Dr Julius Parker: Stretched skin and febrile seizures

Qam a man in my mid 30s. As a child I was obese right up until I was 24 when I weighed 18.5 stone. I embarked on a diet with the help of my GP and dropped to 12.5 stone. I have maintained that weight loss, however I am still suffering as I have loose skin on my belly and chest, effectively meaning I have man boobs and a belly that hangs down about six inches from my body. This is really difficult to live with. Is there anything I can do? I don’t want to go down the surgery route.

A You’ve obviously done really well to lose this weight. One of the common consequences of significant weight loss is the presence of excess folds of skin. This can be centrally over the stomach, or can extend around the sides of the abdomen. Excess skin can also cause problems with “man boobs” and can also be noticeable on the thighs and under the upper arms.

The difficulty you describe is usually not so much due to excess fat, but because the skin itself was permanently stretched when you were heavier. It is now lax and unsupported. Many people do feel self-conscious about their appearance although you should be very positive about how much you have achieved.

Unfortunately in most cases diet and exercise on their own cannot resolve the skin laxity and remove the excess skin. It sounds as if you may have reached the same conclusion. This means you may need to consider a surgical procedure. You are right to be cautious, and before deciding you should discuss your options thoroughly with a plastic surgeon.

Your general health is also an important factor. I think you are likely to benefit from a procedure called abdominoplasty. This tightens the abdomen by removing excess skin and, if necessary, it can remove fat and tighten any loose stomach muscles. This is a significant procedure, and you should go ahead only if you feel confident in your surgeon and you fully understand the pros and cons of the operation, and what it will and will not achieve.

QMy 16–month–old son recently had a febrile seizure. Is there anything I can do to prevent another one?

A This can be a very upsetting event, and it’s natural to feel anxious about a recurrence.

As your doctor has probably told you, febrile convulsions are common and about one in 20 children have at least one. The average age of occurrence is 18 months. It’s a tendency that can run in families, so it’s worthwhile checking this with your partner and parents.

They occur whilst a child has a temperature, usually above 38C. The commonest reason for this is an infection. Your child will not have a febrile convulsion unless they have a fever, there’s therefore no treatment to give to children who are well. However, if your son develops a cold, or for example an ear infection or tonsillitis, it’s reasonable for you to give Paracetamol and/or an anti-inflammatory suspension on a regular four to six hourly basis. You should check the correct dosage on the bottle, and not exceed this. Studies have not proven this approach to be successful, but it remains helpful for parents.

Your GP will understand your concerns, and as it can sometimes be difficult to assess whether or not a child needs antibiotics for their infection. Your GP may have a lower threshold for such prescriptions in children with a history of febrile convulsion.

The risk of another febrile convulsion reduces the older your child gets, and they are comparatively rare after three years old.

Although your anxiety is understandable, I hope this background information will reassure you.