6 November 2006
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
Do you have any idea what's going on with me? Any direction you can point me in?
Thanks.
-RN
Dear RN: If you were my patient, before answering you question I would need to run some tests. Esophageal spasms can cause pain in the back. The absence of an acid taste in your mouth does not mean you reflux has resolved. If you do have reflux, you should stay on an appropriate medicine to control the symptoms. I dose of medication will not cure your symptoms and will certainly not keep them from recurring.
If there is doubt as to whether or not you have reflux, you should see a gastroenterologist for evaluation. Other tests to consider would be chest X-ray, chest CT scan, and blood work.
Sincerely,
Dr. Warren
Dear Readers: Because of the large number of e-mails I receive and the fact that I only have time to publish a new column every 2 weeks, it now takes about 6½ years for a letter to make it to my web site. I occasionally rush to publish one that provides information that I thnk is timely and important to my readers. In any event, for those of you who can remember the Elian Gonzalez situation from so many years ago, this letter might be of some interest.Sincerely,
Dr. Warren
Greetings Dr. Warren: My question is related to a doctor diagnosing a child whom he has never met. Is it acceptable to claim that a child is abused after simply watching a video of a child whom one has never met? If it is, do pediatricians now have qualifications to diagnose patients by viewing videos of their patients? Is it also acceptable practice among Pediatricians to lie about receiving News Media Reports about a Child attacking and biting a Therapist when no such News Media Report was ever issued? Is this normal and acceptable practice for Pediatricians to be dishonest in their work? What if the Pediatrician makes such Dishonest statements in front of over a million television viewers?
Who is in charge of Pediatricians to punish them for improper and dishonest and unprofessional statements and direputable medical practice. I am referring to of course, to Dr. Irwin Redlener of Childrens Hospital at Montefiore, New York.
Thank you for your time.
-JC
Dear JC: Do you have a legitimate question, or do you just want to vent your frustration? If you are venting, you should be aware that those letters which do get posted often take up to a year to get onto my Web site, so this answer is strictly between you and me.
Can a doctor make a diagnosis without seeing a child? Such a diagnosis is questionable at best, but it is something I'm asked to do all the time on my web site. I always caution parents that I cannot do for them what a physician who has thoroughly evaluated their child can, and yet, many who ask me questions have already been evaluated and come to me seeking my advice because they have concerns about their doctor's conclusions and recommendations. Can a physician make a diagnosis of abuse from a videotape? It depends what he sees on the tape. He can certainly raise the question.
I certainly don't know what's best for Elian, but I do think that the emotionally and politically charged situation and media attention which has thrown this little boy into the spotlight has made it very difficult for an unbiased, independent evaluation of what is best for Elian to be done. There are a lot of people on both sides of the issue claiming to know what's best for Elian - good folks who have never met him who honestly believe they have his best interest at heart, when in reality, they are expressing their own firmly held convictions about Cuba, the USA, democracy, and their own values, all of which may have nothing to do with Elian's needs and his relationship with his father. Perhaps you are one of those people.
I don't think a 6 year old boy is capable of choosing what is best for his emotional future, especially when the choice must be made between his good life now and a father he has not been able to see. Whatever the final outcome, I think all obstacles should be removed from reuniting Elian with his father. Only then can anyone hope to evaluate what is best for Elian.
I am sure that Elian's relatives believe that they are doing the best thing for him. Even if Dr. Redlener has overstated his case, I think it's important for Elian's family to be aware that adults with the best of intentions can sometimes lose sight of what a child's real needs are. I don't know if the current situation may be harmful to Elian, but it's important for his family not to lose sight of that possibility in their zeal to keep him in the USA where he can, no doubt, have a better life. The question is, will that better life be an emotionally healthy one without his father and with his notoriety? That doesn't even address whether it is legal to keep Elian here against his father's wishes - a subject on which I claim no expertise.
It's not acceptable for physicians to lie. It's not acceptable for anybody to lie. It is not a normal or acceptable practice for pediatricians to be dishonest. I'm sure you knew that. I tend to look for the best in people. I presume that anything Dr. Redlener said, he believed to be true. If he was mistaken, I hope the proper authorities can rectify the situation. In the meanwhile, there are plenty of pediatricians taking a public stand against Dr. Redlener's statements. Unfortunately, everybody's credibility is tainted by his own agenda.
Do you really believe that Dr. Redlener has acted unprofessionally? Do you have information that shows he lied? If you think you have information of misconduct that is separate from your views and your opinion of his views, then by all means report them to the licensing board of Dr. Redlener's state and the Office of Professional Misconduct.
Sincerely,
Dr. Warren
I believe Dr. Redlener is misusing his position. He clearly appeared on National Television and claimed abuse by Lazaro Gonzalez against Elian with no justifiable evidence. Then he also appeared on National Television and lied about Elian biting a therapist and claiming that he received the report from a News Media Outlet. No News Media Outlet ever reported it., When he was confronted by Peter Novak on Crossfire he refused to recant his statement and reaffirmed it.
