Childhood illnesses marked by fever include:

chickenpox
croup
ear infection
German measles

If your child has a temperature of 97 to 99 degrees, there’s usually no reason to worry. But a fever can be a sign of a childhood ailment, including viral or bacterial illnesses. In a baby or young child, high fever can lead to a seizure.

hand, foot and mouth disease
measles
mumps
rheumatic fever
strep throat
whooping cough

The first sign of Bell’s palsy may be an ache or pain near one ear, which may be a sign that the facial nerve on that side is swollen or irritated. Hours later the child or parent may notice a crooked (asymmetric) smile and drooping facial expression. On the palsied side, the child is unable to smile, frown, grimace, close the eye tightly, purse the lips, or raise the eyebrows.

Because the seventh nerve is also responsible for the tongue’s sensation of taste, some children with Bell’s palsy will say that food has no flavor. They may be unable to drink without dripping and their speech may be slurred. Seeing these problems, parents may worry that their child is having a stroke.

There is no known, specific cause for Bell’s palsy, but it is believed to be the facial nerve’s reaction to inflammation, most likely a viral infection. Herpes simplex virus, which causes lip and mouth sores, may be a likely culprit, as well as varicella, the chickenpox virus. Rarely, Bell’s palsy occurs with Lyme disease. The bacterium Borrelia burgdorferi causes Lyme disease and deer ticks transmit it when they bite.

Your pediatrician or neurology subspecialist can diagnose Bell’s palsy by physical examination alone. A head or facial CT or MRI scan is not necessary. A blood test for Lyme disease should be performed. Some doctors do viral studies looking for signs of recent infection.

Because the cause of Bell’s palsy is not known, there is also no specific treatment. Some experts recommend several days of oral corticosteroids (prednisone), beginning within the first 24 to 48 hours of paralysis, in order to reduce the swelling and inflammation of the facial nerve.

Other experts suggest a seven to 10 day course of an oral antiviral medication, such as acyclovir, for a possible direct viral infection of the facial nerve. But nearly all patients with Bell’s palsy recover complete or nearly complete function of the facial nerve and facial muscles without medication. Drastic surgical measures to “decompress” the facial nerve in the ear canal are not recommended.

In many cases, Bell’s palsy is present two to six weeks or longer before the paralysis begins to resolve. Your daughter is likely to be upset by her facial appearance during this time, and she will need the support and understanding of her family and friends, as well as her doctor.

Reassure her that the facial muscle weakness is temporary, although it seems as if it will never go away. Suggest a straw for drinking on the normal side of her mouth. Eye drops (artificial tears) will be helpful for her eye, which will be dry because she won’t be able to blink or close it completely. Her doctor may suggest an eye patch at night to keep her eyelids closed while she sleeps.

More than 90 percent of Bell’s palsy patients have a very good recovery, and recurrences are fortunately quite rare. Stay in close contact with your daughter’s doctor during these difficult weeks, so she receives the support she needs and so her recovery can be monitored and maximized.

The choice of biopsy method usually depends on a patient’s symptoms, as well as what type of biopsy the hospital staff is familiar with performing. After a piece of liver is removed through biopsy, the tissue is sent to a specialist called a pathologist to be analyzed under a microscope. The appearance of the liver cells can provide doctors with very specific information about what is wrong with the liver. For example, in fatty liver disease, fat accumulates in the liver cells, and they also appear inflamed.

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Cynthia

A.A liver biopsy is often done as a follow-up to blood tests or imaging tests (ultrasound, CT scan, MRI) indicating possible liver abnormalities. The procedure, in which doctors remove a tiny piece of the liver for laboratory analysis, may be done in one of three ways.

A.The oldest method simply involves locating the position of the liver on the right side of the abdomen, giving the patient local anesthesia and then placing a needle directly into the liver through the skin between two ribs on the right side. This procedure takes only a few minutes and is safe if done by an experienced doctor. If a patient is anxious, IV sedatives may be given before this procedure.

A newer method of liver biopsy is done using laparoscopy, which involves making a small incision in the abdomen and inserting a flexible tube through which doctors can manipulate a tiny camera and surgical equipment. Although this takes longer than needle biopsy, the laparoscopic camera enables doctors to actually view the liver and remove tissue samples only from those areas that look abnormal.

