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.

Office updates

There are some important updates about my private office.

1. I will be at a new street address some time in April. You will find me at 255 West Moana Lane, Suite 108. My phone number and fax will remain the same.I will be publishing the exact date as soon as I know. Carpet and paint haven't even been started so don't drop by just yet. It's on the north side of the street, between a car wash and Pritchett Eye Care. If you have been around here long enough it is across the street from the old Moana Pool site.

2. I will be out of the office from May 14 until June 2, 2014. During this time I will not be able to answer phone calls or faxes. Internet service will be sporadic and unreliable so I can't make any promises about returning e-mails or electronically refill requests either. If you need any medication refills during this time please contact your primary care provider.

3. I am not scheduling any new patients in my private office. I am not scheduling any returning patients that I have not seen regularly since opening my private office. this limit is a necessary step for me to be able to provide quality care for my established patients seen on a regularly scheduled basis.

4. Prescription refills, pump supply orders and upgrades, and sensor orders continue to be sent to the incorrect offices. If your pharmacy or supply service send the requests to the incorrect office there will be a significant delay before this is approved. If you have not been seen in the last year it will not be approved at all until you come in for an appointment.

5. For those of you who need to change your appointment at the last minute due to school or work, you already know I don't have an opening available for about 4 months- except for openings suddenly made available by others who cancel a few days in advance. For your convenience you should consider another endocrine office that is open full-time with multiple providers. You will will likely find greater flexibility in your ability to get an appointment on the day and time of your preference with short notice.

Two years later and still not getting the refill requests right

Confusion reigns with pharmacies sending refill requests to the wrong office.  If your pharmacy says they faxed /called multiple times and I didn't respond, confirm with the pharmacy that they are contacting the correct office.  Apparently some pharmacy computers can't track multiple office fax numbers for a single provider. Unfortunately this includes most mail order pharmacies as well as some local pharmacies.
You will be your own best advocate to make sure the pharmacy contacts the correct office.  Because the two offices are independent of each other your prescription can only be authorized at the office where you are seen.
If you see me at the Renown Diabetes Center, 850 Mill Street:
 the phone is (775) 982-5073 and fax (775) 982-3959.
If you see me at 5605 Riggins Court:
 the phone is (775) 287-2625 and fax (775) 996-4116.
These phone numbers are also on your appointment card.
If you have not seen me since I left the Plumb Lane office I cannot provide refills until you are seen.  You can ask your primary care provider for refills until I see you.  You will need to be scheduled as a new patient because I will need the extra time with you to review your complete medical history for the charting system I now use.