Chapter 6: Talia Goes Into the Shop

If Talia was a car, she needed a complete overhaul, starting with the fuel system, in other words, food.

Dr. Barry Russell and Paul Takahashi worked together getting her comprehensive medical insurance which coordinated with her CSU Marysville Student Health plan. With that in place and verified, they selected Dr. Mary Worth, a highly regarded local primary care doctor.

Dr. Worth squeezed Talia in on Tuesday at 5:00; she took one look at her deprived physique shivering in the paper gown and wrote immediate urgent referrals for Gastroenterology (digestion) and Endocrinology (glands, hormones) specialists.

The “Gastro Doc,” as he styled herself, quickly diagnosed Talia with celiac disease, meaning she was completely gluten intolerant. Gluten is a protein, a component part of wheat. In her case her body’s immunity reaction to gluten invariably damaged her intestines, causing diarrhea, bone loss, pain, malnutrition, delayed puberty, in short, almost all of Talia’s issues since childhood. As most of the cheap food she had received was made with wheat flour, she was constantly sick.

Being a pre-teen, lacking access to doctors or health information, she chose to eat as little as possible. Particularly bread, which she had guessed (correctly) was a source of some of her misery. She also never drank milk, thinking her symptoms were from being lactose intolerant (maybe she was).

Years of being afraid to eat and untreated diarrhea had left her significantly malnourished. Privately, Dr. Worth thought she was dealing with anorexia until the celiac diagnosis came in, and she reviewed all the notes from Talia’s file.

The infuriating thing was that 19 year old Talia’s life of deprivation and suffering was absolutely unnecessary. Celiac disease is a well-known and commonly diagnosed autoimmune disease in young people (identified since the 1950s) and the wheat-free diet treatment is well understood by doctors, if she had ever been to see one.

In the weeks following Thanksgiving Talia went on a strictly gluten-free diet, and her digestive issues seemed to magically disappear. For the first time in her life, she was able to eat normal amounts of food. It was easy to substitute, for example, rice and oats as carbohydrates to replace wheat in her diet. Talia began consuming regular portions of calories and nutrients, while avoiding the specific protein in wheat that sickened her in the past.

The next step was to start working on her physical development. Growth and other hormones are normally controlled by glands in the body. These are the pituitary, thyroid, adrenals, ovaries/testes, and so on. Because of her chronic malnutrition, these glands needed to be “switched on” to help Talia grow physically—to become a woman.

Dr. Cassandra Petersen was a board-certified endocrinologist. In plain English, a credentialed expert gland specialist. Talia and Paul drove nearly an hour down to her Roseville office.

“Thank you, Talia, for coming to see me. I want you to know I have reviewed your file closely. Seeing you in person just confirms what I was expecting. I want to be very honest with you and speak quite directly. It might be better if your boyfriend took a seat outside.”

“Oh, no. I want Paul’s support.”

“All right. Well, here we go. To begin with, your growth has been severely stunted—sorry, there’s no other word that fits—stunted by your severe lack of nutrition. Your bone density has suffered, and your bone length was impaired, diminishing your height.

“I propose injecting human growth hormone (HGH) directly. Over time, it may cause you, quite literally, ‘growing pains,’ like some adolescents have. You will feel these pains as your body tries to mature and develop your bone structure.

“The further treatment is more complex, and I need to make sure I get your ‘informed consent’—which is a legal term that says I have explained the risks and the benefits of my proposed treatment, compared to other options.”

Dr. Petersen described her preferred option as a specially compounded “cocktail” of hormones, designed to bring on and rapidly reverse her delayed puberty.

“This will also be an injection. I have to warn you, Talia. If this experimental therapy works as expected, it’s going to have drastic effects on you. I need to confirm: you and Paul are not sexually active, correct?”