How often can you take ibuprofen for menstrual cramps?

Using ibuprofen for menstrual crampsI often joke with parents that my gynecologic knowledge is limited because most female adolescent patients prefer seeing a woman doctor. However, my daughter suffered with severe cramps, and I learned the following tip from my partner, Promise Ahlstrom, MD.

If your daughter has bad cramps, she should take 400 to 600 mg of ibuprofen as soon as her period starts. Then, she should repeat the dose every 4 hours for the first 24 hours of her period. The goal here is to “stay ahead of the pain.” If a girl takes the first does at 8am, she may be tempted to skip the noon dose if the cramps have subsided. This is a no-no. By missing a dose, the physiology that causes menstrual cramps will worsen. By the second day of her period, she can usually drop the dose to every 6 hours, but she should still take the medicine on schedule. By the third day of her period, she can take the ibuprofen as needed.

Three things can interfere with staying on course with this regimen. First, if a girl is at school, she may need to go to the nurse to get her medication. If the school has a strict policy about leaving class, a note from the doctor can help. Second, some girls forget to take their medicine. This can be overcome by putting reminders in her cell phone or getting a friendly text from mom at the right time. Third, her period may start right before bedtime. In this situation, I would consider waking her up for a dose of ibuprofen unless doing so would disturb her sleep and cause other problems the following day.

If this regimen doesn’t help, your daughter should see her pediatrician or a gynecologist to discuss other options.

How should you talk to your daughter about puberty?

In my experience, 90% of girls are not excited when puberty starts. And it’s not just their impending period that’s on their mind. Most girls are happy with the body they have and see no reason for it to change. This uncertainty happens because the physical changes of puberty precede the psychological ones. When I discuss this with girls at their 10- or 11-year-old checkups, my goal is twofold. First, I want them to know that they are not alone in their feelings about puberty. Second, I want parents to know that girls may be reluctant to talk about puberty even though moms want to provide them with the benefit of their experience. However, I encourage moms to always keep their “radar on.” If a girl brings up pubertal issues, moms should drop what they’re doing and be open for a discussion.

I also share a story about what happened in my own home when my daughter, now 21, turned eleven. My wife and I bought Molly a copy of the American Girl book, The Care and Keeping Of You, which is a terrific book for girls entering this stage of their lives. Molly looked at the book and literally threw it across the room. We told her that was okay, but added that her mom would be available to discuss anything in the book if Molly wanted to. Over the next six months, we found her occasionally reading the book at night before bed.

My final comment on this subject at checkups is to remind girls that puberty takes years to finish, and I guarantee that they will be happy with their grownup bodies once the process is over.

The difference between pain and tenderness

Michael Pramenko Jack PerrinPatients are sometimes confused when doctors differentiate the terms pain and tenderness. The reason we use these words differently is because they mean different things when it comes to making a diagnosis. If something is painful, that means it hurts. If something is tender, that means it hurts when it is touched or moved. A good example of how we use these terms relates to abdominal pain. I could have a horrible stomachache, but if it doesn’t hurt more when someone pushes on my abdomen, I am not tender. Appendicitis always causes a tender abdomen. Similarly, migraine headaches cause severe pain in addition to nausea and photophobia (it hurts to look at lights), but patients with migraine usually don’t have scalp tenderness. If someone has a bad headache associated with scalp tenderness, it’s often due to muscle tension that’s brought on by psychological or physical stress such as carrying a heavy backpack or keyboarding for long periods of time.

Tips to help adolescents avoid drugs and alcohol

While every parent hopes his or her teenhow to help adolescents avoid drugsager will be able to “just say no” when asked to use drugs or alcohol, it’s clear that many adolescents will have difficulty resisting peer pressure. One way to handle this situation is to give teenagers an excuse so it won’t look like they’re not “being cool” when asked to use an illegal substance. Here are some comebacks that may help kids get out of tricky situations:

  • “I can’t drink/smoke because I’m taking a medication for my allergies (or some other condition) that interacts badly with alcohol/marijuana.” If someone asks the teen what he’s taking, he can say he doesn’t know because his mom just gives it to him in the morning.
  • “I’ve had a stomach ache all day, and the last thing I need is to drink tonight.”
  • “I’ve got asthma so I can’t smoke weed.”
  • “My parents are planning to buy me a car for graduation, but if they ever catch me doing drugs or alcohol, they told me I can kiss the car goodbye.”
  • “My brother/sister/cousin got into a lot of trouble doing alcohol/drugs so I’m not into this stuff.”
  • “I’ve got plans tomorrow morning so I need to be clear headed.”
  • “I’m the designated driver tonight.”
  • “My brother/sister/pet is sick, so I know my parents will be awake when I get home tonight.”
  • “I’ve got relatives in town so I need to be straight when I get home tonight.”
  • “My dad goes to sleep late every night, so I can never get away with this stuff.”

