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From: somedaydoc@yahoo.com
Newsgroups: alt.sex.stories.tg
Subject: DIAGNOSING DELAYED PUBERTY IN A BOY [M/b, med]
Date: Fri, 04 Nov 2005 13:00:08 -0800
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I am a third year med student in pediatrics. Starting with the third
year, we start to increase the number of clinic hours in order to
polish our patient and diagnostic skills. I also got a job with a
major HMO at their pediatric clinic. I was like a PA (Physician's
Assistant) except that I could not issue a final diagnosis, prescribe
medication or sign off on a patient's medical visit. My job was to do
the preliminaries, report to the Attending of my findings and hand the
patient off to him to either confirm or make an different diagnosis and
prescribe treatment. I normally worked weekends....Friday nights till
9 and either a double shift on Saturday or one shift on Saturday and
one on Sunday. I used the income to pay for things like...food.
Tuition was covered by loans and books by my parents.
I was working on a school holiday, brought in because business tends to
pick up on holidays or when school is out. It was a very stormy day.
I got in at 7:30 to set up the patient files, check and make sure the
exam rooms were cleaned the night before and to restock any supplies
that were low. First patients normally start coming in at 8am. There
were 3 physicians assigned to the boys clinic on this day (we split the
boys and girls into separate areas because of the requirement of a
female in attendance at all female examinations). But the phones
started ringing and one-by-one, they all started to call and either
delay their arrival or give up trying to get into the office. Patients
were also phoning in and canceling so it appeared I was going to get
paid to day to sit by the phone and sleep. Fine with me.
Patients fall into two categories. Either they are put on the "Next
avail" list when they come in if this is a visit for a new diagnosis or
they are put on the 'scheduled' list if they are returning for follow
up with a physician they saw previously. About 9:35, a patient showed
up. His name was Eric and he was accompanied by his uncle who hardly
looked older than he was. When they came up to the receptionist desk
where I was sitting manning the phones since the receptionist had
called to say she was not coming in either, his uncle introduced
himself and gave Eric's last name for me to check off the list. I
asked him if either his Mom or Dad were joining Eric and he said
no...that Eric's dad was with the National Guard in Iraq and his mom
was a flight hostess and at work. I checked the boy's file and this
was an 'assigned' visit and I looked up to see which physician was
going to treat him. I telephoned his doc and he said that Eric was
coming in for follow-up. He was diagnosed with Delayed Puberty and was
going to undergo therapy once we ruled out a host of possible causes.
Usually the cause is obvious....the boy's hormones are not working but
there can and usually is an underlying reason for that. At his
previous visit a wide battery of tests had been taken to rule out
diabetes, testotoxicosis, Cushing syndrome and about 7 other syndromes.
He was back for additional blood workup, urinalysis and to take
additional physical measurements to determine if the cause might be
something other than hormonal. Also, he needed to be scheduled for an
MRI to rule out possible tumors in the brain and on the pituitary.
His physician, knowing he was going to miss the appointment told me to
'handle him' and I saw this as an excellent opportunity to get some
hands-on experience with a not so uncommon problem. So, it became my
job to get his blood drawn (I could send him downstairs to the lab for
that but I usually do it for the practice and frankly I had no idea if
any of them showed up) and check him over and take the measurements
--all within my unsupervised purview since none of it required
on-the-spot diagnosis.
I studied Eric's file. He was 13years +4 months. His absence of
pubertal development was signaled at his back-to-school physical two
months earlier. At that time, he was given another appointment and at
that appointment, he was given the first battery of tests. The reason
for the delay was two-fold: He came in on a school-physical day in
which we herd the guys in on an almost conga-line parade from room to
room. Also, at just 13years, 2 months, he was still on the border for
ripening. Guys can start to develop anytime from late 10 years to as
late at 14 but the vast majority start to show some hormonal presence
by age 12 and his blood work showed an insufficient level of
testosterone. The question now was whether he was a late bloomer or
was something getting in the way. His physician, probably, after
checking his family's history decided it was not simply a case of late
blooming. If his dad wasn't then chances are he shouldn't be.
