8 October 2001

1. Infrequent Urination
2. Amniocentesis
3. Degenerative Disc Disease
4. Help for Retinitis Pigmentosa
5. Student Question
6. Pain, Bulge by Anus,Too Embarrassed to See Doctor
7. Flaky Scalp
8. Masturbating 7 Year Old
9. Disclaimer

• Read Questions & Answers in Another Column

Infrequent Urination

Thank you.

-Gloria

Dear Gloria: Your granddaughter's infrequent urination significantly increases her risk of developing a urinary tract infection.

Sincerely,
Dr. Warren

-BN

Dear BN: There are certainly some risks to an amniocentesis which your wife's obstetrician would have explained to your wife before having her sign a consent. Most amnios proceed without complications and provide vital information which, as of this point, cannot be obtained any other way. There is a risk of miscarriage and hemorrhage after an amniocentesis. There is a risk of injury to the placenta or umbilical cord, but this can usually be avoided by determining the placement of these structures by ultrasound. Amniotic fluid is constantly circulating and replenished. New amniotic fluid will be produced to make up for the amount removed. The volume of fluid removed for testing does not pose a risk to the fetus.

Sincerely,
Dr. Warren

Dear Dr. Warren: Thank you for allowing me to ask you a couple of questions. You have no idea how thankful I am to learn that you might answer my inquiry. Today I was diagnosed with degenerative disc disease L-5/S-1 and osteoarthritis. I am 51 years old and feel great except for the constant aching and burning in my lower back area. The pain and burning is worsened by bending. My doctor prescribed Naprosyn 500mg PO/BID. I asked my doctor if this was a crippling condition, if I will eventually end up in a wheelchair, or if I have cause for worry. He stated that he was not concerned and if the medication did not work he would refer me to a "spine specialist". I would like a second opinion addressing my questions to him. I understand that this condition is irreversible, but is it also a condition that will limit me in all activities, such as housekeeping, walking, daily activities? Will I become crippled over time? Is this a condition that is common in people my age and will this condition worsen on it's own? Thank you again for taking the time to read and hopefully respond to my letter to you.

Most Sincerely,
-Alex

Dear Alex: Degenerative disc disease with osteoarthritis need not be a crippling condition. Obviously severe pain can limit your activity. That can result in atrophy and therefore weakness of unused muscles which can further limit activity. Therefore, it would be wise for your doctor or a physical therapist to set up an exercise program for you to keep your muscles in the best possible shape. Physical therapy can also be useful to reduce symptoms of disc disease. Your medication should be adjusted as necessary to provide you with enough anti-inflammatory activity and pain relief to allow you as much activity as possible.

If you develop any nerve impingement symptoms such as weakness in a leg, numbness, tingling, shooting pains in the leg or buttock, or impairment of bowel or bladder control, then you may need to consult a specialist such as a neurosurgeon.

I cannot state any figures on the frequency of osteoarthritis or degenerative disc disease in people our age (I'm 50). Osteoarthritis can get worse with time, but treatment should be aimed at preventing complications and disability.

Sincerely,
Dr. Warren

Please advise us what we can do to help these littele ones.

Please reply to me.

With Love,
-SG

Dear SG: Unfortunately, I am not familiar with any medical facilities in your part of the world. Perhaps you can get in touch with Retinitis Pigmentosa International at
23241 Ventura Blvd. #117
Woodland Hills, CA 91364
Phone: (818) 992-0500
Fax: (818) 992-3265
Toll Free: (800) 344-4877.

Maybe they can answer your question. Their web site can be found at http://www.irpa.org/.

They list the following contact in India:

Mr. V. Kalyanaraman
Society of Retinitis Pigmentosa Patients (SORPP)
127, Linghi Chetty Street
Madras 600 001
India
Tel: ++91 44 52 29 622
Fax: ++91 44 58 10 22

Sincerely,
Dr. Warren

Can you be promoted when you're a pediatrician or do you just earn more money with more years of experience? If you can, what does it take to be promoted?

Also, what do you feel are personnal qualifications for the job?

If at all possible, could you respond to my e-mail ASAP? The essay is due in a few days and I didn't find your website (which I've found to be extremely helpful) until today. Thanks in advance!

-AP

Dear AP: Most practicing pediatricians in the USA are in private practice, which means they are self employed (i.e., the boss, or a partner), therefore they cannot be promoted, although they can advance in their field. A physician in private practice may spend time doing research or teaching. If he has an interest in hospital politics, he can assume a leadership role in his department and perhaps become chief of his department or chief of staff. These advancements may provide recognition, but they do not necessarily translate into increased income. A Pediatrician may also become known in his community for his expertise in management of certain conditions and therefore attract patients who have specific needs and he may also get referrals from other pediatricians much like a specialist.

