E findings (prolactinoma), webbed neck (turner syndrome), thyromegaly skin exam: evidence of androgen excess (acne, hirsutism), acanthosis nigricans (pcos) breast: state of development, evidence of galactorrhea (prolactinoma) pelvic exam: presence or absence of pubic hair (if sparse: androgen insensitivity or deficiency); clitoromegaly (androgen excess); distention or bulging of external vagina (imperforate hymen); thin, pale vaginal mucosa without rugae (estrogen deficiency and ovarian failure); presence of cervical mucus (evidence for estrogen production); blind vaginal pouch (müllerian agenesis, androgen insensitivity syndrome); ovarian enlargement (tumors, pcos, autoimmune oophoritis) diagnostic tests and interpretation lab initial labs primary amenorrhea: serum prolactin (prl) and thyroid-stimulating hormone (tsh) if no secondary sexual characteristics, measure serum follicle stimulating hormone (fsh) and luteinizing hormone (lh): fsh/lh <5 iu/l suggests primary hypothalamic or pituitary etiology fsh >20 and lh >40 iu/l suggests gonadal failure, and karyotype analysis should be performed if secondary sexual characteristics present, evaluate for anatomic abnormalities. If uterus is absent or abnormal, perform karyotype analysis. Secondary amenorrhea: exclude pregnancy with hcg serum tsh: elevated in hypothyroidism, decreased in hyperthyroidism serum chemistry, cbc, urinalysis to rule out underlying disease prl: >100 ng/ml suggests empty sella syndrome or pituitary adenoma. Perform mri for evaluation. <100 ng/ml: evaluate for other etiologies of which medications are most common if prl and tsh are normal, perform progestin challenge (see “treatment”): if withdrawal bleed: normogonadotropic amenorrhea related to hyperandrogenic chronic anovulation most commonly pcos if no withdrawal bleed: follow up with estradiol priming (see “diagnostic procedures/other“ and “treatment”) and repeat progestin challenge: if no bleed: consider outflow tract obstruction. cheap viagra cheap viagra http://classicmotocrossimages.com/mbs-where-can-i-buy-viagra-locally-without-a-prescription-tl/ cheap generic viagra generic viagra for sale online viagra online in uk medicaresupplementspecialists.com/pfz-buy-cheap-viagra-mq/ viagra without a doctor prescription buy generic viagra buy cheap viagra If bleed occurs: check fsh/lh: elevated in hypergonadotropic hypogonadism, decreased in pituitary tumors or hypogonadotropic hypogonadism if virilizing signs and significant acne present, measure free testosterone, dhea-s, and 17-oh progesterone level.
Kindermusik with Lori: Music and movement for kids ages newborn to 7 years old

Are you looking for a music program for your daycare or preschool?
Read more about my music program
especially designed for a classroom setting

Fall Schedule Now Available!
Click here to read more and to register

a good beginning never ends

The benefits of Kindermusik not only last a few months or a few yearsthey last a lifetime. In every Kindermusik class, you'll witness your child's developmental evolution in language skills, literacy, listening, problem solving, social skills, self-esteem and musicality. Its not about making little Motzarts. Its about developing life-enhancing skills in the whole child. Click here to read more about why music is so important to child development.

Every day
is a Kindermusik day

Kindermusik is much more than a weekly class filled with fun and adventure. Its an enriching journey that lasts all week long. When you enroll in a Kindermusik class, you receive a CD of beautifully arranged songs from class, interactive story books to develop early literacy skills, a family activity book, and an instrument for music-making at home. These unique At Home Materials provide a powerful way for nurturing your childs social, emotional, cognitive, physical and musical development all while promoting a natural love of music and learning.

Read more
about the different Kindermusik developmental programs. Find out what parents are saying about Kindermusik with Lori.


Singing fosters the development of your child's most important instrument, the voice, through vocal exploration, songs, and chants.

Moving develops body awareness, coordination, and spatial relationships through synchronized movement, creative movement, and simple dances.

Playing introduces a variety of musical timbres with percussion instruments such as rhythm sticks, jingle bells, drums, resonator bars, and simple instruments your child creates at home.

Creating stimulates your child's imagination and encourages new exploration with sound and movement.

Patterning boosts your child's ability to think musically through the integration of basic rhythmic and tonal language.

Listening cultivates your child's heightened attentiveness to sound discrimination.

Exploring timbre, dynamics, tempo, and pitch lays the foundation for conceptualization of the elements of music.


Songs and activities to be repeated at least four times because children need familiarity and repetition to learn new skills.

Good musical literature comprised of traditional folk songs and rhymes passed down from generation to generation to form the basis of the curriculum because these selections are melodically expressive and provide an exposure to cultural heritage.

Attention to each individual child during class because children have differences in tempo preference that need to be expressed in order for them to develop beat competency.

Parents and guardians to be active participants in class, singing, rhyming and dancing with the child because parents are the first teachers and role models for their children.

Parents and guardians to learn the songs and activities because repeating them at home during receptive moments will enhance the development of musical potential while parent or guardian and child spend quality time together.

Seven to eight weeks of classes to pass before new skills become evident.

| Home | Class Schedule & Fees | Registration | Class Policies | About Lori | About Kindermusik

Kindermusik with Lori Savage
viagra brand price514-979-3990