His file was pretty complete. It even had photos (all files are
computerized) of his body and genitals. He was evaluated at his last
check up at Tanner stage II and his orchidometer measurement of his
gonads at 4 milliliters of volume. Tanner staging involves evaluating
a number of different physical characteristics of either a boy or a
girl. In this case, the physician looked at pubic hair growth,
underarm hair presence and amount, leg hair, arm hair, Some also add
physical definition of the chest and general physique if they still
have doubt. Yes, even foot size can show promise. The orchidometer is
a measuring device often like a set of plastic orbs, though there is a
disposable kind that is a series of holes whose shape and size equate
to various stages of testicular development. You use it by isolating
each testicle inside the boy's scrotum and compare its size to the
numbered orbs. The numbers correspond to the volume of spermatic fluid
contained in the testicles. Four is definitely on the small side for a
13 year old yet another clue that something ain't right. The initial
lab work that came back showed nothing out of the ordinary except for a
slightly elevated level of a cortisone because of the asthma med he
took. So, I was to give him a sample of a non-cortisone drug with
instructions that he should suspend taking his usual asthma med and see
if this provided him with sufficient protection. Cortisone can get in
the way of hormones though not usually at the levels his blood work
showed, but then there was no assumption that his blood work showed
peak cortisone levels either. It is not unusual for kids to not follow
directions.
I brought Eric back to one of the exam rooms and told him I needed him
to strip to his underpants only. One of the measurements I was going
to have to take was foot size and toe size (as well as index finger,
and the distance of his arms and trunk with his arms spread out like
airplane wings. These measurements have a correlation to a range of
conditions such as hypotrophism. The distance from apex-to-apex
(finger to finger, arms extended. I also needed to get an orchidometer
reading of his testes and stretch his penis (stretched penile length)
and girth measurement --fun stuff for a 13 year old) He was going to
get a pretty detailed going over because we also had to check for
possible testicular tumors ...sometimes they are located on the
Cowper's gland and possible fibrous growths (dysplasia) on the
spermatic cord in the scrotum as well as abnormalities to the
epididymus. Also, his urine turned up no sperm. (Your body
overproduces sperm like crazy and when the storage facility fills up
the excess gets dumped into the bladder and passed out in the urine)
Also, we needed to evaluate prostate growth and sexual response which
is basically making or asking the kid to get erect to see if the
hydraulics work and then checking the firm shaft for fibroids. This is
part of the endocrinological work- up. Bottom line...those undies
were not going to be on very long. These tests are usually done by the
physician but basically the plan was to do them now and those that had
to be repeated would be at his next visit. Two succeeding evals are
very useful in reaching conclusions.
I should also point out that I had recently gotten a somewhat harsh
evaluation of my performance. I got high grades on diagnosis and
procedure. Where I was getting criticized for was for not exerting
control over my patients. The feeling was that they were taking
advantage of my youthfulness (28 but some say I look younger) and my
respect for their modesty was causing the exam rooms to be tied up
longer. This was no small thing in a clinic that rates its performance
on turnover of patients. While I did not agree with the _eval, I had
to address that issue or else my employment was going to be short-lived
and since I was also getting a clinical score for this, I could really
get screwed.
Being the only one in the office, I needed to have somebody cover the
phones and any foot traffic that makes its way in so i didn't have to
keep interrupting my exam. So while Eric was stripping, I went next
door to neo-natal and got one of the staffers there to come over and
baby-sit the front desk. This freed me up to play doctor. When I
walked back in, Eric's uncle asked me how long Eric would be cause
his girlfriend worked at the Starbucks across the street and he wanted
to ...get a cup of coffee. I told him we would probably be an hour.