Have your own tips? Let me know by posting a comment or sending me a note on the contact me page.

Can a teenager be immune to mononucleosis and not know it?

Immune-to-MonoIt’s common knowledge that people are usually diagnosed with mononucleosis (mono) during adolescence. This is the reason it’s often referred to as the “kissing disease.” What lots of people don’t know, however, is that about 20 percent of children get mono before age ten. 

The explanation for this fact lies in the way the human body responds to infections. When a person comes down with an illness, his immune system produces antibodies to help kill the invading microorganism. The first antibodies the body produces are in the IgM class. These antibodies are present for about three months after which they disappear from the circulation.

A month or so after the body starts producing IgM antibodies, it makes IgG antibodies to the same viral or bacterial agent. However, IgG antibodies are produced continuously and will remain in a person’s bloodstream for life. The reason you don’t get the same infection more than once is because IgG antibodies are always around, and they prevent the infection if you are exposed to the virus or bacteria in the future. This is what it means to be “immune” to something.

Antibody production also explains how immunizations work. When you get a vaccine, your body is injected with a tiny amount of a killed or weakened biologic agent. Your body then makes antibodies to that microorganism so if you get exposed to the germ at a later time, you won’t get sick or you will have a milder form of the illness. In most cases, the body’s immune system is superior to vaccinations in terms of conferring future immunity. That’s why vaccines are not 100 percent effective. A notable exception is whopping cough, which is better prevented by vaccines than natural infection.

Okay, back to mononucleosis. When I draw blood to check for mono, I always test for IgM and IgG antibodies to the virus. If the patient’s IgM antibodies are positive, that means he currently has mono. However, if the IgM antibodies are negative, but the IgG antibodies are positive, that means he had mono at some point in the past, but does not have it now, i.e., the current infection is due to another virus. If the patient has a negative test for IgM and IgG antibodies that means he doesn’t have mono now and did not have it in the past either.

Parents almost never recall a preteen child having had mononucleosis because this age group does not get the classic mono symptoms: fever, swollen lymph nodes, horrible sore throat and fatigue. Instead, they usually have a fever that lasts for four or five days.

Blood tests are not needed at every checkup

BloodtestsinchildrenChildren are encouraged to get regular checkups. In addition to answering a parent’s questions, these visits are meant to reinforce a healthy lifestyle and to screen for certain conditions based on the child’s age. For babies and toddlers, screening questions focus on nutrition, growth and development, and safety. For school-aged children, this focus is broadened to include exercise, academic readiness, and the management of common childhood problems. Adolescents need more independence and should spend some time alone with the doctor.

Every checkup includes a physical examination where the doctor ensures the child is growing well and does not have any problems that could interfere with his health. Checkups are also accompanied by vaccinations to prevent the large number of serious diseases that children are at risk for.

Each question or test a doctor does has a purpose. For example, screen vision and hearing is screened yearly for two reasons:

  • Children may not notice if they are not seeing or hearing well.
  • Research has shown that vision and hearing can change over a span of six to twelve months.

The reason most pediatricians do not do blood tests every year is because the situation is different when it comes to blood work. Doctors routinely check for anemia (low blood count) at nine months and two years of age because the rapid growth of early childhood is a risk factor for developing iron-deficiency. However, if a child is healthy and has a healthy diet, the likelihood of developing anemia in elementary school is very low. This does not mean a doctor will not do blood work throughout this time period, however. But research does not support doing yearly blood counts on most children. Adolescent girls need blood counts more frequently because menstruation puts them at increased risk for iron-deficiency.

Other blood tests you may have heard of include:

  • Cholesterol levels
  • Liver and kidney tests
  • Lead tests
  • Vitamin D levels

While each of these tests is important, there is no reason to do them on a yearly basis. Each doctor will decide when to do them based on the child’s age and certain risk factors, which include family history, if the child has an underlying medical problem, and where the child lives.

