Hormone Happenings
Blog Address: http://blogs.medscape.com/hormonehappenings
August 23, 2013

Middle of the Movie

As much as I want people to do well, I must admit that extreme lab work has a way of getting me motivated and engaged in my role as a chemistry repairman.  I will roam through computerized lab data right from the first encounter to find glucoses >1000, calcium < 6.5, free T4 assays that the lab stopped diluting at >7.7, and TSH > 200.  More often than not, these extreme values have a clinical presentation, though some, like unmeasurable 25-hydroxy Vitamin D levels or 5 gram proteinuria or serum albumin of 1.8 g/dl, have little on exam to reveal the extent of the problem.  Still, they need to be thought through, assessed with comparisons from previous medical encounters, and explained physiologically. 

In many ways, these severe aberrations of norm...

Posted By: RICHARD PLOTZKER  

July 19, 2013

Screen Shots

Sometimes Hormone Happenings are really a subset of other medical happenings but with their own unique perspective.  About a month ago, following dedicated training the new EMR for outpatients in our hospital system became a reality.  It was promoted as an upgrade, which was understandable as downgrading what we had would require some effort.  But a month into this, reinforced wi...

Posted By: RICHARD PLOTZKER  

July 3, 2013

Attending the Meeting

Despite readily available global communications nowadays, it is not difficult to get lulled into a form of professional isolation.  My hospital gives me an ample desk, an office in a corner nook off the main thoroughfare neither too big nor too cramped.  The computer works most of the time and the banned sites are realatively few, not that I’ve pushed the envelope a whole lot.&n...

Posted By: RICHARD PLOTZKER  

June 3, 2013

Which Thyroid Hormone?

Management of primary hypothyroidism has become deceptively simple over decades, facilitated by increasingly sophisticated lab studies, from sensitive TSH measurements to direct Free T4 assays. It takes little professional skill to move the levothyroxine dose up or down to get the TSH to the right place, perhaps a little more experience to know where the right place is.

Not everyone nee...

Posted By: RICHARD PLOTZKER  

May 10, 2013

Parathyroid Replacement

There are few hormonal disorders that have never had an entirely satisfactory treatment and a few others where the treatment is rational but indirect. For people who lack thyroid function, thyroxine replacement corrects most problems. For people with adrenal insufficiency or primary gonadal failure we have pretty good direct replacements, none foolproof but reasonable. For people who lack th...

Posted By: RICHARD PLOTZKER  

April 23, 2013

Vibrating Dinner Fork

It wasn’t that long ago that salespeople from pharmaceutical companies or medical device suppliers would stop by the office to promote their wares, bringing with them an assortment of freebies of various utility.  I still have a calculator that converts height and weight into a BMI.  I’ve accumulated laser pointers whose batteries have long since run out, a dry erase board...

Posted By: RICHARD PLOTZKER  

April 12, 2013

From Prescribing to Dispensing: A Serious Gap

Recently a consult came my way on a new diabetic patient presenting with ketoacidosis. Usual care was provided and he stabilized. Handoffs went from the ICU to the medical floor resident who wrote his prescriptions for Levemir and Humalog. For some reason he left the hospital at night, then went to the regional all-night pharmacy to get the prescriptions filled.

Four days later he was b...

Posted By: RICHARD PLOTZKER  

March 21, 2013

Mortality of Sugary Beverages

One of the gas stations near my home has the best price in gas most weeks, location at a popular intersection and an associated Mini-Mart where they offer any size cold beverage for 99 cents. You can choose iced coffee or tea customized many ways, a slurpee or most popularly a name brand soda or Gatorade from the dispenser. Put as much or as little ice in it as you want. When you get to the che...

Posted By: RICHARD PLOTZKER  

March 14, 2013

Geriatric Endocrinology

This past month a few consults came my way to assess borderline TSH elevations in people into their late 80’s and early 90’s.  There is some literature on this which makes it fair game for Endocrinology Boards.  In fact it was taught at board review. 

http://jama.jamanetwork.com/article.aspx?a...

Posted By: RICHARD PLOTZKER  

March 5, 2013

Thyroid Cancer Rescue

People with thyroid cancer generally do well.  Mortality has been historically low, so low that comparison of one therapy over another usually requires assessment of recurrence rather than survival.  Yet for all the relatively innocuous post-operative and post-remnant ablation neck exams and ultrasounds that return to the office, there is a subset of individuals whose tumors prove mor...

Posted By: RICHARD PLOTZKER  

 
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About This Blog

Shuttling from exam rooms, bedsides, and classrooms, Dr. Richard Plotzker shares a mixture of knowledge, insight and perhaps even wisdom to address the challenges endocrine patients often present.
Richard M. Plotzker, MD, has disclosed the following relevant financial relationships: Serves as an employee for: Mercy Philadelphia Hospital

  • RICHARD PLOTZKER

    After maintaining a solo practice in Delaware for twenty years, Dr. Richard Plotzker joined the medical staff of Mercy Philadelphia Hospital in 2010, exchanging the rigors of practice management for the pleasures of teaching the next generation of physicians. Unfortunately, he remains technologically challenged.

 
 


 
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