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Heart Disease

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Physician Extenders play a critical role to help assure that patients are provided with the highest quality of care. Your Endocrinologist may work with a Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS).

All three disciplines have completed bachelor’s degrees and most have a master’s degree. They are licensed by the State of Texas and can prescribe medication. All have had rigorous clinical training and have taken national board exams to certify them in their areas of expertise and must complete a set curriculum of continuing education each year, just as your physician is required to do to maintain their license.

In addition, all of our physician extenders are required to become Certified Diabetes Educators (C.D.E.). This is done after they have acquired the required number of clinical hours to make them eligible to sit for the exam.

Physician Extenders play a critical role to help assure that patients are provided with the highest quality of care. Your Endocrinologist may work with a Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS).

All three disciplines have completed bachelor’s degrees and most have a master’s degree. They are licensed by the State of Texas and can prescribe medication. All have had rigorous clinical training and have taken national board exams to certify them in their areas of expertise and must complete a set curriculum of continuing education each year, just as your physician is required to do to maintain their license.

In addition, all of our physician extenders are required to become Certified Diabetes Educators (C.D.E.). This is done after they have acquired the required number of clinical hours to make them eligible to sit for the exam.

Physician Extenders play a critical role to help assure that patients are provided with the highest quality of care. Your Endocrinologist may work with a Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS).

All three disciplines have completed bachelor’s degrees and most have a master’s degree. They are licensed by the State of Texas and can prescribe medication. All have had rigorous clinical training and have taken national board exams to certify them in their areas of expertise and must complete a set curriculum of continuing education each year, just as your physician is required to do to maintain their license.

In addition, all of our physician extenders are required to become Certified Diabetes Educators (C.D.E.). This is done after they have acquired the required number of clinical hours to make them eligible to sit for the exam.

Physician Extenders play a critical role to help assure that patients are provided with the highest quality of care. Your Endocrinologist may work with a Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS).

All three disciplines have completed bachelor’s degrees and most have a master’s degree. They are licensed by the State of Texas and can prescribe medication. All have had rigorous clinical training and have taken national board exams to certify them in their areas of expertise and must complete a set curriculum of continuing education each year, just as your physician is required to do to maintain their license.

In addition, all of our physician extenders are required to become Certified Diabetes Educators (C.D.E.). This is done after they have acquired the required number of clinical hours to make them eligible to sit for the exam.

Physician Extenders play a critical role to help assure that patients are provided with the highest quality of care. Your Endocrinologist may work with a Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS).

All three disciplines have completed bachelor’s degrees and most have a master’s degree. They are licensed by the State of Texas and can prescribe medication. All have had rigorous clinical training and have taken national board exams to certify them in their areas of expertise and must complete a set curriculum of continuing education each year, just as your physician is required to do to maintain their license.

In addition, all of our physician extenders are required to become Certified Diabetes Educators (C.D.E.). This is done after they have acquired the required number of clinical hours to make them eligible to sit for the exam.

Physician Extenders play a critical role to help assure that patients are provided with the highest quality of care. Your Endocrinologist may work with a Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS).

All three disciplines have completed bachelor’s degrees and most have a master’s degree. They are licensed by the State of Texas and can prescribe medication. All have had rigorous clinical training and have taken national board exams to certify them in their areas of expertise and must complete a set curriculum of continuing education each year, just as your physician is required to do to maintain their license.

In addition, all of our physician extenders are required to become Certified Diabetes Educators (C.D.E.). This is done after they have acquired the required number of clinical hours to make them eligible to sit for the exam.

Physician Extenders play a critical role to help assure that patients are provided with the highest quality of care. Your Endocrinologist may work with a Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS).

All three disciplines have completed bachelor’s degrees and most have a master’s degree. They are licensed by the State of Texas and can prescribe medication. All have had rigorous clinical training and have taken national board exams to certify them in their areas of expertise and must complete a set curriculum of continuing education each year, just as your physician is required to do to maintain their license.

In addition, all of our physician extenders are required to become Certified Diabetes Educators (C.D.E.). This is done after they have acquired the required number of clinical hours to make them eligible to sit for the exam.

Physician Extenders play a critical role to help assure that patients are provided with the highest quality of care. Your Endocrinologist may work with a Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS).

All three disciplines have completed bachelor’s degrees and most have a master’s degree. They are licensed by the State of Texas and can prescribe medication. All have had rigorous clinical training and have taken national board exams to certify them in their areas of expertise and must complete a set curriculum of continuing education each year, just as your physician is required to do to maintain their license.

In addition, all of our physician extenders are required to become Certified Diabetes Educators (C.D.E.). This is done after they have acquired the required number of clinical hours to make them eligible to sit for the exam.

Our office understands that emergencies arise and appointments cannot always be kept. Your appointment time is reserved with your provider in advance. We do not double book patients so we ask that you give as much notice as possible if you are not going to be able to keep your scheduled appointment. This allows us to fill the appointment with another patient that needs to be seen. No shows will be charged a fee of $50.

