Recurrent fever in a toddler


I was recently asked if it’s normal for a toddler to have fevers up to 102.8.  This answer depends on a few things.  Timing of the fever is important;  it is notable that body temperature can increase at night, due to the body’s natural circadian rhythm.  If the fever is various points of the day, it’s important to assure that environmental temperature is not a source.  Make sure the room temperature is comfortable;  not too hot or too cold.  If the child is wearing a lot of clothing, remove them and recheck temperature.  Notice if there are associated symptoms – like not eating or drinking, sleeping more than normal, cuddling more than normal.  These are typical signs that there is something, whether it be a viral or bacterial infection, going on.  Without other associated symptoms, causes of recurrent fever can be many.  If obvious source like ear or throat infection are ruled out, then it’s possible that blood work, urine tests, and a chest xray may be needed.  In some of those cases, causes of fever are found.  I have had children in my practice where no cause for fever was found – and ultimately were diagnosed by a specialist with a condition known as “Periodic Fever”.  In this condition, there is no long term complications notable.

Posted in Infection, Lab tests, Pediatrics | Leave a comment

My child wakes up upset and not wanting to eat….what is it?

I was recently asked about a toddler with difficulty sleeping, awaking in apparent pain, and not wanting to eat or drink much.  I can’t say for sure what this is, but one thing it may be is night terrors.

Sleep, or night terrors, are episodes of fear, flailing and screaming while asleep.  Episodes usually lasts from seconds to a few minutes.  These episodes are frightening, but they aren’t usually a cause for concern. Most children outgrow sleep terrors.

Children usually don’t remember anything about their sleep terrors in the morning.

During a sleep terror episode, a person might:

  • Sit up in bed
  • Scream or shout
  • Kick and thrash
  • Sweat, breathe heavily and have a racing pulse
  • Be hard to awaken
  • Be inconsolable
  • Get out of bed and run around the house

Various factors can contribute to sleep terrors, including:

  • Sleep deprivation
  • Fatigue
  • Stress
  • Anxiety
  • Fever (in children)
  • Sleeping in unfamiliar surroundings
  • Lights or noise

Treatment for sleep terrors isn’t usually necessary. Speak softly and calmly. Shaking your child or shouting may make things worse.

If the sleep terrors are associated with an underlying medical or mental health condition or another sleep disorder, treatment is aimed at the underlying problem. If stress or anxiety seems to be contributing to the sleep terrors, your doctor may suggest meeting with a therapist or counselor.  

If sleep terrors are a problem for you or your child, here are some things to try:

  • Make the environment safe:  close and lock all windows and exterior doors at night. Block doorways or stairways with a gate, and move electrical cords or other objects that pose a tripping hazard.
  • Get more sleep. Fatigue can contribute to sleep terrors. Try an earlier bedtime or a more regular sleep schedule.
  • Establish a regular, relaxing routine before bedtime. Do quiet, calming activities — such as reading books, doing puzzles or soaking in a warm bath — before bed.

 The above information was obtained through the Mayo Clinic website.

Posted in Mood, Pediatrics, Psychology | 1 Comment

Suntanned skin looks nice….but is not worth it

I recently had a family member diagnosed with melanoma.  He was an avid sunbather.  Would spend his days at the pool from 11am-3pm as often as he could.  And in the colder seasons, he went to the tanning bed.
This week his biopsy result showed melanoma.  I talked with him today, and he said he won’t be going to the tanning bed anymore, and that he’ll use sunblock instead of accelerator.
What is melanoma? 
Melanoma is a serious skin cancer.  It can occur anywhere on the skin. When it is not treated, melanoma can spread to organs inside the body.
What are the symptoms of melanoma? 
Melanoma often looks like a brown or black mole or birthmark. But it has features that make it different.  People can remember the abnormal features of melanoma by thinking of the letters A, B, C, D, and E
  • Asymmetry – both halfs look different 
  • Border – uneven edge.
  • Color – uniform or different colors.
  • Diameter
  • Evolution – color or shape can change over time.

Diagnosing melanoma:

Biopsies can confirm or rule out melanoma.  During a biopsy, a doctor will usually remove either a small sample or the whole abnormal area.  If it is melanoma, it will be staged.  This tells us how deep in the skin and how far inside the body the melanoma has spread.  This helps direct treatment. 

How is melanoma treated? 

  • Surgery – Removes the cancer. During surgery, lymph nodes are checked to see if the melanoma has spread inside the body.
  • Radiation therapy – Radiation kills cancer cells.
  • Chemotherapy – Medicines that kill cancer cells.
 What happens after treatment?

You will need to be monitored to see if the melanoma comes back or if new melanomas appear. Blood tests and imaging tests may be ordered.  

 Can melanoma be prevented?

Protect your skin from the sun’s rays. 

