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Medicine Mondays- Early Intervention, Teething, Allergy Testing, Hidradenitis- Suppurativa and Infertility

Posted Sep 07 2008 8:39pm
Hi Everyone!


Welcome to my second installment ofMedicine Mondays!

I started Medicine Mondays just last week on my other website DrCason.org and have had such a good response that I've decided to move it to my professional site. This way even more people can benefit from these great questions!!

As suggested by the title, each Monday I'll post the answers to questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and the medical advice that your family doctor can provide.

Okay! Lets get started:


Early Intervention and Speech Delayin Children

Question:
When should Early Childhood Intervention be called in on a situation? My daughter now 15 months old really doesn’t say anything. I discussed with our pedi at her 9 month appointment in preparation for her 12 month appt. where she is supposed to be saying 6 words including mama and dada. Well, at 15 months says mama and dada occasionally and doesn’t really say anything else - audible that is. I think she tried to say her brother’s name and maybe ball or milk, but not much else. She I ask for Early Intervention to come in and work with her? I know the little ones all talk at their own pace and I am thinking it will just come, but what if there is something going on that I am ignoring.
We are starting sign language which she does: more and please. Jakey spoke late right?


Answer:
Yes. Jakey spoke later than my other two girls and I wasn't so much getting worried as I was just getting overwhelmed with all the screaming!! His language blossomed with signing!

Each child moves at their own pace and even little goobly gook could actually mean something to them. Be patient and use sign language to augment her language. I wrote an article giving you some Tips to Using American Sign Language if you need some suggestions.

Now in regards to Early Intervention. I have one rule. If I am really concerned then I refer any time there is something suspicious.

I have found that you really can't go wrong. There really is never too early of a time to call in for an evaluation. If a child is suspected of having a problem, such as speech delay, it can help to refer them early and get some additional services going.

Speech delay by itself is not that worrisome at 15 months- some babies just develop on their own. Such as my son. But I will look really closely at whether the child is socializing well. Are they looking at you for social cues? Do they point to what they need? If you point at something, do they follow your finger and look as well. These are very important markers in detecting autism. Autism that is detected at an early age can be helped a lot with early intervention.

Having said all of that, it might be that your child is right on target. Make an appointment with your doctor so they can evaluate her again!

Teething and Analgesics

Question:

Is it true that you can give tylenol or motrin for up to 5 days for teething? Then is it 5 days off and back on again?

Answer:
I don't give Tylenol or Motrin for that long. You shouldn't need to either at least not for teething. I would talk with your pediatrician to see if there is something else going on. If they are uncomfortable try teething rings or Orajel. Hyland make some teething tablets and some people swear by it!


Children and Biting


Question:
How do I get my 15 month old to not think her brother (3.5 years old) is a piece of meat she can just bite all the time? We really think she is a tiger and he is her prey! We tell her no, but she just laughs at us and then goes back in for the kill.

Answer:
LOL! Mine have all done that too. Most kids are just testing boundaries. Let them know that this is not acceptable by firmly saying no and then redirecting them. But don't go overboard! I have found that if you get too dramatic about the event then they are intrigued by the response and will seek to repeat the offense. Then you're in trouble!


Allergy Testing
in Children

Question:
My eldest (14yo) daughter just had allergy testing (not nearly as involved as your son’s) because she reacted to some almonds she ate…but the testing came up negative. Ummmm…can you explain to me why she would still be reacting to them if she tested negative? We’re not talking anaphylaxis…just some mild swelling. They did do a RAST at the clinic...I don't know the results of that one...we never saw those results. The tests the allergist did were scratch tests on her arms, and the only reaction she had was to the control.
The allergist made a comment about her having just an oral reaction to the almonds, but not being truly allergic. I wish he'd explained more!


Answer:
Ahh! this is a little tricky. What most people are talking about when they talk about food allergies is an immediate IgE mediated allergic response. This is when the mast cells that contains histamine come in contact with an allergen and break open inducing an allergic response. The reaction can be as simple as some hives or mild swelling or as dangerous as an anaphylactic reaction.

We can test a child's blood for their IgE level in response to a certain allergens (RAST testing) and this can help in predicting what their reaction to the food or allergen will be. I say "help"and "predict "carefully because we don't know EVERYTHING we need to know about allergies in kids. We do think that the gold standard for whether a child is allergic or not is actually what happens when they eat the offending agent never mind what the RAST level is. In the future I will be writing a deeper in-depth article about this using all my info that I have gleaned from my son's allergies.

Now what to do about your child's allergic reaction? With a RAST that's negative and a skin test that's negative and an allergist saying she's not allergic, then she's probably not allergic. At least not with an IgE mediated allergic response. BUT you need to be absolutely sure about this before you give her almonds in the future.

I have heard of Almonds inducing a contact dermatitis. This may be what you are talking about with your child. This can cause redness and painful fissuring of the lips.

Hidradenitis-suppurativa

Question:
Do you have any ideas on how to help Hidradentitis- suppurativa?
I am trying only over the counter medications or herbal remedies as I don't have a doctor. I've had this condition for the past 30 years, but only a few weeks ago found out the name for it. I've gone to doctors in the past for help but have never had any success.

Answer:
This is a tough condition to have. It is chronic skin inflammation that we think may be actually be a severe form of acne. I recommend that you seek the help of a dermatologist. They will be able to help you in the management of your condition. There is no reasons to be treating yourself- unless its so mild that you can control it!

Your doctor may suggest some topical or oral medications as outlined in the article I've highlighted above. (I know that you've seen this as you sent me the link!)

One thing that I will mention as a side note is that we are currently learning more about acne and its relation to diet and inflammation. A low glycemic diet rich in veggies, fruit, seafood, and grass-fed meat can help control acne because it controls inflammation. Since Hidradenitis-supportiva is acne related this may help it as well.

Infertility

Question:
Hi Dr. Cason! I just found your site ( DrCason.org )today and I love it already! I have a question and maybe you can answer it. My husband and I have been trying to conceive for over a year and have been extensively tested for various things. The only thing that has been abnormal has been my progesterone and estrogen ( both are low). I purchased progesterone cream, do you think this will do the trick? My husband is in the army and it is a fight to get anything done at our military treatment facility. They do not want to help us. Every last thing has been a struggle!

Answer:
Welcome!! Now I'm not an OB/GYN but I will say that if your progesterone and estrogen are low it may be contributing to your infertility problems! You need estrogen to ovulate normally and progesterone to help make the endometrium viable.

I know so little about infertility issues that I found you another expert! Edward Joseph Ramirez, MD, FACOG. I just searched and searched and found you someone who is Army trained!! Yeah !! It just might make a difference in your case as he may still have some contacts in the military and may be able to point you in the right direction!

Good luck everyone!

Please let me know if I can answer any more questions or point you in the right direction!
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