Dwarfism FAQ (monthly posting)

[Dan Kennedy]

D W A R F I S M

FREQUENTLY ASKED QUESTIONS

An information sheet on issues related to dwarfism,
on-line resources, and the Little People of America

Monthly posting
Last updated on May 3, 1996

Send questions, comments, additions, and suggestions to:

Dan Kennedy (dken...@shore.net)
FAQ editor and compiler

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DWARFISM RESOURCES ON THE INTERNET

The DWARFISM MAILING LIST, which is now approximately five months old,
has replaced the Usenet newsgroup alt.support.dwarfism as the primary
forum for the discussion of issues related to dwarfism.

To subscribe to the mailing list, follow these steps:

1. Send e-mail to list...@ucsd.edu

2. Leave the subject line blank; or, if your mail program requires
that you enter something, just type anything, since the subject line
will be ignored

3. The body of your message should read: "subscribe dwarfism"
(don't actually use the quotation marks)

That's it! You'll receive a message confirming that you subscribed,
along with some information that you should save. Using it is very
simple. You will automatically be mailed all messages posted to the
list.

To post your own message to the list, send mail to dwar...@ucsd.edu.
Please try to be specific in filling out the subject line. A lot of
messages are posted to the list, and carefully filled-out subject lines
can save people a lot of time when sorting through their e-mail.

If you ever need to unsubscribe, follow steps 1 through 3 above,
substituting the command "unsubscribe dwarfism" in step 3.

So what has happened to alt.support.dwarfism? It continues to exist.
(One of the many quirks of the Internet is that it's nearly impossible
to kill a Usenet group once it's been created.) I continue to post
messages from time to time, such as this FAQ, to publicize the e-mail
list. And if anyone wanders into a.s.d., I let that person know about
the list.

The DWARFISM HOME PAGE, on the Internet's World-Wide Web, serves as the
principal jumping-off point for dwarfism resources on the Net. It
already includes this FAQ, for instance, as well as numerous other
resources. It's listed in Yahoo, Lycos, Alta Vista, and other popular
Internet-searching sites, which means that anyone looking for
information about dwarfism should easily find it. You can reach the home
page at:

http://www-bfs.ucsd.edu/dwarfism

Add it to your hot list today!

Both the mailing list and the home page are the work of Nancy Peterson,
a short-statured member of LPA who works at the University of San Diego.
Nancy has done a tremendous job in a very short period of time. The next
step is to get more content on the home page -- LPA Today, district and
chapter newsletters, and the like. But what Nancy has already
accomplished has put us light-years ahead of where we were just a few
months ago.

Casey Hubelbank, LPA's teen coordinator, recently put the first issue of
TEEN LPA TODAY on the Web. It's a first-rate effort with lots of
articles and even a color photo. Check it out at:

http://owls.com/~jerry/lpaten01.html

Nick Koonce has started a Web page called the LPA INTERACTIVE E-MAIL
DIRECTORY. It's a do-it-yourself directory that lets you add, subtract,
or change your personal information. It is located at:

http://www.west.net/~atroll/emaildir.sht

Jane and Jim Skon recently created a Web page devoted to
spondylo-epiphyseal dysplasia (SED), one of the most common forms of
dwarfism. Although Jane and Jim warn that the location will be changing
soon, the temporary address is:

http://www.cis.ohio-state.edu/~skon/SEDPAGE.html

Among the more interesting features of the SED page is a link to the
ONLINE MENDELIAN INHERITANCE IN MAN database, part of the National
Center for Biotechnology Information. OMIM, which can be searched by
keyword, contains a wealth of information on dwarfism and other genetic
conditions. You can reach OMIM directly at:

http://www3.ncbi.nlm.nih.gov/Omim

Also, Shawn, another short-statured contributor to alt.support.dwarfism,
has put together a Web page that contains links to Nancy's page and
other resources as well. The location is:

http://www.neosoft.com/~brycel/SBHTM /trial.htm

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Q: What is the definition of dwarfism?

A: The Little People of America (LPA) defines dwarfism as an adult
height of 4-10 or shorter, among both men and women, as the result of a
medical or genetic condition.

Q: What are the most common types of dwarfism?

A: By far the most frequently diagnosed cause of short stature is
achondroplasia, a genetic condition that results in disproportionately
short arms and legs. The average height of adults with achondroplasia is
4-0. Other genetic conditions that result in short stature include
spondylo-epiphyseal dysplasia (SED), diastrophic dysplasia,
pseudoachondroplasia, and hypochondroplasia. As one might expect from
their names, pseudoachondroplasia and hypochondroplasia are conditions
that are frequently confused with achondroplasia; diastropic dysplasia
occasionally is, too.

