Do ADHD medications affect kid’s Growth? -- with Dr. Sheila Perez Colon

Dr. Sheila Perez Colon: Parents will say, like we are concerned because my son or daughter has attention deficit, hyperactive disorder is on medication and that's why she, or he is not growing. Um, so we, I see it a lot at first I approach it like every other patient. Like we get a good history what's going on within the history we ask about the medication and when I find.

In this case that they're taking medication for that condition. I go, you know, into how long, how much is the dose, et cetera. Uh, because yeah, I have seen. It's very frequent visit to the pediatric endocrinologist when there's like short statu or decrease pro velocity. And they want to know if it's due to the medications or no.

Dr. Diana Mercado-Marmarosh: Hello. Hello. Welcome to beyond ADHD. A physician's perspective. I am Dr. Deanna Mecado mage. I'm a family medicine physician practicing in rural Texas. I used to be hindered. ADHD, but I now see it as a gift that helps me show up as a person. I was always meant to 

Dr. Sheila Perez Colon: be 

Dr. Diana Mercado-Marmarosh: both in my work and in my personal life.

In the past two years, I've come to realize that unlearning some of my beliefs and some of my habits were just as important as learning the new set of skills.

Hello? Hello. I am so excited today. I have a very special guest. I have somebody who is gonna talk to us about how ADHD can affect or not affect your growth based on which medications you have and, uh, who better than a P. Endocrinologist who is double board certified. She's also a general peaks doctor and her name is Dr.

Uh, Shala fit. And yeah, we're super excited to have her here today. She, um, went to medical school in the university at they, and then she did her residency and her fellowship in New York. And so. She's been practicing about, uh, 13 years now and she just moved to Puerto Rico and is gonna start her direct primary practice there to help children and adolescents, adolescent.

Uh, but. She will tell you all about what she's into, but I know her specialty interests are puberty and growth and diabetes and, you know, thyroid and all that P C O S which sometimes a lot of us don't realize that polycystic ovarian syndrome can. Play a role with our insulin, uh, and our fertility. So anyways, she's happily married and she has a 10 year old daughter.

Who's already a fifth grader. And so we're gonna just hear her and see what she has to share with us today. 

Dr. Sheila Perez Colon: Thank you. Thank you Diana, for that introduction. I'm so happy to be here. Awesome. 

Dr. Diana Mercado-Marmarosh: So tell me, did you. Did you ever realize that, you know, growth, um, could be in a way linked to our sugars? Or, I mean, I know, you know, this is like, I'm asking you disguise blue because this is your specialty, but were you curious or what led you that down that route of interest when you were, you know, you could pick anything when you wanted to be, uh, a doctor, you that's the 

Dr. Sheila Perez Colon: field that you chose.

For me. I, I knew that I wanted to work with children because I always enjoy, you know, their energy that's so like it give me so much vitality, but in medical school I did, um, fell in love with the endocrine system. So when we were ex. Planning and talking about the hormones and how the endocrine system work.

That's when I say, huh, that really triggers me, you know, that, that, that emotion and that passion for what I wanted to do to be able to kind of fix, you know, I, I think it always, endocrine is like a puzzle. We, we try pediatric endocrinologist, we try to put a puzzle together. So the patient present with the sign or symptoms, then we do the exam and then we're like, okay, what could it.

But very interestingly, and for me, it's very regarding that when I say, okay, there's efficiency of a hormone, I just keep the hormone. And most of the time we kind of achieve that balance. And sometimes if that hormone is in excess, I can also work to bring it down, to bring the balance. So that's really what, what make me go into bits and the cream and yeah, I see it every day.

I enjoy bits endocrine because of that. It, it, it get me thinking all the. It's not . Yeah. 

Dr. Diana Mercado-Marmarosh: And then have you had any patients who have ADHD? Like do they come to you? I know they don't come to you because of the ADHD, but have you seen any correlations of the meds that they're taking, whether it would affect their growth or anything of that sort.

