2 June 2008
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
-Mrs. J
Dear Mrs. J: The most likely diagnoses for the blisters you describe on your son's nose are impetigo or herpes simplex. Impetigo is a superficial skin infection caused by staph or strep. Impetigo is treated with Bactroban, a topical antibiotic. Herpes simplex is a virus which causes recurrent fever blisters (also known as cold sores). There are no currently approved medications for treating herpes simplex in children; however, it will run it's course. Unfortunately, it can be recurrent and is contagious during an outbreak. Neither of these possibilities requires a more urgent visit than your current doctor's appointment.
Sincerely,
Dr. Warren
Sincerely,
-JS
Dear JS: While I understand why parents who are desperate for answers write to me after seeing many doctors, I've stated many times that I doubt I can come up with answers which have eluded specialists who have examined the patient and have all the test results at their disposal. The only thought that came to my mind was the possibility of cyclic vomiting. Cyclic vomiting is generally a migraine equivalent; however, it can also be seen as part of a rare autonomic nervous system disorder known as Riley-Day Syndrome. If your son has been evaluated by and followed by a pediatric gastroenterologist and no answers have been found, perhaps you should consider seeing a pediatric neurologist. Because your son's condition has been chronic, make sure he is receiving care from one specialist (such as the gastroenterologist) and seek referrals to additional specialists through your specialist or pediatrician. Emergency room visits may deal with crises and result in referrals to multiple different doctors, but this kind of fragmented care usually results in a haphazard patchwork of evaluation and treatments which are unlikely to progress toward any real solutions.
Sincerely,
Dr. Warren
Many Thanks for your Time and Help.
-V
Dear V: If you were using a reasonably sensitive pregnancy test and did it correctly, it should have been able to detect a pregnancy by 8 weeks; however, I cannot rule out the possibility that you did have a pregnancy and are having a miscarriage. A woman who has always been regular may, on occasion, have such a long cycle. This will result in heavier bleeding due to the greater build up of the uterine lining.
Severe abdominal pain (not menstrual pain) with heavy bleeding may be seen with an ectopic pregnancy. The pregnancy test may be negative with an ectopic. If you are feeling better, I don't think that is a possibility. If you are still having severe pain or unusual menstrual flow, you should see a doctor ASAP.
Sincerely,
Dr. Warren
What are the ways to get rid of the phlegm (or is it water) in the lungs? I have gone through a lot of web sites but it doesn't really give any specifics.
I really appreciate a response. Thank you very much
-JL
Dear JL: The reason that you can't find information on the web about getting rid of fluid in the lungs is that there is no specific procedure for that purpose. You doctor has given you an oversimplified explanation of what he wants you to do. Unfortunately, the inaccuracies built into such incomplete explanations make it difficult for patients to search for more information.
If your son has pneumonia, the fluid in his lungs is inflammatory fluid and mucus which are a result of the infection. That fluid will continue to be produced until the inflammation in your son's lungs subsides, which should happen as the infection gets better. The purpose of postural drainage (hitting your son's back) is to aid in loosening these secretions so your son can cough them up, but the most important part is that your son has to cough. If your son is disabled or has a weak cough, it may require vigorous postural drainage to help clear his lungs. It is also important to keep your son adequately hydrated (he has to drink lots of fluids) to prevent his secretions from becoming thickened.
It would be extraordinarily unusual to have to do bronchoscopy (place a tube in the lungs) to remove secretions from the lungs. If there is a reason your doctor is contemplating that possibility, there would have to be more to this situation than I understand from your letter. For example, perhaps the doctor means that if the "dark spot" on the x-ray doesn't clear up, he will have to do bronchoscopy to see if there is something else in the lung causing the problem such as an inhaled foreign object like a nut. In any event, you should not have been left with the impression that is your responsibility to get rid of the phlegm in order to avoid any further procedures.
Sincerely,
Dr. Warren
-N
Dear N: Dark circles around the eyes may be seen in response to allergies. It may also result from fatigue. It is not an indication of eye disease. If you believe that your daughter is not healthy, have her see her pediatrician, not an eye specialist. At 7 months your daughter should be seeing her pediatrician regularly, so you can show him your concerns at her next visit.
Sincerely,
Dr. Warren
He has led me to believe that there is a narrowing somewhere that doesn't allow baby to digest and urinate well. My question to you is how would a pediatrician handle this once baby is born? Would baby have to be tube fed if the esophagus is too narrow? If so, for how long? Can an operation correct this or does it sometimes correct itself? Can baby even live with a condition such as this? I am anxious for answers! Of course whatever it is, will be. My hubby and I will love and care for baby no matter what, but the hard part right now is not knowing what our options are once baby is born if he does, in fact, have this problem. Any and all information you would have on this would be beneficial.
THANK YOU!
-Ms. W
Dear Ms. W: There are other reasons besides esophageal problems in the newborn why a pregnant woman might have polyhydramnios (excessive amniotic fluid). Women who have polyhydramnios can have perfectly healthy babies. Since amniotic fluid circulates through the baby by being swallowed, being absorbed into its circulation, and being urinated out, an obstruction in the upper intestinal tract which prevents the swallowing of amniotic fluid, or an obstruction to urine flow could cause polyhydramnios. An incomplete obstruction would have a similar effect. I do not know if your OB sees something on the ultrasound which makes him specifically suspect an esophageal problem; however, he is referring to a tracheo-esophageal fistula, a condition in which the trachea and esophagus are attached to each other. There are varying forms of TE fistula including one in which the upper esophagus is not attached to the lower tract at all. All these conditions can be surgically corrected. The distance between the esophageal segments would be the main determinant of how difficult the repair would be.
After delivery, the attending pediatrician will pass a tube from the baby's nose or mouth into the stomach. Then an x-ray will be taken to determine the position of the tube. If it does not go into the stomach, the baby will be put on IV feedings and arrangements will be made for additional radiographic studies and surgery. If the tube passes into the stomach, the polyhydramnios is probably not related to any esophageal problem, but if there is a suspicion, they will observe how the baby handles feedings to be sure that everything is okay.
Sincerely,
Dr. Warren
-A
Dear A: If your daughter is eating a nutritionally sound diet and consuming an adequate number of calories then there are no dietary measures which would stimulate her growth. You must review her diet and her growth with her pediatrician. If she has always been small, but her growth has been adequate you may simply have to wait for her to grow. Since her height is below the third percentile for a 10 year old, she should have a complete examination which includes plotting her growth on a growth chart to determine her growth pattern. If her examination is normal except for being short, your daughter may need blood work to test thyroid function. Evaluation for growth hormone deficiency usually requires consultation with an endocrinologist. There are no medical measure to be taken to stimulate growth without an evaluation to determine the cause of poor growth.
Sincerely,
Dr. Warren
-TR
Dear TR: Brain tumors do cause vomiting; however, they typically cause early morning vomiting (not 2 AM vomiting), and the increased intracranial pressure which causes the vomiting causes headache. If your pediatrician, who has examined your son (which I have not done) thinks that a brain tumor is a real possibility, he should arrange for a CT scan or MRI of the head.
From what you have told me, I think the greater likelihood is that the problem is in the gastrointestinal tract. The main thing I would think of which could cause middle of the night vomiting would be gastroesophageal reflux (GER). Zantac can improve the esophageal discomfort and heartburn associated with GER, but it does nothing to decrease the amount of reflux. To evaluate for this and other gastrointestinal causes of vomiting you should consult a pediatric gastroenterologist.
Sincerely,
Dr. Warren
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