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My daughter

by stefan petkov last modified Feb 14, 2008 10:29 PM

Hi,

I want to share with you the story of my daughter. Now she’s 12 years old.

The pregnancy and the birth were normal. She was born at full term with the weight of six pounds and 5 ounces. She began to walk at 13 months but she fell often while walking. When she was about 24 months we had the impression she could not run. Her orthopedist told us everything was O.K. At the age of five years we saw that while walking she shaked her haunch. An X-ray of her bones was read as normal but her muscles were weaker than normal.  It was recommended she takes gymnastics or dance. Two years she trained Artistic Gymnastics.

She began to talk at the age of  24 months but a little bit babylike. Later she worked with a specialist and all was compensated. The orthopedists told us that she also had problem with her fine motor skills but with the growth everything will be fine.

The big problems began when she was 10 years old. She grew tall fast – for about two-three months she became taller with 20 centimetres. She was 148 centimetres tall and weighed 55,1 pounds. She began to get tired very easily -  going up the stairs was difficult for her. She started folding her legs by the kneels, one of her feet bent inside and the toes also folded up.  Her limbs, the fingers and toes grew even weaker and longer.  Her speech became difficult.  Now she can’t squat.  The experts gave us a lot of scary diagnoses and syndromes but all the examinations showed that these diagnoses to be wrong.  DNA examinations of the mother, the father and the child in our country Bulgaria and in Belgium found nothing wrong.

An MRI of her cerebrum was normal. We made also examinations of amino acids.  She only has lower speed of leading of peronaeus dust and peronaeus proximal with saved reflexes and distended zones.

After two years working with a kinesitherapeutist has brought a little bit of improvement.

Some of the doctors say that everything will be fine while growth but if it won’t be fine?

Another detail for my daughter is that she doesn’t have tears, she cries but without tears. She has optic nerve atrophy but normal mobility of her eyes. She has a non-specific long facial skull and high palate. Her heart  is normal as is her intellect.  Since she was a baby she has had colitis and anemia. She can ride a bike but when walking, if there is unveness, she sometimes falls down.

I write you because there are some resemblances (despite the differences) between my daughter and yours. I really want to find what’s the cause for the state of my daughter, so I would know how can i adequate help her.

Yours faithfully,

Stefan Petkov

 

Bulgaria, Sofia

Petur Velichkov Street №57

+359888571591

shenairco@yahoo.com

 

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Other Marfanoid

Posted by Administrator at Feb 14, 2008 10:37 PM
Dear Stephan:
Thank-you for sharing the story of your daughter. I hope you do not mind my making a few edits to your story. I am having some trouble understanding the sentence about the peroneus nerve- Perhaps you could clarify that. It sounds like your daughter has "Marfanoid" features: long fingers and toe, high arched palate, very tall, thin, long narrow face. Are there other features that conform to "Marfanism"? (I do not mean to suggest that she has the Marfan; I rather want to understand the full spectrum of the signs that might suggest TGFbeta-family involvement.)
best,
hugh

It's not the Marfan syndrome

Posted by stefan petkov at Feb 16, 2008 05:52 AM
Dear Hugh,
The doctors first said that my daughter has the Marfan syndrome. After few examinations they said that she hasn't got this syndrome because characteristic for it is that the kid has underdeveloped mind (i mean that it's not intelligent) but my daughter is very clever kid and hasn't got problems like that.
You've asked something about the peronaeus nerve. This was written by the examination:

                         Rec. site Distance sm. Temp C Lat. ms Ampl. mV NCV m/s
N. peronaeus dist R - M.exr.dig.br 6.5 27.0 5.6 3.4 -
N. peronaeus proximal- M.exr.dig.br 26.5 27.0 12.8 3.0 36.8

N. peronaeus / M.ext.dir.br 5.0 ms/ Div, 4000.0 uV/ Div, 1/0

I hope this can help you undersand my sentence about the peronaeus nerve because i can't explain it in English. If you have another questions i'll try to explain it better.

Yours faithfully
Stefan Petkov

paraneus nerve

Posted by stefan petkov at Feb 16, 2008 05:59 AM
I'll write it again because so it's hard to understand

                         
1) N. peronaeus dist R
   - Rec. site- M.ext.dig.br
   - Distance sm - 6.5
   - Temp. C - 27.0
   - Lat. ms - 5.6
   - Ampl. mV - 3.4

2) N. peronaeus proximal-
   - Rec. site- M.ext.dig.br
   - Distance sm - 26.5
   - Temp. C - 27.0
   - Lat. ms - 12.8
   - Ampl. mV - 3.0
   - NCV m/s - 36.8

The Marfan because ....

Posted by Hugh Rienhoff at Feb 16, 2008 06:25 PM
Stefan:
I did not think it was the Marfan but it may be in that family as with my daughter. There are many ways to become Mrfanoid. By the way, there is no loss of cognitive function or low intelligence with the Marfan so the fact that your daughter has normal intelligence cannot in any way rule out the Marfan. The real reason to consider the diagnosis is the aortic root dilation. That can be detected and treated before it causes serious problems. If this has not been done, I would think it would give you great comfort to know that the heart and vessels were normal by echo. If the aortic root was abnormal, then diagnosis of a connective tissue disorder such as the Marfan would have to be very high on your list.