According to information compiled by Johns Hopkins Medical Center and by
Lee Kitchens, database coordinator for LPA, the frequency of occurrence
of the most common types of dwarfism is as follows:

1. Achondroplasia (one per 14,000 births).
2. SED (one per 95,000 births).
3. Diastrophic dysplasia (one per 110,000 births).

These conditions are essentially untreatable, although some people with
achondroplasia have undergone painful (and controversial)
limb-lengthening surgery (see below). LPA's position on limb-lengthening
is that it is unnecessary surgery with unknown long-term results, and
that it is far more useful to build a dwarf child's self-esteem.

Proportionate dwarfism -- that is, a short-stature condition that
results in the arms, legs, trunk, and head being the expected size in
relation to each other -- is often the result of a hormonal deficiency,
and may be treated medically.

Overall, there are more than 100 diagnosed types of dwarfism, and some
that have never been fully diagnosed.

Q: What is a midget?

A: In some circles, a midget is the term used for a proportionate dwarf.
However, the term has fallen into disfavor and is considered offensive
by most people of short stature. Such terms as dwarf, little person, LP,
and person of short stature are all acceptable, but most people would
rather be referred to by their name than by a label.

Q: What is the medical prognosis of a person with short stature?

A: It varies from condition to condition, and with the severity of that
condition in each individual. However, it's safe to say that the
overwhelming majority of LPs enjoy normal intelligence, normal life
spans, and reasonably good health. Orthopedic complications are not
unusual in people with disproportionate dwarfism such as achondroplasia
and diastrophic dysplasia, and sometimes surgery is required.

Q: Can average-size people become the parents of dwarf children?

A: Yes. In fact, that's by far the most common situation. LPA is deeply
concerned that as it becomes increasingly common to diagnose genetic
conditions in utero, including dwarfism, prospective parents will find
it difficult to obtain the data they need to make an informed decision
as to whether to continue with the pregnancy. LPA believes strongly that
prospective parents who become familiar with the full, productive lives
led by little people will not likely choose termination.

Q: Can short-statured couples become the parents of average-size
children?

A: Yes. The odds vary with diagnosis, but a person with achondroplasia
has one dwarfism gene and one properly functioning gene at a particular
location. If both parents have achondroplasia, there is a 25 percent
chance their child will inherit the properly functioning gene from each
parent and thus be average-size. There's a 50 percent chance the child
will inherit one dwarfism gene and one non-dwarfism gene and thus have
achondroplasia, just like her or his parents. And there is a 25 percent
chance the child will inherit both dwarfism genes, a condition known a
double-dominant syndrome, and which invariably ends in death at birth or
shortly thereafter.

The gene for achondroplasia was located and identified for the first
time in 1994 by a team of scientists at the University of California in
Irvine. The lead scientist, the late John Wasmuth, urged that in-utero
screening for achondroplasia be prohibited except to detect
double-dominant syndrome among achondroplastic couples.

Q: What is LPA's position on the implications of these discoveries in
genetics?

A: The following is LPA's "Position Statement on Genetic Discoveries in
Dwarfism":

The short statured community and society in general have become
increasingly aware of eugenics movements (efforts to improve human
qualities by selection of certain traits) in medical history in the U.S.
and abroad and the traditional desire of parents to create perfect,
healthy children. Along with other persons affected by genetic
disorders, we are not only concerned as to how our health needs will be
met under dramatically changing health care systems, but how the use of
genetic technologies will affect our quality of life, medically, as well
as socially. What will be the impact of the identification of the genes
causing dwarfism, not only on our personal lives and our needs, but on
how society views us as individuals?

The gene for achondroplasia, the most common type of dwarfism, was
discovered in 1994. Achondroplasia is caused by a gene mutation that is
the same in 98% of the cases. The mutation, affecting growth, especially
in the long bones, occurs early in fetal development in one out of every
twenty thousand births. Since the achondroplasia gene discovery, genes
for many other forms of dwarfism have been located and identified,
including those for spondylepispheleal dysplasia, diastrophic dwarfism
and pseudoachondroplasia. These discovers occurred much more rapidly
than either the members of Little People of America (LPA) or the medical
community had anticipated. Suddenly and unexpectedly, LPA was placed
right in the middle of the medical, social and ethical debate
surrounding the brave new world of genetic technology. At that time,
formal discussions and education on genetic issues had not yet begun
within LPA. Most of us, like most of society, had limited knowledge
about the Human Genome Project and the social and ethical implications
associated with the possible applications of genetic technology. On one
hand, the breakthrough may be used to help achondroplastic couples to
identify a fetus with "double dominant" or homozygous achondroplasia, a
fatal condition that occurs in 25% of births to those couples. It is
also possible that the tests for genes causing short stature will become
part of the increasingly routine and controversial genetic screening
given to all expectant mothers.

