14 April 2008
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
-C
Dear C: Skin color is inherited in a complex manner; however dark skin is generally the dominant trait so that if one parent has dark skin, most of the children will have darker skin than the light skinned parent and lighter skin than the dark skinned parent. Assuming, for the sake of simplicity, that skin color is controlled by just one gene, since your husband has some light skinned relatives and you have had one light skinned child, there is approximately a 25% chance that the child will be darker than his father and a 25% chance the child will be light skinned, with the remaining 50% falling somewhere between. I cannot tell you if the next child could possibly be darker than your darkest child, however, I can tell you that if the child is healthy, that is the most important thing. If your child is sick you will quickly see how totally unimportant color is.
Sincerely,
Dr. Warren
-Manuel
Dear Manuel: Almost all branches of medicine deal with Geriatrics because as people age their medical needs increase. The specialties an old person is most likely to encounter are General Medicine or Geriatrics for routine care, Rehabilitation medicine to deal with the aftermath of strokes, and injuries, Oncologists to treat cancer which becomes more prevalent with age, Cardiologists to treat cardiovascular disease including heart attacks, Psychiatrists to deal with Alzheimer's disease and depression, Surgeons, Orthopedists, etc. Each specialty will require college and medical school followed by a residency of 3-5 years plus subspecialty fellowship.
Aside from the physicians who deal with the needs of old people there are careers in nursing, physical therapy, and occupational therapy. Each requires college and specialty training.
Finally, health aides often take care of the elderly's daily needs providing in home care or care in a hospital or nursing home.
Sincerely,
Dr. Warren
Thank You very much for your time,
-PV
Dear PV: I cannot think of something that would restrict the movement of your wife's tongue interfering with her speech, the cause of which could not be found by an ENT or neurologist, with the help of an MRI; however, since speech is the only problem, instead of consulting more doctors, consult the specialist who deals with speech. See a speech pathologist for a complete evaluation and set up a program of speech therapy to help your wife deal with the problem. If there is anything unusual causing the problem, the speech pathologist might point the physicians in the right direction.
Sincerely,
Dr. Warren
Given that he is can raise his head is it safe to leave him on his tummy or should we look into some way to making him stay on his back??
Please advise
-FM
Dear FM: Once an infant has learned to turn over there is nothing you can or should do to keep him sleeping on his back. Yes, there is an increased incidence of SIDS associated with prone sleeping, but sleeping on the belly does not mean SIDS will happen. If you can turn your son back onto his back without disturbing his sleep before you go to bed yourself, then you should do it. It does not make sense to try to restrict the babies movement to keep him on his back. Somehow, I suspect that would end up causing a problem.
Sincerely,
Dr. Warren
Before this started, he had a bowel movement about every three or four days.
-Mr. L
Dear Mr. L: If the baby is having mostly small stools, there is little risk of dehydration as long as the baby is not vomiting and has reasonable fluid intake. Make sure the baby is not drinking any juice. For general principles of diarrhea management please read my article Management of Gastroenteritis.
12 days is a long time for an infant to have diarrhea, even if he is well hydrated. At this point, a stool culture should be done. In addition, since the baby was treated with antibiotics, a stool specimen should be tested for C. difficile toxin to rule out pseudomembranous colitis, a rare complication of antibiotic treatment. A urine culture to check for a urine infection should also be done since a UTI may sometimes cause persistent diarrhea in an infant.
I almost never recommend discontinuation of nursing since it is the best milk for babies and is well tolerated as long as the baby is not vomiting; however, human milk has lactose just like cow's milk, and sometimes after prolonged diarrhea an infant may have relative lactose intolerance. In that case, a trial of a hypoallergenic formula like Alimentum or Nutramigen may help. If you stop nursing even briefly, it is important to pump to maintain your milk supply for your return to nursing.
If all else fails, you should consult a pediatric gastroenterologist for further evaluation and management.
Sincerely,
Dr. Warren
-DL
Dear DL: What was the rash? Was it chicken pox? Chicken pox can have neurological complications. Sometimes a child may appear weak after chicken pox when in reality he has lost his balance. This is a temporary complication.
