DEAR DR. DONOHUE: My family faces a situation that has generated opposing opinions. My granddaughter is small for an 8-year-old, approximately 44.5 inches tall. My daughter has two medical opinions that encourage her to give her daughter growth hormone. I believe this is unnecessary. I think it is fine to be whatever height you happen to be. And I am not certain of the long-term health consequences of these shots. If I knew what doctors would do for their own family members, I might have a change of mind. – R.M.

ANSWER:
Your granddaughter’s height puts her below the bottom of all heights for an 8-year-old. Children (and adults) most often want to fit in with their classmates and friends. Her height might make this difficult. If it doesn’t, she’s a most unusual and well-adjusted child.

If a child has a deficiency of growth hormone, then supplying the hormone makes excellent sense. It’s the same as supplying insulin to an insulin-deficient child. Growth hormone promotes linear bone growth, bone thickness, the synthesis of protein and has a hand in fat metabolism. Increased height is only one effect. If the hormone is to be used, it should be started before a child’s growth plates have fused. The hormone has few side effects.

How about very short children who have normal or near-normal growth hormone levels? That’s a tougher question. The growth spurt that occurs at puberty might make such children catch up with their classmates. However, growth plates close soon after puberty, so a delayed decision could make growth hormone treatment ineffective. Furthermore, treatment is expensive, and the results aren’t always predictable.

If you want to know how one doctor – I – would handle this very difficult decision, it goes like this. I would seek a pediatric endocrinologist, maybe two. I would ask them to examine the child and give me an opinion of the best course of action. I would be guided by these experts’ opinion. Were the doctors who examined your granddaughter pediatric endocrinologists?

TO READERS: The answers to many inquiries on dizziness and vertigo can be found in the booklet on that topic. Readers can obtain a copy by writing: Dr. Donohue – No. 801, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am an 82-year-old man. I have had a few colonoscopies. Is it necessary for someone my age to have any more? – J.B.

ANSWER:
The U.S. Preventive Services Task Force states that people older than 75 can stop colonoscopies if they previously have had normal exams. The Task Force also states that those over 85 do not require screening. If a person has 10 years of life expectancy, many feel that continued examinations are worth it.

DEAR DR. DONOHUE: I am inquiring about a bellybutton hernia. I have one. Some people have told me to have it repaired immediately. Is that correct? It happened years ago, when I had pneumonia and coughed for two months. It has gotten bigger lately. – J.N.

ANSWER:
The bellybutton (umbilicus) is the place where the umbilical cord attached to the fetus to bring nourishment from the placenta. After delivery, a scar fills the attachment site.

All hernias are the same. They are protrusions of the abdominal lining through a weakness in the abdominal wall. Infants can be born with an umbilical hernia. These hernias usually close on their own. If they haven’t done so by age 4 or 5, a surgeon closes them.

If an adult umbilical hernia is small and is creating no trouble, it can be left alone. If it’s large or painful, it should be repaired. You ought to show your family doctor the bulge, since it is getting bigger. Size will determine if treatment is necessary.

DEAR DR. DONOHUE: MGUS – how long can a person have this before it’s diagnosed? – E.O.

ANSWER:
Readers, unless they have had a personal experience with MGUS, will think it’s a curious and extraordinary condition. It isn’t. Up to 3 percent of people over 50 have it, and up to 5 percent of those over 70 have it. Many of these people are not diagnosed because MGUS often has no symptoms. It usually is discovered accidentally, when a person has blood work done for some unrelated reason. People can have it for years without knowing.

MGUS is monoclonal gammopathy of undetermined significance. “Monoclonal” indicates that it originated in one cell that replicates itself over and over. The cell is a plasma cell. Plasma cells produce antibodies – gamma globulins, huge proteins. The gamma globulin produced in MGUS is called an M protein.

So what’s the big deal if MGUS doesn’t cause symptoms? The big deal is its potential to progress into a variety of serious illnesses – the chief one being multiple myeloma.

Multiple myeloma is a cancer where there are large numbers of malignant plasma cells in the bone marrow, which disrupts the production of blood cells and which can destroy the surrounding bone.

Indications that a MGUS patient might be headed for trouble include a high number of plasma cells, a high level of M protein or both. Most affected people have to be checked from time to time to see what’s happening. If one of the MGUS complications is developing, then treatment is instituted.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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