  • Stay out of the sun in the middle of the day (from 10 a.m. to 4 p.m.)
  • Wear sunscreen and reapply it often
  • Wear a wide-brimmed hat, long-sleeved shirt, or long pants
  • Do not use tanning beds.
 Many moles and birthmarks are normal and are not melanoma. But if you have a mole or birthmark that you think might be abnormal, show it to your doctor or nurse
Posted in Skin | 2 Comments

“If only I could look like….”

I saw an article on Yahoo! that struck me.  A model drew on her body what changes would need to be made for her to have a Barbie-like figure.

So many patients, both men and women, have issues with their bodies.  In extreme cases, some people even suffer from Body Dysmorphic Disorder

What is body dysmorphic disorder (BDD)?

Its a serious illness when a person is preoccupied with minor or imaginary physical flaws.  A person with this tends to have cosmetic surgery. 

What are the symptoms of BDD?

  • Being preoccupied with minor or imaginary physical flaws.
  • Having a lot of anxiety and stress about the perceived flaw and spending a lot of time focusing on it. 
  • Strong belief that you have an abnormality or defect in your appearance that makes you ugly
  • Frequent examination of yourself in the mirror or, conversely, avoidance of mirrors altogether
  • Belief that others take special notice of your appearance in a negative way
  • Extreme self-consciousness
  • Refusal to appear in pictures
  • Avoidance of social situations
  • The need to wear excessive makeup or clothing to camouflage perceived flaws
  • Intensely obsessing over your appearance and body image, often for many hours a day.
  • Seeking out numerous cosmetic procedures to try to “fix” your perceived flaws, but never are satisfied

What is the treatment for BDD?

  • Medications: Serotonin reuptake inhibitors are antidepressants that decrease the obsessive and compulsive behaviors.
  • Cognitive behavioral therapy.


Posted in Psychology | Leave a comment

Will the Danish fat tax make it’s way here?

Denmark just taxed fatty foods, like butter, cheese, and pork fat.  The idea is to make these food items less appealing for purchase.  Eventually, they hope this will help decrease obesity and obesity-related conditions.

Read on….

Posted in Diet, Nutrition | Leave a comment

Vitamin supplements…any use?

Vitamins and minerals are essential to any diet.  If you eat a diet rich in fruits, vegetables, and fortified food, you’re probably getting all you need and don’t need supplements unless a physician advises otherwise.  




  • Found in carrots, sweet potatoes, and green peppers.  
  • An antioxidant. 
  • Converted to vitamin A and is important for healthy vision, a functioning immune system, and good skin.
  • A 2004 study found that supplements may actually raise the risk of lung cancer in smokers.

    Skip the supplements if you’re a smoker, and try to get your beta-carotene from fruits and veggies, whether you smoke or not.


  • Found in dairy products like milk, yogurt, and cheese. 
  • Used to maintain healthy bones and prevent osteoporosis. 
  • Best paired with vitamin D to improve calcium absorption

    Skip supplements if you’re prone to kidney stones or are a female over 70 (a 2010 report linked calcium supplements to heart-attack risk in older postmenopausal women).

Folic acid:

  • Prevents spina bifida in babies. 
  • Found in fortified breakfast cereal, dark green vegetables, legumes, citrus fruit juice, bread, and pasta.

    Getting 800 micrograms a day of this if you are pregnant or lactating is advised.  


  • Critical for the proper functioning of red blood cells — helpls prevents anemia.

    Try to get iron from dietary sources, which also include lean meats, seafood, nuts, and green, leafy vegetables.

      You may may need a supplement if you’re anemic.


  • Not proven for much benefit if your diet is rich in fruits and vegetables. 


  • Can even out irregular heart rhythms, and counteract the effects of too much sodium.
  • Found in bananas, raisins, leafy greens, oranges, and milk.

    Consider a supplement if you’re taking diuretics for a heart condition – but only at a doctor’s discretion, as too much potassium can be harmful to people with kidney disease

Vitamin C:

  • Found in citrus fruits, berries, broccoli, and green peppers
  • Not proven to prevent the common cold, though one study suggested that taking vitamin C regularly might reduce the length of a cold by a day. 

    Not great evidence suggesting increasing your intake will combat sniffling and coughing.

Vitamin D:

  • Helps the body absorb calcium;  necessary for bone health.
  • Mostly accessible through sun exposure.  
  • Too little vitamin D can contribute to osteoporosis in adults and rickets in children.

    Supplements may benefit if you don’t have much sun exposure, are over 50, or have dark skin.

Vitamin E:

  • Found in safflower oril, peanuts, eggs, fortified cereals, fruits, and green, leafy vegetables.
  • Not noted to prevent cancer or lower the risk of heart attack or stroke in middle-aged and older women.
Posted in Diet, Nutrition | Leave a comment

I know I should make healthier food choices…how do I start?

Each day, I sit with patients and tell them they have diabetes, or high cholesterol, or high blood pressure.  Part of our discussion is about choosing different foods.  I have found a pretty basic link that will help. 

Now of course, everyone is different, so patients will have to choose foods based on their tastes and food allergies.  Each patient should work with their doctors to help them individually.  Still, this is a good start.

Posted in Uncategorized | Leave a comment