Tuesday, November 30, 2010

meeting dr. fancy pants

After much anticipation Charlotte and I met with Dr. Fancy Pants, a pediatric endocrinologist. I did not share my affectionate nickname with him - at least not just yet - but I was impressed by him and his nurse.  Dr. FP was personable, knowledgeable, and thorough.  Pretty much everything I'm looking for in a man who is now tasked with diagnosing the cause (if there is one) of my baby's "failure to thrive."

First of all, that is a tough description to swallow, "failure to thrive."  I mean, the "f word" seems like a big, long finger pointing blame ... you failed ... and then there's the whole idea of not succeeding.  Whatever happened to failure is not an option?!    I was not surprised by this terminology, but as a mom, it was a blow to the gut to hear those words used to describe my beautiful, happy baby girl.

So little pity party aside, we spent about an hour and 45 minutes with Dr. Fancy Pants - like I said, the guy is thorough.  First Charlotte was weighed and measured.  Just as my scale here at home indicates, Charlotte weighs a whopping 13 pounds 8 ounces - that long-awaited milestone of 13 and a half pounds.  She is 26 inches long. Both of which are far below the "charts" for her age.   However, it is worth noting that she has tripled her birth weight and gained 10 inches in length, and those are standards for the first year of life.  I cannot remember her head circumference, but I do know that it actually makes the charts; a great sign for brain development!

A majority of the appointment was spent discussing my pregnancy, Charlotte's birth (and the decision to induce), and her development. Dr. Fancy Pants also asked a lot of questions to establish a family history - heights of parents, siblings, grandparents, onset of puberty in mother and grandmothers (as if I know when my mom - or Chad's mom - started her period!), ... that sort of thing.  Essentially, he is looking for indicators of Constitutional Growth Delay, which is a common diagnosis and could indicate that Charlotte is simply a "late bloomer."  

To support that possible diagnosis, we had an x-ray taken of Charlotte's left hand to determine her bone age.  It was no surprise and actually good news that her bone age is between 3 and 6 months - probably closer to 3 months.  There is a pattern of typical bone growth, and Charlotte's appears like that of a 3 month old.  That is good news because there is potential for growth; once the bones fuse together, growth is ending.  If her bone age was closer to her actual age, it would indicate that her body has less growing to do.  But the deviation actually indicates that her body is not done growing ... it's more likely delayed - for some reason. (A young bone age could also attribute to her developmental delays - like the fact that she isn't crawling yet or pulling into a seated position - young bones mean lower muscle tone.)

So, we know she has more growing to do ... hooray!  But we also need to determine why her growth is so delayed.  Dr. Fancy Pants did a thorough physical exam and ruled out most syndromes based on lack of indicators and symptoms.  I took that to mean there are no obvious signs of a major issue ... and breathed a sign of relief.

We left the office with a stack of orders for blood work and urine analysis, the next step in this process.  I have to collect a urine sample using a plastic bag that adheres to Charlotte's nether regions, which I am really looking forward to ... not!  And then we'll survive the dreaded blood draw.  And then we'll wait to hear from Dr. Fancy Pants.  Based on how long it took to get an appointment, I am guessing results will probably take a while.  Not expecting to know anything until after the new year.

In the meantime, we just keep doing what we're doing ... and, yes, that includes feeding through the night because Dr. FP agrees that Charlotte needs those calories. {Super great!}  I was also reminded that Charlotte should be treated her age not her size, and perhaps that shift in mentality and how I interact with her will help with hitting some developmental milestones like crawling.  But there's still time for that ...

I will leave you with one final thought ... Dr. Fancy Pants really did not live up to his nickname.  His pants were actually quite plain.  Light gray.  Pleated.  I believe Dockers.

Thank you for all the good thoughts ... and stalking ... sorry this post was delayed ... I chose sleep over blogging last night :)


BJ_Mama said...

Well, first of all, I'm glad you got some sleep! YAY!
And here's a few little things that made a lightbulb go off in my head. They NEVER did that bone growth thing with Sam! Geez, now I might need to ask about that. Is there something that made them go there? With us, it was just blood draw immediately.
Also, I'm glad your doctor told ou to start treating her like her age, not her size. No one told us that. EVER! We figured that out on our own, and not until she was almost 3!!!! And let me tell you, it really worked! But, just curious, if her bone development is only at 3-6months, does that really make sense?
YAY for good head circumference! That's a WHOLE other set of worries (we know)
MAMA, YOU HAVE NOT FAILED! That is a crappy wording, isn't it? We got hit with "Mental Retardation" at like, 2 months old! BTW that is not what most of the doctors we've encountered have EVER said.

one more thing: I <3 U! HUGS!
and just one more: are pleated pants really in anymore? really?!?!

Jessica said...

I'm so glad he was thorough. I would hate to wait 6 months for a 5 min appointment. All good signs at this point - hopefully the bloodwork will provide some more anwsers.

Terri said...

Wow, so glad to hear that the appointment went well (if not seemingly forever... an hour and 45 mins... wow, he is thorough!). And glad to hear that things are positive. Even though you got that one "f word", it seems like all the other comments were positive. I know you won't know anything for certain for a while, but it seems to be good. Hooray! Dr. Fancy Pants may not actually have fancy pants, but if he can figure out how to help little Miss Charlotte thrive, then he still earns the fancy pants in my book. Lots of love and hugs to you and your tiny peanut!(Although, maybe we should call her your jelly bean so Gavin isn't allergic to her too). ;)

Shell said...

Sounds like you got some good news, though. LOL @ FP not living up to his name.

Raising Z said...

Wow...I have been away for a long time. Poor Charlotte and poor you!! I am glad that there was some good news out of that lengthy appointment and that they are doing everything they can to figure this out. I know that C was having problems gaining weight (eating around the clock) at around 6 months due to my thyroid. I know you are already aware of your thyroid stuff (I have your email saved, I need to write you back...have so many questions). She is still not sleeping through the night but I can no longer blame the thyroid now :) I hope they figure it all out soon! You are all in my prayers.

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