I went back into Eric's exam room. He was now down to his boxers but
he still had his socks on so I told him to lose those also. This was a
kid with a bit of an attitude. I could tell that he probably developed
this 'tude cause as the small guy in class he was probably picked on.
Just a hunch but you get to know kids the more you are around them.
You have the big bully's...the tall, bean-poles who cry at the drop of
a hat because they grew too fast and are still dealing with an
oversupply of estrogen in their system....the normal build guys and
then the short ones. The short ones who haven't uncorked their
hormones frequently try to bully their way into a more dominant role in
the school yard. Eric struck me as the bully type. Since I already
got warned about letting patients dictate to me, I decided to use my
new authoritarian role on Eric to see how he would buckle under. Eric
was a small, slender kid. Blond hair, pug nose and big eyes or so they
appeared on his face. He was a cute kid but he had a swagger that I
could tell could be a problem.
He bitched a bit but took off his socks while I washed my hands and put
on some gloves. You would be amazed at how many guys try to hold to
their socks. It isn't really a foot fetish issue as it is a
realization that they didn't have too many clothes left on their body.
I was going to gown him but that seemed stupid since he wasn't going to
be able to keep the gown on much at all and besides nobody else was
around. I opened his file and opened MedTrax (software program) to
follow protocols that it might dictate. Eric was last measured at 50.1
inches and weighed in at 86 pounds. That put him at about 4% on the
height/weight scale for his age....two months ago. The first question
was to find out whether anything changed...the photos showed a total
absence of pubic hair and the parts of his body I was looking at (arms,
legs) showed a continued absence. Of course, being blond that isn't
that unusual.
First things first.... I had to do BP and heart/lungs. BP ...if you
come in with a splinter, we have to check your BP. Heart/lungs because
of his asthma. MedTrax will flag this every time.
I had him stand up and took his BP. It was slightly elevated but
within range. I sat on the stool and listened to his heart....racing
but good strong resonance with no echos. While checking his heart I
observed his nipples. They were very tiny and almost devoid of any
pigmentation or definition...much as you find on infants and toddlers.
You expect to see some definition and coloring appear by age 8 or
9....certainly by 10. It is not unusual for a boy entering puberty to
express some mammary fluid when you pinch their nipples. I realize
this is a favorite porno trick but boys aged 12-14 can be made to ooze.
This is because their estrogen levels have not been overwhelmed yet by
testosterone. Estrogen also explains what is frequently called baby
fat. Boys often display a pudgy fat on their bodies which will
disappear rapidly once their testosterone starts production. Eric did
not display any baby fat. I ruled out checking for any mammary fluid
cause his nipples were clearly under developed.
I put the stethoscope on his back and had him breathe deep to check his
lungs. they were clear. Next, I took his temperature (we use forehead
sticks...looks like a band aid you stick on their foreheads). His temp
was normal. I did notice he was responding to the chilled air in the
room. He had goose bumps and even the occasional shiver. Of course I
was in a white coat, shirt/tie and slacks so I was comfy. Funny how we
make the rooms comfortable for us...
I then asked him to walk across the room to check his gait. Orthopedic
issues can sometimes obviate themselves with some of the possible
syndromes you need to check for. this which is a bit like checking
the tires on your car because one side is sagging before you start
ripping it apart to look at the shocks. Do the easy things first.
His gait was normal but there was a swagger in the way he walked and he
pushed off on the balls of his feet...nothing to be concerned about but
it added to his swagger. However, he had on long, loose fitting boxers
and it did mask his hip movement so I was going to have to get him to
repeat this shortly...
I then told him to remove his boxers and he refused. I tried to be
nice, explaining to him that I had to check some things down there
because we want to make sure he is growing....but he turned into a
defiant little prick. "Keep your fucking hands off me."
Normally when you get a patient like this, you call in the senior
Nurse. But I had none to call upon. So....I simply said to Eric: I
really don't have time to play games with you. Either you drop your
shorts now or I call in your uncle and get two of the nurses to come in
here for the rest of your exam to ensure compliance..... I figured
correctly that he didn't know his uncle had stepped out.
