2 March 1997
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 physician who knows you and cares about you.
Dr. Warren
Dear Readers: I have been working very hard to respond to all your questions within a few days. The volume of e-mail I receive is increasing and sometimes I get busy with sick patients and fall behind. If I receive a question that sounds urgent I try to answer it right away. Since some of you ask me questions I don't have all the answers to, those take a little longer because I have to research my answers.
Recently I received two questions whose e-mail responses were returned to me as undeliverable. I am not sure how that can happen since I respond to the e-mail address I receive the question from. This is done automatically by my e-mail program. I don't type the address, so I can't make a mistake in the address. While neither question was urgent, I have included them as the first two questions in this week's column so that the people who asked the questions can see the responses.
If you send me a question, please be sure that the e-mail address it is sent from is a legitimate address and can accept a response. If not, include the address you wish the response sent to in the body of your e-mail.
Sincerely,
Dr. Warren
-JC
Dear JC: I am assuming that what you are referring to as a "soother" is what we call a "pacifier" in New York. If I have misunderstood you my answer will be somewhat strange and I apologize.Infants have a great sucking need. Some infants still need to suck after a meal or between feedings. This can be quite soothing to them. By 4 months of age the sucking need is not quite as strong, but an infant can start to become quite dependent on using the pacifier. By 4 months parents should be cautious not to put the pacifier into the baby's mouth every time the baby cries otherwise the baby will be dependent on the pacifier for relieving stress.
Once an older infant has become dependent on the pacifier it can be very difficult not to give it to them when they want it. Some children depend on it for sleep. Eliminating this dependence requires gently decreasing the situations in which it is available. Use of a pacifier past early infancy, just like sucking a finger, can have an adverse effect on the position of a child's teeth and may result in a need for orthodonture in the future.
Sincerely,
Dr. Warren
I do however think these sweats are caused by something. Please help I am at my ropes end. Do you have any ideas or suggestions?
Thank you for your time.
-T
Dear T: Many people, children included, have clammy, sweaty palms and feet. The condition is often aggravated by stress. It is not a symptom of heart disease. Sweating may be seen with hyperthyroidism. If your doctor has found your daughter's growth to be normal and has found her to be generally healthy, you should not worry.
Sincerely,
Dr. Warren
- ST
Dear ST: The epididymis is part of the testicle. It is actually a collection of small tubes which run down from top of the testicle along the back of the testicle to carry sperm from the testicle to the spermatic cord. Epididymitis means inflammation of the epididymis. Most epididymitis is caused by viruses and is not sexually transmitted. It is possible for tuberculosis, gonorrhea, and syphilis to cause epididymitis, however there would usually be other symptoms. Both gonorrhea and syphilis are sexually transmitted diseases. If you need more information about the symptoms of either of those illnesses please write back. Since women do not have an epididymis, it is safe to say that a woman cannot catch epididymitis from a man no matter what is causing it; however, all appropriate cautions should be taken to prevent sexually transmitted diseases if a woman cannot be certain of what a man may or may not have.Sincerely,
Dr. Warren
Thank you.
-MV
Dear MV: Hashimoto's Thyroiditis is an inflammatory disease of the thyroid gland. It is true that there is no cure for Hashimoto's Thyroiditis; however the inflammation will go away. After the inflammation has resolved your friend may be just fine, but there is some risk that she may become hypothyroid (low thyroid function). She will need to have her thyroid functions checked periodically. If she becomes hypothyroid she will need to take thyroid hormone replacement. If that happens she will need to take the hormone for the rest of her life. If your friend is still having inflammation of her thyroid gland, and if there is a lot of swelling, it may help to put her on thyroid hormone now to help her thyroid rest. Your friend should see an Endocrinologist. Endocrinologists are the specialists who treat glandular disorders like thyroid disease.Sincerely,
Dr. Warren
Thanks again
-MV
Dear MV: Mood swings, course hair, and weight gain may certainly be seen with hypothyroid (low thyroid function). Also, your friend's thyroid could be getting larger if she is hypothyroid. The enlargement of the thyroid appears as a lump in the neck. You friend may not be taking enough Synthroid. It sounds like it's time for her to see her doctor.Sincerely,
Dr. Warren
-LC
Dear LC: The answers to your questions are as follows:
2) How many years of school and training did you have before becoming a pediatrician? What kind of courses were required of you to take?
After high school I went to college for 4 years. I took a full load of math and science courses with emphasis on biology and chemistry. After college I went to medical school where we studied anatomy, biochemistry, physiology, pharmacology, microbiology, pathology, and then clinical courses. After medical school I took a 3 year residency in pediatrics.
3) What kind of requirements must be met in order to get into medical school?
Since there's a fair amount of competition for medical school you need good grades at a good school. You don't have to major in science, but you will need to meet basic requirements in biology and organic chemistry. You will have to take an exam - MCAT (Medical College Admissions Test) which is sort of like a big medical school SAT.