Dr. Sheila Perez Colon: So I have definitely seen it. I get a lot of consults for, for example, evaluation of poor growth or short stature. And some of them come directly from the pediatrician staying on the referral, or the parents will say like, we are concerned because my son or daughter has attention deficit, hyperactive.

Disorder's a medication. Why she or he is not growing. Um, so we, I see it a lot at first I approach it like every other patient. Like we get a good history what's going on within the history we ask about the medication. And when I find out in this case that they're taking medication for that condition, I go, you know, into how long, how much is the dose, et cetera.

Um, because yeah, I have seen. It's very frequent visit to the pediatric endocrinologist when there's like short statu or decrease of pro velocity. And they want to know if it's due to the medications or no. Yeah. 

Dr. Diana Mercado-Marmarosh: And then have you been able to then give them a treatment so that they can continue with medications if they need to, or, um, I mean, I know every person is, you know, different and you can't really tell me names, right.

Uh, It is what it is, but what would somebody expect? Like sometimes is it just gross supplementation? Is it like, I know, like we say that ADHD is a deficiency in dopamine, like, and that's like a simple way of saying it because there's a lots of factors involved with it, but, you know, To me when I explain that to some of my patients like, and I tell them, yeah, I'm not surprised that you have diabetes and you're using sugar as a way to try to get you to focus.

Or I'm not surprised that you are smoking or you are drinking, or you are having so much caffeine because that can give you, um, you know, the dopamine that your body's again, crazy. And, and when we do make the ADHD diagnosis and I do start them on medications, all of a sudden they didn't even realize that they stopped smoking.

They didn't realize that they stopped eating all the, the food at 3:00 PM. You know, the cookie that when they were trying to do an executive function task, they couldn't. So they would go reach for the 

Dr. Sheila Perez Colon: cookie to try to get them through. 

Dr. Diana Mercado-Marmarosh: Right. Um, so have you, have you noticed like, uh, Any supplements that sometimes you suggest or any things that you, you suggest 

Dr. Sheila Perez Colon: for them?

So for those patients who are on medication, um, again, I do the evaluation, like every other patients on C, like you mentioned, it's case by case, depending on, do I need to treat this patient or not simple way, just because you are, or the patient is on this medication. Um, do or, and they are not growing properly.

Is this a hundred percent due to the medication? Not completely. We need to rule out, like we say, medicine, making sure you don't have any other diagnosis, for example, that's my approach. So when they come, I do have it on mind that they're, they are taking this medication, but let me make sure you don't have like growth hormone deficiency, which could be contributing to your, um, short statu or just like slow down on your growth that you don't have TIAL disorder that you don't have any inflammation in your body, for example, an gastrointestinal conditions.

Right? Like having all those things. First, I make sure they don't have it. And once I, I don't find any diagnosis of that. I could say this could be maybe because of the medication Diana likely, you know, like through many years, over 20, 30 years ago, this has been studying and there's a lot of controversies within this medication.

That's stimulant or, uh, a D ADHD medications cost your stature or compromise the patient's adult height in the past. Many of them say, yes, they compromise the height. The patients end up having like less adult height and it varies. They say like one to three centimeter or two inches, however, more studies have shown like, oh, maybe it doesn't have relationship.

Maybe it's just like casual. Like it just happened to be incidental. Right. So as of today, if you still look on updated research, it there's a lot of controversy. So, and with AVO call results. So I, again, I don't blame you right away, but yes, I rule out other conditions and if they don't have dose, then I say, could this be due to the medication?

And, um, if I think it's due to the medication, then I always do it in a multidisciplinary team. I never tell the patient or the family. Right. Stop the medication. This is due to the medication. I always I'm like old school. Everyone say you're so old school. I always call the other physician who is giving the medication.

And I talk to them and say, what's going on? Why did we start. Do we need to have that medication or can we change it or no, this is what is working for the patient. And I'm okay with that because that's very important, but let me, then I, as an endocrinologist, who's following the patient, make sure they come like at least every six months to monitor their height.

