4 August 1997
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 physician who knows you and cares about you.
Dr. Warren
-EC
Dear EC: A bulge in the anus that occurs after a bowel movement and then disappears spontaneously is probably a hemorrhoid. A hemorrhoid is a varicose vein in the anus. When pushing to have a bowel movement the hemorrhoid becomes engorged with blood. An internal hemorrhoid may poke out through the anus. If so, it should be gently pushed back up into the anus when you wipe yourself.
Sincerely,
Dr. Warren
The OB/GYN had to use forceps (and the vacuum cleaner device) to deliver her (very slow labor, small pelvis, fever, baby not breathing well on delivery, etc.). One side of the forceps left a nasty bruise on her cheek, the other was on the side of her head which now has the problem. We didn't like the forceps but understand the necessity at the time.
Thanks,
-MM
Dear MM: Asymmetrical heads in infants are fairly common. If a baby lies on one side of the head most of the time that side may become flattened. Premature fusion of the growth lines of the skull is much less common. I can't give you a number, but in 20 years as a general pediatrician I have only seen 1 or 2.
The condition is called craniosynostosis.
The forceps delivery has nothing to do with your daughter's condition.
The main risk of the surgery other than those related to anesthesia is infection since an infection around the brain is a serious matter. There is bound to be some pain after any surgery, but most infants can be managed with pain medication and tender loving care. There is always a risk of reactions to any medication, but generally the doses of pain medication given to pediatric patients are not high enough to be dangerous. The surgeon will make every effort to place the scars so that they blend into the hairline and when your daughter is older they will be covered by her hair.
The brain is not entered during the surgery. If there are no complications your daughter's mental capacity should not be affected.
If your daughter has craniosynostosis it could interfere with brain growth if not treated.
A CT scan would more clearly show if your daughter has craniosynostosis than a skull x-ray.
Sincerely,
Dr. Warren
-JK
Dear JK: I know of no trick to keep a child awake during a feeding; however, sometimes infants can be induced to continue sucking by stimulating their cheek with the nipple and getting them to root toward the nipple. If the baby falls asleep try changing the baby to see if he will wake up. You may find within the next day that the baby wakes up and feeds better since babies don't feed much during the first 72 hours. If the baby does not appear to be eating adequately he should be checked frequently by your doctor. If his weight loss is excessive your doctor will have to recommend additional intervention. If the baby is having good bowel movements and wetting lots of diapers, that is a sign that his intake is good.
Sincerely,
Dr. Warren
Thanks for your time!!
-DA
Dear DA: As a general rule I am opposed to sedating children unless it is medically necessary. It's not that I'm unsympathetic to the difficulties a taking a long trip with little children, but unless you sedate the children heavily, which obviously carries significant risks outside a controlled medical setting, you will probably not accomplish your goal. The problem you experience with Benadryl may occur with any sedative. When you make children drowsy artificially, just like when they are over-tired, they may become disoriented and lose what little self control they possess. When they awaken they may have drug side effects. And their jet lag will probably not be altered since their sleep was not induced by adjustment to their environment.
Sincerely,
Dr. Warren
-C
Dear C: A person has to drink huge quantities of water frequently in order to overdose on water because the kidneys filter out the excess water. If you drink a lot, you urinate a lot. But if someone drinks a large enough amount of water frequently enough so that the kidneys can't filter it out fast enough, the blood level of sodium will drop and the person will have seizures. That is water intoxication.
Sincerely,
Dr. Warren
-S
Dear S: It is very frustrating when children are always sick. There is no doubt that there are differences in immunity. We see some families who constantly battle with Strep throat and other families who've never had it. Recurrent ear problems probably occur more on the basis of facial anatomy than immunity. Recurrent ear infections and asthma can turn even the most minor cold into a major problem.
Unfortunately, if the primary problem is upper respiratory viruses, there is not much you can do about it. All of us are susceptible to colds. Nobody is immune. When children are exposed to a lot of colds they're bound to catch some. Older siblings bring them home from school to the younger siblings. The most useful thing you can do is to teach your children to wash their hands and to not share secretions by sharing food and eating utensils.
Your concerns about medications are understandable. Children do not develop resistance to antibiotics. Only bacteria do. But it is true that using antibiotics inappropriately increases the burden of resistant organisms in the environment unnecessarily. Rushing to use antibiotics at the first sign of illness also decreases a child's chance of developing some immunity to certain bacteria.
The best way for your children to remain healthy is for other parents to cooperate and not send obviously sick children to school or day care (if your children attend either). Even then, some children are bound to have only minor symptoms and expose your children to infectious diseases. Adequate nutrition, exercise, and rest, all play a role in good health which includes immunity, and even in the USA some children have reduced immunity because of poor nutrition, but I suspect that doesn't apply in your case. The hygiene steps we discussed can help. Ultimately, your children will become less prone to these problems.
Sorry I don't have any magic bullet, but take heart. This will pass.
Sincerely,
Dr. Warren
PS. There is no complaint of any pain
Please write back soon,
-Concerned Parent
Dear Concerned Parent : If your son was examined by a competent physician in the hospital, he should have been able to tell you if your son had an ear infection, so I would say that is not likely the cause. Even with severe ear infections children don't generally completely lose their hearing. To determine the cause of your son's hearing loss he needs a complete audiogram (hearing test) to determine how much of a loss there is, what frequencies are affected, and if the loss is conductive or sensorineural. If the loss is conductive, a tympanogram would also help. Conductive loss occurs when there is fluid in the middle ear or infection. Sensorineural loss can occur in response to virus infections, chronic exposure to loud sounds like gunshots, some genetic (familial) conditions, and with some neurological conditions. The description of his condition certainly makes me think of middle ear fluid, but since it wasn't evident to the examining physician, I can't make that diagnosis. It is unlikely that the condition is dangerous. The next step is evaluation by the ENT specialist and a complete audiogram.
Sincerely,
Dr. Warren
1) I once long ago read an article that says that fingernails are an indication of a person's health. I have white spots appearing on my fingernails occasionally.. does it mean something? Does that mean my body is deficient in some minerals?
2) Also, I can't seem to gain weight (I'm 184cm and weigh 63kg) no matter how much I eat. Do I have parasites in my intestines? How do I gain weight?
3) One last thing, my hair are unusally thick and I notice that even in individual strands that they are of uneven thickness! What does that implies?
Thank You!
-From J
Dear J: The answers to your questions:
1. Fingernails may develop white spots during any acute illness or fever. By the time the spot grows out form the root the illness will be at least several weeks past. It does not indicate anything serious or any deficiency.
2. You may be slim because you are naturally slim. Body build is genetic. If many other family members are tall and slim that is probably the reason. Hyperthyroidism can also make it difficult to gain weight. People who are hyperthyroid tend to sweat easily, can't tolerate heat, have a rapid heart rate, may tend to have diarrhea, may have a goiter (swollen thyroid gland), may have bulging eyes, tend to have a lot of nervous energy, may have tremors. If you think you have any of those symptoms, you should see a physician.
3. I know of no significance to thick hair or uneven thickness of the hair strands.
Sincerely,
Dr. Warren
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