DEAR DR. DONOHUE: I know I am an old, fussy grandma. I have a 3-year-old grandson who is not potty-trained.

He goes to day care, and they try to train him there, but his mother and father don’t carry on at night and on weekends. They say when he’s ready, he will train himself. Please give some advice. – V.S.

ANSWER:
Your generation had a much different view on when and how to toilet-train children than does the current generation. The shift to an older age to begin training and the technique for accomplishing it began with Dr. T. Berry Brazelton, a Harvard pediatrician who promoted a later age for training and a more relaxed attitude in getting it done.

He advanced the idea that toilet training shouldn’t take place until the child shows certain physical capabilities and mental attainments. Children should be able to walk to the toilet and be stable when sitting on it.

They should have the ability to hold urine for several hours and demonstrate that they can pull clothes up and down. They must have the capacity to communicate the need to use the toilet. They should show that they can place things where they belong, have a desire to please and consistently say “no” to things they are loath to do. Usually these skills are attained between 22 and 33 months of age, but for some children the age is older.

The age when most American children are potty-trained is 3 years old, but 4 isn’t unacceptable.

In your day, most kids were trained at 18 months. In some societies, if you can believe it, children are trained by 5 months.

Children aren’t going to train themselves. Parents have to get involved in the process.

DEAR DR. DONOHUE: I am a 73-year-old woman. In 2006, I was diagnosed with MAI and took three antibiotics for 10 months. After a recent second CT scan, the lung doctor said the MAI was back, and that I had a suspicious node.

I had the node removed, and it wasn’t cancer. It was my understanding that it would take six weeks of laboratory observation before they could tell me the best treatment. At six weeks, I was told all tests were negative. Can a disease like this just vanish? I don’t feel much different from how I felt before all this started. – W.L.

ANSWER:
MAI is an abbreviation for Mycobacterium (MIKE-oh-back-TIER-ee-um) avium intracellulare, a bacteria related to the TB germ. Infection with MAI isn’t tuberculosis and does not spread from person to person like TB.

The MAI germs are widely distributed in nature, in water and in soil, and many people have these bacteria in their bodies without a single symptom of illness.

In those people, the bacteria are harmless colonizers. For a minority of people, the germs create trouble. Because the germs are found in many people and because they are a problem only for a few, discriminating between those who are truly infected and those who are only colonized is a challenge. The truly infected have respiratory symptoms like cough and shortness of breath. Their chest X-ray or lung scan shows changes typical of MAI infection. And the MAI germs grow from their sputum on two or more occasions. If all three conditions are met, antibiotics are given for a prolonged period of time.

What apparently has happened to you is that your antibiotic treatment killed all the MAI germs. I take it you are cured. If the lab cannot grow any germs in six weeks, they aren’t there and you are no longer infected. Clarify this with your doctor.

DEAR DR. DONOHUE: I’ve heard that it’s important to keep systolic blood pressure at 120 or lower. Mine most often ranges from 125 to 135. I exercise, am on a low-salt diet and weigh 150 pounds. Should I do more? – K.B.

ANSWER:
Ideal pressure is one lower than 120 over 80. Your pressure might not be ideal, but it’s not high blood pressure either. High blood pressure is a pressure of 140/90 or higher. You are doing everything you need to do. Your current pressure is not a threat to your health.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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