I can absolutely and TOTALLY understand your feelings. I was computer illiterate until the Liquid Cortef problem and after I was told by 3 different doctors that my son had basically doubled his bone age in one year AND was going into puberty at 4 years old I knew I had to become even more educated than I thought I was. After all, I was a "privelidged patient" of the Chief of Peds at one of the best hospitals around. But, don't beat yourself up too much because I did kick and scream and call on the phone when my son would suddenly drop to the ground and roll back and forth screaming that his bones were being stabbed and pins and needles were poking his face. He STILL did nothing. I know the doctor heard me because, in reviewing all his follow up (LOL) letters to my "well care" ped he reiterates my concerns and arguements about BO, advanced sexual interest, rapid growth, pubic hair, etc. It was as if my cries fell on deaf ears. He, too, sat with his calculator and tried to look important and all knowing. Why didn't he know that my son had just lost 4 years of growth and his calculated max growth potential was now in the 4'8"+/- range? I had one doctor tell me once (and it eccos in my head to this day) that if his son had CAH he would NEVER accept the options of treatment they have available now. When I brought that comment up to another doctor his response was "yes, I would have to say that this protocol is woefully inept". What the?!?!?!?!?!? I think that part of the problem is that you could take 10 children with the exact SAME type of CAH and give them the exact SAME meds and no two would respond in the same manner. Now add the different protocol into the mix as well as the salt wasting/non saltwasting feature and it's a whole different ball game. Then, just like you mentioned, let those children do something sneaky like grow a little and we're back to square one. Another problem is that when we read on the board that someone is having great success with a certain protocol we start to doubt our own. Then we move heaven and earth to have our child try it and when it doesn't work we are depressed. It is very important to really understand that each child will react differently so this is an extremely personalized thing. Titrating is a given with CAH even under the best of circumstances. But, as you said, small increments would seem to be the wise adjustment. I don't really see how your doctor could justify dumping such a huge increase on your child all at once unless he needed to immediately introduce more meds into your child's system as in my son's case. At the time we finally faxed our medical files and current levels to Dr. Pang's office in Chicago. I was told we were just days away from possible death. Dr. New was pleading with Upjohn to make a 1mg pill but I do believe it fell through. I will be sitting down with some representatives from Upjohn in the not too distant future and I will ask them directly myself. I don't have dreams of grandure that I would make a difference, but we can only try. The problem with the mass produced, extended shelf-life liquid was with one ingredient that didn't fare well. I do know that someone has posted a receipe on the board in the past for a liquid version of the Cortef that could be made by your TRUSTED pharmacist. Perhaps that could be posted again for others to try. I am understandably a bit skittish about the whole liquid thing but, given your experience, can certainly see your point as well. Just because one company failed at something miserably doesn't mean that someone else can't come up with something that actually works for us. Just for the record, we are not really supposed to have to beat our endos up so that they will listen to us and our parental experience. To me, that is something that is sadly lacking in many of the endos I hear about on this board. I think you did as much as you could possibly do to help your child. Now you have that experience AND all the new knowledge you have gained and God forgive the next ped endo that gets in your way (:>). I wish you and your child health, happiness and the ever elusive peace of mind.