5 November 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
-JS
Dear JS: I don't know of any specific OTC substance which could result in a false positive drug screen; however, all laboratories do confirmatory testing on all positive drug screens, so before you draw any conclusions based on a drug screen, do yourself and your son a favor and have the test done at a reliable laboratory.
In addition, regardless of the outcome, any parent who finds himself doing drug screening on his kid must be dealing with some significant behavioral concerns or issues of trust which might benefit from professional counseling.Remember that trust is a two way street. If your son has not given you any reason to worry about drug use other than his being a teenager, resorting to drug screening could close the doors of communication which need to be opened. If you can talk to your son and be a part of what's going on in his life you'll have less reason to worry about drugs. If you can't talk to your son or he is engaged in worrisome behaviors, the drug screen is only one step in dealing with these issues. A negative drug screen does not solve the problem.
Sincerely,
Dr. Warren
Thanking you.
-M
Dear M: If you have gone through a normal puberty, including menstruation since age 11, you may simply have to deal with the reality that not all girls have big breasts. Based on your weight and height, you appear to have a slim build. If your doctor has examined you and found your body development to be normal, and hormone tests have shown everything to be normal, you need to consider a realistic plan for body building and nutrition to get the appearance you wish. Avoid all the garbage advertised by disreputable sources which promise breast enlargement. Ultimately, if it is that important to you, you might need to consider cosmetic surgery.
Sincerely,
Dr. Warren
Our 3½ year old daughter has been quite a teeth grinder since she had teeth. When she is sick it is the worst. When she is well it is still quite frequent and loud. I can only imagine that she is doing damage to her teeth and jaw. Is there anything we can/should be doing? Is this an indication of any medical or psychological problem of which we should be aware?
Any help you could give is appreciated.
-Beth
P.S.: Do you get a lot of questions regarding bowel movements, or what? it would appear that many parents are fixated on their children's bathroom activity - what is this all about?
Dear Beth: Bruxism (tooth grinding) may be a sign of stress, but could also be perfectly normal. If it is extreme during sleep you might even look for signs of anal itching which could be a sign of pinworms. Severe bruxism can grind down the teeth. Your daughter's dentist would be the best person to tell you if there is a problem. If there is, he can refer you to an orthodontist who can fit her with an appliance to be worn at night to prevent the grinding.
I get a fair number of questions regarding bowel movements. Parents are concerned about their children's bathroom habits as indicators of health and due to social issues associated with bathroom habits. Children who are difficult to toilet train cause a great degree of stress for their parents.
Sincerely,
Dr. Warren
I have been on the birth control pill for quite some time now. But the only reason I started it was to clear up my skin. I have recently become sexually active though so I'm now more concerned about whether or not I'm taking it correctly. The instructions that come with it are a little complicated... so here are my two questions... One, I take a pill everyday, but I haven't been all that concerned about making sure that I take it at the same TIME everyday. How important is that to making sure I don't get pregnant?
My second question is this... the last 7 pills in the pack are the green ones that they call "reminder" pills without hormones. So if they don't have hormones, then would that mean I could get pregnant during that week... cause I don't have sex while I'm on my period anyway... but there are 7 days worth of those pills and I'm only on my period for about 3... so wouldn't it technically be possible to get pregnant during that week? Maybe I'm wrong, I just don't really understand how that works, so I would appreciate any help you can give me so that I'm sure I'm safe. :) Thanks!
-Krista
Dear Krista: Birth control pills prevent pregnancy by preventing ovulation. If there is no egg to fertilize then there can't be a pregnancy. The hormones in the birth control pill simulate a normal cycle in order to prevent ovulation. The 7 dummy pills simulate the hormone withdrawal which causes menstruation. Even though you may not menstruate for the whole 7 days you take the dummy pills, if you take your pills every day, you should not ovulate, and therefore you cannot get pregnant even while taking the dummy pills. You should try to take your pill around the same time each day, but most important, try not to miss taking any.
