a*********d
发帖数: 2763 | 1 very good point.
i personally don't really buy that postprandial hypoglycemia (reactive
hypoglycemia)theory, but that's just me, it's still a controversial topic,
some suggest it is just a functional symptom that might have nothing to do
with real hypoglycemia. the only exception is in patients with history of
bariatric surgery.
secondly, OGTT has no role in diagnosing hypoglycemia, 72 hour fasting is
the only way to know for sure if her hypoglycemia is real deal or not. also
keep in mind, gluco... 阅读全帖 |
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n*******c
发帖数: 501 | 2 Very informative.
My thinking is OGTT can be easily done to see if the patient has diabetes.
If yes, we know the hypos may not be true or just reactive, assuming it is
unlikely he has two different pathologies. If normal glucose tolerance, then
those hypers are most likely to be reactive to hypos.
Just saw the post about referral. Can the neurologist refer a patient who
presented to him with peripheral neuropathy to an endocrinologist for
opinion about diabetes? Or it all goes back to the family... 阅读全帖 |
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a*********d
发帖数: 2763 | 3 唉唉唉，本来超不想回这个贴，但是看到你这个帖子挂在这里好几天都没人说什么，还
是忍不住说几句。我说话有什么说什么，你可能觉得不中听，但是我可以说这是任何一
个内分泌医生见到你心里都会这么想的，呵呵，当然他们不会告诉你。
首先，你的心情很理解，安慰一下，甲状腺肿瘤一般预后还是很良好的。
其次，你应该手术，不要来来回回拖了，本来很简单的一件事情，看看你搞得这么复杂
，说得难听点，医生看见您这样的病人最头大了。
第三，手术前，最重要的，是找到好的medical center做一个detailed neck
ultrasound，看看有没有可疑的进步淋巴结，这会影响到手术要不要清扫淋巴结。东北
部那好的医院太多了啊，波士顿那几个大医院你随手挑一个就行了，你这个也不是什么
疑难杂症阿，最重要的是你的保险cover啥。
第四，对于你对医生的质疑，我只能说，你多花了不少钱，多吃了一次radioactive
iodine和biopsy，都是因为你不愿意按照医生建议手术。needle biopsy是有限制的，
有时候确实只能告诉你这么多，要真正确认是不是肿瘤，就是要手术才行。这跟医生担
不担责任没关系，... 阅读全帖 |
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n*******c
发帖数: 501 | 4 Thanks for the very educational case.
1. Glucose tolerance test should be done properly before we can rely on its
result. It is very important to make sure for days or even weeks before the
test, the patient has not been restricting carbohydrate. Secondly the
patient should be fasted properly (8hrs rule). You would be surprised how
people understand fasting.lol I have had a patient (back in china) who
thought fasting means no meals but fruits doesn't count so she had some
grape before bed...
2.I... 阅读全帖 |
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b******a
发帖数: 704 | 5 我怎么就不问"is the body weight loss intentional?" BMI稍偏低，我如此担心她的
体重，这个年纪，我就活生生没往厌食想。应该要考虑精神因素的影响。 血糖波动那么大
，我还在考虑可能胰岛素分泌延迟，或其他不正常啥的。 我潜意识的字典里只有“贪
吃”，没有”厌食“，要扩容啊。看了大家的讨论，最收益的是我这个危险的PCP。谢
谢如此简单，又不简单的病例。
不过，在没有明确的诊断前，病人病情并不紧急，连我都会药物治疗不要先上，耐心等
Endocrinologist的咨询. |
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a*********d
发帖数: 2763 | 6 very good indeed!
1. patient should see reproductive endocrinologist for fertility concerns,
and starting testosterone might not be a good idea for those who still
desire fertility.
2. true, also should screen prostate cancer,if any history or suspicion,
consult
urologist first.
3. true
4. always true
5. i am not quite sure what you mean
6. they always follow up, hehehe
other things should be mentioned include acnes, skin rashes, breast
tenderness. more importantly, patient should be evaluated a... 阅读全帖 |
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j**W
发帖数: 89 | 7 【 以下文字转载自 NextGeneration 讨论区 】
发信人: jasW (夏夜轻风), 信区: NextGeneration
标 题: 请教：宝宝血检不正常
关键字: IUDC
发信站: BBS 未名空间站 (Tue Apr 23 23:46:01 2013, 美东)
一岁半的宝宝，测了好几次都是这样。Endocrinologist说她也不知道怎么回事，但是
还让接着测同样的东西。每次宝宝胳膊上都要扎两三个眼，哭得一塌糊涂。宝妈心疼死
了。又不想再测了，又怕真有什么大毛病。上来问问，有知道的吗？谢了先！
宝宝 Un/Crea Ratio 45-65， 正常值 12-20
Anion Gap 13-17， 正常值 5-11 mmol/L
Total Calcium 11.1-11.2, 正常值 8.5-10.6 mg/dL
Serum Ionized Calcium 5.3-5.6 mg/dL, 正常值 4.8-5.5 mg/dL
TSH 1.31, 正常值 0. 7-6.0 uIU/mL
Total PTH Intact 两次 <10 一次 11, 正常值 12-72 pg... 阅读全帖 |
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J*********4
发帖数: 1274 | 8 So just listen to your doctor. Get the Ultrasound done to see if you have
any lumps in your thyroid gland first.