Right. And make sure like the dose, if we C. if we can decrease the dose as possible, then we will decrease it. But there's, it's not a hundred percent. It hasn't been shown that yes, this medication for sure will affect the height. This is one of the, I would say one of the grace areas that we do have, and as an endocrinologist is something that I would like a clear answer.

There's different mechanism for that, you know, there's research that show that it inhibit like the growth release from the brain, right? The growth hormone is released from the brain. So it just stopped the release or the production. Of course, then they will be compromised height or they say, no, it's not the message directly through by the brain or blocking the, the brain message.

But it's through the liver. Like there's some conversion that happened with the growth hormone liver. So some research show, it could be that. And another proposed mechanism, it's like, it goes indirectly affecting like your bones. Um, but I do give advice like everyone else, you know, let's make sure that.

If we need the medication, we keep it. Let monitor you closely. Let me give you some straight, uh, recommendation for growth, making sure that patient is, is sleeping. And I know with this condition, you know, it's could be challenging at time, but ideally, um, 10 to 11 hours at night because we know the growth hormone is P and it release at night as well, uh, to make sure we're doing some exercise, exercise will help with the release of growth hormone.

So basic things, um, To help us, you know, like manage that kid. Not necessarily, we need to give growth hormone. Yeah. That's so 

Dr. Diana Mercado-Marmarosh: good that you just explained all that because I think there's a lot of misunderstanding or like you said, just mix information out there. Right. Mm-hmm and that might be part of the reason that maybe like patients don't even start on the medication or if they do start on the medication.

Uh, you know, they are quick to blame it for something, right. Um, I, myself was not diagnosed until I was a first year medical student. So me being, you know, five, one I'm really probably five, five feet, or who knows maybe four 11. And I, I tried to give myself more inches. Right. But. I didn't take any meds until then.

So like, it could be that some of us are just short, like you said, coincidence. Right. And you just don't know, but like you said, modifying it and taking a multi team approach so that you could figure out if there is a different type of medication, because, um, you know, it, it could be metabolized through the liver.

Uh, differently or it, you know, it could be different things. Right. And so I think it's so important. What you just mentioned that people really hear, because we all underestimate the importance of sleep and the importance of exercise. And so it's so good that, like you're saying you are treating not just like the little chief complaint, but you're helping them be set up to, to really thrive, right.

To really thrive and, and enhance themselves. Um, Because as you're exercising, like you just mentioned, you're, you're causing the release of both hormone. Plus you're also causing the release of oxytocin and serotonin and Rine, which are the feel good hormones, which can help you tame yourself so that you don't always feel so overwhelmed or feel.

Oh, I have plenty of time and I'm gonna procrastinate. And then the adrenaline kick in, which is kind of like me taking steroids all the time. Um, and so it, it's interesting how the body will try to compensate, but if you just sit back and ignore what might be happening, uh, it's just a lot harder. You don't even realize how much harder you're making it on.

Dr. Sheila Perez Colon: Yes. I agree. And with, for example, we do know that medications, all medications have side effect, right? Um, one of the side effects of this medication is like decreasing appetite, right. Because of how it worked, the medication. So it's decreasing your appetite and yes, decreasing appetite could lead to some, maybe weight.

And why I bring that because for us to grow, we need to make sure our height and actually, essentially our weight is in normal weight. So patients who have malnutrition or have underweight that by itself could compromise the growth. So not necessarily right. It's like, oh, it's the medication by it.

Directly affecting no, it could be that in some cases they lead to decreasing weight or decreasing appetite. We're losing some weight. And of course the, the body's kind of protecting itself and there's some stopping of some mechanism that happened. Um, and then you, your height could be compromised. So it's like, I again, recommend parents who have patients in this conversation with this condition, ADHD who are in medication, who, or who are not because actually Diana interestingly as well, like we mentioned, it's like some patients have compromised height already, even without.

