DEAR DR. DONOHUE: I have a 13-year-old grandson who still wets the bed. He is a deep sleeper. His parents have tried many things, but without success. Do you have any other techniques? – J.H.

ANSWER:
Bed-wetters are not willfully wetting the bed, so they should never be punished or humiliated. At age 5, about 7 percent of boys still wet the bed. By age 10, that number decreases to 3 percent, and by age 18, only 1 percent have the problem. A smaller number of girls wet the bed. For some, it’s a family trait. A bladder slightly smaller than it should be for the child’s age is another factor. Slowness in maturation of the nerve connections of the bladder is a possible cause. And some children secrete too little of the hormone (antidiuretic hormone, also called arginine vasopressin) that slows the production of urine during the night. Children who are in the deep stages of sleep might not respond to signals that the bladder is full.

The boy should cut back on his fluids after the evening meal. He should empty his bladder before going to bed. An alarm clock, set to ring two to three hours after the boy has fallen asleep, can wake him so he can make a trip to the bathroom.

Alarm systems often work. The system consists of a sensor that responds to the first few drops of liquid. It is in a pad on the bed or in the child’s undergarments. The sensor activates an alarm and the child gets up to relieve himself. If need be, he changes the bedding and his pajamas before returning to bed. After three or four months of dryness, use of the alarm can be stopped. If the child relapses, the routine is repeated.

For special occasions like a sleepover, medicines such as DDAVP (antidiuretic hormone) can keep the boy dry.

Children with this problem should be checked for things like diabetes, an overactive thyroid gland and sickle cell disease.

DEAR DR. DONOHUE: Thanks for the information on steroid creams for canker sores. I have cold sores on my lip repeatedly, and they take forever to heal. I have a supply of triamcinolone (a cortisone medicine) cream on hand for my gums. I tried it on my cold sore, and it worked. I have no idea what causes them, but I am glad to find a remedy. – A.B.

ANSWER:
That treatment was only for canker sores. It’s not intended for cold sores.

The herpes-1 virus causes cold sores. It doesn’t cause canker sores. The herpes-1 virus is not the sexually transmitted virus. More than 90 percent of the population has been infected with it. It lives in the body forever after. From time to time, it creeps down to the lip, where it brings on an outbreak of a cold sore. (Cold sores and fever blisters are one and the same.) Cortisone drugs such as triamcinolone can prolong viral infections.

If you’re searching for a cold sore cream, try Abreva, available without a prescription. Denavir cream is a prescription item that shortens the life of cold sores. Oral valaciclovir tablets also work.

DEAR DR. DONOHUE: I read in your column and in other columns, and also in medical books, that a cold sore is not due to a cold but to the herpes virus – it is sexually transmitted. I would appreciate your input on this matter. – M.J.

ANSWER: The herpes-1 virus causes cold sores. It’s not sexually transmitted. The herpes-2 virus causes genital infections. It is sexually transmitted.

Almost every adult has been infected with herpes-1. Why don’t they all break out with cold sores? Because many people have an immune system that keeps the herpes virus in its hiding place. In those less fortunate, sunlight, a fever and emotional stress allow the virus to escape from its hiding place and travel to the lip, where it produces a cold sore.

DEAR DR. DONOHUE: There seems to be a vaccine for everything except strep throat. My kids get it at the drop of a hat. Their pediatrician claims that tonsillectomies don’t work. Is there a possibility of a vaccine? – K.T.

ANSWER:
There is a possibility of a strep vaccine. Doctors currently are working on it.

Is the doctor sure that these repeated sore throats are strep throats? The only definite proof is a culture of the throat or specific tests for the strep germ. Most sore throats are viral-caused.

If a child has severe and frequent strep throats, removing the tonsils lessens the number of infections. “Frequent” means seven or more infections in one year or five or more in the preceding two years.

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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