You say the child just figured out how to crawl. What is the evidence that your nephew has weakness in his legs? Did he lose the ability to do something he could previously do? Based on your scant description of the events and your concerns I'd suggest seeing a pediatric neurologist for evaluation.
Sincerely,
Dr. Warren
My question is where and how can I find an pediatric orthopaedic surgeon if (as has been suggested) Holly has to have surgery to stop the progression of her scoliosis? I live in ****, Missouri and there are no pediatric orthopaedic surgeons in my city that can do that sort of surgery. We are close (within 3 hours) to three major cities - Tulsa, Oklahoma, Kansas City, Missouri and St. Louis, Missouri.
I have been trying to find a place on the internet that will recommend a physician - but all the sites don't say much about the physicians record (i.e. how often they have performed certain surgeries, how qualified they are to perform a certain sort of surgery). Frankly, I am afraid of such a big problem as back surgery, with such long term potential effects for my child, being handled by anyone at all. But I would feel so much better if I could just figure out where to find the very best doctor in my area that specializes in pedicatric orthopaedics.
I know this question is a very difficult one.
Is there any way to find out things about doctors that would help me to determine which one would be the best in his/her field of study? I would like to know what kind of training (how specialized) the doctor has had and also if and how often they have been sued for malpractice and if they have ever had any license or certificate revoked for any reason - things like that.
Thank you for your time and attention. I, for one, truly appreciate your willingness to help people you don't even know. I read one time that a person could never get in to heaven on their own - that all of us will be carried there on the arms of those we have helped. Looks like you are going to have a pretty nice trip.
Thanks again.
-H's Mom
Dear H's Mom: Unfortunately I have been little help to people seeking experts in their area since, with few exceptions, I only know physicians on Long Island. To the best of my knowledge, there are no internet resources which rate physicians. Since no rating system is fool proof, I can imagine the legal issues involved in posting such information. There is a web site, DoctorDirectory.com, at http://www.doctordirectory.com which claims to provide a referral service to the best doctors for a fee. You can check their site to see if their methods for finding the best doctors suit your needs. As to whether or not they truly have the best doctors, I have not used their services so I cannot endorse them. You will have to decide for yourself. As far as I know, I'm not listed, but then, I never claimed to be the best.
You can do a web search using a search engine like Google searching for Orthopedic Surgeon and you will probably get a number of personal web sites in which the physicians will have posted their credentials. I can assure you that they won't post their malpractice history. In addition, I would urge you to be cautious about evaluating malpractice history if you can get the information. Just because an outcome is bad doesn't mean the surgeon isn't good. Just because the surgeon is sued doesn't mean he was negligent. Those surgeons who handle the most complicated cases are most likely to have the most surgical complications.
You can contact your state medical society or the closest medical school or children's hospital to see if they can help you find a pediatric orthopedist in your area. There are surgeons who specialize in scoliosis surgery.
Finally, you should ask the doctor who is treating her for a referral. If you are not seeing an orthopedist now, your physician should contact an orthopedist he knows for a recommendation of who to refer you to. Just as every physician has specialists he refers his patients to, every specialist has an expert to whom he refers his most complicated cases. If you just follow the path your specialist sends you down, it should eventually lead you to the expert you need.
Sincerely,
Dr. Warren
Sincerely,
-A Concerned Parent
Dear Concerned Parent: Sometimes conditions may be evident in prenatal ultrasound studies which are no longer evident after birth, so unless your doctor believes that this is a serious condition, it's too early to be alarmed. Even though the incidence of artifact on prenatal ultrasounds is low, it is possible that what looks like a brain cyst on the ultrasound really isn't one. Was your doctor able to tell you how much of the brain was effected by the cysts? i.e., how much normal brain there was? Could the doctor tell if the rest of the brain was normal? Did the doctor have a diagnosis based on his findings? These are crucial questions in order to know the answer to your question.
Sincerely,
Dr. Warren
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