Sincerely,
Dr. Warren
-ML
Dear ML: Traces of blood may be found in the urine of healthy children after an illness with fever, after bouncing on a bicycle, and after a strep infection. Elevated calcium levels in the urine may cause blood and may be familial. If the blood is associated with white cells, it could be due to infection. Structural abnormalities could cause blood, but generally not protein elevation.
A trace of protein in the urine may be insignificant. It depends how concentrated the urine is. If a first morning urine is negative for protein, the protein in the urine could just represent the increased amount of protein allowed to pass due to activity. This is known as orthostatic proteinuria and is normal.
The presence of significant amounts of blood and protein in urine could be associated with kidney disease such as glomerulonephritis. That is why these screening tests are done.
Your doctor could do a urine culture. He can collect a first morning specimen to test for protein and, if that is elevated, get a protein/creatinine ratio to see if the urine protein is truly elevated. An elevated calcium/creatinine ratio would clarify the possibility of high urine calcium. A renal and bladder ultrasound would check for structural abnormalities. Blood work could check kidney function. Since we are talking about trace amounts of each, before a major diagnostic workup is launched, the first thing to be done is repeat the test. Blood which persists more than a year should probably be evaluated.
Sincerely,
Dr. Warren
Dear Readers: Some kidney specialists don't even think an evaluation is necessary for microscopic blood in a child's urine as long as it's not associated with significant protein in the urine. Their reasoning is that the different forms of glomerulonephritis require a kidney biopsy for diagnosis and an invasive test for diagnosis is not warranted for a condtion that wouldn't be treated and won't progress to kindey failure. If there is gross (visible) blood in the urine or significant protein, then further evaluation is needed. This wait and see attitude does not apply to children who have urinary symptoms or abdominal pain. It also does not apply to adults where blood in the urine could be a finding of bladder cancer.
-DW
Dear DW: You are describing an extreme form of allergic reaction known as serum sickness. Serum sickness usually starts within 7 to 14 days after exposure to an allergen. Since penicillins are high on the list of medications which can cause serum sickness, it may indeed have been a reaction to the Augmentin. In the future, your daughter should not receive any form of penicillin. If there is any reason penicillin would be necessary in the future, she should be tested by an allergist.
The usual course of serum sickness is resolution within 3 weeks. She should probably be on an antihistamine such as Benadryl as well as medication for pain. More extreme cases may be treated with steroids. She should be monitored closely by your pediatrician.
Sincerely,
Dr. Warren
I want to be -
-anonymus
Dear Anonymous: Incontinence refers to the inability to hold urine or stool. Technically speaking, you did have an episode of incontinence; however, it would be a stretch from that one accident to say you are incontinent. The question is, "Why did it happen, and what can you do to prevent it from happening again?"
Are you having any ongoing symptoms of frequent urination or an urgent need to urinate where it's hard to hold? If so you may need a urinalysis and urine culture. Are you having excess thirst, losing weight, and urinating large amounts? These are symptoms of diabetes. Again, a urinalysis should answer that question. Are you experiencing any weakness, loss of sensation below the waist, or difficulty controlling your bowel movements? Then a neurological evaluation may be in order. If the incontinence continues, as embarrassing as it is, you need to tell your parents so that you can have a medical evaluation to be sure there isn't a cause requiring evaluation and treatment.
If there is no medical problem, keep in mind that ignoring the urge to urinate until it becomes urgent can result in situations where you can't hold your urine. Therefore, you shouldn't ignore the feeling that you need to go for too long.
Sincerely,
Dr. Warren
-KP
Dear KP: You may be describing something normal, but indeed, what you're describing could be the result of a malabsorption syndrome. If your daughter has difficulty gaining weight, her stool should be sent for analysis to determine if there is any kind of malabsorption. Her doctor may also wish to consider some other tests (such as a sweat test for cystic fibrosis), so you should review her growth and your concerns with him.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
