Meet Our Specialists
Our endocrinologists believe in very personalized medicine where each patient’s disease, no matter how similar in medical mechanics, is only treated by first understanding the individual. Their treatment regimen is found only after truly understanding both their strengths and weaknesses and combining that knowledge with medical therapy. Education is the key to empowering patients to take control of their health.
What is an Endocrinologist?
An endocrinologist is a doctor who has studied the endocrine system and its diseases. These physicians know how to diagnose the diseases of the endocrine glands, and also how to treat them. Because they specialize in these conditions, which can be complex and have hard-to-spot symptoms, an endocrinologist is your best advocate when dealing with hormonal issues.
What do endocrinologists do?
Endocrinologists are trained to diagnose and treat hormone imbalances and problems by helping to restore the normal balance of hormones in your system. They take care of many conditions including:
- Thyroid Diseases
- Thyroid Cancer
- Metabolic Disorders
- Over or Under Production of Hormones
- Cholesterol (Lipid) Disorders
- Lack of growth (short stature)
- Cancers of the Endocrine Glands
Endocrinologists also conduct basic research to learn the way glands work, and clinical research to learn the best methods to treat patients with a hormone imbalance. Through research, endocrinologists develop new drugs and treatments for hormone problems.
This is a type of blood test. A hemoglobin A1C percentage is important because it is the only way to know how well patients are controlling their diabetes over time. Based on blood tests taken over a period of two or three months, doctors can estimate patients’ average blood sugar levels. The goal for most diabetics is an A1C of less than 7%. This is roughly equivalent to an average blood sugar level of about 150 mg/dl. An A1C of 9% indicates an average blood sugar level of about 210 mg/dl.
Here’s how blood sugar works in the body. Glucose (blood sugar) circulates in the blood after food is absorbed in the intestine. A small amount normally combines with the hemoglobin molecule (A1C). Hemoglobin is the red-colored protein in red blood cells that carries oxygen to the rest of the body. It operates in direct proportion to the amount of glucose in the blood. The glucose remains with the hemoglobin molecule until the individual’s red blood cells die – usually between two and three months. When the patient’s blood is analyzed for hemoglobin A1C, the resulting value number provides an estimate of the level of glucose over that time period.
Chocolate is not usually the best choice because the fat in it slows down the absorption of the sugar. Treat a low blood sugar reaction with some type of fast-acting sugar, such as glucose tabs, four ounces of juice, four ounces of nonfat milk or a half can of regular soda.
Diabetes often causes poor circulation in the legs and feet. This is one reason people with diabetes must take special care of their feet. Diabetics are likely to have foot problems, such as fungus, ingrown toenails, infections, bunions and ulcers. Most foot amputations can be prevented with good foot care. Note any changes in your feet, such as cuts, scratches, red areas, corns, cracks, itching or other abnormalities. Any changes should be reported to the podiatrist. To smooth down calluses, use a pumice stone when bathing, and never cut calluses off. Trim or file toenails straight across to cut down on the chance of ingrown nails. Make sure shoes fit properly. Pressure from ill-fitting shoes can cause sore areas and lead to ulcers and infections. Patients who have foot pain should see a podiatrist regularly. Most insurance companies will cover podiatry care for patients with diabetes.
Diabetes is a condition in which the glucose remains in the blood, without getting transported out into the cells, and used as a source of energy. There are two types of diabetes:
- Type 1 or insulin-dependent: It is diagnosed during childhood. In this condition, the body is unable to make enough insulin, a hormone that is required for blood sugar metabolism.
- Type 2 or non-insulin dependent: It is a more common type of diabetes, usually develops in adults, and may remain undiagnosed for some time. In this condition, the body is capable of producing insulin, but the tissues become resistant to its actions and hence blood sugar levels increase
The blood sugar levels in both type 1 and type 2 diabetes may be controlled. Type 1 requires daily injections of insulin, whereas type 2 is controlled by dietary modification, weight loss, and exercise. Foods such as fruit juices, sports drinks, candies, jelly, jams, honey that contain high amount of simple sugars are to be avoided. The American Diabetes Association recommends that blood sugar level after fasting should be in the range of 80 -120 mg/dl, before meals, it should be below 140 mg/dl, after 2 hours following a meal, it should be below 180 mg/dl.
We recommend using new lancets and syringes for each injection. However, many people reuse their personal lancets for one week. This is acceptable as long as the lancet device is not shared with anyone else. In reusing the syringe, patients run the risk of insulin contamination. Therefore, every syringe should be discarded after use.
Blood sugar levels change all the time and vary with each individual. The American Diabetes Association recommends the following: after fasting, your blood sugar should be between 80 and 120 mg/dl; before meals, it should be less than 140 mg/dl; and two hours after a meal, it should be less than 180 mg/dl.
Blood sugar levels should be checked at least twice each day.
Visit the ophthalmologist once a year. For patients with retinopathy, an ophthalmologist should be seen on a routine basis.
Your blood sugar level should be between 60 and 90 mg/dl when you have been fasting and less than 120 mg/dl two hours after a meal.
Signs include extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness and nausea.
Signs include shaking, fast heartbeat, sweating, anxiety, dizziness, hunger, impaired vision, weakness/fatigue, headache and irritability.
Diet and Diabetes
Foods with higher amounts of simple sugars should be avoided, such as fruit juice, regular soda, sport drinks, candies, sugar, brown sugar, honey, syrup, jelly and jams.
Total carbohydrates include sugar, starches and dietary fiber. The total amount of carbohydrates is what affects blood glucose levels – not just sugar.