Your doctor will decide whether you need any medication, which is basically
supplementation of thyroid hormone based on your whole clinical picture.
No big worries. This is subclinical hypothyroidism, likely secondary due to
auto-antibodies against your thyroid gland.
Again, I do not have any expertise in treating thyroid disease. Please trust
your doctor or get a second opinion with ... 阅读全帖 |
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p****y
发帖数: 23737 | 9 http://www.nytimes.com/2010/11/30/health/30vitamin.html?_r=1&hp
Report Questions Need for 2 Diet Supplements
By GINA KOLATA
Published: November 29, 2010
The very high levels of vitamin D that are often recommended by doctors and
testing laboratories — and can be achieved only by taking supplements —
are unnecessary and could be harmful, an expert committee says. It also
concludes that calcium supplements are not needed.
The group said most people have adequate amounts of vitamin D in their blood... 阅读全帖 |
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c*****t
发帖数: 749 | 10 Another bad news. My nurse called me today that I have a borderline high TSH
. And my doctor wants me to start a medicine to lower TSH (don't remember
the name). But I still want to have another test or even a second opinion
before rushing to take any medicine.
If anyone knows a good reproductive endocrinologist around NJ or NY, please
let me know. Thanks very much! |
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h********u
发帖数: 2207 | 11 直接去看RE，reproductive endocrinologist， 他们就是管治不孕的。 |
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z****t
发帖数: 75 | 12 赞！
我在家一年多了虽然还是不孕，的确养得不错了，有时间干点喜欢干的事。我还看了3
本关于infertility的书，有时间见医生，去做检查和宫腔镜手术。终于有一个专科医
生（reproductive endocrinologist）说我为什么不孕了，我很快要开始IVF了。一个
IVF cycle大概要去看医生或护士4，5次，因为在家就不用考虑时间表跟工作冲突的事。
不孕的姐妹不管工作还是在家，真的需要花时间去找专科医生而不是普通的妇产科医生
替你找不孕的原因，确诊越早效果越好，选择越多。我以前还是做得不够，没把这件事
放在第一位，又忙于身份工作等到现在年近40，只有IVF一个选择，而且前景不容乐观。 |
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z****t
发帖数: 75 | 13 今天终于去见了不孕症专科医生, 得到了既震惊又不那么震惊的诊断。
不那么震惊：本人接近40岁，当然是advanced maternal age (AMA，高龄产妇)，是low
ovarian reserve（低卵巢储备）也不奇怪。
Advanced maternal age (AMA) is defined as age > 35 years old at the time of
delivery. 胚胎遗传性异常的风险大大增高。
B超显示双侧卵巢里一共只有5个antral follicles （窦卵泡，即小的储备卵泡），所
以是low ovarian reserve 。
输卵管问题是不孕的常见原因。输卵管造影影像（HSG）显示左侧输卵管末端功能丧失
，但医生没明确说是输卵管积水。右侧输卵管末端功能虽然没全丧失，也不是很好。即
使输卵管是通的，末端功能不全或完全丧失，卵巢排出的卵子没法被输卵管末端手指状
的结构吸入输卵管。
让我震惊的是，同样的3张造影片子，不同医生的判断是如此不同：放射科医生的报告
里结论是bilateral tubal patency （双侧输卵管不堵），还说双侧输 |
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M********8
发帖数: 3837 | 14 “我这种情况IVF是最好的选择，因为高龄每个周期的成功率只有20%，但是如果自己试
成功率就是1-3%。做IVF时，他会先试在第二天植回子宫，因为子宫的自然环境总是优
于体外培养。如果两次都不成功，大部分情况是因为胚胎质量不行，那第三次就培养到
第5天，5天的胚胎植入前的质量应该是大大提高了。子宫内膜的厚度对胚胎的存活也很
重要，如果胚胎好了，内膜还没达到最佳状态，就将第5天的胚胎冷冻，等内膜好了再
植回子宫也就是frozen embryo transfer (FET，冷冻胚胎移植)。”
有点不赞同的是，如果两次day2都不成功的话，第三次的重点不应该是培养到第5天，
我看到过research说接近40岁的胚胎能够存活到第5天的比例较低，也是为什么高龄的
一般都是day3或者以前ET，除非lab的技术非常过硬，这方面北欧的诊所做得最好，美
国的就只有CCRM能与之比较，普通的lab未必有这个实力。我的诊所就不能打保单，宁