Before starting medication. So they already come for evaluation. We are thinking, or the doctor is thinking to start, but they already have like decreasing growth velocity or they have, may have mature stature. So not necessarily the medication, it could be again, the condition itself or, or everything that the ADHD involved, or again, could be something else.

It could be familiar genetic. So that's why we evaluate and make sure it's not something else before we kind of say, this is the diagnosis. It's secondary to. Yeah, 

Dr. Diana Mercado-Marmarosh: that's so good that you also mentioned that because, um, and I know we're talking maybe about kids, but because I'm a family medicine physician, I see everybody see, I, I see the kids 

Dr. Sheila Perez Colon: and I see the adults mm-hmm and with the adults, 

Dr. Diana Mercado-Marmarosh: the way that works is that once you do start on some of them on sting lids, like I was saying, you do see the weight loss, like you're saying, and, and.

And now they feel so much better because. Think and function and do different things. Plus they're losing weight. And, and so it's good to realize that some side effects might be wanted because, you know, like I said, maybe you were carrying those extra, um, inches under abdominal area that was leading to cholesterol and was leading to metabolic syndrome or prediabetes or diabetes.

And now that you're. Some of that under control. And then sometimes we don't even realize I've had a conversation in, in another episode with a doctor, Rebecca, who was talking about the correlation of like venting because of ADHD and 

Dr. Sheila Perez Colon: that impulsive fee 

Dr. Diana Mercado-Marmarosh: that you forget. And then you remember, and then, you know, all the stuff that happens, the, the part is that you don't realize how we're all interconnected and, and it's all.

So 

Dr. Sheila Perez Colon: I. Yes. Yes. Agree. A hundred percent. And we do, I mentioned like a part of the workup just for everyone who is listening when they present with decreasing velocity concern for height or short stature, right. Already we say, oh, he's short or she's short. We do the evaluation. Like I mention of the block work, right.

That I mentioned all the hormones. We also do like a CVC to make sure there's not an chronic anemia. We look for everything. In blood, but we also do an x-ray of the hand that we do it in all patients, including patients with ADHD, it's called a Bon. And what it give us an idea is to see, okay, let me see where we are.

Normally the chronological age, meaning the age of the patient. For example, E hypothetically, it will be an H year old boy. So he should be the chronological age is eight, but the bonus could be either delay, like kind of behind like a six year old or could be advance. If we are concerned about, uh, slowing growth, technically if it's not, um, early puberty or things like that, it tends to be delayed for some conditions.

And it may help us say predict how tall that patient will be. Or even if it's within normal and the bone is not affected. He's like the bone are our ag at all and match tech chronological age. I can calculate like within, when you're like 18 or 20 years, it's called predicted height. How tall you will.

What will be your final height and careful, we all endocrinologists. We say, this is not a fit. You know, it's not set in stone because it has some deviation, but it give us an idea to see if it will compromise or not. Because some of the study have shown. Listen, when patients are started on the medication, it, depending on the, how long the patient has been treated for, is it a short course of medication or if its for a long time, right.

And some of them say like, oh, if it is just like a short time, then you will see at deceleration at the beginning, but then it will normalize and the patient will catch up. others suggest like if it is for a long time though, patients may have like risk, but again, going back to the same, even for long time, if you look the studies, uh, updated studies, there's like controversies.

Yeah. About that. And 

Dr. Diana Mercado-Marmarosh: so tell me, um, I know you're onto a new adventure, right. Um, now that you're in Puerto goal, mm-hmm , can you tell us a little bit about your practice 

Dr. Sheila Perez Colon: and what people can find you? I'm very excited. Diana I'm opening. I'm bringing this new model, which is common in, in United States and it's like kind of a movement and it is like known as, um, It's direct specialty care.

