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Question for iParenting
Depend Expert Questions
Questions for GoodNites
Expert Questions for GoodNites
Expert Question PST
Questions for iParenting
Q: My son is currently in the first grade. In kindergarden he started talking
back and would argue with his teacher which I told him repeatedly was disrespectful. Apparently
he's starting to do it again this year. He also argues quite a lot with me. He's been diagnosed
with ADHD and is currently on Ritalin since school started a few weeks ago. How can his teacher
and I work on this behavior?
A: ADHD is becoming a more common diagnosis and is being treated in many more children. ADHD is
associated with other diagnoses, however, and it is important to test for these, including
learning disabilities and oppositional-defiant disorder (a distinct possibility in your son). In
addition, the medications used to treat ADHD can cause children to become irritable and moody;
consultation with the prescribing physician would be in order. Another possibility is that the
ADHD is inadequately treated, and changing medications or increasing dosages may be helpful. I
would also consider psychologic counseling and consultation with a psychiatrist.
Depend Expert Questions
Q: What type of incontinence problem is it when a person urinates extremely heavily
shortly after falling asleep, whether day or night? This happens to me regardless of how long I go without
drinking before I go to sleep or if I go to the bathroom immediately before going to sleep.
A: Incontinence means the involuntary loss of urine; the content of your question is unclear about
whether this is occurring. Without more information, it is difficult to categorize your problem, although
you may have a condition called spastic or neurogenic bladder. This is a problem where the bladder is
unable to store the urine appropriately and the bladder begins to contract uncontrollably. It would be
unusual to only have this issue immediately after falling asleep, however. Neurogenic bladder is often
treated by timed voiding (bladder training) and medications.
Q: Could having a high sugar count be the reason I'm incontinent? I have to wear absorbent undergarments 24/7.
A: Hyperglycemia (high blood sugar) can cause an increase in the amount of urine in the bladder, which would
worsen incontinence, but is not normally the cause of incontinence. Hyperglycemia can, over time, cause problems
with the automatic nervous system, resulting in problems with the bladder, but this is a result of the long-standing
hyperglycemia associated with poorly-controlled diabetes. I would advise an evaluation to see if you have one of the
more common forms of incontinence
Q: Is there good surgery to stop the incontinence experienced after prostate removal? I have very good control when
I am lying in bed. I have good control when I am sitting. I have poor control when I am standing or walking. I have
no control at all when I try to lift something or have a little bit of lifting pressure. Coughing and sneezing also
is bad. Thanks for your suggestions.
A: Unfortunately, the short answer is no. One very small study looking at tubularized bladder neck reconstruction
during surgery showed promise, but another larger study showed no benefit, and no other post-prostatectomy surgeries
have been successful. Post-prostatectomy 10-50% of men will have incontinence, depending on the author and the
definition. This is one of the reasons there is such controversy about screening for prostate cancer.
Conservative options (such as pelvic floor muscle training, biofeedback, electrical stimulation,
compression devices/clamps, lifestyle changes, extra-corporeal magnetic innervation, or a combination of methods)
have occasionally helped in the short term, but after 1 year of any type of therapy, 10-50% of men still suffer
from incontinence.
Q: How much does diabetes cause incontinence?
A: While diabetes is always considered a potential cause of urinary incontinence, there are no large scale
studies to support a link between the two. In my experience, I have not encountered any diabetic patients where
glucose control had a significant effect on urinary continence.
Q: When I cough I leak. Do I have a bladder problem?
A: This sounds like stress urinary incontinence; approximately 10% of women have regular problems with
incontinence, and about 50% have intermittent problems. The most effective non-surgical therapy are Kegel
exercises (which are similar to trying to stop urinating in the middle of the process).
Questions for GoodNites
Q: My 12-year-old son still wets the bed occasionally. He also has asthma.
Can how he breathes at night during sleep cause him to wet the bed?
A: There is no association between asthma and enuresis (bedwetting). It is unlikely that breathing problems
at night would cause enuresis; more likely it would help the problem, as children with night-time breathing problems
sleep less, and are therefore awake and won't wet the bed.
A: There is no association between asthma and enuresis (bedwetting). It is unlikely that breathing problems
at night would cause enuresis; more likely it would help the problem, as children with night-time breathing
problems sleep less, and are therefore awake and won't wet the bed.
A: No; almost all children with enuresis (bedwetting) have a family member who suffered with it, and
bedwetting predictably goes away at about the same age as it did for those other family members. Special
underwear has no relation to when children will begin to stay dry.
Q: Does consuming too much sugar or spicy foods have any relation to bedwetting? My daughter is 12 and
doesn't drink milk but does chew a lot of gum and love really spicy food.
A: No; no well-done studies have shown any relationship between sugar or any type of food and enuresis (bedwetting).
It is known that liquids which are ingested shortly before bedtime can cause problems, but this is timing, not content.
Sugar containing gum can harm teeth, however, and a 12-year-old girl needs calcium and vitamin D, both found in milk.
Expert Questions for GoodNites
Q: My husband had a "problem" with bedwetting well into his early teens. What are the chances that my
7-year-old will repeat history?
A: There are very few recent studies which have examined the issue of enuresis (bed wetting). A single study in 1973
showed that if both parents were enuretic as children, 77% of their children developed enuresis; 43% of children with
one bed wetting parent were enuretic. However, if your son were to have problems, you would almost certainly be seeing
them by now. It is very unlikely that a child who remains dry at age 7 will begin to have enuresis later.
Q: Can you give me any information on relapses and how to handle them? My 7-year-old daughter recently started
wetting after being dry for three months and she is so very upset and feels that she will never be able to stay dry.
A: Relapses are very common, having been reported variously at 12-69%. Putting all the data together we can suppose
that approximately one-third of bed wetters will have a relapse at some time during the 2.5 years after becoming dry.
Fortunately, in the only study done on relapse rates and successful treatments, 62% of children relapsed only once,
25% relapsed two to three times, and only 10% relapsed four or more times. The mean number of relapses was 1.7,
meaning that almost all children will have one or two relapses; thankfully, 98% eventually remained dry permanently.
The duration of the relapse was 4-12 months.
The most effective ways of treating this turned out to be exactly the same as what was successful in the first
place. The good news is that this means parents and children can rest assured that relapses are normal, and that
they will almost certainly be successful in remaining dry simply by continuing with their current strategies.
Expert Question PST
Q. I've heard there may be a new shot required soon -- Hepetitis A? Is this true, if so why,
and what are the risks? Also, how many shots are required for this series?
A: Hepatitis A is a food-borne viral illness affecting the liver. It is recommended for the following persons
(from the CDC website http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm):
•Men who have sex with men
•Injecting and non-injecting drug users
•Persons with clotting-factor disorders (e.g. hemophilia)
•Persons with chronic liver disease
•Children living in areas with increased rates of hepatitis A during the baseline period from 1987-1997
(Alaska, the west coast, and the desert southwest).
•Travelers to areas with increased rates of hepatitis A (Central and South America, Africa, Asia, and Greenland)
All formulations of the injectable vaccine are given in two doses 6-12 months apart. At this point the vaccine is not required.
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