Do you have any tips for dealing with chronic pain?

Posted on November 25, 2010 by Dr. Pat

I’ve had chronic pain since 2007 and I have just entered into high school. I’m having trouble concentrating when I have intense pain (I have hemicrania continua with side shift) and I’m still waiting to get into a pain clinic. Are there any tips you can give me to help me get through the pain?

It is unusual, but not unheard of, for someone your age to have hemicrania continua. Hemicrania continua shifting from one side of the head to another is not typical. Diagnosis of types of headaches should be done by a physician specializing in this area. You should be under a doctor’s care. He or she should check out to make sure the diagnosis is correct. A referral to a pain clinic or a headache specialist is needed.  Either a pediatric or adult pain clinic or neurologist should be helpful.  This type of headache can be misdiagnosed  so a careful diagnosis is needed.

As you know, hemicrania continua is the fancy name for a specific type of  headache that is marked by constant pain on one side of the head. On top of the constant pain are attacks of more severe pain that can last from minutes to hours several times a day.  It is more common in girls than boys.  Some people have a remitting form that comes and goes over time. In addition to pain there are usually either autonomic system symptoms or migraine symptoms.

Autonomic system symptoms can include:

  • runny nose
  • tears
  • eye redness and discomfort
  • sweating
  • puffy eyelids

Migraine symptoms can include:

  • feeling like throwing up
  • throwing up
  • sensitivity to light
  • sensitivity to sound

One drug, a type of non steroidal anti inflammatory drug that is also used for gout, indomethacin,  is usually effective. However, this drug has rather nasty side effects in terms of stomach bleeding. Other drugs may be effective.

Several studies of brain imaging have detected a very specific pattern of where the headache arises suggesting that this is a very unique type of headache.

In the meantime, I would suggest the following strategies:

  1. You should learn some type of meditation or relaxation that can help you isolate and reduce the pain. You will have to become really good at it.  The exact type of relaxation or meditation is not important.  It is likely to help.
  2. As you have already done, make sure you keep up as many of your activities that you enjoy as you can. Chronic headaches can continue for a long time, so you have to be prepared to continue your life.
  3. With your parents, you  should discuss with your school how, when the pain gets really bad, you  may have to put your head down on your desk or lie down for a short time in a quiet place.  This would allow you to stay at school, so you can continue when the attack lessens.
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Does my three-year-old daughter have Tourette’s?

Posted on November 25, 2010 by Dr. Pat

I have been told that one of the signs for Tourette’s, particularly in children, is pointing or when they connect their fingers, knuckles or fists together (my mother-in-law said my husband did this from 2-8 years of age, my husband has Tourette’s). I have noticed my three-year-old daughter doing that with her knuckles, she also has a stuttering problem for which she has just started speech therapy. I have talked to my doctor but they don’t seem concerned and brush off my concern. I just want to know if my daughter had inherited Tourette’s or not so I can start any tactics or therapy now.  She went through a “blinking” stage that started my worrying, but that has calmed down. It takes her hours to go to sleep unless she’s overly tired from playing outside. I am just concerned and can’t get any answers from my doctor.

We don’t know much about the genetics of Tourette’s. We do know that it often runs in families. One gene mutation, on the SLITRK1 gene,  has been linked with a small number of Tourette’s cases. Most people with Tourette’s do not have this mutation though.

Your concern about your daughter is legitimate but medical knowledge is just not sufficient to answer your concerns.

The most common problem with Tourette’s  is tics. Tics are sudden movements or noises that the person does not mean to do. They just happen.  Sometimes the noise is like a bark. The sudden movements may involve the hands but do not always.

Many people with Tourette’s also have other problems, especially with attention, anxiety and sleep.  Your daughter has some features of Tourette’s but it is impossible to diagnose at her age. The picture will become clearer with time.

Keep doing what you are doing. If she has a problem, such as stuttering, get some help for that problem.

There is no Tourette’s treatment that I would recommend at this time.  An excellent web resource for Tourette’s information is the National Institute for Neurological Disorders and Stroke

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How can I grow taller?

Posted on November 25, 2010 by Dr. Pat

How can I grow taller? I’m 20 years old and my height is 161 cm.

There is no way that you can grow taller. Any schemes that you may learn about are a fraud and may be dangerous to your health. Even if you did try some outrageous and dangerous scheme, I would be very surprised if you grew at all.

I would encourage two possible solutions. The first and best solution is to accept your height. You can acknowledge that you wish to be taller but that you are never going to be taller. It is not a disaster. Most people of your height live happy and productive lives.

You are a bit short for a man but well within the normal range of height for a woman. I have a brother and a wife that are both shorter than you and both are quite well adjusted and happy. You can change your negative beliefs about your height.

The second possible solution is to get shoes with lifts. This is not as good a solution but if it makes you happy, do it.

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Teachers complain my son is hyper, what can I do?

