jack's rash does not sound like part of an infectious illness, but as you knew when you asked, since I haven't seen Jack's rash I cannot state with certainty what the rash is or whether or not he is contagious. With the onset of diarrhea and irritability the rash could be viral. You and your friends will have to decide whether or not you are willing to chance exposing their kids to Jack on the grounds that he doesn't appear to have anything serious, regardless of the unknown diagnosis.
I have never seen Benadryl cause diarrhea.
If Jack had hearing loss intermittently from persistent middle ear fluid, the sounds he heard could indeed have been muffled. Now that he has the tubes, hopefully there will be a dramatic improvement in his language development including an improvement in the way he speaks.
Sincerely,
Dr. Warren
Sincerely,
-Julie
Dear Julie: Reassuring someone that their swollen lymph nodes are not worrisome without examining the patient is just not possible. By your description, the nodes sound like inflammatory nodes because they have started to shrink since your son's viral infection is getting better. In addition, you only mention swollen lymph nodes in the neck, which is fairly common due to childhood viral infections. On the other hand, I have no idea from your description whether the size of these nodes is typical of childhood viral infections or if they are unusually large. If these are inflammatory lymph nodes which grow and shrink in relationship to infections, they are not worrisome. Only your doctor can tell you if he is concerned about something else.
Sincerely,
Dr. Warren
Sincerely,
-KR
Dear KR: It's not a good idea for physicians to draw conclusions from such scant information; however, from the little bit you've told me, I would be very concerned about this child's vision and would most definitely recommend a thorough evaluation by a pediatric ophtalmologist. On the other hand, don't forget that the child has been seen by a specialist and you're not privy to what he told the parents. There may be a reason they've decided not to pursue it which they are not sharing.
Sincerely,
Dr. Warren
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