LPA's discussion of these possibilities brought forth a strong emotional
reaction. Some members were excited about the developments that led to
the understanding of the cause of their conditions, along with the
possibility of not having to endure a pregnancy resulting in the
infant's death. Others reacted with fear that the knowledge from genetic
tests such as these will be used to terminate affected pregnancies and
therefore take the opportunity for life away from children such as
ourselves and our children. The common thread throughout the discussions
was that we as short statured individuals are productive members of
society who must inform the world that, though we face challenges, most
of them are environmental (as with people with other disabilities), and
we value the opportunity to contribute a unique perspective to the
diversity of our society.

LPA is revitalizing its public education campaign, so that people of all
sizes, including potential parents and health care professionals, will
be properly informed of the realities of life with short stature. LPA is
made up of over five thousand individuals with more than a hundred types
of dwarfism, their families, a medical advisory board, and other friends
and professionals. We are teachers, artists, lawyers, doctors,
accountants, welders, plumbers, engineers and actors. We represent every
nationality, ethnic group, religion and sexual orientation. Many of us
have secondary disabilities as well. We are single and married, with
families with spouses, parents and children who are average size and
dwarfed, biological, and adopted. For LPA members there is a common
feeling of self-acceptance, pride, community and culture. Since 1957,
LPA has provided peer support, social and educational opportunities to
thousands of individuals with dwarfism and their families. We have been
educating society and the medical community about the truths of life
with short stature and working to dispel commonly held myths. With the
discovery of various genes and mutations causing dwarfism, our
educational and advocacy efforts have become ever more important, in the
face of a rapidly changing genetic frontier.

Q: We're the parents of a newborn child who's been diagnosed with
achondroplasia, and our pediatrician doesn't know anything about it.
What should we do?

A: Make sure she sees "Health Supervision for Children with
Achondroplasia," an article by the Committee on Genetics of the American
Academy of Pediatrics, which appeared in the March 1995 issue of the
journal Pediatrics. It is an excellent overview to the issues involved
in treating a child with achondroplasia. You can find the article, as
well as other resources, on the Dwarfism Home Page, located at
http://www-bfs.ucsd.edu/dwarfism. If you don't have access to the Web,
send an e-mail to dken...@shore.net, and I'll be happy to e-mail the
article to you.

Q: We don't want our child to be treated differently from other
children. We've read articles in Time magazine, People, and elsewhere
about a miraculous operation to lengthen an achondroplastic dwarf's legs
and arms. Should we consider this?

A: As a general statement of philosophy, most members of the dwarf
community believe that no child should undergo surgery unless it is for
a treatable medical condition that will improve her or his health.
Limb-lengthening surgery, by contrast, does not address any medical
condition. Instead, it permanently weakens healthy arms and legs simply
so the person who is operated on looks more like the average-sized
majority.

Moreover, a person who's had her or his limbs lengthened still has
achondroplasia. She or he is just as likely to experience orthopedic
problems with age, and just as likely to pass on the gene -- and now may
suffer from long-term side effects of the surgery as well. Dwarfism is a
genetic difference, not a disease, and many dwarfs are proud of not
being like everyone else. Oftentimes a 14-year-old child who, because of
teenage insecurity and peer pressure, wants his limbs lengthened will
mature into an adult who is proud of who he is.

Limb-lengthening surgery involves cutting leg and arm bones,
constructing metal frames around the limbs, and inserting pins into the
bones to move the cut ends apart. New bone tissue fills in the gap, thus
increasing length. The procedure is extremely painful, and it often
lasts several years. The most common complications are:

o Bending or twisting of the bone at the site where it is cut.
o Nerve damage caused by the metal devices that are inserted into
the bones. This can result in paralysis of the limb.
o If the length is increased too much, the muscle and skin will be
stretched too tightly over the limb. This locks the limb out, either
straight or bent, and leaves the person unable to control the limb. The
only way to overcome this problem is to go back into surgery and shorten
the bone.
o Any time a major bone is broken or cut, there is a risk of
releasing fat emboli into the bloodstream, which can cause death.