Upon entering private practice, it takes time for a practice to grow, and so for a while, the practitioner's workload will increase and so will his income. If he joins another practice, his advancement in the practice will depend on the terms of his partnership contract. These may vary from practice to practice and I do not have knowledge about the terms of most standard 1990s contracts. Unfortunately, more years of experience does not guarantee more income. Pediatricians get paid by the number of patients they care for. The only way to get paid more is to work more. Fees are largely set by HMOs and insurance companies since few uninsured patients seek private care and those that do cannot afford high fees. Rich folks generally have health insurance. The average pediatrician in my area today spends more time doing paper work for insurance companies, pays more to his staff to deal with insurance issues, and gets paid less to see each patient than he did in 1993.

Those physicians who are not self employed may work for HMOs, medical groups, the military, or hospitals. Depending on the organization of their departments they may rise through the ranks or be recruited by more prestigious institutions if their reputations become widely known because of noteworthy accomplishments or administrative skills. Physicians in private practice may also be recruited by institutions, or may choose to leave private practice for other employment. A pediatrician's education and skills provide him with a wide range of employment possibilities.

The personal qualifications (qualities) to be a pediatrician are: A pediatrician should be kind, caring, gentle, patient, honest and ethical, genuinely concerned about helping people, love children, committed to educating and helping his patients and their parents, dedicated to the well being of his patients, intelligent, well educated, have good diagnostic skills.

Sincerely,
Dr. Warren

What are the chances of becoming a pediatrician? Is the job high in demand or are too many college students deciding to go into pediatrics and there aren't many job openings?

Also, what is the outlook of this career in the future?

I know that this is definitely pushing you to the extremes, but could you please, please get the answers back to me as soon as you can? I need to have the information by tomorrow.

I'd really appreciate it if you could have it to me by sometime today but if you can't, you can't and I understand.

Thanks in advance!

-AP

Dear AP: If you look in a newspaper like the New York Times, there are plenty of jobs for pediatricians, but as I previously explained to you, most pediatricians are self employed in private practice. There are areas of the country with physician shortages and areas that have a glut of pediatricians. Somebody wishing to start a practice today would do well going to an area that needs pediatricians and participating in as many major insurance plans as he can.

The practice of medicine may change dramatically over the ensuing years, but as long as there are children, there will be a need for pediatricians.

Sincerely,
Dr. Warren

Thanks for your time, I really need your help

-CZ

Dear CZ: A hemorrhoid is a varicose vein in the anus. It may bulge out from the anus and become swollen and painful. If that is what you have, you can relieve the pressure on the hemorrhoid by using a lubricated finger to push the hemorrhoid back up into the anus, and avoid future strangulated hemorrhoids by making sure you don't ever leave a hemorrhoid sticking out through your anus after a bowel movement in the future.

If the lump to which you are referring is 1 to 2 inches away from the anus, it cannot be a hemorrhoid. It could be an abscess, but without knowing more exactly where it is, I cannot be sure. In any event, if you are having extreme pain, you shouldn't fool around with your problem. You should see a doctor.

Many college students attend the clinic at school. Nobody has to know why you are going. Your visit is private and confidential. Clinic staff will not discuss your condition with anybody. College clinics understand that young adults need access to care without involving their parents. Nobody will contact your parents without your permission. Most young adults are healthy and have little experience seeking medical care. What you and many young adults need to understand is that medical afflictions of private areas of the body may be embarrassing for you, but the doctors have dealt with a variety of private parts many time. Do not let embarrassment prevent you from getting the care you need.

Sincerely,
Dr. Warren

I'm wondering if I should contact the doctor or let it be. My mother in law said that his aunt was like this when she was young and it went away as she out grew it. I am an elementary school teacher in a lower income community and the children in school sometimes have patches where they have no hair because of a scalp problem. I don't want this for my son and I'm concerned that waiting will cause it to be more serious.

Thank you for any advise you can give me on this matter without having actually see him.

-KB

Dear KB: Some children with severe cradle cap do outgrow it, but the progressive spread of the cradle cap while being treated with a tar shampoo is a bit unusual. On the off chance that there is some secondary infection or other condition rather than seborrhea (the medical condition which causes cradle cap), you should have your pediatrician reevaluate it or consult a dermatologist.

Sincerely,
Dr. Warren

-DA

Dear DA: Children vary in their desire for sexual stimulation, but the human being is a sexual animal, and even children sometimes masturbate. You cannot watch your son every minute to control his primal urges. Therefore, the most important thing you can do is to make sure he understands that masturbation is a private matter and that he should not be touching himself in public, which includes at home in the presence of other people.

Sincerely,
Dr. Warren

If your questions haven't been answered here, perhaps you would like to

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