Take care of your brain

There are ways to make your brain 'stronger'. This research in 2011 demonstrated visible improvements (on MRI) in brain structure after only 8 weeks of "Mindfulness-Based Stress Reduction".

Mindfulness is a concept that started in the 1970's and has grown steadily since then. It is the opposite of multitasking. you focus your mind on a single thing and actively exclude all other thoughts. In practice it is a form of meditation.

You can do the same thing! What makes it easy is the Muse brainwave sensing headband. This device gives you feedback on your thoughts. When you are focused on a single thing, your breath, you hear gentle sounds and even chirping birds. When you are distracted the wind, waves or rain will get louder as a reminder to focus your thought. 

When you buy this device direct from the developer you get a 60 day money back guarantee. You will need a smartphone or Ipad or Android tablet to run the app for the headband. Check to make sure your tablet or phone has the operating system necessary to run the app.

Too busy to blog

A lot has happened in the last 2 years. Here's a summary.

1. Ariana is in law school. My front desk person is Tammy Manke as of Aug 2017.

2. I have a Certified Diabetes Educator, Josh Quinn, 'on loan' from Medtronic. He is here on the 2nd and 4th Thursday of the month to co-manage people on Medronic/Minimed pumps and those wanting to start on the pump.

3. I have a medical assistant, Kaitlin Shonnard, here each Tuesday and Thursday to get your vital signs, update your medication list and upload your glucose meter or pump. Be sure to bring your meter. She has the app for uploading 26 different meters. 

4. If you need a coach for stress management, see Toni Caruso. The visit will be included with your appointment with me. I also have a device, a Muse headband, that facilitates stress management. You can demo the unit at the office any day I'm open. Bring your smartphone to run the app.

5. I have guest wifi available. Just ask when you're here.

6. I love my Medtronic 670G hybrid closed loop pump. It's reduced my hypoglycemia by 80-90%. Instead of averaging 1-2 h/day under 70 I'm down to 10-15' on the average. I can go days without a low.
7. I have a Facebook page for my office to announce when I'm out of the office, etc. Search For Dan Caruso MD on Facebook to stay up-to-date. Please don't use Facebook to communicate with me about your health care.
8. I also have a Yelp page. I'm not as attentive to it as I am Facebook.

Merry Christmas!

Moana Lane will be my only location for office visits starting Jan 1, 2016

Starting January 1, 2016, I will no longer be a provider at the Renown Diabetes Center. This means changes for my patients at both locations:

      

For my Moana Lane patients: A letter has gone out explaining my new office days and what insurances I will be contracted with starting in 2016. If you have any questions or need to reschedule an appointment, please call the office.

For my Renown patients: My private practice is very small and a major change from the Renown practice. I only have a small refrigerator so I will, unfortunately, not have the room to keep samples as I have been at Renown. This means that I will not be able to provide enough samples to get people through their deductible or doughnut hole.

I do not do the hemoglobin A1c test in the office. I don't have the space or staff to maintain, operate, run quality control and manage inventory for it.  Please go to the lab before your appointment to get it done. You can also go to a health fair lab and order your own A1c if you don't have a lab order. 

I do not have a nurse or an educator or a medical assistant at this office. I am going to miss them dearly.  Unfortunately, this means your refill request may need to wait until the end of the day or if I am out of the office for an extended period of time, it may have to wait until I get back. This is a very important reason to have a primary care provider- to help you get your prescriptions ordered if I am not available. Education will still be available at the Renown Diabetes Center and is also available through Karen Fisher at Nutrition Connection.

Another important service I am outsourcing is influenza vaccine.  Your primary care provider or local pharmacy can help you with your vaccines.

My office policies will stay as they are for the foreseeable future. I understand these are significant differences from the Diabetes Center so please be sure to take all of it into consideration. If these changes are not to the level of care you would like from your endocrinologist, there are several other doctors in Reno who could provide you with the care you need. Please check with your primary care physician or check your insurance provider list.

For ALL my patients: I have officially opened up my 2016 schedule for my Monday through Thursday schedule. If you have any questions regarding scheduling and/or on any of our office changes, please call the office and we can help you. However, also please remember that I am only in the office on Thursday and Friday (excluding Holidays) until the end of the year. Also remember that I only have one receptionist in charge of scheduling. She is getting a high number of calls so if you call during office hours and don’t speak with her, leave a message. It will take her some time to get back to you, but she will return all messages as soon as she can.

you can email me at caruso.patient@gmail.com. Keep in mind this email account is not HIPPA compliant.

