30 April 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
-RC
Dear : There is little growth of the penis during childhood. Growth starts during puberty. The timing of puberty varies, but it is likely that your son should not expect any growth of his penis over the next 5 years.
Sometimes appearances can be deceiving. Boys with large pubic fat pads may have a significant length of the shaft of the penis buried in the pubic fat pad. Uncircumcised boys may sometimes have a short foreskin making the penis appear as if the tip comes directly from the scrotum with little or no length of penile shaft in between.
A genital exam is part of the normal checkup. Your pediatrician should be able to reassure you and your son that everything is normal, or if not, recommend appropriate evaluation and treatment or refer you to an endocrinologist or urologist as needed.
The reality is that we can't all be the tallest, biggest, prettiest, or whatever a person considers best. And not all men have the same size penis. If your son's penis is normal, he needs to understand that it's okay if his cousins' penises are bigger. It's unusual for an 8 year old to be concerned about the size of his penis. You ought to talk to your son to find out why he is concerned about it. Has anyone made fun of him? or has he picked up on your concerns about his size?
There is not shot just for the sake of making the penis grow. It is likely that your brother was treated for delay in pubertal development. If he was an adolescent who was distressed about his development it is even possible that he was treated to induce genital growth in order to help his self esteem, rather than waiting for nature to take it's course.
Sincerely,
Dr. Warren
-AB
Dear AB: There isn't a set length of time between the onset of vomiting and/or diarrhea and the development of dehydration. The smaller a baby is, the less fluid volume he has in his body, and therefore the less fluid needs to be lost to result in dehydration, therefore small infants become dehydrated more quickly that bigger children and adults. In addition, the rate of fluid loss balanced against the amount of fluid retained will determine how quickly a child becomes dehydrated. If a child is vomiting and unable to retain fluid, he will become dehydrated more quickly. Even if a child vomits multiple times, if he retains the bulk of fluid that he consumes, his risk of dehydration is small. A very small infant with severe diarrhea could become dehydrated after 2 to 3 large watery stools, but most infants and children who are not vomiting can be kept adequately hydrated with feedings of oral electrolyte solution even in the presence of severe diarrhea. On the other hand, if the child is very ill and does not have adequate oral intake, he will eventually become dehydrated even if his losses are small.
Sincerely,
Dr. Warren
Yours truly
-HP
Dear HP: Allergic shiners, the purplish to dark gray circles around the eyes of kids with allergies, are usually associated with other allergy symptoms such as runny nose, sneezing, and watery eyes. The cause is generally inhalant allergies like pollen, dust, animal dander, or feathers, rather than foods. I would not subject a child to allergy testing if his only symptom is allergic shiners. In fact, I wouldn't do any testing at all on a child just because of dark circles around the eyes, as long as he is healthy, happy, and has had regular checkups which include routine laboratory tests such as checking for anemia and doing a urinalysis.
On the other hand, if a child has just developed dark circles under the eyes and is otherwise seeming not as well as previously, he should have a thorough examination.
Sincerely,
Dr. Warren
Any help would be appreciated!!!
-Marty
Dear Marty: Without details such as whether or not your fiancee's son was previously clean with normal bowel habits and whether or not he willingly has bowel movements on the toilet, it is hard for me to be sure, but I suspect that the child is withholding stool, i.e., he holds it in and only lets out what he can't hold, resulting in accidents and frequent stools.
A more detailed history and a complete examination including a rectal exam by the boy's pediatrician should clarify what's going on.
There is a large emotional component involved in stool withholding including issues of control. For more information read my article, Fecal Soiling.
Sincerely,
Dr. Warren
Within 24 hours of my milk coming in, my son started to become very fussy after feedings and was having extreme gas. I was watching my diet, avoiding spicy and gas producing foods. I did, however, drink large amounts of milk.
When my son was five days old, he was having "screaming fits" that lasted up to an hour. I called his pediatrician who, without even speaking with me, hadhis receptionist tell me to switch him to Similac with Iron.
We started him on it that morning. By the next day, he hadn't had a bowel movement in over 36 hours and he was crying for longer periods. He also started eating lesser amounts of formula. While crying, he would arch his back and extend his legs. He would go from intense sreaming to dead sleep in the blink of an eye, only to resume screaming shortly after. It took him an hour to eat 1 to 1.5 oz, as he would cry, arch his back, extend his legs, and throw his head back and shake it from side to side. He would do these thing, with the exception of shaking his head from side to side, when not feeding as well. While sleeping we noticed that frequently his arms and legs would suddenly extend, almost like a spasm. He couldn't be comforted often, but when he was he would have to be in an upright or sitting position. He would awake as soon as you put him in his bassinet. He never had a real problem with spitting up, and he only vomitted once or twice. We switched pediatricians and made an appointment.