4) What was your undergraduate major? If you had one what was your minor?
I majored in Biology. I didn't have a minor, but the science requirements at RPI were so stringent that to be a biology major I had to take 10 biology courses and 7 chemistry courses, calculus, physics, and differential equations. I'm sure that would count as a minor in chemistry in most schools.
5) Through the research I've done thus far, I was told that the average income, after expenses, for all first year physicians is about $72,374, and with twelve or more years of experience one could easily approach $200,000 yearly. Comparing this to your salary would you say this is pretty near accurate or is this a high or low estimate?
You must consider that I started in practice 20 years ago. I earned $30,000 my first year. I'm sure some physicians earn $200,000. In fact some specialized surgeons earn more. I would be unable to base a conclusion on my own earnings. Pediatricians are near the bottom of the pay scale. I am not near $200,000. I would also tell you that my income has dropped since 1993 when HMO's took a strong foothold in the NY area.
6) Do you still see patients on a daily basis or do you deal strictly with the internet now? What kind of hours do you work when you see patients on a daily basis?
I have a very full practice schedule. I get to the office at 8:30 AM for telephone time (answering parents questions). I see patients from 9 AM to noon. Then I make hospital rounds and if I'm lucky I have time for lunch. I see patients again from 2 PM to 5 PM, but lately I'm never finished before 6:30 or 7 PM. On Monday evenings I'm scheduled from 7 PM to 9 PM but haven't left before 10 PM in months. Since I have a partner I am on call only half the nights and half the weekends. On Saturdays, whichever one of us is on call has a full schedule just like a weekday. On Sundays we see sick children from 10 AM to noon. And we see emergencies whenever we need to including the middle of the night.
7) Did you have your own practice?
I have a partner. I have been working with him in the same practice in Lynbrook, NY for the past 18 years.
8) Were you required to spend many hours at hospitals?
During my training I spent a lot of time in the hospital. Pediatrics is not a hospital based practice. We manage most of our patients in the office. Except for newborns in the nursery I rarely have more than 3 patients in the hospital at a time, and many weeks I have none.
9) What do you like and dislike about this profession?
I love helping people and caring for them. I love it when a child I've cared for from infancy has grown up under my care. I like a diagnostic challenge, but I can do without the anxiety that challenges cause until the patient is finally better.
I hate night call and weekends on call. When I was younger I could handle being out in the middle of the night better, but now I don't handle the fatigue as well. I try very hard to be available for my own family but I've missed my share of family events because I was working or had an emergency. If you care about what you do, and I do, this is a very stressful job. After I reassure the mothers about their sick kids I get to be the one that worries until they're better. I always pray that I'll never make a serious mistake or harm anyone.
10) If you had to do it all over again would you choose to go into pediatrics?
I would do it again. Even though I dislike many of the ways my practice has changed with government regulations and HMO's I'd do it all over, and I'd continue to complain about the same things.
Sincerely,
Dr. Warren
-GH
Dear GH: There are many things one could look for in a pediatrician, but the importance of some of them will depend on what's important to you.You would like to know whether the doctor's usual office hours will accommodate your needs.
You want to know what happens after hours. Does he carry a pager? Does he have an answering service? Is there always someone on call? Will the doctor give you advice after hours? Will he see you or send you to an Emergency Room?
How does the doctor handle routine questions and advice? Does he have a call in hour for parents to ask questions? Does he stop what he's doing and get on the phone? Remember, if you're the patient on the phone that may be great, but if you're the patient in the office, being interrupted for phone calls might not be so great. When does he return calls if he can't talk to you when you call?
Is the office so busy that the visits will be rushed? Or will the doctor take time to answer your questions? Consider that the doctor who gives patients all the time they need may fall behind schedule. The doctor who stays on schedule may not be able to spend all the time you feel you need. In fact the doctor you love for all the time he spent with you when you had your first child may be the same doctor who drives you nuts when you're waiting in his waiting room and your 3 kids each have to be in a different place at a different time.
If you plan to nurse you'll want a pediatrician who supports nursing. Not all do, so ask.
Does the doctor handle most illnesses by prescribing medicine? If your child has a fever will he prescribe antibiotics? I don't personally agree with that approach, but as much time as I spend trying to make patients understand what their illness is, what its natural course is, and what treatment (if any) is appropriate, some patients still get mad at me because they think I'm withholding vital treatment and want that prescription.
Does the doctor spend the time to explain everything? Not everyone wants that. Some patients want the doctor to take charge. They may find too many facts and choices confusing and ultimately want someone they can put their faith in to make the decisions.
What emergencies is the doctor equipped to handle in his office?
And certainly, what is the doctor's training? What are his credentials? Is he board certified?
Sincerely,
Dr. Warren
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