April 21, 2007
Per doctor: ESR, tTGA and growth hormone stimulation test are all within the normal range, however, the growth hormone was producing at a very low normal. Normal growth hormone production falls between 183-850. Kyle's barely topped 200. The tests ruled out chronic illnesses, celiac disease or a growth hormone deficiency as a cause of Kyle's poor growth development. Since Kyle's linear height is -2.53 SD (standard deviations) as compared to his genetic potential of 5'8", we highly recommend to start growth hormone treatment. In addition, he may also need Letrozole to slow down the skeletal maturation for optimal time for treatment. A growth hormone application has been turned in.
Kyle has been diagnosed with Idiopathic Short Stature (ISS). That means there's no clinical reason why he is short. But the doctors strongly feel that since he is less than 3% below the size of other boys his age, the growth hormones could benefit him.
Saturday, April 21, 2007
Wednesday, April 18, 2007
Test Day
Once again, we found ourselves getting up early and heading towards the big city. Yeah, it was early, but to finally be able to know for sure why Kyle wasn't growing was worth every early minute. At this point, I was looking for peace of mind. Either he had something wrong and they could fix it or he didn't have anything wrong and would start to grow eventually. I wanted to see my son grow to be the same size as all his friends. I wanted his friends to be able to remember a time when Kyle was just a little guy. We were very lucky, though. Kyle didn't get picked on too much because of his size. He is a genuinely good guy, very quiet, very non-confrontational, very friendly. Mostly, his friends would surround him in an effort to protect him. After all, Kyle was preparing to enter high school (9th grade). You've heard stories about what upper classmen do to freshmen. So have I, which worried me. But, Kyle's dad had spent a couple years coaching some of these upperclassmen, which probably helped Kyle gain some respect among them.
Shortly after we arrived and checked in, Kyle's name was called and we followed the nurse once again. This time, we were taken to one of several small rooms, which had a comfortable recliner, a TV and a curtain used as a door. To begin with, the nurse explained the testing process to us. Medicine is given to stimulate the pituitary gland to release the growth hormone. The two medications that will be used are Clonidine and Arginine. Once the IV is started, a baseline blood sample will be obtained. Clonidine is then given orally. Common side effects to this medication include drowsiness and decreased blood pressure (Kyle's blood pressure will be monitored during the test). Blood specimens will be obtained from the IV every 30 minutes for 3 hours. Arginine will be started at 90 minutes and will be given through the IV over 30 minutes.
The nurse then brought Kyle a pillow, a blanket and a notebook containing movie titles of all the movies they had available. He chose Remember the Titans, an excellent choice I might add. When the test had begun, I put in the DVD and sat in a chair that was not nearly as comfortable as Kyle's and watched as Kyle's eyes began to droop. Just as he would doze off, the nurse would come in to take another blood sample. He eventually was so tired he didn't even wake up while they took the blood sample. Good thing I liked the movie he chose. Once the movie was over, I began to read a book to pass the time. Finally, the testing was complete. The IV was removed. Kyle was starting to wake up. They checked his blood pressure, which was very low, so they gave him something to eat and drink while he waited for his blood pressure to become normal again. After his BP was back to normal, we were finished with this appointment. The results would be available in a couple days...
Shortly after we arrived and checked in, Kyle's name was called and we followed the nurse once again. This time, we were taken to one of several small rooms, which had a comfortable recliner, a TV and a curtain used as a door. To begin with, the nurse explained the testing process to us. Medicine is given to stimulate the pituitary gland to release the growth hormone. The two medications that will be used are Clonidine and Arginine. Once the IV is started, a baseline blood sample will be obtained. Clonidine is then given orally. Common side effects to this medication include drowsiness and decreased blood pressure (Kyle's blood pressure will be monitored during the test). Blood specimens will be obtained from the IV every 30 minutes for 3 hours. Arginine will be started at 90 minutes and will be given through the IV over 30 minutes.
The nurse then brought Kyle a pillow, a blanket and a notebook containing movie titles of all the movies they had available. He chose Remember the Titans, an excellent choice I might add. When the test had begun, I put in the DVD and sat in a chair that was not nearly as comfortable as Kyle's and watched as Kyle's eyes began to droop. Just as he would doze off, the nurse would come in to take another blood sample. He eventually was so tired he didn't even wake up while they took the blood sample. Good thing I liked the movie he chose. Once the movie was over, I began to read a book to pass the time. Finally, the testing was complete. The IV was removed. Kyle was starting to wake up. They checked his blood pressure, which was very low, so they gave him something to eat and drink while he waited for his blood pressure to become normal again. After his BP was back to normal, we were finished with this appointment. The results would be available in a couple days...
