My last request to this board regarding my current CAH issues is to please read the following letter and forward it to anyone you deem appropriate.  Any responses, confidential or otherwise, can be sent via this board, letter, e-mail or by phone.  Thank you all again.  Douglas

Dear Endocrinology Professional,

Thank you for taking your valuable time to assist with my CAH issues. I understand that medical professionals typically do not wish to involve themselves in legal matters, and I apologize in advance for this imposition. However, It is with my most sincere intentions of expanding mine and the courts understanding of what constitutes an "appropriate" CAH caregiver AND what are the real dangers presented to CAH children from life's "Normal Stressors" such as running, swimming, school sports, bumps, bruises, scratches, minimal corporal punishment, verbal scolding and the like, that I would appreciate any professional clarification you deem appropriate on the following three questions:

How are parents of children with CAH advised on the extent to which they are to minimize a CAH child's potential exposure to "Normal Stressors" such as running, swimming, minor bumps, minor bruises, scratches, minimal corporal punishment, verbal scolding and the like?

What additional cortisol may be advised for the CAH child upon the occasionally excessive exposure to life's normal "Normal Stressors"?

What constitutes an "appropriately" informedtrained care provider of a CAH Child?

To place my request for professional clarification into the appropriate context, I wish to provide the following additional information:

I have been recently served with court order terminating my visitation rights and authorizing my ex-wife to remove Triton from his Paternal Grandparents care in Dallas, TX during his 1 week summer vacation with them. This court order based its decision on the interpretation of two medical professional position letters and an Pedi-Endo Dr's "Suggested" prescription included within the pleadings requested of the courts by the mother. These letters include:

1st Letter: Pedi-GP (Clarence L. Kemp, MD) regarding his professional opinion on what constitutes an acceptable care provider for CAH Children. To quote:

"If Triton's condition is not properly monitored, evaluated, and treated, and if strict compliance to Triton's schedule for the administration of his prescriptions is not given, Triton's health can rapidly deteriorate with Triton suffering irreversible damage that can be life threatening. Person(s) caring for Triton need education and training to properly treat and monitor Triton's condition. Person(s) entrusted with Triton's care need training to recognize symptoms that may indicate that Triton may have an infection and those person(s) would need the requisite knowledge to administer regular or stress doses of medicine. Without having the proper knowledge or appropriate training needed to evaluate and treat Triton's condition, Triton can suffer a catastrophic or fatal episode. From a medical standpoint, it is necessary for the continued health and well being of Triton that he only be cared for by those person(s) who have the requisite knowledge and training specific to his condition. Dr. C. L. Kemp, MD (Pedi-GP)"

Apparently the Judge interpreted the Dr's letter in a way whereby he agreed that my parents did not have the specialized training required to care for a child with CAH. I am currently under court order not to leave Triton unattended with them, and this court decision sets the legal precedent for further court ordersrestrictions as to whom where I am permitted to leave my son unattended with without providing and tangible criterion as to what knowledge is required.

2nd Letter: Pedi-Endo-MD (Steven Kemp) regarding his professional definitions of stress and the CAH patient. All of the definitions of "Physical Stress" and Serious Injury descriptions are consistent with what I understand. However the last line of the letter reads: "The CAH patient needs to maintain a low stress level and continue medications as directed in order to maintain a healthy life." The Dr.'s letter included the following:

Dr's prescription: "Please avoid situations that cause Triton excessive stress. While I can't keep Triton from being spanked, it would be in his best interest to avoid these situations as much as possible. Pedi-Endo-MD (Steven Kemp, MD)

As a direct result of this "Dr's Suggestion" the court subsequently ordered that I was permanently restrained from using any form of corporal punishment on Triton for any reason.

As a result of the corporal punishment order imposed by the courts in the 1st Order, I was subsequently served with another court order taking away my unsupervised visitation rights with my CAH Son for a "so-called" violation of the no corporal punishment restriction.

Thank you again for your opinions and contributions to mine and the courts understanding of what constitutes an "appropriate" CAH caregiver AND what are the real dangers presented to CAH children from life's "Normal Stressors" such as running, swimming, school sports, bumps, bruises, scratches, minimal corporal punishment, verbal scolding and the like.

Best Regards,

Douglas L. Arnold, Jr. (father)

PO Box 1552

Paragould, AR 72451

LSDATA@GRNCO.NET

(870) 236-2473