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Ian's orthopedic visit was today. It went well, as usual. We all really like

Dr. Gupta, he is very well informed, has a great manner with Ian, is genuinely

interested in his patients and is a doctor with a mission!! Ian's spine looks

fine, no problems there. His leg discrepancy is getting larger, it went from

1/2 inch to 5/8 inch- 3mm difference from his last visit 10 months ago. We

talked at some length of various subjects, his opinion of GH regarding Ian, limb

lengthening, etc.. His opinion is very strong that Ian SHOULD NOT receive

growth hormone since it is not going to help him achieve a taller final height.

His opinion is that since he will not gain any inches ,there is not enough data

on the various affects that GH has to other areas of your body is not

significant enough to justify GH treatment. He strongly urged us to work on

developing self esteem and to think of joining Little People Of America. He

spoke to us about limb lengthening-explained to us that at final height, if the

variance is between 2-4 cm, then the LONGER LEG IS SHORTENED. If the variance

is over 5cm, then it will require TWO surgeries to achieve level leg lengths..

His point about limb lengthening is not specifically geared for adding height,

but to even out the variance in leg difference. He told me to find out from the

parents of the older parents what was the discrepancy of leg length, what age

was this and what was the bone age of the child at this point?? So, if anyone

would reply to me concerning this, I would much appreciate it. Also, he would

like to know more about limb lengthening regarding an RSS child specifically, so

told me to find out if any info could get passed on to me concerning this or if

he could find out a doctor who oversaw such a case. Ian is his only orthopedic

patient with RSS, so he would like to gather as much info as he can to be armed

with to review and learn about. He will definitely be Ian's ped ortho over the

long haul, so the more he knows about this, the better. He told me that if limb

lengthening is something we might consider, to do research on it and should

decide by time he is 7 or 8 because there are only 2 places he would send

us-Baltimore & Italy and there is a long waiting list for this surgery!! He gave

the age of 12 when he told us to get on a list by 7 or 8, that is one long

list!!!

I am involved with parent advocacy for special needs kids and he actually

gives some of the workshops that the group schedules. He spoke at the annual

conference last year, which included Kemp, CEO of Very Special Arts and Ted

Kennedy Jr. He sits on an internal review board at the children's hospital here

and had me write a letter to the hospital explaining why I chose to take an for

a 40 min to his private practice instead of a 15 min drive to see him at the

hospital clinic-the ortho clinic there is horrible~~ Anway, he also would like

to create a website that would offer info to parents of special needs children

regarding the various insurance plans and what they cover in regards to what the

children would need.. Like I said, he's a doctor with a mission!! I feel very

fortunate that we have two such great specialists overseeing Ian's long term

care.. Wish I could say that for everyone else.

Missy

mom to Ian

<br><hr size=1><b>

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Missy,

Thanks for telling us about Dr. Gupta. I'd be interesting in hearing about

any websites or publications he writes.

One concern for Tim's and perhaps others' assymetries is that it is his

skinnier leg that is somewhat shorter... I wonder how limb lengthening

would affect stability and strength in such a case? I knew a brave little

girl who around 10 years ago had this done, and it was a painful procedure

of breaking bones several times and separating them with plates so that new

bone would grow a little at a time. She made the decision to do it herself.

Inga

At 01:55 PM 9/8/99 -0700, Missy Shost wrote:

>Ian's orthopedic visit was today. It went well, as usual. We all really

like Dr. Gupta, he is very well informed, has a great manner with Ian, is

genuinely interested in his patients and is a doctor with a mission!! Ian's

spine looks fine, no problems there. His leg discrepancy is getting larger,

it went from 1/2 inch to 5/8 inch- 3mm difference from his last visit 10

months ago. We talked at some length of various subjects, his opinion of GH

regarding Ian, limb lengthening, etc.. His opinion is very strong that Ian

SHOULD NOT receive growth hormone since it is not going to help him achieve

a taller final height. His opinion is that since he will not gain any

inches ,there is not enough data on the various affects that GH has to other

areas of your body is not significant enough to justify GH treatment. He

strongly urged us to work on developing self esteem and to think of joining

Little People Of America. He spoke to us about limb lengthening-explained

to us that at !

>!

>final height, if the variance is between 2-4 cm, then the LONGER LEG IS

SHORTENED. If the variance is over 5cm, then it will require TWO surgeries

to achieve level leg lengths.. His point about limb lengthening is not

specifically geared for adding height, but to even out the variance in leg

difference. He told me to find out from the parents of the older parents

what was the discrepancy of leg length, what age was this and what was the

bone age of the child at this point?? So, if anyone would reply to me

concerning this, I would much appreciate it. Also, he would like to know

more about limb lengthening regarding an RSS child specifically, so told me

to find out if any info could get passed on to me concerning this or if he

could find out a doctor who oversaw such a case. Ian is his only orthopedic

patient with RSS, so he would like to gather as much info as he can to be

armed with to review and learn about. He will definitely be Ian's ped ortho

over the long haul, so th!

>!

>e more he knows about this, the better. He told me that if limb

lengthening is something we might consider, to do research on it and should

decide by time he is 7 or 8 because there are only 2 places he would send

us-Baltimore & Italy and there is a long waiting list for this surgery!! He

gave the age of 12 when he told us to get on a list by 7 or 8, that is one

long list!!!

> I am involved with parent advocacy for special needs kids and he

actually gives some of the workshops that the group schedules. He spoke at

the annual conference last year, which included Kemp, CEO of Very

Special Arts and Ted Kennedy Jr. He sits on an internal review board at the

children's hospital here and had me write a letter to the hospital

explaining why I chose to take an for a 40 min to his private practice

instead of a 15 min drive to see him at the hospital clinic-the ortho clinic

there is horrible~~ Anway, he also would like to create a website that

would offer info to parents of special needs children regarding the various

insurance plans and what they cover in regards to what the children would

need.. Like I said, he's a doctor with a mission!! I feel very fortunate

that we have two such great specialists overseeing Ian's long term care..

Wish I could say that for everyone else.

>

>Missy

>mom to Ian

>

><br><hr size=1><b>

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Missy

Now this is unlikely to clarify anything, but should give you and the

ortho's something to discuss. The child growth foundation in the UK

states in it's literature on RSS, ref limb lengthening that the shorter

leg must always be lengthened, not the longer shortened, despite what

some ortho's suggest!

Still, there's no surprise in the fact that medical opinion is so

contradictory! is 3 1/2 now, and we have been advised that

lengthening will not be done before he approaches his final height. But

what was your ortho's basis for suggesting that GH would not help his

height? Was that peculiar to assymetry, or yet again just a different

opinion?

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