If You Give a Doctor an Appointment . . .

So the end of August I took Anna and Grace in for physicals because they needed forms signed so they could run cross country.  I'm pretty good about getting babies in for well-baby checkups, but once the kids turn 3, I'm a lot less consistent if they are healthy.  (Okay, we pretty much never go in for physicals anymore because who has time for that, and I've always been running smaller kids in for well-baby appointments.  You would think that would make it easier, but it is next to impossible to keep all my kids on the same "team" of pediatricians, so the upshot of it all is that the olders never get well child appointments.)  BUT we needed paperwork, so off we went.

Bethesda is a teaching hospital, so what that means is you always are seen by a resident, then the supervising doctor, and that is what happened that day.  Both ladies were super nice, and definitely super . . . thorough.  They both spent approximately forever listening to both girls' hearts--sitting up, lying down, over and over again.  Lots of murmuring and "Did you hear that? . . . How about now?"  Eventually the older doc said that they heard a murmur in both girls, which was perfectly normal, except that Grace's had a different sound to it.  Not "like a guitar string, and also not harsh, but different."  Okay . . . They asked Grace a bunch of questions about whether she has ever felt dizzy or faint while exercising, or ever felt her heart race or anything.  (No)  But they decided we needed to see cardiology for a consult.

So this morning was our consult with the pediatric cardiologist.  Before we were even seen, Grace had an EKG done.  Then the resident came in to say that looked just fine, and he took a listen to her heart.  He listened for awhile but didn't even hear a murmur, much less one that sounded weird.  Next the supervising doctor came in, and he also listened for awhile, but couldn't hear anything wrong at all.  He was actually a little irritated that they sent her over, although he did end that sentence with the obligatory "better safe than sorry," lol.  He said that every child probably has a murmur at some appointment--a murmur is just blood flow they can hear--and that they aren't anything to worry about.  If there are actual real structural problems with the heart, then those murmurs won't be here one day, gone the next, so a problem most likely wouldn't just all of a sudden show up at a routine physical at age 10 with no symptoms of a problem.  So Grace got a clean bill of health, and her heart is cleared to keep on being as physically active as it has been, which is good because she has another cross country meet coming up on Saturday!

The second issue the original doctors found with Grace is that she is really skinny.  This is not actually a new problem for her.  Although she was 8 lbs. 13 ounces at birth, she quickly fell off that, and has spent the rest of her life hugging the 5th percentile growth line for weight. Once when she was 18 months, she got really sick with a stomach bug over Christmas, and she dropped back below 20 pounds.  At that point everyone was concerned (even me!), and we had to give her cream on her cereal, lots of butter on bread, ice cream every night, etc.  This was while I was in my third trimester of pregnancy with Faith, battling gestational diabetes, so that was a challenging period for me, lol.

Anyway, she has always been skinny.  The problem here was that she did have a doctor appointment back in May, when she had strep throat, and since that time she had grown taller but lost some weight, so she was on the day of the physical 55 inches tall but only 59 pounds.  That puts her BMI at the 0th percentile.  So now we are supposed to go back for a weight check in November so they can make sure she is not losing anymore weight.  

Grace has put herself on a strict regimen of milkshakes almost every afternoon, and I am pleased to say that it is working!  When she was measured today, she was almost 56 inches--and 66 pounds!  She's really packing it on!  That puts her in the 11th percentile for BMI, and actually it makes me wonder if the scale over at the pediatric clinic was really accurate that day?  Weird.  No one looks at Grace and thinks she is wasting away, an unhealthy "skinny".  She looks strong and fit--just skinny!  Anyhow, I don't think I'll be bringing her back in for the weight check.  It's not like we can just pop over there for 15 minutes.  A 15 minute appointment takes me the entire morning, driving there and back plus navigating the parking garage.  And beside, we have to make other trips for Anna . . . 

Which brings me to Anna's issue.  She got out of the physical appointment unscathed and pronounced healthy.  But now there is a routine lipid scan for 10-12 year olds, so both girls had to have blood draws.  I got a call from the doctor a few days later saying that Anna's LDL had been very slightly elevated, so she needed to go back in for a fasting blood draw.  We did that before our weekend at WSS, but again, I got a phone call the next week.  Her levels are *just slightly* elevated, right at the top end of normal.  SO we need to go back in 2 more months for another fasting blood draw so they can keep an eye on these levels.

Well.  I quickly researched high LDL levels in kids, and all the articles talked about were obese kids.  Parents were supposed to encourage weight loss, healthy food choices, and more exercise.    Anna is 58 inches and 80 pounds, giving her a BMI of 17, which is completely healthy.  She is super fit, strong, and active.  She swims, runs, plays basketball, and was competing in gymnastics until this past spring.  She runs a 20 minute 4K, and at this point in her life, I don't actually think it would be healthy for her to exercise more, and she certainly doesn't need to lose weight!  She eats very healthily, and rarely eats any fried, fatty food.  We don't eat tons of red meat because it's expensive to feed all these kids steak and roast all the time, and I cook pretty much all the time, with very little processed food.  She doesn't even eat cereal most mornings, which is our most processed meal--she usually makes herself a fruit smoothie!  

I did ask around, and people suggested more oats, chia seeds, and fish oil.  So now we are making big batches of steel cut oats in the instant pot with chia seeds, and she is eating a bowl of that every morning.  I also got some chewable omega 3 pills from Costco, and she's eating 2 of those a day.  We'll see if any of this makes a difference.  I have had 2 other friends tell me that their very active and healthy teen sons also have slightly elevated cholesterol levels, per this blood test, and it makes me wonder.  How did doctors get these healthy-range numbers for growing tween/teen kids?  They are wanting to help obese kids, but it seems like maybe they are pulling in healthy kids with their wide net.  I don't think Anna is at risk for heart problems right now, and neither of our families have histories of kids/young adults with high cholesterol.  Once people get older (40's, and less fit), yes, but that seems pretty normal. I wonder if once she is through puberty and in her 20's, if she will still have any cholesterol issues (well, probably not because of all the oatmeal, lol!).  Maybe this is something that works itself out in healthy, non-obese kids, especially since she's not in a range that would indicate a need for medicine or anything.  Regardless, we'll be back at Bethesda for another fasting blood draw the end of October.  

And so now you see why I don't make annual well child appointments a priority for healthy kids of mine!  If you don't report a problem, they'll find some!