He also portrayed himself as an Independent evaluator in the Elian case but, that is far from the truth as he is often by used the Clinton Administration as a Medical Mouthpiece. He made attempts to be seen as Independent without bias.
As for Elian return to his father. There is increasing evidence that if he returns to Cuba he will not go home to his father's home which is in Cardenas, Cuba. Elian will be living in a reeducation Center in Havana, Cuba which is the headquarters of a Communist Youth Group.
I will agree that I am somewhat biased in this issue. But, I get very disturbed when I see professionals making claims that are misleading and just out-right lies in order to serve their own agenda and then claiming it to be "Medical Professionalism".
In my own opinion, if I had a member of my staff act in such a way. They would be punished with at least a letter of rebuke.
Again, thank you for your time as I know you are very busy.
-JC
-NM
Dear NM: Boys should play with boy toys, but playing with dolls is not a problem. The differences in choices for toys between boys and girls are a result of cultural expectations, and while it is important for boys to identify with male traits, there is nothing inherently masculine or feminine about a specific toy. These days men are encouraged to be nurturing and take part in the care of their children.
Dolls aimed at boys have been around for a long time, but they are usually action figures like GI Joe. That's fine for certain games but families with babies, mommies, and daddies are an important part of a boys life and there's no reason his role playing games shouldn't include caring for a baby. It takes a lot more than playing with a doll to have any reason to be concerned about a 3 year old boy's gender identity.
Sincerely,
Dr. Warren
Thank you.
-S
Dear S: I understand your reluctance to take risks in your nephew's management. Unfortunately, to benefit from the wonders of modern medicine, we have to take some of the risks involved in diagnostic studies and treatment protocols. In order to decide what risks should be taken, the patient or his guardian must understand what risks are involved, what alternative approaches could be taken and what the risks of those are, and what the risks of doing nothing or not following the doctor's current recommendations are.
The risk of injecting a dye for an MRI is small. To decide whether or not the risk is warranted, your nephew's parents need to know what the doctors are looking for, how the MRI will help them, and what to expect if they don't proceed at this time. Since you have not told me just what part of the baby the doctors want an MRI of, I cannot give you more specific advice.
It is not clear to me what the doctors mean when they talk about fluid collecting in the baby's throat blocking feeding, unless they believe that the baby has some kind of tracheoesophageal fistula. If the parents' only understanding of what is going on is that there is fluid in the baby's throat, they need a more thorough explanation of what's actually going on.
It is also not clear to me whether or not you are describing a baby who is having problems because of a neurological injury due to lack of oxygen at birth. As long as the baby is being fed adequately through the tube and is able to breathe normally the baby is not at risk to develop any brain damage (or additional damage if any brain damage has already been sustained).
Sincerely,
Dr. Warren
She has very brittle and soft nails that breaks easily and her last tooth came out cracked about 2 weeks ago. There is a vertical crack in her tooth.
She is still drinking powder milk because if she drinks too much cow's milk, her tummy gets funny. She is developing normally in every other aspect and has no serious illnesses or allegeries.
What should I do? What kind of food should be given to her?
-MC
Dear MC: I cannot possibly advise you regarding your daughter's diet, nor can any other doctor, without knowing if she indeed has an abnormality of calcium metabolism. She needs to be examined by your pediatrician who may also want to do some blood tests or have her evaluated by an endocrinologist to determine if there is some metabolic problem.
Sincerely,
Dr. Warren
-MV
Dear MV: It is unlikely that anything is being overlooked as long as your daughter is making progress with her physical therapy. Low muscle tone is often seen with developmental delays. As your daughter starts to walk, the strength in her muscles may increase. Right now the most important thing is for her to continue in the early intervention program.
The medical evaluation of a child with low muscle tone and developmental delays should be done by a pediatric neurologist. If your daughter has never been evaluated by a pediatric neurologist, she should see one.
Sincerely,
Dr. Warren
-TR
Dear TR: Sometimes young children develop a habit of urinating frequently. If left alone, this behavior will often stop on its own. The normal urinalysis rules out diabetes as a cause. That is expected because the fact that the second urination is only a few drops indicates that the urine output is not increased. Only the frequency is increased. A normal urinalysis would also go against an infection as a cause of the symptoms, but only a urine culture can truly rule out infection.
The pattern you are describing could indicate that your son is not emptying his bladder completely when he does his "regular urination." If the symptoms persist he should see a pediatric urologist for further evaluation.
Sincerely,
Dr. Warren
Thank you.
-WT
Dear WT: Current recommendations from the American Academy of Pediatrics regarding milk are as follows:
You are doing the correct thing by giving your children skim milk.
Sincerely,
Dr. Warren
If your questions haven't been answered here, perhaps you would like
to
question?!?
