19 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
Regards,
-PY
Dear PY: I have never heard of NF Factor, so at first I thought you were referring to Neurofibromatosis (Von Recklinghausen's disease). However, before I answered you I researched the phrase "NF Factor" and found out that it could be referring to nuclear factors such as the NF-kappaB factor, a transcription factor involved in the normal inflammatory pathway.
"The NF-kappaB transcription factor was originally described as a B cell nuclear factor that binds to the kappa chain enhancer and plays a key role in the expression of kappa chain gene. It is now recognized that NF-kappaB is important in the expression of many other genes that play important roles in responses to infection, stress, and injury. [Lee: Wintrobe's Clinical Hematology, 10th ed., Copyright © 1999 Lippincott Williams & Wilkins]"
"NF-kappaB may play a pivotal role in the inflammation of chronic allergic disease because it is activated by many factors that increase inflammation and results in the coordinate expression of multiple inflammatory genes and proteins. [Middleton: Allergy: Principles and Practice, 5th ed., Copyright © 1998 Mosby-Year Book, Inc.]"Since this NF factor is a normal part of a regulatory pathway involved in inflammation, it's presence alone does not indicate a problem or lead to disease; however, a trnaslocation of the gene for this factor plays a role in leukemia, and all inflammatory diseases including asthma may be modulated by NF factor.
If you can clarify your question, perhaps I can provide more useful information.
Sincerely,
Dr. Warren
My questions: are the two types of seizures related and is there anything I can do to prevent him from having a seizure while sleeping. I'm now petrified that he will stop breathing at night if he has a seizure.
Please advise or recommend any sites that have this information
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Dear :
Sincerely,
Dr. Warren
-Beth
Dear Beth: Many boys have no signs of puberty by 12 years of age. It is perfectly normal for a boy to not have started puberty until he is 16. Of course, most of the boys who have to wait that long are not too pleased about it.
In addition, your son's penis may look even smaller to him and to you if he is overweight, because a significant amount of the shaft of the penis may be buried in the pubic fat pad causing it to look shorter.
Chronic disease may contribute to a delay in pubertal development, but you must keep in mind that your son is not delayed. His lack of pubertal development is still normal. There is no reason to suspect his medication. While oral steroids may have a significant effect on growth if taken for prolonged periods of time or taken frequently, the effect of inhaled steroids is minimal.
Finally, while I don't think you need to embarrass your son by taking him to his doctor to have his penis checked, his genitals should be checked as part of his complete checkup. Complete checkups should be done regularly even (and especially) during adolescence to be sure that growth and development are normal and to provide the adolescent an opportunity to deal with health and social issues which are unique to teens.
Sincerely,
Dr. Warren
Regarding my niece who is 4½ years old: She was toilet trained at 2½, but recently (last 3 months) has been having accidents (just can't make it to the bathroom on time) about 3 times per day. Also she wets the bed quite frequently. Should she go back to using pull ups for awhile, or would it be a medical problem of some type or is there any type of medication to help? My sister has noticed that my niece can't seem to recognize when she has to go.
Thank you so much.
-Auntie D
Dear Auntie D: don't really believe that a child who was successfully toilet trained suddenly can't feel when she has to go. Denial is a potent psychological defense mechanism used frequently by young children. If they say something isn't so, that's enough to make it not so for them. The child who has accidents may vehemently deny having had an urge before the accident, but you can be sure that isn't the case. Many children who are fully trained may progress to the next step of mastery, which is to hold it as long as possible and not allow the need to urinate to interfere with their activity. This may result in an increased number of accidents until the child learns just how far he can ignore his urge.
Since your niece is wetting at night as well as during the day, and this is a new problem, she should be evaluated by her doctor to be sure that there is no medical cause. A urinalysis and urine culture are necessary to check for diabetes and rule out a urine infection. If those medical causes are ruled out, she may still need further evaluation by a urologist to be sure there is no medical cause and to discuss medical treatments.
When a child who has been fully trained starts having day and night wetting, aside from considering medical possibilities one must also consider psychological causes. This could include anything from the birth or impending birth of a new sibling, a death in the family, problems between the child's parents, to the extreme of physical or sexual abuse.
Sincerely,
Dr. Warren
-MN
Dear MN: Gastroenteritis, diarrhea caused by intestinal virus infections, is one of the most common illnesses in children. Since many different viruses can cause diarrhea, some children may experience several bouts during the year. As long as the symptoms come to an end and the child remains well hydrated and well nourished, there is no cause for concern. For more information please read my article about gastroenteritis.
If the symptoms persist for weeks to months, that would not be typical for gastroenteritis and evaluation for another cause of chronic diarrhea would be necessary. Lactose intolerance can develop in an older infant or child.