Pain medicines can be effective and successful in treating many kinds of pain, such as pain after surgery, pain from arthritis, back pain and earaches. Medication for pain are remedies which you may buy without a prescription.

Treating amblyopia — the fact that the eyes are not working together for normal vision and depth perception — is another part of restoring normal vision.

Physicians treat amblyopia by blocking the vision of the better-seeing eye in order to strengthen and improve the weaker amblyopic eye. This may be accomplished with an eye patch, which sticks like an adhesive bandage to the skin around the healthy eye. The healthy eye could also be covered using an occluder lens, which is a black contact lens that prevents light from entering the eye. Another option is using eye drops to enlarge the pupil of the better-seeing eye to blur its visual image. These treatments may occur before, during or after treatment for the condition causing the amblyopia.

Occluder contact lenses may be a better treatment than an eye patch if your child’s skin is sensitive, he or she is socially conscious about the patch, or he or she keeps removing the patch. The parent typically places the occluder contact lens in the child’s eye. After lens placement, check the child frequently to make sure the lens remains properly placed. After lens removal, check the lens for tears or breaks. Discourage the child from rubbing his or her eyes. For younger children, it may help to give them something that will keep their hands busy, such as blocks or other toys.

Do not insert a lens into your child’s eye if there are any abnormalities in the lens or if the eye is obviously red or sore. Occasionally, doctors treat amblyopia by using special drops to blur, or penalize, the vision in the better-seeing eye.

However, since this only blurs vision, as opposed to other methods that completely block the light coming into the eye, this method may be less successful.

A child who has been successfully treated for amblyopia is not out of the woods until approximately age 9. Frequent vision checks may be necessary to adjust treatment and prevent a relapse.

V.K.

A. Diarrhea is a common problem that often leads people to consult gastroenterologists. Possible causes of chronic diarrhea include infections, inflammation in the small intestine or colon, side effects of medication, pancreatic dysfunction, endocrine disorders and tumors.

You mention a “stomach hormone,” and I assume you are referring to gastrin. Gastrin is a hormone that is normally released from the stomach in response to a meal. Its function is to regulate the production of acid from the stomach, an important part of digestion.

There is a condition, known as Zollinger-Ellison syndrome (or gastrinoma), in which a tumor produces excessively large amounts of gastrin. The tumor is usually located in the pancreas or duodenum, and because it can be very small, it may be hard to locate on imaging examinations. The excess gastrin leads to excess acid production by the stomach. Patients often suffer from severe ulcer disease in the stomach and duodenum that may not respond to the usualanti-acid therapies. In addition, diarrhea is a common component of gastrinoma. The reasons for the diarrhea are several: First, the excess acid from the stomach leads to increased fluid in the intestine, which then passes down into the colon. Also, the acid in the intestine disables the normal bile acids and pancreatic enzymes necessary for normal digestion. The result is soft or liquid stool with large amounts of undigested fat in it.

Although you may have an elevated gastrin level in your blood, other factors besides a gastrinoma may cause this abnormal reading. These include certain medications, kidney disease and the timing of a meal relative to when your blood was drawn. If your doctor suspects a gastrinoma, he will want to perform certain imaging tests to localize the tumor. The treatment options will depend on those findings and may include medications to prevent acid production and/or surgery for the tumor. You should discuss your concerns with your doctor.

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Symptoms of amphetamine use:

Restlessness marked by unusual talkativeness;
Decreased appetite with weight loss;

Dilated pupils and dry mouth; Insomnia and trembling; Angry, paranoid, or violent behavior. Health risks:Increased risk of violence;

Stroke or heart failure.

When it comes to consuming the recommended two to three servings of calcium-rich dairy foods, the women most likely to need calcium are the ones most likely to shun it, thinking “I don’t like to spend my calories drinking milk.” They forget that dairy foods offer more than just calories; they are a convenient source of calcium (for bones) and protein (for muscles). Within only 300 calories, weight conscious women can easily enjoy three calciumrich servings per day: 1) 8 oz of milk on breakfast; 2) a halfpint of skim milk with lunch; 3) a yogurt for a snack.