Q: If limb-lengthening is such a terrible procedure, why would anyone go
through it?

A: There are some people who've been quite happy with the results. For
instance, we recently heard from a person with achondroplasia who
thought LPA's assessment of the surgery was too harsh. He told us that
he went through the procedure between 1988 and 1991, increasing his
height from 3-11 to 5-1 and having his arms lengthened as well. Although
he acknowledged that it was a painful procedure, he hastened to add that
it was not unbearable by any means. He also believes his arms and legs
are stronger than when he began the procedure, that his back is
straighter, and that, overall, he is medically better off today than he
was before the surgery.

With all due respect, it seems impossible that his arms and legs are
stronger as a result of the surgery. It's possible that they're stronger
because of the rehabilitation he underwent. But even advocates of the
surgery have acknowledged that there may be long-term weakening of the
limbs and an increased risk of arthritis.

There is one known medical benefit to limb-lengthening: the patient's
back comes into better alignment, and swayback is reduced, which can
result in fewer lower-back problems over the long term.

What follows is the LPA Medical Advisory Board's position paper on this
issue:

The techniques for leg lengthening were originally developed for
correction of limb length discrepancy and are considered the accepted
therapy. Particularly in Europe and Russia, similar surgical techniques
have been modified for use in symmetric lengthening in short
individuals. Though this new application has generated widespread
interest, it has also created controversy among medical professionals,
persons of short stature, and their families.

There are no established medical indications for symmetric extended limb
lengthening (ELL) at this time. However, it may have benefit in
preventing orthopedic and neurological complications of the skeletal
dysplasias while the function is primarily being performed for adaptive,
cosmetic, and psychosocial reasons.

Nationwide research is being done on the safety and long-term functional
outcome of the procedure. Experimental protocols to assess benefits and
risks of ELL are being carefully drawn. The Medical Advisory Board would
welcome the opportunity to review additional protocols, to assure that
projects meet the standards of modern scientific research, and to
protect persons from undue risk.

The complications of ELL are numerous. These include:

o Nerve injury
o Vascular injury
o Infections
o Angulations
o Non-union
o Paralysis
o Increased hip flexion leading to dislocation of the hip
o Predisposition to early osteoarthritis
o Reabsorption of the bone ends
o Fractures
o Unequal limb lengths

Although the acute complication rate associated with ELL has been
reduced, it is still substantial. Furthermore, the long-term stability
of limb lengthening has not been determined, particularly subject to
physical (such as pregnancy) and hormonal stress.

At this point we consider the use of ELL to increase stature to be
experimental. We caution individuals and their families who choose this
procedure to select as the site an institution with a multidisciplinary
program with special emphasis and expertise in skeletal dysplasia. The
institution should be equipped to follow the patient for a decade or
more.

This is what patients should have prior to initiation of ELL:

o Confirmation of short-stature diagnosis. Relative risks and
benefits are different for the many types of skeletal dysplasias.
o Counseling concerning the natural history and genetic
implications of the relevant skeletal dysplasia, independent of ELL.
o Adequate discussion of benefits and risks (including medical
complications, fiscal issues, educational and psychological concerns).
It is recommended that prospective patients be of an age to participate
fully in the decision-making process.

We recommend that before, during, and after that all subsequent ELL
evaluations include:

o Orthopedic assessment
o Physical-therapy assessment, including evaluation of mobility,
activity, functional limitations, etc.
o Clinical neurological evaluations
o Electrophysiologic testing, including nerve-conduction
velocities, and electromyography- and somatosensory-evoked potentials
o Peripheral vascular assessment
o Psychological evaluation, including self-image, body image, peer
relationship, and familiy relationships.

All these evaluations will require cooperative involvement of
orthopedists, physical and occupational therapists, medical geneticists,
radiologists, neurologists, clinical electrophysiologists, peripheral
vascular specialists, psychologists and/or psychiatrists, and social
workers in longitudinal management.

As a group, what we are trying to impart is that ELL is a complex
procedure with far-reaching implications. Complete success is not
guaranteed. We caution prospective patients and their families to seek
out only institutions that can offer the broad, multidisciplinary
approach that is needed. An institution ill-equipped to handle the
multiple demands of this procedure should not even be considered.

We are certainly not trying to discourage anyone of short stature from
exploring extended limb lengthening. That is not our purpose. Our
purpose is to call for a careful assessment of institution and
personnel, as well as all risks and benefits.