When his new pediatrician saw him, he was 7 lbs. 9 oz. and 9 days old. She switched him to Nutramigin, and he seemed to improve - at least for about 2 days. Then the sreaming resumed and he started eating less and less. One week later he was screaming from one to three hours a day, and went from eating about 17 oz. a day to 11 oz a day (we kept records and totalled from midnight to midnight each day). When weighed at the doctor's office he was still 7 lbs. 9 oz. The doctor was concerned, but relieved that at least he wasn't losing weight. She suggested "acid reflux" and started him on Zantac twice a day at .3 ml. His doctor suggested raising the head of his bassinet about 4 or 5 inches due to the acid reflux. This did not relieve ANY of his symptoms, nor did the Zantac.
Three days later he was drinking only 9 to 11 oz. per day, and we called the doctor again. She switched him to Prilosec and Reglan. He also had an Upper G.I. which confirmed the acid reflux and showed no other abnormalities. Two days later he was even worse. His screaming lasted up to 16 hours, with 5 to 15 minute naps every few hours. We called the doctor again, and she saw him that day. My son had lost 5 oz. in 5 days. He now weighed 7 lbs. 4 oz. She had him admitted to the hospital that afternoon.
The doctor ordered an NG tube placed for feeding, and for the first 16 hours he was receiving 22 cc. of Pedialyte an hour. The next morning he weighed 7 lbs. 7 oz., as he was rehydrated. She stopped the feeding tube to see if he would take a bottle, but again he ate too little too slow (I believe it was .5 oz in half an hour), so she started the feeding tube again as she wanted him to put on some weight. He was eating half strength Nutramigin. The next day we tried several times to get him to eat from the bottle. The first time he had half strength and at 1.5 oz in about half an hour. The second time he ate 1.5 ounces of full strength but vomitted all of it after eating. Again he was placed on the feeding tube. The next day we tried again. We tried feeding him from the hospital bottles and used several nipples trying to find one that made him eat faster, even cutting a criss-cross in the nipple. He kept falling asleep during feedings and wouldn't finish his bottle. We even tried bringing in the Playtex nursers we used at home, but no luck. He had to eat 2 oz. every 3 hours, so the doctor allowed him half an hour to eat. Whatever wasn't finished was given to him via the tube over the course of the next hour. PLEASE NOTE: The entire time that feeding was assisted with the tube, he didn't cry or fuss and slept well.
At our wits' end, that night we went and bought NUK nipples thinking since he was breastfed to start, maybe that nipple would encourage him to eat (he never had a problem consuming on the breast). IT WORKED! He was eating 66 cc. (the formula was mixed 13 oz of formula to 9 oz water) in about 15 to 20 minutes. At first I was thrilled. Then it occurred to me that he HAD eaten 2 to 3 ounces at a time on the other nipple, but slowly he cried more and ate less. But, I was desperate for an answer, and apparantly so was the doctor. We all agreed it must have been the nipple, though on the inside I was praying the problems wouldn't gradually return. For the next 16 hours he ate 66 cc in 15 to 20 minutes. He vomitted twice, but the first time he had just gotten his meds (as a matter of fact, the nurse was giving it to him through the tube WHILE I was feeding him the bottle) and the second time he had burped, hiccupped, then vomitted within a matter of seconds, so the doctor and I dismissed it. He was discharged that day and had been in the hospital 6 nights.
His first feeding at home, he vomitted as soon as I sat him up to burp him. I called the doctor, and she suggested that I burp him after ever half ounce instead of every ounce. The rest of the night I didn't have a problem, though his sleep was VERY restless.
Which brings me to today. The next day he was starting to fuss. He vomitted about 5 minutes after I'd burped him during an afternoon feeding, and he was having half hour screaming fits. Now he has been screaming for the last 3 or 4 hours. He is still drinking 66 cc of concentrated Nutramigin (13 oz formula to 9 oz water) as the doctor wanted him on 24 calories. He is inconsolable. He has resumed arching his back and extending his legs. This is NOT a fussy baby cry. My son is in pain and no one seems to know why. He doesn't cry, he shrieks. he only gets relief for a few minutes if you have him in an upright position. He also seems to get a minimal amount of relief for about 10 minutes after he passes a bowel movement.
He is taking Zantac (.2 ml TID), Reglan (.2 ml QID), Ceclor (2 ml TID) because he had a small amount of fluids in his ears which is clearing up, and he is on eye drops for a staph infection in his right eye.
Also, when he was 14 days, I noticed him getting thrush. He was on Nystatin (1 ml in each cheek QID) and got a LOT of relief after receiving each dose. Sometimes it was the only quiet time we had, and at times it quieted him enough to get him to sleep. All of his oral meds seem to give him some relief, with Nystatin having the biddest effect. He took the Nystatin for 14 days and his tongue and cheeks are clear.
We have tried swings, vibrating musical bouncers, car rides, putting his infant seat on the washer... NOTHING seems to give him relief.
Dr. Warren, we are desperate. You may not be able to diagnose my son, but can you give me a clue? Do you think it is time for a specialist? Should we get a second opinion? Do you have a guess where the pain might be coming from? We are so desparate. When my son isn't in pain, he is so content and sweet. Everyone saw it when he was on the feeding tube.
