22 October 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
-H
Dear H: The average child has 6 to 12 upper respiratory infections (URIs) each year, most clustered in the winter months. Symptoms may last from a few days to a few weeks. URIs are caused by viruses and do not respond to treatment with antibiotics. Therefore, your doctor msut be treating more than an ordinary cold. Without knowing what your son is being treated for, it is hard for me to recommend a best course of action.
Your son probably catches a lot of colds (URIs) becuase he is in school. It's a matter of exposure and the luck of the draw. If he is always sicker than a child should get with the average URI, the best course of management depends on what the underlying problem is. If he has recurretn ear infections or chronic sinusitis, he should be evaluated by an ENT surgeon. If he has recurrent bronchitis, especially since you say he coughs all the time even when he is well, he should be evaluated for the possibility of asthma and allergies. If he has recurrent pneumonia, your son needs a thorough evaluation of his immune system, a cardiac evaluation, and a sweat test for cystic fibrosis.
I suggest you read my articles about asthma and URIs so that you can discuss these possibilities with your son's pediatrician armed with a good understanding of the range of symptoms and treatments for both asthma and URIs. You can find my list of articles with links to them here.
Sincerely,
Dr. Warren
-Angie
Dear Angie: Your brother could have had an anxiety attack with hyperventilation causing all his symptoms, but a normal pulse and blood pressure are not sufficient to rule out other medical causes. Is your brother prone to anxiety? If not, it's not a safe assumption that his symptoms are due to anxiety. In fact, without a complete physical, it's not a safe assumption anyway.
Things to consider: Your brother's age, weight, blood pressure, and diet (fats). Is he at risk for stroke or cardiovascular disease? I suggest he have a complete physical and sort it out with his doctor.
Sincerely,
Dr. Warren
-Jill
Dear Jill: Lichen sclerosis does not appear to be mentioned in any of my pediatric texts which leads me to believe it is not seen in the pediatric age group. In any event, the description of lichen sclerosis does not sound anything like labial adhesions. Lichen sclerosis is a rash which causes itching and irritation and is characterized by whitish bumps. Untreated, I suppose it could lead to some degree of labial adhesions; however, labial adhesions are unique to the pediatric population. Adult women don't develop labial adhesions because of the effect estrogen has on the membrane. A child who has labial adhesions will have the labia stuck together with what appears to be a thin membrane covering them. There is no rash as seen with lichen sclerosis.
Sincerely,
Dr. Warren
His doctor has ordered (finally) several tests they are "C Diff, giardia, cy or cx, and O&P". I am sorry I don't know the exact names, but that is what is written on the vials. Can you tell me what these tests are for? What else could be causing this? My daughter was prescribed Vancomycin twice for her problem and it is my understanding that is no longer prescribed due to some severe problems with it. Any information you can give would be greatly appreciated.
Thanks
-RJ
Dear RJ: I'm guessing that your daughter had pseudomembranous colitis, which is a complication of antibiotic treatment caused by the toxin of a bacteria called Clostridium difficile. I am guessing that because your daughter was treated with vancomycin. The usual treatment for pseudomembranous colitis is metronidazole or vancomycin. I am not aware of any reason vancomycin should not be used for this condition although it is certainly not a treatment for other routine infections.
The C. Diff test is to check for pseudomembranous colitis as discussed above. Giardia is a parasite which can cause recurrent diarrhea, gas, and abdominal pain with symptom free periods between bouts of diarrhea. The O&P (ova & parasites) test is looking for the eggs (ova) of other parasites besides giardia and other evidence of those parasites. Cx probably is a shorthand for culture which is a test to look for bacteria such as salmonella, shigella, campylobacter, yersinia, and some strains of E. coli, which might cause severe or persistent gastrointestinal symptoms.
Should all of these tests come out negative, ask your pediatrician about seeing a pediatric gastroenterologist for further evaluation.
Sincerely,
Dr. Warren
-Mr. & Mrs. G
Dear Mr. & Mrs. G: The normal range of blood pressure readings depends on body build (size) and maturity (stage of puberty). A prepubertal girl is more likely to have a blood pressure in the usual range for children - approximately 90/60, whereas a fully mature girl (some girls at 12 have reached adult development) might have a blood pressure of 120/80. Many adult women who are slim have blood pressures in the 80/50 to 90/60 range. The average (50th percentile) systolic reading (top number) for a 12 year old girl is approximately 102. The 90th percentile is 121/77, meaning that higher readings bear monitoring for hypertension.
Sincerely,
Dr. Warren
-Lee
Dear Lee: The condition about which you are asking is called "trigger finger."
Sincerely,
Dr. Warren
Thanks
-Benny
Dear Benny: It's possible that the lump you are describing is adolescent gynecomastia, an enlargement of male breast tissue associated with changes of puberty. There are several letters about gynecomastia on my web site. If you've had the lump since early to mid puberty, that is very likely what it is. In most instances the swelling does go away. If your body started the changes of puberty more than a few years ago and the lump has just developed, I would not be confident about suggesting it was related to puberty and would therefore have to suggest you get it checked by your doctor. In fact, if you haven't had a recent physical, you should go for a routine checkup and point the lump out to your doctor.
On the chance that you chose not to see a doctor, since breast lumps may be caused by hormonal changes, I would urge you to examine your testicles for lumps. If you find any, do not delay getting it checked out by your doctor.
Sincerely,
Dr. Warren
-Mr. F
Dear Mr. F: The absence of daytime urinary symptoms and nighttime symptoms once asleep suggests that there is no major physical cause; however, you should be aware that minor symptoms which can be ignored during the day may sometimes interfere with sleep and so become more evident at night. Any child with urinary symptoms deserves at least a urinalysis and possibly a urine culture. Some children who have absolutely nothing wrong do develop temporary symptoms of urinary frequency, but it's better to check a child and have him declared healthy than to miss something.
If your son is having difficulty sleeping or difficulty with separation, that could be causing or contributing to his symptoms. That does not necessarily mean the boy is making it up. The symptoms may be very real to him even if there is no physical cause.
All you need to tell the pediatrician is what you told me.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