Friday, April 13, 2007
Big City Hospital - Big Hopes
April 12, 2007
It broke my heart to step into the children's hospital and see so many sick children. I had to stop and thank God that the reason we were here with Kyle was not a life-threatening situation. On our way to the Endocrinology unit, we passed kids being wheeled around in wagons; some without hair, some crying, some content at looking at the bright colors a children's hospital displays. We saw parents with tears in their eyes as they sat comforting their sick little one. My heart truely goes out to parents who have a child with a life-threatening disease.
We got comfortable in the waiting room and I began to fill out the necessary paperwork. After just a short time, Kyle's name was called, so he, his father and I went to join the nurse as she led us into the unknown. "First things first." she said. "Take off your shoes and jump on the scale." Kyle weighed in at 76 pounds. "Okay, sweetie, let's get your height". Kyle was 4'8". Kyle was within one week of turning 14 years old.
We sat in our room waiting for the doctor, who eventually joined us and began by asking a ton of questions about family history, what types of diseases run in the family, etc. Mother's height is 5'3". Father's height is 5'8". Child's pulse is good, blood pressure is good, pupils are good, ears are a little dirty, but good. Neck is supple, Oropharynx is clear, Tympanic membranes are clear, Respiratory: Clear. Cardiavascular: Regular rate and rhythm without murmurs. Abdomen is soft and nontender and nondistended. Neurological: Nonfocal. No scholiosis. Very early signs of puberty. His bone age was concurrent with his actual age, thus ruling out a constitutional delay of growth.
The doctor spent some time reading over the test results and reviewing the growth records. She was extremely grateful that Kyle's doctor had done all those preliminary tests and was glad we brought the results and the growth charts with us. According to the test results, Kyle's IGF-1 revealed a low-normal which is suspicious for growth hormone deficiency. She wanted to schedule him for a growth hormone stimulation test to rule out a growth hormone deficiency. She explained how the window of growth opportunity would soon begin to close, so treatment, if necessary needed to begin immediately. She also mentioned that she would have liked to have seen Kyle 5 years earlier, but it's a little late to worry about that.
In addition to the growth hormone stimulation test, she ordered a tTGA and ESR to rule out celiac disease and chronic illnesses that would impede his growth.
Preliminary diagnosis: His height is -2.53 standard deviations which would actually qualify him for idiopathic short stature if his growth hormone stimulation test is normal.
We were given a pamphlet which included the instructions on how to prepare for the Growth Hormone Stimulation Test, as in do not eat or drink (except water) after midnight the night before the test. We scheduled the appointment for April 17th...
It broke my heart to step into the children's hospital and see so many sick children. I had to stop and thank God that the reason we were here with Kyle was not a life-threatening situation. On our way to the Endocrinology unit, we passed kids being wheeled around in wagons; some without hair, some crying, some content at looking at the bright colors a children's hospital displays. We saw parents with tears in their eyes as they sat comforting their sick little one. My heart truely goes out to parents who have a child with a life-threatening disease.
We got comfortable in the waiting room and I began to fill out the necessary paperwork. After just a short time, Kyle's name was called, so he, his father and I went to join the nurse as she led us into the unknown. "First things first." she said. "Take off your shoes and jump on the scale." Kyle weighed in at 76 pounds. "Okay, sweetie, let's get your height". Kyle was 4'8". Kyle was within one week of turning 14 years old.
We sat in our room waiting for the doctor, who eventually joined us and began by asking a ton of questions about family history, what types of diseases run in the family, etc. Mother's height is 5'3". Father's height is 5'8". Child's pulse is good, blood pressure is good, pupils are good, ears are a little dirty, but good. Neck is supple, Oropharynx is clear, Tympanic membranes are clear, Respiratory: Clear. Cardiavascular: Regular rate and rhythm without murmurs. Abdomen is soft and nontender and nondistended. Neurological: Nonfocal. No scholiosis. Very early signs of puberty. His bone age was concurrent with his actual age, thus ruling out a constitutional delay of growth.
The doctor spent some time reading over the test results and reviewing the growth records. She was extremely grateful that Kyle's doctor had done all those preliminary tests and was glad we brought the results and the growth charts with us. According to the test results, Kyle's IGF-1 revealed a low-normal which is suspicious for growth hormone deficiency. She wanted to schedule him for a growth hormone stimulation test to rule out a growth hormone deficiency. She explained how the window of growth opportunity would soon begin to close, so treatment, if necessary needed to begin immediately. She also mentioned that she would have liked to have seen Kyle 5 years earlier, but it's a little late to worry about that.
In addition to the growth hormone stimulation test, she ordered a tTGA and ESR to rule out celiac disease and chronic illnesses that would impede his growth.
Preliminary diagnosis: His height is -2.53 standard deviations which would actually qualify him for idiopathic short stature if his growth hormone stimulation test is normal.
We were given a pamphlet which included the instructions on how to prepare for the Growth Hormone Stimulation Test, as in do not eat or drink (except water) after midnight the night before the test. We scheduled the appointment for April 17th...
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