4 January 1999
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
What other causes are there for diarrhea besides milk allergy or infection? Thanks for any advice.
-DD
Dear DD: Six months is a long time to have diarrhea. Let's first be sure we're talking about the same thing. If your child has 1 or 2 loose bowel movements per day, is gaining weight well, has a good appetite, and does not appear to be having abdominal pains, I would not call that diarrhea, and I wouldn't pursue the matter. If your daughter is having frequent, watery bowel movements, or muscousy movements associated with cramping, decreased appetite, or poor weight gain, she needs further evaluation.
Parasites may also cause diarrhea. If tests for viral and bacterial infections have been negative, your daughter should be tested for parasites.
Usually when milk intolerance causes diarrhea it is not allergy, but rather lactose intolerance (an inability to digest lactose). Intolerance of other sugars may cause the same problem. One of the most common causes of diarrhea in children is excess consumption of fruit juice.
Malabsorption of other nutrients, irritable colon, and inflammatory bowel disease are also possible causes of diarrhea. Evaluation and treatment for less common causes of diarrhea might best be undertaken with a pediatric gastroenterologist.
Sincerely,
Dr. Warren
-Chris
Dear Chris: As a physician, I tend to be careful about suggesting any treatment whose claims have not been proven scientifically. Most of the information about Kombucha on the Net is in the form of testimonials. These anecdotes of health benefits people have had from using Kombucha do not constitute proof. On the other hand, scientific proof requires a large sample and a statistical analysis which could prove something to be ineffective even if it truly helps a small number of people. To look at those possiblities one must at least have an explanation of what ingredients make a potion work, and how it works.
The other side of the coin is that even if something can't be proven to work, will using it cause any harm? Remember that if sick people die while taking Kombucha, that doesn't prove that Kombucha contributed to their death. Again, a cause and effect mechanism must be found, or a large sample must show statistically that a particular ill effect is seen more in Kombucha drinkers than those who abstain.
My personal bias is to be cautious about taking anything that may be questionable. If you haven't looked at the following two articles, you should.
Sincerely,
Dr. Warren
Thank you,
-Ellen
Dear Ellen: Seven and eight years old is very young to have eating disorders. The fact that both granddaughters have it adds to the concern. You don't say what is going on in their lives that they are coming to live with you, but you should be aware that the treatment of eating disorders involves treating the psychological aspects of it as well as the physical aspects of it. Children with ongoing eating disorders require the attention of a physician and psychologist experienced in dealing with eating disorders.
I would suggest that you schedule a conference with the doctors who cared for your granddaughters to be sure that you are familiar with their treatment program. If their living with you will take them away from those doctors, you should ask for a referral to physicians in your area who will be able to continue their care and advise you on their management. If the reasons for their move to you include troubles at home or any major change in their lives, you might also want to plan for professional psychological counseling. There are many excellent resources available to children with eating disorders. You would probably be wise to not go it alone until you are sure you have things under control.
Sincerely,
Dr. Warren
Any advice would be appreciated.
Thankyou.
-Nikki
Dear Nikki: If the red cell count becomes very high it makes the blood thicker, and that increases the risk of stroke. Your stepfather can control the polycythemia by having blood removed regularly. If he has no blood borne diseases like Hepatitis B, he can certainly donate blood regularly to a blood bank since there is always a need for blood. He will be saving lives while he helps himself.
Sincerely,
Dr. Warren
Thank You
-Jenny
Dear Jenny: Bowel habits vary from child to child. Diet may play a role, but some children tend to be constipated and others don't. Some nursing babies may go as infrequently as every 4 to 5 days and it's perfectly normal. If your baby's bowel movements are not hard and he is not uncomfortable, it is okay for him to move his bowels every 4 to 5 days. If the stools are hard, then it's okay to give him the prune juice regularly if it helps.
Sincerely,
Dr. Warren
My 11 month old baby has this breathing condition; he has been diagnosed with a light bronchial inflammation ( letīs say bronchitis ), and the Doctor has prescribed among other things antiobitic and the use of a nebulizer. The question is, I donīt know if its normal that my son has a breathing rate of 50-55 per minute, and if this condition can or can not lead to another serious illness, considering that the baby hasnīt had fever or other condition beside that I described.
-E
Dear E: A breathing rate of about 40 per minute at rest would be normal for an infant, so 50 to 55 is a bit fast, but not alarming. If the baby is active, his respiratory rate will go up, so you must be sure you are counting his breathing when he is quiet and not excited.
A nebulizer can be very useful for treating acute symptoms of wheezing associated with asthma and bronchiolitis. There are also medications which can be given by nebulizer for long-term management of asthma. If your child has persistent or recurrent wheezing, it can be managed with medication, but requires close medical follow up to determine the best treatment.
Sincerely,
Dr. Warren
-TE
Dear TE: Epilepsy is a term that has largely gone out of use because of the great deal of stigma associated with it. There is no difference between a diagnosis of epilepsy and a seizure disorder. They are both the same thing.
Having a normal MRI tells you that the structure of your daughter's brain is normal. The abnormal EEG associated with seizures confirms that your daughter has a seizure disorder. Evaluation for the causes of seizures also includes some metabolic tests such as measuring the blood concentration of calcium, magnesium, sodium, and glucose at or near the time of the seizure. If clinically indicated, your neurologist might also want to check for lead intoxication and rare metabolic disorders by checking a blood lead level and obtaining urine for mucopolysaccharides, amino acids, and toxicology.
Management of seizures may require close monitoring of anticonvulsant levels and trials of different medications until one is found that controls the seizures well.
Sincerely,
Dr. Warren
Yours
Patient
Rushdi
Dear Rushdi: Pain is often a signal from the body that something is wrong. Three to four days of pain after an activity cries out for a change in your activities. Perhaps you have strained a muscle. If you have injured yourself and continue to ignore the pain your injury may get worse. You need evaluation by an orthopedist to determine what is causing your pain. When your condition has improved after you have started on appropriate therapy for your problem you will probably be able to resume your activities, but while you are having a great deal of pain, I have to recommend that you listen to your body.
Sincerely,
Dr. Warren
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