He then says to me: "What are you going to do?" I responded that it
depended on what he forced me to do but what he meant was ...what
examinations was he going to get? I inadvertently smiled a bit and
said...don't worry, you will be the first to know... truthfully, I did
not mean to be flippant but the kid was pissing me off. And I was not
about to let him start dictating to me. I had to exert total control.
With that, I go up to him (he is still standing) and I bend over and
pull his boxers down to his feet. Step out of them please.... "Why?"
Because I need to do a series of tests and procedures and it is going
to require you to move around without tripping...and with that I lifted
his right leg up and then his left...when I grabbed his left leg, he
lost his balance probably because I was a bit rough and he had to grab
hold of my shoulder for balance. But I now had him naked...not even a
watch on.
Yikes....this guy was bare as a baby. we have these raised platforms
to spare our backs and I told him to step up on stage for me.
Reluctantly he did, suddenly getting shy and covering his genitals. I
pulled my stool over to the stage which elevated him two feet off the
ground placing his groin at about eye level when I am sitting. There
is a switch that turns on these blazingly bright lights and there is a
goose-neck lamp that I can use to bend and focus on his body. First
things first....I had him turn around so I could see his back end. I
wanted to look at his spine and skeletal profile. Nothing untoward
here. His neck was nice and straight and in line with his spinal
column. He did have nice glute development and his calf development
indicated he was an active boy. I then had him face front and moved
his hands away from his genitals and I twisted the goose neck lamp to
light up his pubic area and look around for any tell-tale sign of fuzz.
Nada. You usually find fuzz in mid to late 11 year olds...not dark
pubes although sometimes you do but at least some very light peach
fuzz. Certainly by mid-12 but not on Eric. His legs were also devoid
of any hair as were his arms. Under the lights I had on him anything
on his skin would have showed up. His genitals were obviously behind
schedule too. I didn't need to measure his penis which was little more
than a skinny nub or his testicles to see things were still way too
dormant down here. He was circumcised. In fact, his glans was about
all of his penis visible but because the room was at 68 degrees, he
probably went turtle a bit. He had the typical pinkish coloring to his
penis and scrotum...his glans a bit darker. Of course, some guys have
darker pigmentation but either is normal. His scrotum was tightly
coiled to his pelvis showing that wrinkly texture from being cold and
scared. Guys not only shrink up when cold but also when scared. He
kept trying to cover his genitals no matter how many times I told him
to put his hands by his side. I finally got a bit gruff and told him
to clasp his hands behind his back. My initial assessment was that I
was looking at an 8 or 9 year old, not someone approaching mid-13.
After I looked over his profile from the front, I then asked him to
clasp his hands behind his head to check for underarm hair. Again, not
even a wisp but I did notice some perspiration. Gee...you think this
guy didn't like being on stage, lights blazing stark naked with his
hands clasped behind his head? In this position, I could also see his
ribs and rib cage clearly under the lights. In fact his entire
musculature was clearly visible. Not much fat on this kid. His legs
showed some bruises probably from play and I saw a scab on his right
shin. I asked him how he got that and he gave me a one word answer:
hockey. Are you a hockey player I asked? Yes. he played on a travel
hockey team. I thought to myself that he could almost skate through an
opponent's legs...
I needed to get him measured and wanted to use the electronic equipment
out in the corridor. I probably should have done that before I
stripped him naked. But, this area was separate from the waiting room
and nobody else was around (though he didn't know that), so I decided
to play some mind games with him and told him to follow me....and I
opened the door and walked out. I had to walk back in to tell him
again to follow me. "Outside??" he asked in a voice quivering in an
almost panicked falsetto cry? I said...yes...this is a doctors
office, remember? as if we parade all of our patients naked to the
world.