I know next to nothing about nerve conduction studies so I cannot interpret what you have sent though I appreciate your effort.
Can you put up a picture or send me one -- that would be helpful too.

best wishes,
hugh

sorry

Posted by stefan petkov at Feb 17, 2008 12:14 AM
I've made a mistake about the Marfan, I wanted to write that everything is allright with her heart but I went wrong. Because all the doctors said us a lot of different diagnosis and terms and in this moment I've forgoten that not the inteligense but the heart is connected with the Morfan. So we've made examinations and her heart is in perfect condition.
I didn't understand what kind of picture do you want me to put up - of my daughter or of this examination about the nerves?

Best wishes,
Stefan

No reason to aplogize!

Posted by Administrator at Feb 18, 2008 11:16 AM
Stefan:
I think it would be very useful for the users of this site to see detailed pictures of your daughter. Perhaps you could provide several pictures, one of the back, the hands, the face, the legs. Given that she is quite tall, this does limit the differential diagnosis considerably.
Many thanks,
hugh
 

pictures

Posted by stefan petkov at Feb 19, 2008 12:44 PM
Hugh,
I've put up some pictures of her face, back, hands and legs so that you can see them from different sides. If there's something that can help or will be useful for the users i'll put it up, just say me.
Stefan

Other diagnoses?

Posted by Gary S Gottesman at Feb 26, 2008 08:40 PM
Dear Stefan:

I am a clinical geneticist who has joined this web site.

After reviewing the history and pictures you've supplied I wondered whether any of your daughter's doctors considered a mitochondrial myopathy as a possibility. The multisystem involvement detailed in your notes always raises concern for me regarding this group of disorders. Like Hugh, I am unable to interpret the NCV studies.

Another disorder with lack of tears is Triple A syndrome: achalasia, alacrima, adrenocorticotropic hormone (ACTH) insensitivity, with late neurologic manifestations. Lastly a mild variant of familial dysautonomia might be a possibility. Are there any Jewish relatives in your family tree?

Regards,

Gary S. Gottesman, M.D.
Director, Division of Medical Genetics
Saint Louis University School of Medicine

other diagnoses

Posted by stefan petkov at Feb 27, 2008 12:17 PM
Dear Gary,

We have made an examination about mitochondrial DNA and no motation were found and the following syndromes were expeled : 3 243-MELAS , 4332 encephalopathy/MELAS , 5814- mitochondrial encephalopathy , 8344-MERRF , 8993-NARP/Leigh disease , 9176-Leigh disease

The following month we will make an examination about this Triple A syndrome. Our doctor wasn't sure if she has this syndrome because my daughter doesn't have the third syndrome-
adrenocorticotropic hormone. Because of that we are making this examination and the doctor told us that he'll check if it is posible this third syndrome to appear later.

There aren't any Jewish people in our family tree - we are Slav.

Your sincerely
Stefan Petkov

Adison - Tripple A-syndrome

Posted by stefan petkov at Mar 19, 2008 01:05 PM
Dear Hugh,
Finally my daughter has a diagnosis - Adison. The doctors made an examination about cortison in her blood. In the morning the level of cortison was 9 (it's normal to be 171 to 522) and in the evening - 4,7 (it's normal to be 64 - 250). Now she's under cortisonian treatment. We hope that she will get better and her muscles will become stronger. She's still working with kinesitherapeutist.
For now she hasn't got the third syndrome - Ahalasia.
Thank you for the attention to my daughter's case. I wish you good luck with your work.
Best wishes
Stefan

Diagnosis

Posted by Administrator at Mar 19, 2008 08:13 PM
This is very good news and I hope that she can return to a full life.
Thank you for contributing to the site and please keep us informed.
warm regards,
hugh

A reference with discussion

Posted by Administrator at Mar 19, 2008 08:19 PM
http://www.kfshrc.edu.sa/annals/203_204/99-318R.PDF
Annals of Saudi Medicine, Vol 20, Nos 3-4, 2000

the article

Posted by stefan petkov at Mar 24, 2008 10:45 AM
Thank you about the information you sent me. There are a lot of similarities between this kids and my daughter but also some differences - for example she hasn't got Ahalasia and hyperpigmentation.
I'll inform you about the changes in the condition of my daughter.

Diagnosis

Posted by stefan petkov at Oct 05, 2008 04:58 PM
Dear Hugh,
My daughter's under cortisonian treatment since 7 months and now she feels better. She isn't tired any more. She comes back from school beeing there the whole day and plays basketball in our garden. She eats more and doesn't have pigmentation on her fingers. She rides bike every day and still works with kinesitherapeutist. Everything is better.
Thank you very much for the support.
Best wishes
Stefan