Q: We've heard that very young achondroplastic children can run into a
variety of complications. What should we be looking for?

A: Essentially there are three complications that are sometimes found in
achondroplastic infants and toddlers. In all likelihood your child will
not run into any of these problems, but she or he should be evaluated
for them nevertheless.

o Compression of the brain stem resulting from the top of the
spinal column, known as the foramen magnum, being too small to
accommodate the spinal cord. Symptoms include central apnea (a condition
that causes a person to stop breathing frequently while sleeping) and a
general failure to thrive. This condition is treated through surgery,
and children who have undergone this operation tend to do very well.
o Hydrocephalus, the technical term for excess fluid on the brain,
resulting from the drainage openings in the skull being of insufficient
size. All people with achondroplasia have some hydrocephalus, and no
harm generally results. In addition, all people with achondroplasia have
slightly enlarged heads, which can sometimes create the appearance of a
problem where there is none. Nevertheless, occasionally hydrocephalus
can present a problem, in which case a shunt may be surgically implanted
to drain excess fluid.
o Obstructive apnea resulting from an infant's or very young
child's airways being too small or improperly shaped. The child stops
breathing and wakes up frequently during the night (unfortunately, as is
generally the case with apnea, these moments of wakefulness are fleeting
and often go undetected by parents), sweats, snores, and fails to
thrive. Depending on the severity, a physician may recommend waiting
until the child outgrows the problem; monitoring the child's oxygen
levels and trying treatments such as supplemental oxygen and/or CPAP, a
treatment device that provides pressure to the lungs; or, in rare
instances, performing a tracheostomy to circumvent the tiny upper
airways until those airways have a chance to grow.

All of these problems, as well as others, are discussed in more detail
in "Health Supervision for Children with Achondroplasia," the article
recommended in the previous question.

Q: Can you recommend any books?

A: Yes. Two excellent books by medical anthropologist Joan Ablon,
"Little People in America" and "Living with Difference," discuss the
social dimensions of dwarfism, both on LPs and their families.
"Dwarfism: The Family & Professional Guide," by the Short Stature
Foundation & Information Center, is a good introductory resource, and
it's currently being reworked. "Thinking Big," by Susan Kuklin, is a
portrait/photo essay of an eight-year-old girl with achondroplasia that
is an outstanding introduction for a young child with achondroplasia.
There are a number of other books that are also helpful. Most of these
are listed in LPA's newsletter, LPA Today, which members receive as part
of their dues.

Q: Is it safe for a person affected with dwarfism to exercise?

A: Although exercise must be taken on a case-by-case basis, bearing in
mind the type of dwarfism and how severely the person is affected, in
general exercise is highly recommended. For a healthy person with
achondroplasia, as well as some other types of dwarfism, swimming and
bicycling can be recommended without hesitation. A doctor's advice
should be sought out in the case of other physical activities.

There's even an exercise video for people with dwarfism: "The Perfect
Little Body Workout," a 35-minute tape that emphasizes low-impact
aerobics, starring Pam Prentice, who's an achondroplastic dwarf. The
video is popular with all ages, among both men and women. It focuses on
exercises to prevent back pain and to increase mobility, and has been
approved by members of the LPA Medical Advisory Board. It costs $29.95
plus $3.50 postage and handling, and is available in VHS and PAL. To
order, send a check to : Pam Prentice; 538 Ironwood Terrace #6;
Sunnyvale, CA 94086.

Q: Either I or a member of my family needs specialized medical care. Can
you recommend a doctor?

A: The Little People of America's Medical Advisory Board is made up of
outstanding medical professionals who specialize in dwarfism. They have
all given unselfishly of their time and expertise in order to serve on
this board. You or your physician may wish to contact them for
specialized information. The members of the board are:

Charles I. Scott Jr., MD (chairperson); Director, Division of Genetics;
Alfred I duPont Institute; P.O. Box 269; Wilmington, DE 19899; telephone
(302) 651-5916; fax (302) 651-5948.

George S. Bassett, MD; Department of Orthopedic Surgery; Children's
Hospital of Los Angeles; 1300 North Vermont, Suite 600; Los Angeles, CA
90027; telephone (213) 669-4658; fax (213) 666-4409.

Betty R. Elder, MS; 5007 Sweet Air Road; Baldwin, MD 21013; telephone
(410) 592-6759 (home); (410) 825-1841 (work).

Clair A. Francomano, MD; Johns Hopkins Hospital; Blalock 1012; 600 North
Wolfe Street; Baltimore, MD 21287-4922; telephone (410) 955-1408; fax
(410) 614-2522.

