Journey Starts For Joshua

The purpose of learning is growth, 

and our minds, unlike our bodies, 

can continue growing as we continue to live.

- Mortimer Adler -

Yesterday we had gone to Oklahoma City for a second opinion.  The second opinion was for what is going on with Joshua by a Pediatric Endocrinologist.  Joshua had been seeing a specialist in Lawton and it has been slow going...literally.  Between Joshua's lack of growth biologically and with the answer from the doctor we were done.  I am sure the doctor meant well but I didn't get answers to questions I had, she wanted growth hormones for Josh but made it almost sound like he would be on them forever.  I was not comfortable with the whole situation.  As much as I respected the doctors opinion I wanted to seek out another.

We were greeted very kindly and was seen fairly quickly at the other specialist's office.  The doctor took the time to explain his reasoning and answered any questions that I had.  After reviewing the medical chart, hearing what I had to say and seeing Joshua he determined that Joshua has Idiopathic Short Stature which is just slightly different than what the other specialist said he had which was Constitutional Growth Delay.  In my opinion Constitutional Growth Delay (CGD) and Idiopathic Short Stature (ISS) are similar in that there is no medical reason why they are small. Their growth, physical body (biological age is a few years younger than chronological age) and puberty is slowed considerably. They both can benefit from Growth Hormone Replacement Therapy (GHRT). How I believe they are different is that those with CGD will resume normal growth by age three but still may be on the small side while ISS means that they may never have a normal growth and will benefit from GHRT or IGF-1 Replacement Therapy (which Josh may take if the GHRT does not appear to be working) plus they may also need a boost for puberty by having some andogren.  CGD is a delay so those kids can reach normal height but it might take them till they are in their 30's to reach 'normal' height.  ISS may never reach it. So at the time being if nothing changes Joshua would be well below 5 feet tall and they consider someone for either diagnosis when prediction is below 5'4'' for men and 5' for women or a standard deviation of -2.25 from normal on a growth chart.  Joshua is something like -4+ so he is considerably lower than most of the small 1.2% of the population.  This is the best I could do to try and give you a comparison between CGD and ISS as I know it to be. 

So the plan is that Joshua will be started on Growth Hormone Replacement Therapy.  We should hopefully receive the medicine in 1-3 weeks.  Once received we will have to go back up to OKC to be shown how to properly administer medication.  Joshua will receive a shot every night for six months.  We will go back in three months and at six months to assess progress.  If he is making progress Joshua will remain on GHRT.  If for some reason he doesn't respond to GHRT, the GHRT will end and IGF-1 Replacement Therapy will begin.  Positive side is that we are very happy with the doctor in Oklahoma City and will be seeing him from now on. He was nice enough to explain things to us and answer any question we had which is more than we could say about our specialist in Lawton. I am sure she meant well but we are happy with our second opinion.

So we are stepping out on a new adventure with Joshua, one that we hope will help.  Far as Joshua knows he is just like every other kid, he is just very small for his age.  Joshua has learned to deal and use what God has given him.  We feel confident with the doctor and his assessment and can move on from here.  Joshua has the world ahead of him whether he is 5'4'' or 4'5''. 


We just ask that you do not judge a book  by its cover.  Kids can be short or tall, skinny or husky, smart or academically challenged, the list could go on.  The point is that do not judge children or adults for that matter, on their outward appearance.  There is usually more than meets the eye if you just take the time to see it.  So the next time you are out in public and you see a child that might seem a little different, please do not make faces, whisper or worse yet make a rude remark to the parent about a child especially when you might not know the situation.  Please just ask the parent if you have questions and it will be up to the parent if they want to answer you or not.  I just ask this out of respect for the child and the parent.  


Taking a line from Veggie Tales; something we tell our children often is, "God made you special and He loves you very much!"  Our kids are loved for who they are, not for what they look like or what sports trophies they can bring home.  They are precious gifts that we are blessed to know and we hope they are a blessing to others.