17 December 2001

1. Baby Refuses to Nurse
2. Wedding Night Advice
3. Giving Water to Infants
4. Safety of Flying with Infants
5. Dots on Penis
6. Vomiting. ?Metabolic Disorder
7. Pricked by Dissection Needle
8. Degenerative Disc Disease
9. Disclaimer

• Read Questions & Answers in Another Column

Baby Refuses to Nurse

Please help, I really enjoy nursing and I know how good it is for my son. I really don't want to stop nursing, but I do want to find out what is causing this problem and what I can do to make nursing an enjoyable experience for him again.

Sincerely,
-TH

Dear TH: If your son has experienced a sudden decrease in nursing and it persists, you should probably have him checked by his pediatrician to make sure everything is okay. Children do lose their appetites when they are ill.

If he is eating solids well, and is happy, you may have to decrease the amount of solids you feed him to get your son to nurse more. But if he really likes and eats a lot of solids, he may indeed prefer that. After 6 months of successful nursing, you won't lose your milk if your son cuts down on nursing. Your supply will decrease to meet his lower demand. Your son may also have less desire to suck. He may be taking more milk than you think in the amount of time he spends on the breast.

If you are unsure how well your son is doing, you should have him weighed periodically and review his diet with your pediatrician.

Sincerely,
Dr. Warren

I am afraid about my first sexual intercourse. What is the best way to perform sex with full enjoyment, for me and my partner too. And also tell me what is the best position for first sexual drive. My friend was telling me that at first time, some bleeding is normal during first intercourse and pain too. Is this normal or not?? And also please tell me that what advice and preparation is necessary before my first sexual intercourse for me and for my virgin wife, i.e. first touching her nipples & kissing etc.

What kind of fruits & vegetables are more suitable for my sexual life (i.e. for increasing semen). Please don't write any drug or tonic names.

I am very very thankful to you, if you reply my above questions.

I have not any experienced & knowledgeable friend that he could answers my questions. And here is no adult education or good adult books that they help me. I am very confused & very curious, about it.

So Please Please HELP me and send answers to my questions.

I am waiting of your reply.

Thank you.

Yours truly
-A

Dear A: It is possible for there to sometimes be pain or bleeding on the first intercourse, but this can be significantly decreased if both partners are relaxed. If your mate is anxious and tightens her pubic muscles, it will increase her pain. I think the thing to remember is that your wedding night is not about having intercourse. It's about making love. There is no rush to get to intercourse. You will both know when you are ready, and you will both have so much more joy if you don't rush the wedding night to it's first climax. It doesn't matter what you touch first or what position you're in. Your touches should be gentle caresses that make your wife feel safe and loved. Explore each other's bodies and enjoy each precious inch. Kiss, hug, hold, love. Don't think about your pleasure, but rather, look to find what gives your wife pleasure. If you please her, you will find your own excitement growing. As she becomes excited from your touch, she will become lubricated, making intercourse easier and more pleasurable. Don't be afraid to communicate about this most important occasion. Whether or not you speak while you make love, or use a gentle touch to guide a hand, you most both teach each other and discover what each other like. Your wedding night is not a contest. Neither friends nor relatives need to hear tales of sexual Olympics. This night is for just the two of you. But it doesn't have to be the best night of your life. It is the beginning. If you love each other, are patient with each other, and communicate with each other, it will get better and better. You do not need any tonics. There is no special diet to improve sex. If you are healthy and have no medical problems which could contribute to sexual difficulties, all you need is each other, love, patience, caring, and consideration. The rest will take care of itself.

Sincerely,
Dr. Warren

-ER

Dear ER: I have never heard that the AAP recommends not giving water to infants; however, most infants will meet their fluid needs through nursing or formula feeding, so additional water is generally not necessary. It would be undesirable to give large amounts of water to young infants because it may decrease their intake of nutrients and, since water has no salts, an infant who drinks too much water too quickly could become hyponatremic (low blood sodium) and have seizures.

If an infant is feeding well, it would certainly be all right to give him a few ounces of water between feedings if he seems to need something.

Sincerely,
Dr. Warren

Thanks.

SF-

Dear SF: Young infants are more prone to ear problems than older children because of the size and shape of structures related to the middle ear, but if an infant is not congested, even a young infant should be able to tolerate a flight. The baby may have discomfort during take off and landing which may be decreased by nursing or feeding since swallowing opens the Eustachian tube. Flight does not pose a danger to an infant.

Sincerely,
Dr. Warren

-Dustin

Dear Dustin: Without seeing the dots on your brother's penis I cannot be sure what they are. The skin on the underside of the penis may sometimes have large hair follicles giving it an appearance somewhat like chicken skin. On the other hand, your brother could have a rash. I doubt that it is serious, but it's not possible for me to give reassurance without knowing just what your brother has.