This time, I got behind him and placed my hand on his lower back. Once
again, he covered his genitals. I walked him over to the electronic
scale which was located about 50 feet from the exam room he was in. I
was able to observe his gait, particularly his hip movement and things
seemed normal. The scale is accurate to within grams. I steered
Eric on to the scale. This scale is computerized and you enter his
patient number and name and once a reading is made, it downloads the
weight to his file. He had to stand heels together, but toes apart in
a sort of V fashion. In addition, he has to take a deep breath and
hold it....look straight ahead with hands by his side. Because of the
delicate mechanism, he has to hold still for about 20 seconds until it
give off an audible beep and red light blinks and it prints out a
reading much like a cash register receipt. I guess you could call
this idiot-proof. The only wrinkle is that any vibration or jarring
will delay it from locking a reading until the vibration
stops...including knocking knees and at this point Eric was so scared
that somebody like another patient was going to walk by and see him.
Following this procedure I had him stand on the stadiometer which is a
laser precision height measurement device. It gives a number of
readings in one printout. The patient stands with his feet on two red
dots which keep daylight between his legs. He stands, back straight,
cheeks and shoulder blades against the devices wall and arms slightly
extended away from the body. You then bring a receptor down so that it
sits on the top of the skull. A laser reads the height of the receptor
and then relays that information to his file and to a printout. With
the stadiometer, you can also get not only a precise height measurement
but also measurements of the legs and arms. I then had him extend his
arms out like an airplane and got that reading. I was also able to do
his foot size. Finally, while the patient is still standing in the
same position, you can unlock the base, raise the receptor off his
skull and hit a button and with the patient rotating, it measures the
circumference of head. If you want chest girth or waist line you
simply lower the infrared sight to the area you want measured and the
base slowly rotates one revolution. The patient has to raise his arms
to measure chest and waist. So, except for measuring his index finger,
I had all of his measurements complete.
After that I brought him back to the exam room. He was much relieved
and now less focused on hiding his genitals. Slowly he was getting use
to be naked. I checked to make sure the data was input into his file
and I compared it to his last readings. There was no perceptible
change in his height and only a few ounces increase in his weight which
could be attributed to a full tummy or fuller tummy. Next, I gave him
a glass of water to get him ready to pee in a cup. But that came later
after he had time to absorb the water into his bladder. While he was
standing I pressed against his bladder (lower abdomen) because placing
pressure wakes up the urge to want to empty. With the additional
12ozs, he was going to have no trouble filling the cup in about 15
minutes.
While his bladder was stewing, I had Eric step back up on the stage. I
wanted to check his scrotum for a variceole and any other possible
abnormalities. The physician was probably going to schedule him for a
sonogram of his genitals or even an MRI but one tried-and-true method
is to take a penlight and shine it through the thin scrotal skin which
illuminates the contents. I washed my hands and donned a new pair of
gloves and started checking his scrotum. You move the light around
and try to observe if something is in there that should not be. An
extra vein for example, again which is not uncommon, can be a cause for
delayed puberty and not caught early, sterility. Eric was not fond of
this procedure. It requires quite a bit of handling of his genitals
and moving his penis out of the way. He also had to stand legs wide
apart. Next, I turned on the lights that lit up the stage. I went to
the drawer and took out the Orchidometer. His testicles had not
changed since the exam two months ago. I did not really expect a
change but this is one of those simple, painless tests that really
brings a guy down a notch...especially when he reads a #4 and there is
a whole string of orbs much larger.
I then handed him the cup to void his bladder. He asked me if he could
go into the bathroom and I replied....sure but remember it is down the
hall and you are naked. He decided he would make do. I turned to
check MedTrax while he peed with his back to me and mine to him. When
he was done, I took the cup and capped it and filled out his name and
patient ID number and handed him a wet-nap and told him to wipe his
penis.