Posted on November 24, 2010 by Dr. Pat

I have a kid of 4 years old. He is intelligent and very sharp but his teachers complain that he is hyper. He is a fidget. He cannot concentrate on one thing at a time and doesn’t have any patience for it. This is found in most of children, but most people who come in contact with my kid call him hyper, including myself and my spouse. Please advise.

There are at least two issues here. Maybe, three or four.  One is fidgeting.  A second is poor concentration. The third might be that your son does things without thinking (impulsivity). The final problem is that he may not be able to sit down in the classroom (hyperactive behavior).

Fidgeting could be moving his hands, tapping his feet or moving in his chair. Don’t worry at all about fidgeting.  There are some advantages to being a person who fidgets.  Fidgeters are less likely to be overweight. It might be a bit irritating but adults should give fidgeting children a break. Fidgeting is almost impossible for people to change. Fidgeting does not affect learning.

Poor concentration can interfere with learning.  The best advice is to use a positive approach. When he is paying attention, say playing with Lego, notice it. Be gentle with your noticing so you don’t distract him by noticing his attention. Quietly tell him. Smile or touch him gently.  Make his environment less distracting. Turn off the television. Read to him in a quiet place. Attention span increases with age and he may catch up with encouragement.

If your son does things without thinking, that can be a problem. He needs to:
Stop
Think
then Do.

The best way to teach him this is to do it yourself, a lot. Show him how it works.
Use examples that he has a problem with.  I don’t know what he does without thinking but I am sure you can figure out some examples. The secret is practice, practice, practice.

If your son is hyperactive and moving around all the time, this is a challenge for teachers in the classroom but it is not a problem with his learning and development.  If he has a teacher who will tolerate moving around while learning, your son will thrive. But this is very hard for teachers and most do not have the skills to teach like this.

He may have to learn to be less hyper in the classroom. Encourage him.  Get him to practice at home.

Develop a strong relationship with his teacher.  Notice the good things that his teacher does. Do not criticize his teacher. Try to figure out with his teacher how together you can help him do well in school.

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What is the treatment success rate for OCD in children?

Posted on November 23, 2010 by Dr. Pat

What is the cure rate for children with OCD?  Or, better yet, what is the management rate for children with OCD?  Can this disorder be helped in children?

Children with obsessive compulsive disorder, OCD, have repeated thoughts, images or impulses that cause them a great deal of anxiety. They feel that something is harmful, dangerous, wrong, or dirty.  They may have thoughts that something terrible might occur. They have strong urges to control these thoughts by repeating certain actions. Examples are hand washing, checking to see if the doors are locked or repeating some other ritual behaviour. Sometimes they have urges to control the anxiety by deliberately thinking in a certain way such as by counting certain things.

OCD can be genetic. Sometimes it is triggered by stress.  Occasionally, it comes on very quickly following a streptococcus infection.

There are both medical treatments and cognitive behavioral treatment. The medical treatments are usually the antidepressant medications. The cognitive behavioral approaches involve triggering the anxiety and then not responding to it (response prevention). Other types of psychotherapy or counseling do not work.

Success rates with cognitive behavioral treatment tend to be higher than for medication. The best effects may occur with a combination of treatment. Children who don’t respond to the first approach to treatment may respond to the second or third approach.

I cannot give a specific treatment success rate because there is not enough research yet. However, the outlook is very promising and most children will respond well to treatment. It is a very positive outlook. Children with OCD can be helped.

Any child with OCD will need a lot of encouragement and support to stay in treatment.  It is hard work and success may not come immediately.

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Should I report my friend for having sex with one of her students?

Posted on November 22, 2010 by Dr. Pat

For some time I have been  torn between taking action or staying put on the following matter. My best friend of 20 plus years who is a school teacher has had a sexual liaison with one of her students. Though they waited until he was out of school he was still under age and she in a position of authority. She still holds a teaching position and is now thinking of going to other schools to apply for jobs, she is a very skilled, motivated teacher who besides this has really worked hard to be where she is. I am confronted however with something that is so beyond my comprehension that if my kids were having sex with a teacher double their age…well, I’d take action! I don’t know what to do.

You are in a very difficult situation. Your best friend has betrayed a trust and has broken the law. In some jurisdictions you may be breaking the child abuse law by not reporting her. You can check on the law with your local library or Children’s Aid Society with an anonymous phone call.

She may be a dedicated and motivated teacher and a wonderful friend but she is also a pedophile. She will likely do this again.

I understand the agony you must feel. However, I would encourage you to report her to the child protection authorities. You can do this anonymously or you can give your name. It is up to them to investigate and decide whether to charge her or report her to the teacher licensing board.

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My grandson’s speech ability is not at the level it should be.

Posted on November 19, 2010 by Dr. Pat

My grandson just turned 4 years old and is still only saying a few words. He has been going to speech therapy for some time now and it doesn’t seem to be helping much. He has been tested for autism, and many other developmental disorders, plus has had hearing test and no one can find what the problem is. He is very smart and follows orders such as “go into the bedroom and get your sisters teddy bear for her” etc. We are at our wits end and don’t know what to do, is their specialist at the IWK that could help him?