I really don't understand why your brother doesn't want to tell your parents. As a big brother, it's good that your little brother can trust you to come to you with his concerns, and you don't want to violate that trust. But you are also a kid, lacking enough life experience to always provide the best answers. As the big brother, you need to know when you're in over your head and encourage your brother to talk to your parents. It's perfectly okay for kids to expect some privacy and not tell their parents every detail of their thoughts or lives, but you ought to be able to trust your parents enough to confide in them. Trust is a two way street. If you don't trust your parents and keep secrets from the when you should be turning to them, they will not be able to form a basis for trusting you. If there's a reason you can't trust your parents, you must find an adult you can confide in. You are always welcome to write to me, but I can't be there to really help out.

Sincerely,
Dr. Warren

-MF

Dear MF: Diabetes is not difficult to diagnose in children. When children are sick from diabetes, they have sugar in their urine, and their blood sugar is elevated. There are a large number of metabolic diseases which can cause vomiting and dehydration. If the gastroenterologist or your pediatrician think your child has a metabolic disorder, they should refer you to a pediatric endocrinologist.

Sincerely,
Dr. Warren

-U

Dear U: Specimens used in school biology classes are generally preserved in a material like formaldehyde which also kills infectious agents. I have never heard of a case of infection from a school biology class specimen. They do not carry fatal viruses.

Sincerely,
Dr. Warren

I would like to know what I could/should ask our doctor concerning physical therapy for my DDD. I haven't the foggiest idea how I may benefit from physical therapy, how I can pose the request to our doctor (I am certain I have the right to ask and am not intimidated to ask, but I do not want to be ridiculed for asking if it is not an option at this particular time ), what I could expect from receiving physical therapy and even if I should seek physical therapy at this time. Only occasionally do I have a very slight tingling in my left leg. I still have difficulty rising off our daughter's waterbed or from laying on the floor. Would PT help eliminate some of the constant dull pain I experience?

Also, the Naprosyn 500mg I take 2 twice a day is a great comfort, however it does not seem to have a lasting daily effect. I would like to know what other drugs would be useful in managing my pain, yet not cause rectal bleeding, and not cause me to feel drugged. I want/need to stay as active as I possibly can, yet have found myself becoming somewhat depressed when I think I could possibly be crippled in 5 or so years-or even sooner. I do not wish to become dependent on drugs and am very grateful that the Naprosyn has nearly eliminated the burning sensation and dulled the pain, yet it's effect seems to fade quickly. If I was knowledgeable on what to ask our doctor then I would feel as if I had some control in living with and managing this condition.

I wonder if this is hereditary, as our son was diagnosed with Grade 1 L-5, S-1 Spondylolysis and Facet Degenerative Arthritis while serving in the military and was told that he inherited the disorder. He was d/c'd from the Army with a 20% Veteran's Disability.

Thank you again, sir, for taking the time to answer my concerns. I look forward to learning from you and appreciate your kindness in replying to my many, many questions posed to you.

Most Sincerely,
-Alex

Dear Alex: Unfortunately your questions are really outside the area of my expertise. You may need to see a specialist such as an orthopedist or rheumatologist if you are having increasing pain. If your doctor doesn't answer your questions adequately, I'm glad you're looking for another. I should tell you that it is the person, and not the degree which makes the difference. My son's first pediatrician was a D.O., and the assistant director of the pediatric ICU where I went to medical school. Actually, the training of a D.O. should make him eminently qualified to deal with back pain, but communication skills, unfortunately, don't necessarily come with any degree.

Physical therapy will not do anything to prevent the progression of degenerative disk disease or osteoarthritis; however, except for rest as a temporary measure for extreme pain and inflammation, it is important for you to remain active. Inactivity and muscle wasting will only aggravate your pain in the end. Physical therapy can help you maintain strength in the muscles you find painful to use and teach you effective, less painful ways to do things you have difficulty doing because of pain. Maintaining and improving muscle strength and learning the right way to do things for a person with your current degree of disability can help to prevent injury. Physical therapists also use modalities such as heat, ice, massage, and electrical stimulation as appropriate to relieve symptoms. Relieving the secondary muscle spasm that results form your disease is an important part of your treatment. An appropriate course of medical management including pain relief, anti-inflammatory medications, and physical therapy is considered essential before considering surgical options for the treatment of low back pain and sciatica. The fact that your underlying condition cannot be cured and may progress is every reason to get as much benefit as you can from therapy rather than resigning yourself to a life of progressive disability.

Naprosyn is an effective anti-inflammatory as well as a pain reliever. There are many drugs in the same category. These drugs do not cause dependence, but if you have a chronic condition, you may find that your symptoms increase when you don't take your medication. That is no different than an asthmatic staying on appropriate asthma medicines or a diabetic taking insulin. You will need to work with your doctor to find the best combination of therapies to control your symptoms. While it is reasonable to take the least amount of medicine to maintain adequate control over your symptoms, your goal is not to be medication free. Your goal is to maintain maximum function.

Some forms of arthritis are hereditary such as ankylosing spondylitis. They are often associated with specific tissue types or HLA types. If there is a question about whether or not you have such a condition, a consultation with a rheumatologist is in order.

Sincerely,
Dr. Warren

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