And what I do is like, I kind of, I got tired of the traditional system because I have been working in different states in United States. Like I work in New York, in Los Angeles and in Miami, which I love all my patients and my clinic, but I'm very devoted to my patients. And I realized that with the traditional, uh, System, I wasn't giving the time and the care that I wanted to give to my patients.

So now I'm joining that movement and in Puerto Rico, I'm bringing for the first time, the, the direct specialty care, the specialty one. And on that one, I'm gonna be offering to my patient, which I open next week. It's my first day in clinic. I'm gonna be, yes, I'm excited. Um, I'm giving my patients more time.

I'm gonna be giving accessibility to my patient. I will be able to spend as much time as I want to with my patients so we can, you know, Families and patient and myself be on the same kind of team. Um, so I think that's very important and definitely for endocrine conditions, most of them are chronic. So chronic condition like diabetes, uh, need a lot of time.

So I'm gonna be offering this in Puerto Rico. Um, you can find me, I will be working in two different location. One is in San Juan, uh, in the north of the island. The other is in Dorado. Um, and I will be having clinic there in my Instagram. I have a professional Instagram page, which I am. Is slowly like trying to give some, you know, advice or maybe like just what I think about the endocrine conditions.

Right. My learning, my experience, and it is known as elite endocrine MD, and then an founder score. And my name Dr. Paris is kind of long, but that's how I wanted to, you know, I want everything to be there, so people know who I am and what I, I am offering. Um, yes. And you can find me there always, you can write me, um, in private message and I always.

Dr. Diana Mercado-Marmarosh: Awesome. So, um, now I'm gonna do some rapid fire questions. Um, okay. So, um, where do you see yourself in the next three to five years? For fun? For fun. 

Dr. Sheila Perez Colon: Okay. I see, I see myself in three to five years here in Puerto Rico. I see myself like having, uh, time to enjoy with my family at the beach. I see myself like very happy with, with myself without how much I have grown professionally.

I I've see myself satisfied with the way I'm practicing medicine and the change that I did. And I see my patients driving. 

Dr. Diana Mercado-Marmarosh: Awesome. Is there any place you would like to go travel or something that you're like, you can't wait to do that you think, you know, it's a little crazy, but you're dreaming it. 

Dr. Sheila Perez Colon: I always wanted to go to Malif.

And couple of years ago, my husband did buy me the ticket and the hotel, but it depends of the seasonal, the season there. And like three days before we were leaving, they, they, they say that it was going to be severe thunderstorm for many days and they say it's better to cancel, so we needed to cancel. So yeah, I would like to go.

Okay. Awesome. So 

Dr. Diana Mercado-Marmarosh: thank you so much for sharing everything, uh, today. And the last question is that, you know, my audience has ADHD. So if they just started tuning in like right this second, what is the takeaway point that you want them to walk away with? 

Dr. Sheila Perez Colon: So for patients, um, right children and adolescent with attention deficit, hyperactive disorder, I will say like, if there's indication for the medication, if we need to start it and the doctor recommended it's okay to start it right.

Because there's some things that we need to address, but we need to follow closely either with the P pediatrician or the pediatric and endocrinologist, make sure that you go more than once a year, not just for the regular checkup, maybe go like every six month to make sure that we're tracking the, the growth velocity of your child.

To make sure everything is online. If there's any deviation or any concern, then a pediatric endocrinologist will evaluate. And then we will decide if anything needs to be done. Awesome. 

Dr. Diana Mercado-Marmarosh: Well, thank you so much for your time and for sharing all your expertise, your patience and their families are so lucky to have you.

And if everybody go get her busy in 

Dr. Sheila Perez Colon: Puerto Rico. Yes, I'm excited. Thank you Diana, for having me. Thank you for everyone who's listening or watching. 

Dr. Diana Mercado-Marmarosh: Thank you for spending your time with me. I really. That time is your most valuable asset. Please subscribe to the podcast, share with your colleagues. And don't forget to check out my website at ADHD.

Live coach.com, where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happy.