Next, after changing gloves, I had him spread his legs apart more,
placing my hands on his inner thighs to move them apart a bit and told
him to grasp his hands behind his back. I then palpated his testicles,
rolling them slowly to feel for any abnormalities. The apex of the
lowest part of the testicle is very sensitive to touch. Not ticklish
but sensitive nevertheless and as I gently stroked this area, he
started to squirm and his penis began to come to life slightly
elongating. This isn't some perversion on my part...you want to see
reactions to certain actions. His reaction did indicate that the guy
was not dead down there.
Since I was in the neighborhood, I did a hernia exam. He only had had
one done a few months back but with what was coming up the more
stimulation I gave him the easier it was going to be to complete the
procedures that were to follow. I carefully extended my middle finger
up and behind his right testicle near the inguinal ring and had him
turn his head and cough....twice. I felt a slight tightening reaction
of his right orb which was perfectly normal as he placed a strain on
his abdomen by coughing. His scrotal bag was quite coiled and tight
probably due to the temperature in the room and his discomfort at being
naked and being examined. I repeated the procedure on his left orb
which he carried slightly higher than his right. Obediently, he
coughed twice on command. Most guys are well-experienced at this
procedure by age 13.
Following this, I had to check his penile shaft for any signs of tumor.
Penile tumors are usually not bumps but fibrous swellings wrapped
around the penile cartilage. I grasped his penis at the glans and
stretched it out and away from his body and carefully felt along the
shaft for anything that felt untoward on all four sides. He was most
uncomfortable with this procedure and asked me what I was doing. I
explained generally that I needed to make sure there were no
abnormalities in his genitals. There was no need to talk about
growths, cysts or tumors and alarm him. His shaft was so white it was
almost gray in color but started to color up a bit as I felt around.
Boys, no matter the age, always eagerly respond to any touch of their
penis even though they don't want to.
Following completion of this procedure, I needed to see him erect.
Size was not the issue. But when the penis swells irregularities can
obviate themselves. I grasped his glans again with my left hand and
with my thumb and index finger of my right, I stroked his shaft right
at the frenulum and he quickly started to respond. Once again he asked
me what I was doing and I told him that I needed to see him firmed up.
I thought that was a bit more delicate than saying erect or hard. He
said....No...please no. But I told him to just let it happen because
the sooner he did the sooner we could get this over with. He was
hardly in a position to resist at this point. I had been working his
genitals for the better part of ten minutes and his nerve endings were
now on high alert. He firmed up pretty quickly and I then felt his
erect shaft and also checked for any extra veins or other
abnormalities. He didn't have much but what he did have was looked
normal. I didn't measure him but I would guess he firmed up to
something close to 4 inches. I did note that he had a nicely
proportioned penis. The glans was robust but in proportion to his
shaft.
After I finished this, I careful angled the goose neck lamp and stroked
his lower pubis to see if I could detect any signs of hair growth. I
even took off my glove and repeated the procedure. I could not, and I
also did not see any signs of discharge from stroking his penis, not
that I really expected to.
Following this, I told him to walk over to the exam table. I put on
another pair of gloves and got the KY. Doing a prostate exam on a kid
is a challenge without adding significant discomfort. Their anal
openings are smaller and more importantly tighter. Their anal muscle
is very tight and if they so choose penetrating it can be not only a
challenge (surmountable) but quite painful. It isn't always the boy's
choosing to clench up. The sphincter has the ability to clench up on
its own. We do have special techniques that we can follow to help the
boy relax. Of course, Eric thought I was finished with him when I told
him to walk over to the table. "Can I get dressed now?" I told him
that we were almost done but I could see his face tighten cause he was
not sure what else I was going to do to him....and he wasn't going to
like what was next.
We needed to see if his prostate gland showed signs of developing.
Endocrinologists believe that this gland is a far better predictor of
sexual maturity than Tanner staging. There are four stages of prostate
growth. Initially it is the size of a peanut and hard like one too.