I have some of my own possibilities but don't want to share them because I want a fresh opinion.
I am so afraid my son will start to lose weight again. I don't want to see him suffer anymore.
I thank you in advance for your time and consideration.
Sincerely,
-Cyndi
Dear Cyndi: Too bad we can't take a step back in time. Given how severe your baby's gas pains sound, I'm not sure it would have made a difference, but I would have advised you to stop drinking cow's milk and to continue nursing. If, by any chance you still have your milk, you should certainly consider putting him back on your breast.
Perhaps it is because I come from an area where specialists are plentiful and most of my patients have insurance, but I am not at all comfortable prescribing Zantac, Prilosec, or Reglan for newborns. I would have already had you consult a pediatric gastroenterologist. I don't want to sound like I'm questioning your pediatrician's actions, but given how extreme your infant's problem has been, I would advise seeing a gastroenterologist.
I can't think of any reason why your baby's oral medications would have soothed him. Even assuming your son had thrush going down into his esophagus contributing to his discomfort (not a likely possibility), the Nystatin would not have provided any immediate relief. That leads me to conjecture that it wasn't the medication that was soothing him, but rather that it was getting some oral intake without sucking on a bottle. That leads me to suggest trying some spoon feeding or feeding from a dropper or syringe to see what happens.
Finally, if the gastroenterologist finds nothing, we have to remember that feeding problems and irritability can arise outside the gastrointestinal tract. Babies with neurological problems may be irritable and have difficulty feeding. Infections such as urinary tract infections can cause irritability and feeding problems. So if there are no answers in changing the feeding and managing the reflux, the whole problem may need complete reevaluation.
Sincerely,
Dr. Warren
Can you help?
Regards,
-Jeff
Dear Jeff: I'm always reluctant to suggest that I have an answer when a patient hasn't gotten the answer from specialists caring for him. Perhaps your doctors, who have had the benefit of examining you, have already considered my idea and discarded it as not fitting the clinical picture.
I sounds like you're describing angioneurotic edema. Angioneurotic edema can be seen as part of an allergic reaction, and as such may be treated with antihistamines, steroids, and, in situations where the swelling may pose a danger, injections of adrenaline. Angioneurotic edema is also seen as a result of a congenital enzyme deficiency, C1 Esterase deficiency. The treatment is not different for C1 Esterase deficiency, but testing for it can help the patient understand what is happening if the diagnosis is made.
Sincerely,
Dr. Warren
Sincerely,
-A Very Concerned and Loving Mom
Dear Concerned and Loving: There are no medications to treat learning disabilities; however, if your daughter has attention deficit disorder contributing to her difficulty learning, there are a variety of medications which might help such as methylphenidate (Ritalin) or dextroamphetamine.
Each child has a different style of learning. For the child with learning disabilities it's crucial to understand what helps that child best to learn in order to devise an appropriate IEP (individual education program). Some children require more visual stimulation (demonstrations, diagrams, seeing the words). Others require more auditory input (reading out loud, discussion of what is happening while it happens). Yet others require combined sensory input including the feedback of writing things down.
Your daughter should have a complete learning evaluation done by a psychologist who specializes in testing for learning disabilities. The result of that evaluation should include a report telling the school what methods should be used in teaching your daughter. In addition, certain accommodations should be made for your daughter in the regular classroom since she is not in the LD class full time. Your daughter may require additional time to complete tests and assignments. If she has a reading disability she may require assistance reading the questions on a test. Without that help, the test cannot assess her understanding or knowledge of new material. Any lessons which require reading may require additional assistance from the teacher or an aide. Your daughter may need to tape record lectures instead of taking notes and then transcribe them later with assistance.
Sincerely,
Dr. Warren
I wish to ask another question is it healthy or any side effect if I masturbate everyday ...
-CKO
Dear CKO: Tinea Versicolor is a fungus infection of the skin. It is in a superficial layer of the skin so that the only symptom most people experience is the appearance of the fungus on the skin and the fact that the areas of skin covered by the rash don't tan.
There are many treatments for tinea versicolor. One of the newest and generally successful medications is Nizoral shampoo. I am not familiar with Tartamite and was unable to find any information about it.
Some people are prone to the tinea versicolor infection because of the consistency and pH of their skin oil. You may have difficulty eradicating the infection because even when you successfully treat it, you may develop it again. Or you may not be fully eradicating it if you don't make sure that all of the infection is covered by the medication. Since it is a living organism, it will grow back if any of it is left living on your skin.
My advice would be to get your treatment from one dermatologist. If the infection recurs, continue treatment with the same doctor so that he will know what prior treatment you've had and what degree of problem you're having with it. Often, going to multiple different doctors in search of answers complicates treatment and makes it more difficult to get answers.
There are no medical problems caused by daily masturbation unless you do it in such a way as to injure yourself.
Sincerely,
Dr. Warren
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