Thank you for your understanding and for continuing to utilize me for your health care needs.

change in practice schedule

Beginning August 2015 my office schedule will change and I will be open at Moana Lane on Thursday and Friday.  I will no longer see patients at Moana Lane on Tuesdays starting in August.

I will be working at the Renown Diabetes Center on Monday, Tuesday and Wednesday.  Dr Claude Lardinois works at the Diabetes Center on Thursday.  There is full-time staff including certified diabetes educator nurses and dieticians at Renown.  Phone messages are checked regularly at the Diabetes Center.  You are more than welcome to see me at Renown for your diabetes.

If you do not have diabetes and my new schedule does not meet with your needs I will forward your records to another endocrinologist of your choosing.  Your primary care provider may also be able to treat your endocrine condition. Consider discussing this with your PCP.

Thank you for your understanding.

Christmas gift for your New Year resolution

Health, wellness, exercise, nutrition and weight loss are popular topics for New Year resolutions.  Unfortunately by mid-February the new year resolutions have been abandoned.  Yet health and wellness aren't goals that should be left behind after 6 weeks.

 I know if I really try I can usually stretch my exercise resolution to early March,  Something happens between spring break and the outdoor cycling season that leaves me with no desire to exercise or eat right.  I am fortunate to have my coach, Toni Caruso, right with me saying 'let's go for a ride' and 'cook some quinoa for dinner'.

Toni is available as a life coach to help with nutrition, exercise, natural weight loss and stress management.  Call, text or email this office to schedule and appointment.  We will offer open group discussions for these topics if we hear from enough people that you would like to attend a group.  This may be the best Christmas present you could give yourself this year.

If natural weight loss efforts have not been effective for you then Dr Caruso is available to discuss prescription treatments to achieve your weight goals.

maybe it's not your thyroid

     You're tired. You want to nap. You don't sleep well at night. You don't have any enthusiasm for anything. You can't lose weight even though your appetite is poor.   You have inexplicable food cravings.  You ache.  You feel moody, irritable, anxious or depressed.   Sometimes you feel too cold, or too warm, or both. Your heart may skip or race. Maybe you have night sweats.
     According to a number of websites and self-proclaimed thyroid specialists you have a thyroid problem. These sources say that even if your blood tests are normal you still have a thyroid problem. Ignore the blood tests and ignore the research, find someone who will prescribe you desiccated pig thyroid and you will feel better.
     You probably will feel better for the first few weeks taking a dried animal gland, and then you will relapse. So you take a higher dose, you feel better for a bit and then another relapse. Keep upping the dose and you will eventually start having typical symptoms of too much thyroid medication. Not only that but now you have also damaged your glands ability to function naturally on its own, which it was doing just fine before you started taking an unnecessary medication.  I know there are plenty of testimonials about the miraculous recovery of people once they went on thyroid, but these are a mere handful compared to the many for whom it failed or caused adverse side effects such as osteoporosis with fractures, or atrial fibrillation.
     So why then do you feel so poorly? It is spelled S-T-R-E-S-S. the symptoms you're having are attributable to stress hormones cortisol and adrenaline.  Our bodies are developed to handle acute stress but not chronic stress.  When these hormones are chronically elevated bad things happen, namely the list of symptoms at the top of the page.  No, this isn't 'adrenal fatigue' either.  You don't need to help your adrenal glands work better with any herbs or nutritional supplements.  Your adrenal glands are doing exactly what they are supposed to do in response to stress and it becomes quite unpleasant.  The stress isn't easily fixed with a pill so people don't want to deal with it.  but until you deal with it you will continue to look for novel diagnoses and a convenient pill treatment and you will continue to feel poorly.
      There are some wonderful resources to learn more about stress and stress management. I highly recommend visiting the American Institute of Stress website. there is a program coming up July 24-26 and I look forward to watching it.  No it isn't easy to manage chronic stress.  But is may be the only effective treatment available.

insulin without a prescription

If you find yourself in a bind needing insulin because your forgot it, the bottle broke, etc you can buy human regular insulin and human NPH without a prescription. They are available at WalMart for around $25 a bottle. No, it's not available in pen form so you may need to buy syringes as well. No, they don't work exactly the same as Humalog, Novolog, Apidra, Lantus or Levemir. But it can still help you through the situation. Ask your doctor about appropriate dosing in case you need to use this option.