Press on it and it creates a feeling of discomfort for the boy,
sometimes even pain. It affords no pleasure. Stage II it starts to
grow and is closer to a large grape or lima bean...you can feel the
curve and some suppleness in the texture. Still, there is usually no
pleasure afforded the boy when you touch it. Stage III the gland is
larger and you can feel the the distinct curves and when you press on
it you can feel a slight give like a firm plum in texture. At this
stage, the boy may experience sexual arousal and give off a moan of
pleasure by surprise. Stage IV will result in prostatic fluid being
expressed through the urethra and a pronounced sexual response
(firming) of the penis from the stimulation. I needed to see where his
development was.
I will relay the procedure as I did to him: I brought over the box
that contained the tube of KY. KY has a new formula that contains a
slight warming agent. When properly applied to the anal cavity, the
heat effect triggers an unclenching action on the part of the boy. Ok
Eric, I want you to face the table for me. I gently placed my hand on
his shoulder and turned him towards the table. Take a half-step back
please. Ok...now, I want you to bend over and turn your head sideways
like you are listening to the table..... Why? he asks.... Just do as
I tell you please. You giving me a shot? No. No shots. (I had to
grin at that one). He watched almost fixated as I opened the KY box
that contained a 3 oz tube and a screw on nozzle that looked like an
enema tip. I watched his eyes almost bug out of his head at this
point. Sensing he was going to give me trouble, I gently pushed on his
neck and forced him over and he submissively turned his head towards me
as i was standing towards his right. He started to complain even
though I am not sure he actually knew what was about to happen.
Continuing my instructions to him.... Eric...move your feet apart
more. (You want to have them place the bulk of their weight on their
chest and have their feet out wide and back so that they are almost on
the balls of their feet but not quite.....ok...now move your arms out
on the table like they were wings on an airplane.....good boy....now,
bend your knees just a smidgen and turn your feet so they are pointing
inward....good. (in this position, their sphincter relaxes
sufficiently that often they will release gas --fart). I then gently
placed my left hand on his lower back. Ok....you are doing fine now
just relax. I moved my left hand from his lower back and using my
thumb and index finger stretched apart his cheeks....I took the KY tube
which I had laid on the table and squeezed some of the ointment out to
cover the exterior of his anal opening so it glistened. The warming
agent helped him relax his sphincter muscle and I then introduced it
into his anal canal. He let out a almost a dull roar "arrrrrghhh" as
he felt the tube slide in. Just relax Eric...this won't hurt....keep
your toes pointing inward for me....slowly I withdrew the nozzle
squeezing the tube generously as I did to force the contents out
introducing most of the 3 oz into this anal passage. I then took the
remainder of the contents and squeezed it on to my gloved index finger.
I re-introduced my left hand's two fingers to widen his anal opening
and just before I slid in I said to Eric...now just relax son....and
placed my finger against his bud....and letting the warming gel do its
job, I pushed in. He continued to mildly thrash about but I found his
prostate gland. It was immature...about the size of a grape and as
hard as tennis ball. I rubbed it gently before pressing on it to see
if he might release any ejaculate. He let out a a sort of a growl
turned into a moan before I withdrew my finger. I then had him stand
and took hold of his penis to see if there was any moisture on the tip
of his urethral opening. There was none. Nor was there any erection.
I removed my gloves, grabbed some wet-naps and had him turn once more
and wiped the gel from the entrance to his anus.
