30 August 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
A dermatologist perscribed an antihistimine and a hydrocortizone cream for the itching but do I have to give that to him until they go away.. (sometimes they last over a month)?... That to me sounds like too much medicine...
I would appreciate any input....
-Jessica
Dear Jessica: Papular urticaria is generally a delayed allergic type reaction to insect bites. Since it usually affects only young children, other family members may not be affected even if they are exposed to the same insects. If your son's outbreaks occur after exposure to cats and dogs these animals may have fleas.
Hydrocortisone cream and antihistamines provide symptomatic relief. You are not required to constantly medicate your son; however, without medication he may itch intensely and scratch to the point of having open sores which may become infected. This is a situation where the benefits and risks must be weighed. When he is intensely itchy, you will need to provide him some relief.
Sincerely,
Dr. Warren
-LJ
Dear LJ: A glycerin suppository can help a constipated person to have a bowel movement, but an enema would be more effective for someone who is impacted. Your best bet would be to use a Pediatric Fleets Enema. It is a self contained unit with the medication, and the tube for administering it. The package should come with instructions. She has to hold the contents of the enema in her rectum for 20 minutes before going to the bathroom. This is best accomplished by administering the enema with the child on her side with her knees drawn up to her chest. Immediately after the enema is given she should turn onto her belly with her legs out straight and her buttocks held together. Just in case of an accident it is best if this is all done with a rubber sheet under the child.
If your daughter hasn't had a bowel movement in many days she may need a second Fleets Enema the day after the first one.
Your daughter should be told that the medicine she needs to take to make her feel better has to go into her rectum because that's where her problem is. Be sure to use the words she uses for that body part. Explain that it is a bit uncomfortable going in but that she will feel much better after she has a bowel movement.
Sincerely,
Dr. Warren
Sincerely,
-HW
Dear HW: By this time you have probably been seen in the clinic and hopefully received the appropriate care and answers to your questions. Unfortunately, I cannot rush answers to people on an emergency basis as I spend my days taking care of my own patients.
It is unlikely that the green material on your wound was a fungus infection. When a wound has a large surface area, it weeps, and often the tissue fluid congeals on the dressing. This is often yellow in appearance. If there is secondary infection, the surrounding area will be red and tender, and there may be pus on the wound. Wounds like this can be cleaned gently with hydrogen peroxide and an antibiotic cream can be applied.
Sincerely,
Dr. Warren
-BH
Dear BH: Virus infections can lower the white blood count, but three months is a long time to take for recovery from a virus infection. While fatigue is common with mononucleosis, a low white count is not. If any other elements in his blood are low like platelets or hemoglobin, your son should be seen by a hematologist. Unfortunately, leukemia must be considered as a possible diagnosis in a chronically ill child with a low white cell count.
Sincerely,
Dr. Warren
Best regards,
-TB, MD
Dear Dr. TB: I don't claim to be an expert on the matter you have asked me about. I am not a professor. I am an ordinary pediatrician sharing my knowledge with people seeking help. I am not aware of ischemic bowel releasing toxins which provoke seizures. With a case of intussusception I would think more of dehydration, acidosis, and electrolyte abnormalities. If all those things were normal preoperatively and the child's seizures persist, the child may have seizures unrelated to the events which may have been triggered by the stress. You must also look to intraoperative and postoperative management in terms of fluids and electrolytes, hypovolemia, and anoxia during anesthesia as possible causes of neurologic injury.
Sincerely,
Dr. Warren
My granddaughter is a very active child who does not complain and for the most part, with exception of her ears, has been very healthy. She still remains active, but complains of this back and stomach ache. At times she act as if she does not feel well and is somewhat pale.
If you have any advise, I would appreciate it.
Thank you.
-JS
Three weeks is a long time to have diarrhea. There are a whole bunch of diagnoses to consider from a food intolerance to parasites to inflammatory bowel disease. Since I don't know what stool test came back fine, I can't advise regarding specific testing, but you might wish to consult a pediatric gastroenterologist. One thing you may wish to try is limiting the lactose in your granddaughter's diet. Children can develop lactose intolerance even if they drank milk previously without a problem. If your granddaughter is a big milk drinker, lactose intolerance could cause gas and diarrhea.Dear JS:
Sincerely,
Dr. Warren
-TM
Dear TM: Many infants have breast engorgement from exposure to maternal hormones in the womb. While this usually fully resolves during early infancy, it sometimes persists. Some infants do have a minor degree of breast development without any signs of puberty. These children should be monitored to be sure there are no pubertal changes, especially if the breast tissue is enlarging, but this is not otherwise worrisome.
You are probably feeling normal breast tissue, but if you never noticed it before, or it is a change, it is best to have your pediatrician check it out.
Sincerely,
Dr. Warren
-CH
Dear CH: Your daughter's elevated ASO titer means she has had a recent strep infection. The titer remains elevated for a while after a strep infection. If the titer were rising, it could imply ongoing infection. If your daughter has had recurrent or persistent strep throat or has had a lot of exposure to strep in school, that could explain the persistent elevation of the ASO. Other than laboratory error, I know of no other cause of an elevated ASO.
One of the maxims of medicine is to treat the patient and not the laboratory data. Abnormal tests should not be ignored, but healthy patients shouldn't be subjected to excessive diagnostic evaluations because of one laboratory test. Since children have such a large degree of exposure to strep infections, the upper limit of normal for ASO titers is higher for children than for adults. Before proceeding any further, you should make sure you understand just how significant your daughter's ASO titer elevation is and whether it is stable, rising, or falling.
Sincerely,
Dr. Warren
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