Regarding the protein group, some athletes feel cheated by the recommendation: 2-3 small servings totals only 4-6 ounces per day, the amount in one tuna sub or a dinnersize (6ounce) piece of fish. Vegetarian athletes, however, must be sure to eat enough from this group for adequate protein and amino acids to build and protect their muscles. A balanced diet includes a protein rich food at two out of three meals per day. This might be two tablespoons (one serving) of peanutbutter on a bagel, one cup (two servings) of chili beans, and/or a big bowl of lentil soup. (Note: this protein is in addition to the protein provided by the dairy foods.

The tip of the Pyramid (fats, oils and sweets) can easily topple some athletes’ diets. If this sounds familiar, you can correct the imbalance by eating more foods from the body of the Pyramid before you get too hungry. (When athletes get too hungry, they tend to choose “junk”.) By eating bigger meals that prevent hunger, you will nourish yourself with wholesome foods. You can still leave space for a small treat, if desired. Sugars and fats, after all, are an acknowledged part of an overall balanced diet. In moderation, they can nourish us with taste, pleasure and a liveable food plan.

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For those who understand the concept, the Food Pyramid clearly describes a carbohydrate based sports diet. But not everyone understands the Pyramid’s messages of balance, variety and moderation. Confusion abounds, in particular, regarding the recommended number of servings: 6-11 servings of grains; 2-4 servings of fruits; 3-5 servings of vegetables; 2-3 servings of milk and dairy foods; 2-3 servings of proteinrich foods such as meat and beans. Although this sounds like several fivecourse meals, the calories range between 1,600 to 2,800 depending on how many servings you choose. That’s just the right amount for a petite skater on a 1,600 calorie reducing diet or a businessman who worksout for a half hour per day and requires about 2,800 calories.

The trick to understanding the Pyramid is to know the definition of “serving”. Even athletes balk at the thought of eating 6-11 servings of breads, cereals and grains every day, commenting “I’d get fat if I were to eat that much..”. But one serving of cereal is only one ounce-not one bowlful. Most athletes eat two to three ounces of cereal per bowl.. that’s two to three servings according to the Pyramid. One serving is also one slice of bread. Hence, a sandwich with two slices of bread provides two more servings. Your dinnersize portion (3 cups) of spaghetti is a 6 halfcup servings in itself. Add a piece of garlic bread and, voila eleven servings are down the hatch! Six to eleven servings is only two to four servings per meal (about 150-300 calories), not much for hungry athletes.

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Relatively safe high blood pressure drugs include the calcium channel blockers such as Procardia® and beta-blockers like Labetolol®. I’ll talk more about high blood pressure in a future column.

Accutane®, used to treat severe, cystic acne, is one of the most teratogenic drugs around. It is so dangerous in pregnancy that doctors prescribing it are advised to recommend a strict protocol of birth control after first checking a pregnancy test, and have patients sign informed consent agreements before taking it. It is fat-soluble, so it can be stored in the body for up to three months after the last dose is taken. If you have used Accutane®, I recommend using contraception for three months after you stop taking it to make sure all of it is out of your body before you try to conceive.

Diuretics are another thing to be careful of in pregnancy. So-called “water pills” may be used by non-pregnant women for bloating or swelling, and you may have some in the house. Don’t use these when you are pregnant, unless prescribed by your doctor. Bloating and swelling are common in pregnancy, and diuretics can cause dehydration and other problems.

Psychiatric medications like Prozac®, an anti-depressant, and Xanax® an anti-anxiety drug, are generally safe in pregnancy. That said, remember that Prozac® and other drugs from the SSRI class affect brain chemistry and have not been used long enough to study their effects on the developing brain fully. They are to be used judiciously.

Lithium, used to treat bi-polar disorder, may have a small risk of causing heart defects in the fetus and should be avoided during pregnancy. If you need lithium to stay healthy, don’t stop taking it on your own if you find out you are pregnant, but if you’re thinking of trying to get pregnant, talk to your psychiatrist about alternatives.

As for herbal remedies: These substances aren’t regulated by the government and the amounts of the agents, like St. John’s Wort and echinacea, vary from formula to formula.

Since we really don’t have clear evidence that echinacea lessens cold symptoms or that St. John’s Wort cures depression, why use them at all?

Lastly, be sure to tell your midwife or doctor whether you are taking any medication at all, including cold remedies and things you may buy in the health food store. It is important to note all medications, as well as any allergies to medications, in your prenatal record in case you need to receive other treatment later on in the pregnancy.