Judith G. Hall, MD; Department of Pediatrics, UBC; BC Children's
Hospital; Oak Street #710; Vancouver, BC V6H 3V4; Canada; telephone
(604) 875-2315; fax (604) 875-2890.

William A. Horton, MD; Shriners Hospital; 2101 SW Sam Jackson Park Road;
Portland, OR 97201; telephone (503) 221-3467; fax (503) 221-3451.

Orest Hurko, MD; Department of Neurology -- Meyer 6-119; Johns Hopkins
Hospital; 600 North Wolfe Street; Baltimore, MD 21287-7619; telephone
(410) 955-3950; fax (410) 955-0672.

Steven E. Kopits, MD; International Center for Skeletal Dysplasia; St.
Joseph Hospital; 7620 York Road; Towson, MD 21204; telephone (410)
337-1250; fax (410) 337-1042.

Leonard O. Langer, MD; 1235 Yale Place, #710; Minneapolis, MN 55403;
telephone (612) 338-6850.

Victor A. McKusick, MD; Johns Hopkins Hospital; Blalock 1007; 600 North
Wolfe Street; Baltimore, MD 21287-4922; telephone (410) 955-6641; fax
(410) 955-4999.

Kathleen "Dee" Miller; Greenberg Center for Skeletal Dysplasias; Johns
Hopkins Hospital; 600 North Wolfe Street; Blalock 1012; Baltimore, MD
21287-4922; telephone (410) 614-0977; fax (410) 614-2522.

Richard M. Pauli, MD, PhD; Clinical Genetics Center -- Room 353;
University of Wisconsin; 1500 Highland Avenue; Madison, WI 53706-2280;
telephone (608) 263-6874; fax (608) 263-3496.

Cheryl S. Reid, MD; Department of Pediatrics; Cooper Hospital University
Medical Center; E & R Building -- 410 Haddon Avenue; Camden, NJ 08103;
telephone (609) 757-9797; fax (609) 757-9647.

David L. Rimoin, MD, PhD; Director of Pediatrics; Cedar-Sinai Medical
Center; 8700 Beverly Boulevard; Box 48750; Los Angeles, CA 90048-0750;
telephone (310) 855-4461; fax (310) 967-0145.

Kathryn K. Smith; Johns Hopkins Hospital; Blalock 1007; 600 North Wolfe
Street; Baltimore, MD 21287-4922; telephone (410) 955-6641; fax (410)
955-4999.

Joan O. Weiss, MSW; Alliance of Genetic Support Groups; 35 Wisconsin
Circle, Suite 440; Chevy Chase, MD 20815-7015; telephone (800) 336-GENE
or (301) 652-5553; fax (301) 654-0171.

Q: What is the background of the Little People of America?

A: LPA was founded in 1957 by the actor Billy Barty. There are about
5,000 members, half of whom are average-size family members. It's been
estimated that LPA reaches about 10 percent of the dwarf community.

Q: Who is the president of LPA?

A: The current president is Ruth E. Ricker, of Boston. She can be
reached by e-mail at rri...@shore.net.

Q: How do I join LPA?

A: Send a check for $25 made out to Little People of America, with your
name, address, phone number, age, and type of short stature, to: Lee
Kitchens, Database Coordinator, 27 Sunrise Lane, Ransom Canyon, TX
79366.

Q: Does LPA hold an annual convention?

A: Yes. The 1996 convention will be held the second week of August in
Indianapolis. The 1997 convention will be held in July in Atlanta.

Q: How do I find a specialist who understands my type of short stature
in my part of the country?

A: Call (800) 24 DWARF. We are working to update listings. If you have
had particularly good experiences with a specialist, send a posting to
LPA president Ruth Ricker at rri...@shore.net and LPA will look at
adding that specialist.

Q: How do I find out about a chapter in my area?

A: You'll find information about local chapters on the Dwarfism Home
Page, at http://www-bfs.ucsd.edu/dwarfism. If you can't find what you're
looking for, or if you don't have access to the World-Wide Web, send a
message to LPA president Ruth Ricker at rri...@shore.net for more
information.

Q: There's a topic that I think the FAQ should address that I don't see
in here. What should I do?

A: The FAQ is a compilation of accepted wisdom about dwarfism to which a
number of people have contributed. If there's a topic you'd like to see
addressed in the FAQ, or if you have a suggested addition, please e-mail
it to Dan Kennedy at dken...@shore.net.

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