persistent diarrhoea and abdo pain

Thank you for writing back so quickly, my daughter has had a stool sample taken last week that came back clear. She also has been on a dairy free diet since January. The doctor said to put her on a wheat free diet to see if we can get an improvement but she is still in a lot of pain at the moment. I will let you know the outcome once she has been on it for a couple of weeks. Thank you for your time and advice.
Kerry

A routine stool sample will not detect Yersinia and may not detect Giardia. Your doctor has to specifically ask the laboratory to look for Yersinia. Giardia is so often missed that I would treat her for Giardia anyhow.
I am sorry you are having so much trouble. If the above does not detect the reason or cause improvement, she should have a urine collected and analysed for infection.
Please do let me know what happens.
David Robinson

persitent infantile diarrhoea

Hello: my 12 month daughter has had diarrhoea for the last 2 weeks. She is opening her bowels up to 10 times per day and is having really terrible stomach pains. She also has severe reactions to dairy produce. Could you advise me on the cause of this?

Dear Kerry,
This sounds like she has lactose intolerance probably brought on by a gastro bug. She needs to go on a milk product-free diet. This means no milk, no cream, no cheese, no icecream and no commercial products that contain milk such as bread, biscuits,most margarines and yogurts. Check commercial products to make sure they don't contain "milk products or "casein"-this means you will have to do a lot of home cooking. She should stay on the milk-free diet for 2-3 weeks to let the gut heal although you should see an improvement long before that time.
If this does not work ask your doctor to look for Yersinia and Giardia in a faeces specimen and treat her for Giardia anyhow as it is sometimes difficult to detect. Uncommonly diarrhoea can be due to a urinary tract infection but it is so difficult to collect a suitable urine sample, I would wait until all the above have been done.
If none of these work ger back to me as there are further things that could be considered. I would be interested in what happens in any case.
David Robinson.

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severe infectious mononucleosis

Hello:My daughter is 7 and has been diagnosed with mono. She started with a low grade temp for 12 days off and on. Then she got the "bad attack". She has had high temps for the last 5 days. They get up to 104.5-105.4 if I am not giving her tylenol and/or ibuprofen every 4-6 hours. Her spleen is swollen, tonsils are very swollen, bad headache and in bed for 5 days. Yesterday she had difficulty even walking because of weakness. It is my understanding that children this age typically do not get mono this bad. Will this last longer for her because of the severity of her symptoms and how long should she have this high fever? She is also taking codeine for the pain. Thank you for any information you can offer me. Leanne.

Dear Leanne,
You are correct, the younger the sufferer of mono the milder it is in most cases. This usually means that children under 6 do not have the diagnosis made although they certainly do catch it.
I presume your doctor has confirmed the diagnosis and a blood test has been taken.
I guess there are always exceptions to the rule. I don't think she will have an unusually long course because it is so severe - this is based on my own observations and I am not aware of any proper scientific study that has measured length of illness against severity in mono.
I would not base the giving of Tylenol on the presence of fever but more on whether she is in pain or not. Fever is one of the body's defences against viral infection, which mono is. Temperatures around 105 are rare in adults but quite common in children.
Regrettably, there is little modern medicine can do to help your daughter to overcome mono but she will recover.
David Robinson