Update on Ava...

As many of you know, Ava's 4 y/o appointment revealed a happy healthy girl....who has stopped growing for some reason. She has always been petite, and recall that even before she was born, they were concerned about her size (she came out 7lbs 3 oz which is pretty average!). The doctor is now concerned and wanted to investigate further into her growth.
They started with an x-ray of her left hand and lots of blood work. Ava was very sad about this, since she had checked out (literally) every book at the library about going to the doctor for a check-up and even had her brother put the books that weren't at our library on "hold" from the surrounding area libraries. We read about the doctor until we were blue in the face. When she got there for her check-up, you'd think she had won the lottery when the nurse came into the waiting room to call her name! She grinned from ear to ear and said, "Oooohp! It's me!" She got weighed and measured and thought it was pretty funny to look like a pirate with her eye patch for the eye test. She told Dr. Cannon MANY stories including her favorite things to do at school and even that recently, they had "Dad's Day" at school (sexist school doesn't have a Mom's Day ...I won't even start on that, since that's a whole different soap box). When Ava had to do the x-ray and get blood taken, she kept saying through her tears that this wasn't in the books!!! It was heart wrenching and left both me and Ava in tears! Ugh. She didn't fight it, she was just very sad, and unfortunately, it took a significant amount of time and needle sticks to get 5-6 tubes of blood. :(
Ava has always been about 15-20% on the growth charts (although if you use the Chinese growth chart, she's right on target!), but now she has officially has fallen off her own curve. It seems that she hasn't really grown in the last year specifically. Her stats were 32lbs and 36", so she has only grown about 4" in the last 2 years.
The x-ray measures bone age, and that came back normal. Yay! The blood work was taken for all sorts of things including a basic CBC, thyroid tests, growth hormones etc... They also tested her for Turner's Syndrome which is a chromosomal disorder in females which causes short stature. We're happy to say that everything came back normal except for her tTG (tissue transglutaminase), a marker for celiac disease. Celiac disease can cause "failure to thrive" in children, so they are not gaining weight and growing.
We immediately took her off gluten. This is no small feat for a girl who can eat her weight in plain pasta! You'd be surprised how many forms of gluten there are...and it's not just bread products. Luckily, with Portland being very focused on health and wellness, there are ample stores and even dedicated bakeries for the gluten-free crowd. She did okay despite us having to provide her own food and snacks for EVERYTHING. After talking with the doctor again, she advised us to put Ava back on gluten, so that her intestines will stay inflamed for further testing (if that's indeed what it is).
The next step is to go to Doernbecher Children's Hospital for an endoscopy and biopsy (ironically, we are familiar with the hospital as it is where we made our Owen Day donation this past year...it's also a part of OHSU where I work). That will mean conscious sedation (she'll be out of it but won't have to be intubated), and knowing Ava, lots of anxiety! We have a Pediatric GI consult on the 31st of March. They take the referrals that are most critical first, and Ava's at the bottom of the list which we are thankful for (the cancers, GI bleeds etc... are top priority...slow growth is not). After our consult, we will schedule the endoscopy. If all of that comes back fine, we will continue testing from there.
Ava continues to be happy and healthy and a bright spirit! There is no difference in our girl literally....she's even the same size! :) No matter how tall she is, she is full of spunk! When we go to the library, she finds the wooden stool (which is actually pretty significant in weight) and carries it around to reach whatever she is looking for. She is a girl who knows what she wants and if there's a will, there's a way. We will help her to be her strongest, boldest, and most confident now matter what!
We will continue to keep you all up to date as we know more.