23 February 2004
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
A few months ago, you answered a few questions for me. I'm finishing my 3rd year in medical school. I'm approaching decision time with regards to my residency choice. I know I want to work with kids. That's a no-brainer for me, but i'm not 100% sure that Pediatrics is the way to go.
What are the advantages/disadvantages of choosing: Pediatrics vs. Family Practice vs. Pediatric Physical Rehabilitation medicine with regards to salary, residency and post residency call schedule, and amount of free/family time life outside of work. Any other advice regarding alternative residency avenues (that involve children) would be most helpful I've read your advice with regards to pediatrics, and I know you do not specialize in the other 2 areas listed above, but anything you do know, would be helpful.
Thanks.
-Jeff
Dear Jeff: If you want to work with kids but you'd also enjoy taking care of adults and working within the milieu of the whole family, family medicine is the way to go. If you then take it a step further and go to an area where there are shortages of physicians, you could be in for a rewarding career as the town doctor. If you consider family practice, you need to be aware that the elderly require a great deal of medical care, and unless you restrict your practice to avoid geriatrics, as a family practitioner you will be seeing a lot of elderly patients. If that's not your cup of tea, you have to think twice about that option. Perhaps you could visit the practice of a local family practitioner and see what family practice is like in the real world.
Pediatric Rehab is likely to be a salaried position at a hospital or rehabilitation facility. As such, it is likely to be less lucrative than private practice, but it will also avoid a lot of the hassles of private practice and running a business. These days, with the influence of HMOs, a salaried position may be close to or on par with the earnings potential of private practice. The hours are likely to be better and more regular than private practice. Your patients will include children with neuromuscular conditions and children recovering from injuries. Since my interest in pediatrics was sparked by my job as a camp counselor at a camp for physically handicapped kids, I considered that possibility for myself.
Pediatric psychiatry would also allow you to work with children in a very different way than other pediatric specialties. It may also be more amenable to regular hours than general pediatrics, but even in general pediatrics, it's up to you to decide how you want to handle call schedules. Building a practice requires availability, but even that depends on the competition and standards in your community.
You can look at any of the pediatric subspecialties. Specialization generally requires a longer residency, but it can also result in a better call schedule and possibly better pay (less true in the days of HMOs). No matter what specialty you choose, emergencies occur and night call and holiday call are a fact of life. How it affects you depends to a large extent on the size of your practice and how you decide to handle call.
Sincerely,
Dr. Warren
My two year old son recently had pneumonia and was admitted to the hospital. I was told his blood oxygen level was 90. I know this was serious but I have not been successful in getting my doctors to tell me everything. I want to know exactly how serious that was and if there could be lasting effects from it. I would truely appreciate your answer.
By the way, I think your web page is a great service. Thank you.
-Mrs. S
Dear Mrs. S: The blood oxygen level of 90 probably refers to the oxygen saturation. The normal oxygen saturation for a healthy person in room air is 98-99%. There are people with chronic lung disease or cardiac disease who walk around with oxygen saturations in the 80s. An oxygen saturation of 90 will not have any lasting effects on your son, but it indicates that his pneumonia significantly impaired his lungs' ability to oxygenate his blood.
Sincerely,
Dr. Warren
Thank you.
-Patricia
Dear Patricia: I would agree that you don't want to do unnecessary surgery to treat a simple problem like constipation, but in my 22 years as a practicing pediatrician, I have never had a child treated surgically for simple constipation. Your doctors must have some reasons for thinking surgery is warranted and it is their obligation to explain it to you in detail. They need to tell you the suspected diagnosis, what tests confirm their suspicions, what other tests need to be done, and what treatment alternatives there are. Explaining their diagnosis in layman's terms such as saying "the intestine is tight" is helpful to aid your understanding, but it is not sufficient. You are entitled to the full medical explanation.
Does the doctor suspect Hirschsprung disease? If so, a rectal biopsy will confirm the diagnosis and you can intelligently discuss the need for surgery. Is there an abnormality of the anal sphincter or its position? Have intestinal abnormalities been demonstrated on x-ray studies? If the diagnosis is not clear, consult a pediatric gastroenterologist before consenting to any surgery. If there is no pediatric gastroenterologist in your area, it is worth the trip to a university center for evaluation.
Sincerely,
Dr. Warren
Q: Does she need some sort of iron in her diet right now? If not now, when?
-JB
Dear JB: Eliminating the iron from your daughter's diet may not help at all with gas, but if you find that she is happier on the low iron (no iron) formula, you should try to get her back on to iron by 3 or 4 months, by which time her hemoglobin will be at it's lowest level and she will start having an increased need for iron.
The American Academy of Pediatrics recommends formula with iron.
Sincerely,
Dr. Warren
As you can see, this is a problem that would be of interest to many readers, and not a personal problem. Thank you.
-RS
Dear RS: I don't know of any medical means for improving the appearance of eyelashes. I think you need to talk to a beautician.
Sincerely,
Dr. Warren
Do these medications in any way neutralise the effect of the prepulsid? Yesterday I stopped using the Prepulsid as it simply wasn't doing anything (he was only on it for 9 days). He seems to be spending at least 3 hours a day screaming and its a mixture of teeth and wind. Do you have any suggestions to help him sleep a little longer of a day time - he is currently unbearable and I'm fast becoming a basket case.
-JO
Dear JO: Panadol will not interfere with the function of propulsid. I am not familiar with bongela, nor can I find any medical reference to it. If your doctor seriously suspects GE reflux as the cause of your infant's irritability, considering that he did appear to respond at first to propulsid, he should have an evaluation by a pediatric gastroenterologist. There are many medications and approaches to treating reflux, and if the diagnosis is established, then you and your doctor can be committed to finding the appropriate regimen for treating him. If the diagnosis of reflux cannot be established, then other avenues should be explored.
Sincerely,
Dr. Warren
Note To My Readers:Use of Propulsid has been discontinued in the United States.
-(unsigned)
Dear Sir: First, I must tell you that I don't think stretching your penis by hanging weights on it can make it any larger. I can certainly think of some potential dangers to this technique. First, since the penis is fairly soft, except when erect, you will have to tie the string tight enough to constrict in order for it to stay on. If you should get an erection, the string will cut into your penis. The constriction of the penis may cause the head of your penis to swell. This could make the string difficult to remove causing it to constrict progressively more and act like a tourniquet, cutting off the blood supply to the head of your penis. In the event that the string is thin enough and tight enough, if it should accidentally get yanked suddenly, it could act like a guillotine, cutting off the head of your penis. At the very least it could cause significant injury. Finally, I cannot imagine how you will urinate with a string tied tightly around your penis.
Having a large penis may certainly help your self esteem, but it won't make you a better lover. I think you need to explore why you are so concerned about the size of your penis.
Sincerely,
Dr. Warren
Thanks
-Cole
Dear Cole: Even after reading the chapter on vertebral fractures I couldn't come up with a simple answer to your question. A lot depends on the type of fracture and whether or not surgery is required to repair the fracture. In general, early healing of most fractures (like a finger or collar bone) is established within 2 weeks. The larger the bone and the more weight it has to bear, the longer it takes to return to full function. I would guess, depending on how complicated the fracture is, it would take 1 -2 months to return to normal function. That doesn't even consider the issue of spinal cord involvement.
Sincerely,
Dr. Warren
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