Sincerely,
Dr. Warren
-J
Dear J: Unfortunately, I did not get your e-mail until well after your surgery due to a problem with my mail server. The bulk of the anesthesia would have left your body within the first day. The radiation would not affect your milk. If you felt well enough, you could have resumed nursing within a few days from your surgery. However, many mothers choose to stop nursing after 1, 2, or 3 months for a variety of personal reasons. All their babies benefit from whatever nursing they have had. The immunity that comes through breast milk is temporary, but is extremely important to protect the newborn against infection while his own immune system starts gearing up to make the baby immune to diseases. By 3 months of age the infant's immune system has already matured enough to fight off many of the diseases which are more serious in the newborn period.
Sincerely,
Dr. Warren
Finally, my question is, is social anxiety hereditary and if so, can it start in a young child like this? Is there counseling that can help her overcome this before she goes to Kindergarten in the fall?
One last question. Her eating habits are terrible. She eats maybe 6 different things, none of which are vegetables or fruits. If she refuses to eat anything for breakfast but a hotdog, my sister will give it to her. My opinion is to not give in to her and give her nothing. At 5, she will not starve, if she gets hungry enough, she will eat what is being offered to her. (breakfast food) Is this the best route to go?
Thank you for your time and if you could email a response to staciborg@hotmail.com I would really appreciate it.
Thank you.
-SB
Dear SB: I was unable to find any information regarding the heredity of social anxiety disorder. There is no question that certain aspects of personality are heritable which could include the tendency toward anxiety. In addition, a child's upbringing, including the environment in which he is raised, will affect his personality. The debate continues (nature vs. nurture) regarding which has the greatest influence, but it may be a moot point. You cannot change what your niece has inherited so you must focus on the best approach to dealing with her current mental health needs.
Children of divorce may have plenty of problems due to the divorce even when both parents are psychologically healthy. The father's illness compounds the issue since his problems no doubt affected your niece and she may have learned to be protective of him long before the parents separated. Your sister's new lease on life with the support of her family and fiancé should benefit your niece emotionally, but for your niece, this new life further separates her from her father. Regardless of his mental health, he is her father and they have a bond with each other. Even a child cannot turn away the powerful feeling of being the most important person in someone else's life no matter how big a burden it ultimately proves to be. Therefore, in a sense, Dad's desperation is forging a stronger bond between him and his daughter while Mom's desire to move on is creating a schism. Dad will always be a part of the child's life regardless of the fact that Mom and Dad are divorced. The current situation cries out for family therapy. The child would no doubt benefit from therapy for her separation problems, but these did not occur in a vacuum, so the interpersonal problems among family members (Mom-Dad, Mom-Daughter, Dad-Daughter) which contribute to the problem must be addressed in order to effectively deal with the problem.
You are right that giving a child what she demands for a meal when it is not an appropriate choice, will not foster good eating habits. You are equally correct that a child will not starve from missing one meal. In addition, a child who eats what she wants, when she wants, without regard to its nutritive value, may be malnourished even if not hungry. However, since your niece has not been raised with hunger, don't expect her to immediately be willing to eat whatever she is offered just because she misses a meal. Her attitudes toward food will take a while to change, and starving her to effect those changes is not reasonable. For additional information please read my article, Nutrition Without Tears.
Sincerely,
Dr. Warren
Thank you for your time,
-T & N
Dear T & N: My condolences on your loss. Kasabach-Merritt syndrome is not a congenital syndrome, and so, to the best of my knowledge, does not have any specific recurrence risk. Kasabach-Merritt syndrome is an abnormality of clotting which results from consumption of clotting factors in a large vascular malformation such as a hemangioma. Small hemangiomas are common and are known as strawberry marks. Kasabach-Merritt syndrome is associated with large hemangiomas. Kasabach-Merritt may occur due to internal hemangiomas which are not noticed until the problem ensues.
According to Behrman: Nelson Textbook of Pediatrics, Sixteenth Edition, Copyright © 2000 W. B. Saunders Company "The association of a giant hemangioma with localized intravascular coagulation causing thrombocytopenia and hypofibrinogenemia is called the Kasabach-Merritt syndrome. In most patients the site of the hemangiomas is obvious, but retroperitoneal and intra-abdominal hemangiomas may require body imaging for detection. Inside the hemangioma there is platelet trapping and activation of coagulation with fibrinogen consumption and generation of fibrin(ogen) degradation products. Arteriovenous malformation within the lesions can cause heart failure. The pathology of these lesions is undergoing scrutiny, as some authors contend that Kasabach-Merritt syndrome is really a kaposiform hemangioendothelioma rather than a simple hemangioma."
Sincerely,
Dr. Warren
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