Now We're Getting Somewhere -- Sort Of . . .

Our little Miss Minsy has had a busy week.  This is a week we have been waiting for ever since we got home from China -- the week we would finally be able to decide what to do about her age.  For those of you out of the loop -- Minsy was assigned a birthday by her orphanage in China because she was a bit older when she was abandoned.  They estimated that she was around 14 months old after checking the number of teeth she had and some developmental milestones.  For that story about Minsy you can re-read my earlier post HERE.  They gave her the arbitrary birthday of September 1, 2007 which would make her four and a half years old.  We went to China expecting to pick up a four year old girl who was smaller than the average four year old American, but we ended up finding an adorable little girl who was closer in size to a two year old.  Even with China's smaller norms in sizes, she was extremely small for her age.

So then the debate in our family began.  Was she really four years old?  If so, was she developmentally where she needed to be?  With foreign adoption we expected to find some developmental delay, but was this delay because of the normal and natural consequences of life in Chinese foster care, or was this delay because she really was much younger than her records led us to believe?  Should we keep her age the same, or should we assign her another arbitrary birth date?  These were somewhat daunting decisions to make because we didn't want to choose something too old or too young.

We decided to wait until we had an appointment with a pediatric endocrinologist in Springfield.  He would be considering whether we needed to be giving Minsy growth hormones to help her make up some height while she was young.  We figured that he would be able to help us to figure out of she was just extremely small or just younger than we thought.

It was with high hopes that Laney and I jumped in the van and brought Laney to her appointment last Wednesday.  I knew from the very beginning that this was not going to be any ordinary doctors appointment because when we arrived the office was completely empty.  Only us.  You don't normally find that condition in an average doctor's office.  Normally the waiting room is fairly packed with patients.  It was obvious that Dr. Schwartz was going to take his time with us and do a thorough exam.  I did appreciate that, especially with our crazy situation, but I have to point out that the reason he can do that as a doctor is because he charges an arm and a leg for his services, and therefore he doesn't need to see as many patients.

He was thorough.  The visit was over an hour long, and Dr. Schwartz did one of the most detailed exam I have ever seen on a child.  He checked every inch of her body, taking measurements, making observations, and asking me about ten thousand questions about what I had observed and understood about Minsy from her China records.  In the course of his exam he found that she had a significant heart murmur.  He tried to explain it to me.  At first I didn't worry at all because Spencer had a heart murmur when he was born, and we found out that most of those murmurs close on their own, so we only needed to monitor the situation.  We did, and the murmur disappeared within a few months.  I expected the same would be true for Minsy.  Dr. Schwartz said that hers appeared to be a bit more serious than that, so he referred us to immediately go and see a pediatric cardiologist that day to get an echocardiogram.  That freaked me out a bit.  I wasn't anticipating any trouble with her heart.

I was very interested in figuring out what age we needed to use for Minsy.  Dr. Schwartz was not terribly helpful in that.  He said that it would take some more observation and study before he could say what age she might be.  He didn't want to start any hormone treatment until he had a better idea about that, and he wouldn't probably consider that for another year or so.  For now he advised us not to change her age since we would only be guessing.  He said that if anyone asked how old she was we should just say, "It's none of your business.  Leave me alone!"  For now he wanted for us to treat her as if she is four and a half.  When it is time to think about her entering kindergarten we should consider her developmental readiness rather than any age that she may have reached.  That makes sense.  It really does.  But it still leaves me questioning exactly how old my little girl may be.  Hopefully during the coming year we'll be able to determine this a little better.

Well, the visit with Dr. Schwartz ended, but we weren't done for the day.  After he explained that he would mail us a record of his findings during the visit within a week, only calling if he found something wrong, we headed straight to another clinic to get an x-ray of Minsy's chest and wrist.  The chest x-ray was to double check and make sure that she didn't have tuberculosis since her test in China had been borderline, and tuberculosis could contribute to her stunted growth.  The wrist x-ray was to see if he could see an indication of her age through her bones since the cartilage and bone growth in the hands shows a person's age in some ways (although this would be skewed with something like malnutrition that we suspect with Minsy's early years).

After the x-rays we headed to the physical therapy clinic to pick up Minsy's new shoes and elastic strap that would help her correct the alignment of her feet and toes.  This was a fairly quick visit.  Unfortunately the shoes they had ordered were too big, so we needed to wait a week for those to be sent to us, but she did get her elastic straps.  It's funny, but they are just simple elastic, but they make such a huge difference in her feet alignment.  It is an elastic belt that goes around her waist, and then elastic straps wrap around her leg and hook under the laces of her shoes.  The tension in these straps pulls her feet around so that they point straight out instead of inward.  It looks a bit weird, but it works.  Today her shoes came finally.  They are kind of cute in an old fashioned kind of way.  They look like old fashioned baby boots.  They are extremely rigid, so they don't bend with the foot when Minsy walks.  This has been a bit hard for her to get used to, but she's learning to manage.

Here is Minsy after she got her new shoes today!
Doesn't she look happy?

Here she is modeling the new shoes and her tension bands

After our physical therapy session we headed right over to the cardiologist's office for her echocardiogram.  This was another office with few patients in the waiting room.  But there were a few little kids there.  Just looking at them made me feel as if Minsy wasn't too bad off with her heart problems.  So many of the kids in this office had blue lips and fingers because of poor circulation due to their heart problems.  One little boy even had blue arms because his heart was so weak.  I haven't noticed anything even close to this with Minsy, so my guess was that we would find that her heart wasn't too bad off.  Still we did the test.  After waiting in the waiting room for fifteen minutes a nurse came out and told us to go on home without seeing the cardiologist at all.  He had looked at the test results and didn't see any glaring problem that required that we rush to the hospital or anything like that.  He would do a thorough reading of the test and let Dr. Schwartz know his findings.  Then Dr. Schwartz would let us know.  Here it is a week later, and we still don't know anything from the cardiologist.  I'm going to just believe that this is because Minsy is in no danger in this regard.  Hopefully I'll find that this is the case when we get some solid results.

The worst part of the day came right after this visit.  I forgot that I needed to take Minsy to the lab for some blood work.  We headed back to the clinic and got right in.  Minsy hated this part of her day.  Luckily she had an excellent lab guy, and he did an amazing job getting her vein poked right away. But (holy cow!) they had to take a bunch of blood.  They just kept filling tube after tube after tube.  I wondered how this would affect a little girl like Minsy.  I noticed the lab request from Dr. Schwartz, and he must have requested a thousand  tests.  I'm glad for his thoroughness, but I hope that he doesn't need to do so many tests each time we come to see him.

So tiny, but so cute!

I was planning on doing some shopping while we were in Springfield, but I was emotionally wiped out after all our doctor hopping that day, so I headed straight home.  I had only sat down for a few minutes when the phone rang.  I saw that it was Dr. Schwartz, and my heart immediately dropped into my feet since he had said that he would only call if he found something very wrong in the results.  But I sucked it up and answered the phone.  It wasn't as bad as I expected.  First of all he told me that he looked at the x-rays, and it showed that Minsy has the bone structure of a 2 1/2 to 3 year old.  This doesn't necessarily mean that she is that age, but it does give us a good starting point to compare as we watch her in the coming months and years.  The reason Dr. Schwartz called was because Minsy had a significant Vitamin D deficiency, and he wanted to start treating that with over the counter supplements right away.  This would affect her bone development and ability for her body to absorb calcium.  So we made a plan to deal with that.  Everything else would be stuff that we would continue to test and monitor throughout the coming years.  So, not terrible news, thank goodness.  But it wasn't news that brought us any closer to figuring out how to treat her small stature.  Bummer!