24 September 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
As we were working on closing the case on Monday, we found out that the doctor on base is refuting this diagnosis. He refuses to speak with the onsite doctor, but he has done his own research, and we have learned that if the ER doctor's diagnosis was correct, our daughter would be the first infant case of Vascilitis in history. CPS is disgusted with the base's behavior and is the ER doc. The base has refused to look at her ears again (to see, as the lady from cps put it, if they were bruises they would be turning colors. Our daughter's marks merely faded from dark red to pink and now flesh-colored). Do you know anything about this?? And is it usually obvious to doctors that there is a difference between bruises and inflamed blood vessels (the doc off-base, realized it SO quickly!)
Thank you for your time. (we're meeting tomorrow with the commander).
-L & F
Dear L & F: Since I did not see the marks on your child's ears, I cannot comment on how easily they could have been distinguished from bruises. Vasculitis certainly does occur in children as part of other diseases, but I have no experience with vasculitis as a presenting sign of a viral infection. If your daughter should have recurrent symptoms, further investigations will be needed to establish the underlying cause and recommend treatment.
In an ideal world all physicians would recognize every diagnosis immediately, but in reality, we've all had different experiences in our training and cannot possibly experience everything, therefore, even the most experienced physician is always learning. The problem does not lie in the fact that the physician on base did not recognize the marks as vasculitis. The problem lies in his unwillingness to confer with a colleague whose opinion differed from his, and his refusal to do a follow up exam which would document the current status.
Sincerely,
Dr. Warren
Thanks for your help!
-MD
Dear MD: While underarm odor is usually associated with mature sweat glands young children can have odor. If there are no visible signs of pubertal change, underarm odor is not a sign of an endocrine disorder. If the deodorant deals adequately with the problem, you need not do anything else. Odor is often caused by bacteria. If the deodorant isn't helping sufficiently, you might consult your doctor or a dermatologist about treatment with a topical antibiotic.
Sincerely,
Dr. Warren
Thank you for your time.
-Lindsay
Dear Lindsay: I don't believe that chiropractic manipulation is dangerous for infants as long as it is being done by a practitioner who has training and experience dealing with children. I also don't believe there is any evidence that chiropractic manipulation provides any benefit in the treatment of middle ear infections or middle ear fluid. If your daughter's ear problems persist I would recommend that you consult an ENT.
Sincerely,
Dr. Warren
Thanks.
-Her Parents
Dear Parents: There are many causes of low platelet count in newborns. Your daughter's prognosis depends on what is causing her problem. If Mom had a disorder causing antibodies to platelets (maternal ITP or lupus, for example), or if Mom produced antibodies to the baby's platelets (similar to the situation when Mom has O or Rh negative blood and produces antibodies to the baby's blood), eventually those antibodies will dissipate and stop destroying the baby's platelets. If the low platelet count was due to a medication Mom was taking, again one would expect the condition to improve. If the thrombocytopenia (low platelet count) is due to a medication Mom was taking the infant should eventually recover. Infection may also cause thrombocytopenia. Bacterial infection requires appropriate treatment whereas viral infection just requires time for recovery. Rarely a newborn has a congenital deficiency of megakaryocytes, the bone marrow cell which produces platelets, for which a bone marrow transplant may be necessary.
The treatment and course is dependent on the cause, so that if the low platelet count persists, you will need to consult a pediatric hematologist for complete evaluation.
The primary risk of a low platelet count is bleeding. If the platelet count was low during the delivery, the biggest risk would have been bleeding in the head during delivery. If the baby made it through delivery without complications, then it will be necessary to maintain the baby's platelet count in a range to prevent bleeding until the infant recovers. Most of the causes of neonatal thrombocytopenia usually resolve.
Sincerely,
Dr. Warren
Tonight, we were doing the same routine......I had a long day at work today and was very tired, and I had fell asleep with her. Suddenly, I heard a noise and found that she had rolled off the bed. She only whimper for about 5 second and fell back to sleep. She seems fine, no vomiting or anything.......fortunately our bedroom's carpet is quite thick.
Please advise if there is anything I need to be concerned. It is very frightening to me when I found my daughter rolled off from a 25 inches high bed. Is there any case that would suggest this fall will cause any permanent damage on her brain........Please advise.
Look forward to hear from you very soon!
Best Regards,
Jenny
a very concerned parent.......
Dear Jenny: Usually a fall from rolling off the bed, especially onto a plush carpet, does not cause any serious injury. If your daughter is acting fine at this point, alert, playful, not vomiting, there is little reason to be concerned about head injury. If she is not acting right, especially if she is lethargic, cranky, or vomiting, then she should be seen by a doctor.
Sincerely,
Dr. Warren
Can you please give me good advise.
-S
Dear S: Your son's weight gain is fine. It is unfortunate that you had a problem with nursing, but your son can do perfectly well on formula. If you have not been nursing for the past 53 days, it is highly unlikely that you would be able to start nursing again.
There are many reasons that infants may cry. Gas pains and colic are the most common causes. Since these are internal sensations, you may feel that there is no cause for your son's crying because you cannot see the cause for his discomfort. If the crying continues and is severe, you may need to try your infant on a different formula. This should all be done under the guidance of your pediatrician. It's okay to ask for e-mail advice on general matters, but if you think your young infant has a problem, it must be evaluated by his pediatrician.
The normal color of urine is clear to yellow.
I still do not understand what your concern is regarding your son's stretching. These are normal movements, especially on awakening. If you feel that you are seeing something abnormal, since I cannot tell from your description, it should be observed by your son's pediatrician.
Sincerely,
Dr. Warren
-LD
Dear LD: Bright red blood on the toilet paper or in the toilet bowl is usually from the anus, making the most likely causes hemorrhoids or fissures. While these are usually associated with constipation, your stepdaughter need not be constipated now to have either of these problems. Large amounts of red blood could be from the intestine. While it is most likely not serious, since you don't know the cause of the bleeding, your stepdaughter needs to be checked by her pediatrician.
Sincerely,
Dr. Warren
Thanks A Lot
-D
Dear D: Red blood on the toilet paper is usually from the anus, making the most likely causes hemorrhoids or a fissure. Hemorrhoids are varicose veins of the anus. A fissure is a tear in the anus. Both conditions are generally caused by constipation. Neither is serious, but could benefit from treatment of the constipation and local treatment of the condition. That alone might be a good reason to see your doctor, but even more important is that without examining you, I can't be sure what the source of your bleeding is. Therefore you should see your doctor. Physicians routinely deal with embarrassing problems and examine embarrassing parts of the body.
By the "back of your penis," from your description I'm assuming you mean the underside of your penis. The line you are describing is simply a normal part of the anatomy having to do with the way the body forms symmetrically around the midline. This median raphe is more prominent on some men than others. If you check, you will probably notice that it runs even further back coming from near the anus and going to the area where you noticed it.
The little "zits" to which you are referring are probably hair follicles. The hair follicles on the scrotum and underside of the penis are often prominent like goose flesh. Since they are superficial you may be able to pop out the hair root by squeezing on it. Some of these hair follicles may even form small cysts filled with the secretions from the glands associated with the follicles. This is perfectly normal.
Sincerely,
Dr. Warren
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