Our office utilizes an automated system to remind you of your appointment three days in advance as a courtesy. This system allows you to confirm or cancel your appointment. If you need to cancel or reschedule your appointment please call at least 24 hours in advance. This allows us to make your appointment time available to other patients who need an earlier appointment. Appointments cancelled with less than 24 hours notice will be charged a late cancellation fee of $50.

If you are scheduling a new patient appointment, please be prepared to provide the following information to the scheduler:

  • 
Name of referring physician
  • Name of health insurance carrier
  • Diagnosis
  • Address so that we can mail your confirmation letter

We see patients by appointment only. All urgent appointments will be scheduled with a provider that has availability to see you. This may be a physician extender. All referrals must be received prior to your appointment.

You may schedule an appointment by calling our main number: 512-458-8400, option 2. Schedulers are available Monday-Friday, 8:30 am – 4:30 pm. Our telephone lines are closed daily from 12:00 – 1:30. Should you require a thyroid ultrasound prior to your appointment, we will try to schedule these on the same day as your office visit so that you do not have to make multiple trips to the office.

Please make sure to bring the following items to every appointment that you schedule:

  • 
Insurance card
  • 
Complete list of all medications you are taking
  • 
Blood sugar log (if you are diabetic)

We use the latest in thyroid fine needle biopsy techniques with ultrasound guidance. We also use the most advanced technologies for evaluating thyroid biopsy specimens. We participated in a research trial which led to the use of molecular diagnostics for evaluating selected thyroid biopsy specimens and now we routinely use the Affirma gene expression classifier (GEC) to evaluate thyroid biopsy specimens. The Affirma test is done on specimens in which the result is not clearly benign or cancerous. It tests proteins inside of the cells to determine if characteristics are consistent with benign or cancerous findings. This technology has reduced the number of patients requiring surgery.

This is a short procedure that is done in the office. It involves taking tissue samples from one or more areas in the thyroid gland. It is done under local anesthesia, and with ultrasound guidance.

ECNU is a professional certification in the field of neck ultrasonography for physicians who perform consultations and diagnostic evaluations for thyroid and parathyroid disorders through both diagnostic ultrasound and ultrasound-guided fine needle aspiration (UGFNA).

AIUM ultrasound practice accreditation is a voluntary review process that allows practices to demonstrate that they meet or exceed nationally recognized standards in the performance and interpretation of diagnostic ultrasound examinations.
Practices accredited by the American Institute of Ultrasound in Medicine (AIUM) have demonstrated competency in every aspect of their operation, including:

  • Personnel Education, Training, and Experience
  • Document Storage and Record Keeping
  • Policies and Procedures Safeguarding Patients, Ultrasound Personnel, and Equipment
  • Instrumentation
  • Quality Assurance
  • Case Studies

AIUM Accreditation demonstrates our commitment to clinical excellence and commitment to the highest quality patient care.

It may be difficult for a sonographer or doctor to obtain the desired pictures if you have a short or thick neck. Also, if there are multiple nodules or cysts, it can be difficult for the doctor to see each one individually. An ultrasound examination of the thyroid cannot determine the exact cause of a nodule; however, there are characteristics of the image that can help the doctor determine if there is a high chance of cancer (malignant) or a low chance of cancer (benign). Your doctor may recommend further tests, such as an ultrasound-guided biopsy or a fine-needle aspiration. Finally, the quality of the ultrasound examination also depends on the examiner’s experience and the type of equipment used.

  • What will it be like?

You will be lying down on an exam table, as the sonographer uses an ultrasound device to take images of your thyroid. This is done over the skin without any invasive procedures

 

  • Who will perform the exam?

In most cases, a sonographer, who is a professional trained to conduct ultrasound examinations, will perform the exam. He or she obtains and records a series of pictures. Your doctor then reviews the pictures. The doctor may discuss your exam with the sonographer, and will then give you an official explanation or interpretation of what was seen on the sonogram. This interpretation may not be available immediately after you have your exam. In some cases, the doctor also will examine you to confirm or resolve uncertain or unclear findings.

 

  • Are there any special preparations for the exam?

There is no special preparation for this examination.

 

  • Will it hurt?

There is no pain involved in an ultrasound examination of the thyroid. The transducer is placed on your skin surface after a gel is applied to your neck to provide better contact.

 

  • How long will it take?

The length of time for the examination will depend on the specific reasons your doctor requested it. The reasons will affect how complex the examination needs to be.

There are no known harmful effects linked to the medical use of ultrasound.

There are many reasons for examining the thyroid with ultrasound. The most common reason is to provide more information for your doctor about the following:

  • A mass your doctor felt while examining you;
  • Something unusual was found by other exams, such as a nuclear scan, a CT scan, or an MRI exam;
  • What caused your thyroid gland to get larger;
  • What caused the pain or swelling in your thyroid gland; or
  • Abnormalities in your thyroid, such as masses or cysts.