Hernias and other problems in teenage boys

This blog post is really for adolescent males. If you are a parent, copy the information or send a link to your son. Concerned aunts, uncles and grandparents can do the same thing.On May 14th, I wrote a blog about testicular torsion. [Link:] The purpose of the blog was to inform kids and parents about a serious condition that can happen at any age, but is more common in teens.

I educate all of my adolescent patients about testicular torsion so they will act quickly if they develop the sudden onset of testicular pain. I also encourage them to check their testicles on a monthly basis to look for other problems. They don’t always listen.A few months ago, I saw a 16-year-old for a routine checkup. During the genital exam, I found a large inguinal (groin) hernia. When I asked Jeremy (not his real name) how long the bulge had been present, he got quiet and said, “I’m not sure, four months maybe.”The reason Jeremy didn’t tell me about the swelling is because he had hoped it would go away. This is an example of denial, something that can happen to anyone. Males of all ages, but especially teenagers, are reluctant to report problems in this particular location.

I referred Jeremy to a surgeon who repaired the hernia without complications. But the take-home message is clear. If something else had been causing the swelling, such as testicular cancer, not telling anyone about it for months might have had a different outcome.

Although testicular cancer is rare (5.4 cases per 100,000 males), it is the most common cancer in males aged 15 to 39. Because the incidence of testicular cancer is low, there is disagreement among medical professionals regarding the value of monthly screening. That being said, the survival rate for Stage 1 testicular cancer is better than advanced disease.

The best time to do the exam is after a shower when the scrotum is relaxed.

  • Examine one testicle at a time.
  • Using gentle pressure, roll each testicle between your thumb and fingers. Testicles are egg-shaped and should feel smooth and firm. One may be slightly bigger than the other, but they should be about the same weight and consistency.
  • Feel for small lumps, swelling, hardness or other changes in the shape of the testicle.
  • The epididymis is a spongy, tube-like structure that is attached to the top and back of each testicle. It is a normal finding.
  • If you notice a change in either testicle, see your doctor promptly.

An uncommon, but serious side effect of acne medication

Tetracycline and its derivatives (doxycycline, minocycline) are commonly used to treat acne. I have noticed that dermatologists sometimes forget to warn patients that a severe sore throat may occur if these medications dissolve in the esophagus. This can occur if the capsule “gets stuck” on the way down or if a teenager has an episode of stomach reflux while lying down and the capsule washes back into the esophagus. Although there is a warning label on the bottle that instructs patients to take the medication with lots of water, people do not always read these labels. 

To avoid this situation, I always tell teenagers why it is important that the capsule makes it into the stomach. I also prefer derivatives such as doxycycline because they can be taken with food. This reduces the chance that the pill will lodge in the esophagus and circumvents the need to take the medication on an empty stomach before bed. If one of my patients remembers to take his acne pill within an hour of bedtime, I tell him to skip the dose that night. 

Have You Ever Heard Of Testicular Torsion?

Most parents know that certain symptoms that can be associated with serious medical conditions. The most common ones are as follows:

  • stiff neck may mean meningitis
  • abdominal pain may mean appendicitis
  • bad cough may mean pneumonia

Testicular torsion is a rare condition that most parents have never heard of. However, as with the problems noted above, it is important to get urgent medical attention for the condition. Although testicular torsion can occur at any age, it is most common in 12- to 18-year-olds.

In order to prevent the testicles from twisting, they are anatomically anchored within the scrotum. Sometimes, this anchoring is in the wrong place, which allows the testicle to twist 360 degrees. If this happens, the artery that supplies blood to the testicle will twist thereby cutting off its blood supply. Shortly after this occurs, a child will experience pain and swelling because the testicle is being deprived of oxygen. Although this is not a life-threatening condition, the testicle itself may die if the problem is not diagnosed and treated within eight to ten hours.

Although doctors know about the importance of diagnosing and treating testicular torsion as soon as possible, lay people don’t. In addition, since adolescents may be reluctant to discuss genital symptoms with their parents, further delays can occur before the diagnosis is made. You can remedy this situation by asking your doctor to discuss the problem at your next checkup. If a teenager knows that testicular pain is an emergency, he will hopefully be more proactive reporting the problem to his parents.