6 August 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
Thank you for your time.
-V
Dear V: Gross motor delays are unlikely to directly affect toilet training unless the delays are due to muscle weakness associated with spina bifida. With spina bifida, sphincter control is affected. There is no affect on bladder, rectum, anus, or bladder sphincter with most gross motor delay. Gross motor delays are often associated with other developmental delays even when the child's intelligence is normal or superior. In addition, some of the tasks associated with toilet training such as getting on a toilet or potty independently, opening a zipper, or pulling down one's pants, may be affected by motor delays.
Toilet training is a complex matter which involves a child's understanding of your goal and his willingness to participate in the training process. I don't think readiness can be gauged by a child's hopping ability. Handicapped children who cannot hop can learn to hold it until someone puts them on a toilet. On the other hand, some children with advanced motor skills are simply not ready or willing to potty train.
Sincerely,
Dr. Warren
She told me that it MIGHT be Lupus. I am very scared.
Is there anything else it might be..????
Thanks for reading my e-mail.
-LT
Dear LT: You've given me too little information to answer your question, "Is there anything else it might be?" You haven't explained what "it" is. I don't know what tests were done or why,... only that you had a positive AA (probably ANA since I don't know what AA is), and a urine culture which was probably contaminated since it grew 5 organisms.
An elevated ANA in the absence of any other findings might suggest lupus, but cannot make the diagnosis. Based on the little information I have, I'd have to suggest consulting a rheumatologist to clarify the significance of the test as well as for further diagnostic evaluation.
Sincerely,
Dr. Warren
Thanking you
-Dr. R
Dear Dr. R: The hemoglobin electrophoresis is most consistent with Thalassemia trait; however, the hemoglobin is much lower than expected for Thalassemia trait. The hypochromia is certainly consistent with iron deficiency, and, as this child is only 1 year old, even if he has Thalassemia trait he could also be iron deficient. I would recommend doing a serum ferritin and checking the RDW to see if it supports the diagnosis of iron deficiency, or, alternatively, you could try a 1 month course of iron and repeat the hemoglobin with a reticulocyte count to see if there has been a response.
Sincerely,
Dr. Warren
-GG
Dear GG: Malrotation is incomplete rotation of the intestine during fetal development. The gut starts as a straight tube from stomach to rectum. As the bowel develops and grows it rotates around the artery which supplies its blood. As the bowel rotates into the correct position it forms attachments to keep it in place. Abdominal rotation and attachment are completed by 3 months gestation. When the rotation of the bowel is not correct the bowel can twist on itself (volvulus) causing intestinal obstruction which may be intermittent. This results in recurrent abdominal pain and vomiting. Symptoms usually become evident in the first year of life, and often, within the first week of life; however, it may cause no symptoms at all with 25-50% of adolescents with malrotation being asymptomatic. Acute obstruction caused by volvulus can be life threatening and may result in loss of a significant portion of the small intestine. Surgical intervention is recommended for any patient with a significant malrotation, regardless of age.
Sincerely,
Dr. Warren
-CC
Dear CC: Size is not an issue when it comes to essential surgery. Small infants do just as well with surgery as bigger children even though the surgery requires special skills when it comes to working on small organs. A 52 pound 8 year old is certainly bigger than the many infants having surgery each day in this country. All surgery involves a preop and postop period without eating. A person cannot become malnourished during that short period of time. If the status of your daughter's nutrition is already precarious, the surgery may be what is needed to improve the situation. At 52 pounds, I don't think you need to worry about your daughter's nutrition, but should there be a problem, the surgeon can place a line for intravenous nutrition if necessary.
Only your doctor can tell you how essential the surgery is for your daughter and what benefits you might anticipate from the surgery. All surgery has risks, but your daughter's size and the recovery period without food are not major factors.
Sincerely,
Dr. Warren
-K
Dear K: Many infants do not maintain a sitting position without support until 7 months and do not pull themselves into a sitting position until 10 months. Although most infants do sit without support by 6½ months, a 6½ month old who is not sitting is not delayed.
Sincerely,
Dr. Warren
She doesn't get out of bed so I don't think she could inadvertently hurt herself, but I just sit there with her and cry because it is so obvious that she is petrified and scared to death of whatever she is seeing. She will literally cover her mouth with her little hands, cry, and pull back from whatever it is in this dream. Is there really nothing to do once these start to get a child to come out of them faster? We have not been able to find any relationship to anything she eats or does before going to bed other than the timing of when they occur, it is within the first couple hours after she goes to sleep. I don't know how to help her.
Thank you for any help you can provide us.
-A scared mother of a scared little girl
Dear Scared: Your daughter is having night terrors. You have given a perfect description of a night terror down to the crucial detail that the child is not awake, not aware of his surroundings, and therefore, not responsive to his surroundings. The fact that your daughter doesn't even have the vaguest recollection of these episodes should at least provide you some comfort in the knowledge that these night terrors are more difficult for you than they are for your daughter.
Your daughter is the typical age for night terrors as well. As she gets older, the frequency should decrease and they should disappear. The only intervention I know of, besides reassuring the parents that night terrors are not serious, is to try waking the child just before the night terror begins. Done regularly, this may break the cycle. As you have noticed yourself, the timing is fairly consistent, occurring each night approximately 2 hours after your daughter goes to sleep.
Your only other option is to try to wake your daughter from her night terror. There is no guaranteed method to do it nor any evidence that waking child from night terrors will prevent them on future nights.
Sincerely,
Dr. Warren
-B
Dear B: Vicodin is a pain medication made from a combination of acetaminophen (the ingredient in Tylenol) and hydrocodone (a narcotic). It may be an appropriate medication for your menstrual pain if it is prescribed by YOUR doctor.
Your mother's concerns are legitimate. Narcotics have a potential for abuse even when they are used appropriately for disabling pain. If you stay on them long term, even for appropriate reasons, you can become addicted. And the temptation is there to use the narcotics for any pain when it's available. No matter how mature a 16 year old you are, your mother has your best interest at heart when she is concerned about your judgment about the appropriate use of narcotics.
You're thinking, "It worked, nothing bad happened, and it might be the right medication for me, so what's the big deal that gave Mom a *heart attack.*" But consider that you took a medication from a friend which was not prescribed for you. You didn't know what it was or whether there was any medical reason that YOU should not take it. Just the picture of one teen offering her drugs (prescription or not) to another, and that teen taking it without a second thought just because teen #1 said it worked well for her, is enough to give any parent a heart attack.
I think that the safety issue with Vicodin is appropriate use. If you don't experience any untoward effects form the medication it would be safe for you as long as it is used correctly and not abused. There may be non-narcotic medications that would work for you as well and not cause anxiety for your mother. You should see your doctor and have him help you find the right treatment for you. If it is taken as prescribed, under the doctor's control, and you are not trying other people's medications outside the house, I'm sure your mother can be reassured about safe and effective treatment.
Sincerely,
Dr. Warren
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