Patients who take blood pressure medication should limit sodium intake to 2,000 mg a day. One teaspoon of salt contains about 2,300 mg of sodium. Most sodium in the American diet comes from processed or prepared foods, not from the kitchen table salt shaker. Foods that have 400 mg per serving are considered high sodium foods.
The recommended amount of fiber is 25 to 30 grams per day. Check for fiber on food labels to help reach this number. Some examples of high fiber foods are fruits, vegetables, legumes and whole grains. Fiber is not completely digested and absorbed in the intestinal system, and it is unavailable as blood sugar. Therefore, a high-fiber meal does not provide as much available carbohydrates as a similar-content low fiber meal. To avoid constipation, increase water intake as more fiber is added to the diet.
No, tumors of the pituitary gland are benign in nature. Their growth is very slow, and also they do not spread over to other body parts. In some cases, these tumors are treated with medications. Synthetic hormones may be given in order to replace low hormone levels due to the malfunctioning of the pituitary gland. These may be either taken orally or injected.
No, these tumors are caused by an abnormality in the genetic material of the pituitary cell, which causes the cells to continue growing and dividing.
Some pituitary tumors can be controlled with medication. Others may require surgery of radiotherapy.
We have synthetic hormones that patients take either by mouth or injection to replace the missing hormones from the malfunctioning pituitary gland.
Osteoporosis is a condition in which bones gradually become thin and lose mass. This causes the bones to become frail and break more easily. Osteoporosis is the most common bone disease in America, affecting about 10 million people.
The body is constantly replacing old bone with new bone, just like growing new hair and skin. Osteoporosis occurs when the body does not make enough new bone to replace the old, or old bone is lost too fast for the body to replace it. A number of factors cause bones to begin thinning and become frail. As women become menopausal, they make less estrogen, the female hormone that helps keep bones strong. Other causes of osteoporosis may be a diet low in calcium or vitamin D, heavy steroid use and alcoholism.
Preventing osteoporosis starts early in life with a good diet rich in calcium and vitamin D. Frequent exercise also plays an important role since It increases bone strength and makes patients less likely to experience fractures or breaks. After menopause, some women may take estrogen supplements to help keep bones strong. Persons at risk for osteoporosis should be checked regularly by a doctor. When the disorder is discovered early through bone scans and X-rays, the doctor can suggest changes in diet, exercise and medications to keep bones healthy. Unfortunately, when osteoporosis is discovered as a result of a broken or fractured bone, it is too late to take preventive action.
Women should take in 1,000 mg of calcium in their daily diet. If there is a strong family history of osteoporosis or osteoporosis has already been diagnosed, a woman should take 1,500 mg of calcium daily. A small daily supplement of vitamin D (400 IU) is recommended because it improves the absorption of calcium by the body. Either calcium carbonate tablets or calcium citrate tablets may be taken four to six times a day up to 1,000 to 1,500 mg total. Calcium citrate is absorbed better by some patients and may have fewer digestive track side effects. Men with osteoporosis are usually given calcium supplements of between 1 and 1.5 grams a day. When there are signs of reduced calcium absorption, supplements can be increased up to three grams a day, and vitamin D supplements of 50,000 IU may be given once or twice a week. However, at dosage levels this high calcium levels should be closely monitored.
Some people with osteoporosis experience no symptoms at all, while others may experience pain in the bones and muscles, particularly of the back. A person may experience fractures or broken bones (particularly of the hip and wrist) with very little to cause them. Some people develop humps in their upper back or experience shrinking height because of compression fractures in their backs. When symptoms are experienced, a person may have pain that comes on suddenly, does not radiate, gets worse when weight is put on the area, may be tender locally and generally begins to go away in a week. However, some pain may remain for three months or more.
Both men and women can get osteoporosis. In fact, a rare form of osteoporosis can occur in children and young adults of both genders. Postmenopausal osteoporosis tends to occur between the ages of 51 and 75. Although osteoporosis is six times more common in women, it can also occur in men with low levels of testosterone. Another type of osteoporosis is associated with the normal aging process. It usually occurs in people who are 60 or older, and it is twice as common in women as in men. Osteoporosis can also develop as a side effect of:
- Endocrine diseases, including hyperthyroidism and diabetes mellitus
- Drugs, including glucocorticosteroids, alcohol, tobacco, dilantin, barbiturates and heparin
- Various conditions, including being immobilized, chronic kidney failure, liver disease, chronic obstructive lung disease and conditions in which vitamins and minerals are not absorbed properly.
Not everyone gets osteoporosis, but as we age, it is more likely that we will experience some osteoporosis. Besides age and gender, certain things will make osteoporosis more likely, including:
- A family history of osteoporosis
- Being less active
- Not taking in enough calcium, phosphorus and vitamin D
- Having your first period late and menopause early
- Not bearing children
- Drinking coffee or alcohol and smoking
- Being Caucasian or Asian (Blacks and Hispanics have a higher bone mass than do Caucasians or Asians)
Thyroid hormone replacement therapy is commonly used to treat hypothyroidism. Thyroid hormones may be used to replace the functions of the thyroid gland that has stopped its functions. Hypothyroidism is a condition in which the thyroid is incapable of producing thyroid hormone, and may occur due to a non-functioning thyroid gland as in Hashimoto’s disease, thyroid gland destruction due to surgery or radiotherapy or as a result of a non-functioning pituitary gland.
Pure synthetic thyroxin (T4) will be used, and it functions similar to the patient’s own thyroid hormone. As thyroid hormone plays a significant role in the health of our body’s cells, the objective of thyroid hormone replacement would be to replicate the thyroid gland functions. The thyroid hormone supplements should be taken in prescribed amounts only, and your thyroid function will be closely monitored by your endocrinologist.