This is late for a child to be saying only a few words. I would encourage his parents to talk to their son’s speech therapist about a further referral. It is really impossible to know what type of referral would be best without knowing your grandson. Your grandson’s family doctor may also have some suggestions. From your description, his speech is poor but his language is much better.  This is a very positive sign.

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My son is upset because, having separated from his father, I want to take back my family name.

Posted on November 18, 2010 by Dr. Pat

After 4 years of being legally separated, I’ve decided to take back my family name. I have two sons 9 and 7. Their Dad and I are active, effective parents who work well together to ensure the kids are OK. We may not live under the same roof, but we are family and care for each other. Last night I told my older son about the change and then found him crying in his room. He says he’s fine if Dad and I don’t live together but he still wants us to be married and he didn’t want me to change my name because then, in his mind, we wouldn’t be a family. I’m afraid he’s holding out hope that his Dad and I will re-unite, which isn’t a likely possibility. My gut tells me we shouldn’t let him live with false hope, but it’s hard to see them in pain over something I am doing. What’s the best approach?

There is no easy solution. Your son’s concern is that the excellent family life that you and his father have created will disappear. He may cope better if you can give him concrete indicators that you are still a family. This should not be difficult as you are committed to this. Name some things as Family Events. Treasure these events.  Feature some family pictures in your own home and make sure he notices these. You could allow him to call you whatever name he wishes. You may even want to keep your married name as an unofficial middle name for family purposes. He may not like the name change no matter what you do.

It is important to consider his feelings. I would not suggest that what you do be dictated by his wishes. At times adults have to make decisions that our children don’t fully understand.

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My husband’s ex-wife is actively encouraging parental alienation. What can we do?

Posted on November 17, 2010 by Dr. Pat

My spouse and I are having on going troubles with his 13-year-old daughter. Her mother actively engages in parental alienation. Discussing court proceedings with the child, speaking poorly of both of us in their household etc. My spouse has been attempting to resolve the issues through court. Securing visitation and finalizing their divorce for over a year now. There is such fierce resistance from his soon to be ex-wife. The last proposal asked for divorce and only 4 weeks holiday with the child (who lives 18 hours away), she turned it down. She constantly makes her father out to be this horrible person he is not. Even going as far as telling the daughter that the child he and I had was to replace her. How can we regain the relationship we once had with her and show her the truth that we are not who she has been made to believe? Mom constantly changes flights, cancels weekends, holidays. Agreements that were set out the first time in court.

Your partner should continue to use the courts or formal mediation to get a settlement. Your stepdaughter is being put in an impossible situation. She is being made to choose between her mother and her father. Do everything you can not to participate in this false choice.

Do whatever you can to maintain contact and build a relationship with your stepdaughter.  Right now, it may have to be by email or letter. Don’t try to correct any misinformation. Do not criticize her or her mother. Do not expect that she will respond. Be very light. Be gentle. Find ways to engage her. Don’t go overboard but send her very small presents every once in a while.  Be only friendly. Her mother may try to block your contact but continue as well as you can.

Your stepdaughter may reject your efforts right now. Don’t be too pushy but persist. When she is older, she may change her mind.

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My grandson is very aggressive and hits other kids. What can we do?

Posted on November 17, 2010 by Dr. Pat

My four-year-old grandson is  very aggressive and strong. He hits his friends regularly in daycare and does not seem to be bothered by the consequences of his actions. He is now wearing glasses for astigmatism and he is very intelligent. His older brother is gifted and they are physical when they play as all boys will do. The parents are not verbally or physically aggressive and they are getting very worried about his behaviour. Could you give me insight on why a toddler would be hitting others around him and how to talk to him about this?

Research suggests that children are naturally aggressive.  They become less aggressive with teaching and learning. Your grandson needs to learn how to play nicely. The first step is to notice every time he is playing nicely with others. He needs to “get it” that playing nicely, without any violence, is the “big boy” or “grown up” way to play with others.

This will need a strong effort.  His older brother needs to help. Talk to him about playing nicely.  Explain that his younger brother needs to learn to play without violence. A “good play” chart for the two of them would help. For every half hour of “good playing” they should be rewarded. I know the two brothers are not hurting each other, but the younger one is learning to play aggressively with other kids from the roughhousing with his brother. It is not wrong or bad, it is just not good learning. Playing with his brother is a particularly good learning time as his parents can see it and do something.

The second effort should be to stop his aggression. Every time he is aggressive he should be immediately “timed out” or given 3 minutes to calm down and think about playing nicely.  Don’t be angry or hostile. Don’t go on and on. Just insist that he sit quietly and think about how he will play nicely.

A “good play” chart and time out can be used whenever he is playing with other children. His daycare should be involved.  They can send his chart home every day.

It will take a lot of hard work and months of work. But it will pay off. He is at a critical point in his development. He can learn to be a strong but friendly fellow or else he will become a bully. If he doesn’t stop hitting others, he will be rejected by other children. He will become more aggressive and hostile. School failure and other negative outcomes are likely.

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