愿day3保险。
如果两次day2不成功，应该是改变protocol, 因为stim的方法会影响卵子质量。如果你
的ovarian reserve不多，而且respo |
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z****t
发帖数: 75 | 15 非常感谢Milpitas88码这么多字给我提供宝贵建议。很佩服你搜集和研究信息的能力！
关于第三次培养到第5天，医生给我的解释是前两次当然希望得到结果，第三次就是医
生希望从失败中学些东西，做些不一样的尝试，病人呢，就再给自己一次机会。诊所做
3次的package比分别做2次还少$200，所以第三次他们认为是免费给你做的。
关于Mini-IVF，我跟你的想法不谋而合，我去看的就是做Mini-IVF的医生。 |
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d***o
发帖数: 1514 | 16 我喜欢耐心细致能回电话回email的医生
不过最重要的还是医术比较好
谢谢 |
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b*******y
发帖数: 12791 | 17 大多数有名的医生都很忙，哪里有空回长电话，回长email阿。
我医生现在早上7点到诊所，晚上6点过了才离开，人也不是铁打的
我每次都攒好了问题，office visit的时候一起问了 |
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d***o
发帖数: 1514 | 18 我的问题是每次连医生都见不到，去了就是抽血，B超
而且一个月只查两次，每次最后都是助手和我联系下次什么时候去
唉
有名不有名我也无所谓了，只要合格就行了 |
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d***o
发帖数: 1514 | 20 如果你的医生在纽约的话，能向我推荐一下你的医生吗 |
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b*******y
发帖数: 12791 | 23 他们说东边cornell好，你离那里也不算太远太远，要不去看看？ |
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l****a
发帖数: 459 | 24 cornell医学院就在nyc，world-class researchers，排队可能比较长
www.ivf.org |
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l****a
发帖数: 459 | 25 据说不错，如果错了不要找我
Eileen C Chen, MD
622 W Duarte Rd, Ste 304
Arcadia, CA 91007
Phone: (626) 445-8877
Fax: (626) 446-8877
Speaks: Chinese
Education: Yale University, 1993
Residency: UCLA MEDICAL CENTER, 1997
Fellowship: Univ of TX Hlth Sciences/San Antonio, 1999
Accuracy of mammographic appearances after breast fine-needle aspiration.
Hindle WH, Chen EC.
Am J Obstet Gynecol. 1997 Jun;176(6):1286-90; discussion 1290-2.
Cocaine impairs follicular phase pulsatile gonadotropi |
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d***o
发帖数: 1514 | 26 但是发现这里的这里的姐妹们都特别nice，所以冒昧问一下
因为去年的自然流产，还有这半年的努力没有结果，所以特别担心自己有问题，想找个
医生好好查一下，毕竟自己年纪不小了(在30和35之间）
可是我现在的医生似乎不在乎不孕的原因，只想给我IUI,IVF
前一阶段还来这里求推荐医生，这几天自己也在看各个医生的review
但是发现似乎一般的Reproductive Endocrinologist都把病人当机器一样，不管什么原
因，就知道IVF,success rate
我不反对IVF，但是如果是可以治疗后自然怀孕的还是希望自然怀孕
问一下，现在的医生是不是都这样，我还要继续求医问药吗，还是自己努力？ |
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c*****u
发帖数: 1826 | 27 Yes, I paid a co-pay every time I saw my endocrinologist. He told me about
the pills and said don't even worry about it cuz I will need insulin
anyways, and since it is safe for the baby and I will need to get used to
it so the earlier that I start it the better.
Afterall, controlling the sugar level is more important for the baby. |
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k******u
发帖数: 3137 | 28 来自主题: _IrishFootball版 - 有美女在求助 http://www.iwanttogotonotredame.com/index.php
"She says she has been accepted to the University of Michigan but hopes to
raise enough money from donations through the site to attend the more
expensive Notre Dame.
Harris plans to pursue a degree in biomolecular engineering and then attend
medical school to become a pediatric endocrinologist. " |
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