Next I needed to drain about a gallon of blood from him (500 ml). I
went down to the supply room at the other end of the floor and
retrieved a 21g syringe and five vials. I returned and when Eric saw
the array of equipment, I could see him blanche-white. Anticipating
that I might have some trouble with him, I moved him to the stool to
sit on, wrapped a tourniquet around his arm just below his muscle and
and wiped the vena-puncture area with an alcohol swab. He had nice
smooth arms with a hint of tan but his vein was easy to spot. I
pressed about two inches below the site that I picked as Ground Zero on
the vein with my left thumb and then punctured his vein and started the
blood extraction. By the end of the second vile, Eric started to get
woozy. I had to stop, and force his head down between his knees while
I opened an ammonia swab to bring the kid back. Ok, so maybe I paraded
the syringe in front of his face with a bit more gusto than I would
have ordinarily. As I pushed his head between his legs I was thinking
since he was still naked that I was probably giving him a birds-eye
view of his genitals unlike any he has seen before...and that it was a
good thing his erection deflated. It took a little under ten minutes
to bring the color back to his cheeks and I then went to his left arm
and complete the extraction. I put a band aid on each of the two
punctures then I had him hop up on the exam table to lie down and rest
a bit. I retrieved a small towel and rinsed it under the cold water,
rung it out and folded it and placed it on his forehead. I then took
another wet towel and patted his chest and abdomen. I noticed that in
the chilled air his tiny nipples responded when I patted them with the
wet cloth.
I went out and spoke to his uncle. He had returned from his rendezvous
with his girl friend at Starbucks. I told him that his nephew had
gotten a little faint when I took some blood. He laughed and said that
it happens to him also. At the spur of the moment I told him to come
on back. I hadn't intended to involve him in his nephew's condition,
but I thought it might serve to instill a bit more humility in the kid
on his next visit. We walked in and he was quite surprised to see Eric
laying there naked. As soon as Eric saw his uncle he immediately put
his hands over his genitals. It was pretty obvious that he had never
let his uncle see him naked before.
We walked over to Eric on the table and I said: How are you feeling
Eric? He responded that he was ok and wanted to know if he could get
dressed. I told him that we were almost finished and proceeded to talk
to his uncle. Do you know why Eric came in today? His uncle responded
that he understood Eric was getting a check up. So, I explained to him
that Eric's last physical two months ago it was observed that he had
not yet reached puberty. While continuing to talk, I looked down at
Eric who now had the wet towel off his forehead and I noticed his color
had returned to his face....his face being beet red. Continuing my
conversation with his uncle, I said....Normally in a boy that is well
into his 13th year, we would expect the start of sexual maturity.
..with that I moved Eric's hands up and back behind him. As you can
see he has not started to show any pubic hair development, his genitals
are considered under developed for his age and he lacks any sign of
hair on his lower legs, arms or under his armpits --which were now on
complete display-- which are secondary sex characteristics. By now, we
would have expected to see at least some peach fuzz on his pubis --and
I reached down and stroked his lower pubis moving his penis away -- but
as you can see, he has not started to grow any hair. Also.. if you
notice his testicles, they are quite small for his age. He has an
orchidometer reading of 4 when he should at least be at 8. I then
invited his uncle to feel his gonads and grabbed the orchidometer still
out on the table and showed him what 8's looked like in size. His
uncle carefully felt around his testicles but did not try to isolate
each testy as it would be done during an examination. I then explained
that I also checked his prostate gland and found it to be the size and
consistency of a hard grape and showing no signs of ripening. His
uncle commented: Wow...you stuck your finger up his butt? Even i
haven't had that done yet... Eric was not enjoying this conversation.
I concluded by saying that I conducted a battery of tests and that the
results would be back in about five working days and that he should
have Eric's mom call and schedule his next visit within the next two
weeks.
I then looked over the list of tests and realized I had not measured
his index finger and so, I grabbed a six-inch ruler and took a
measurement of his right hand.
I then told Eric that he could get dressed, and handed his clothes to
his uncle suggesting that he help him since he may still feel
weak-headed. I concluded my examination and wished the both of them a
good day. As I walked out the door, Eric was slowly climbing into his
boxers. I turned back and told his brother one more thing....when Eric
got home that he should lay down and rest for an hour or so to make
sure there are no lingering effects from the blood extraction and that
if they had orange juice in the house to give him a tall glass. His
uncle thanked me and said he would probably see me in two weeks. I
left the door to the exam room open as I left.
JJD
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