A sonogram may not provide all the information your doctor needs. In these cases, more studies or tests may be needed. These may include blood tests; a biopsy in which your doctor removes a small amount of cells or fluid; or other types of ultrasound examinations.

Ultrasound is like ordinary sound except it has a frequency (or pitch) higher than human beings can hear. When sent into your body from a device called a transducer resting on your neck, the sound echoes back from the organs inside your body. These returning echoes are converted by a computer into a picture. During your thyroid ultrasound examination, ultrasound will produce pictures of your thyroid gland, including its size, shape, and blood vessels. The ultrasound will reveal any nodules (lumps) or cysts (lumps with fluid) that may be present in your thyroid gland. An ultrasound examination is commonly called the practice of sonography, but also may be referred to as diagnostic ultrasound imaging.

The Thyroid operates as part of a feedback loop involving body parts called the Hypothalamus and the Pituitary gland. First, the hypothalamus sends a signal to your pituitary gland through a hormone called TRH. When your pituitary gland receives this signal, it releases another hormone called TSH to your thyroid gland. Upon receiving TSH, your thyroid releases 2 of its own hormones (T3 and T4), which then enter your bloodstream and affect the metabolism of your heart, liver, muscles, and other organs. Finally, your pituitary gland monitors the level of thyroid hormone in your blood and increases or decreases the amount of TSH released, which then changes the amount of thyroid hormone in your blood.

The Thyroid is a butterfly-shaped gland that wraps around the front part of your neck just below your Adam’s apple. The Thyroid makes hormones that help control your body’s metabolism. The hormone produced by the Thyroid has an effect on almost every tissue and cell in your body.

There is currently no treatment to “reverse” Type 1 Diabetes.  Type 2 Diabetes can sometimes be “reversed” by weight loss and exercise.

There is no treatment to prevent Type 1 diabetes.  Type 2 Diabetes can be prevented by weight loss and exercise (see info on Pre-diabetes)

A1C is a blood test done by the lab, which reflects overall control of Diabetes, dating back 3 months.  The A1C target according to ADA is <7% .  This level is associated with a low level of complications of Diabetes.  The target A1C should be individualized depending on a number of relevant factors such as age and duration of Diabetes.

The A1c should be done no more often than every 3 months.  The A1C test measures part of the red blood cell hemoglobin.  Red blood cells live 3-4 months, and one of the hemoglobin fractions in the red blood cell is the A1C.  This fraction irreversibly attaches sugar which crosses the red cell membrane.  The A1C, then, offers a 3-month barometer of overall Diabetes control

Continuous glucose monitoring (CGM) is a newer technology which allows very frequent monitoring/checking of blood sugar.  To use a CGM, the user must insert a tiny filament into the subcutaneous space for up to a week at a time which is attached to a small transmitter which is adhesed to the skin.  A signal is sent from the transmitter to a reading device.   The CGM measures the sugar in the spaces between the fat cells.  This reading correlates well with the actual blood sugar.

CGM gives the user the ability to monitor the blood sugar more comprehensively.  The CGM monitors can be programmed to alarm if the patient is below or above a glucose threshold.  We have used CGM extensively in Type 1 diabetes and it is sometimes used in Type 2 diabetes.

Insulin pumps are recommended for people with Type 1 Diabetes or Type 2 Diabetes on multiple doses of insulin per day. The insulin pump is used by people trying to improve their Diabetes control and is a must for people with frequent or problematic hypoglycemia.  It offers flexibility in insulin dosing and offers more insulin dose adjustability than injection insulin.  The pump is commonly used in pregnancy.

Thanks to research advances, there are more, and better, options available to treat Diabetes.  Oral medications, which treat the deficiencies in Diabetes have been developed.  The medications are effective and generally safer than older medications such as sulfonylureas.  The newer medications tend to not cause hypoglycemia and they are associated with either weight loss or no weight gain.  Oral medications are currently available, which increase insulin levels and lower glucagon. One oral medication induces the kidneys to lose glucose in the urine, thereby lowering the blood sugar.

One relatively new class of injectible meds is available to be given in daily and weekly injections.  Insulin is also being developed which provides a more predictable background or basal insulin and faster mealtime insulins are being developed.  Inhaled insulin has recently been approved as a rapid-acting mealtime insulin.

One of the most predictable ways to give insulin is with an insulin pump.  Insulin pumps constantly infuse a small amount of insulin to provide a basal insulin.  At mealtimes the user enters data, such as amount of carbohydrate to be eaten and the fingerstick sugar result to help calculate the mealtime insulin dose.  In our practice, it is estimated that over 50-60% of people with Type 1 Diabetes are using insulin pumps.

Gestational Diabetes (GDM) is a frequent complication of Diabetes.  Gestational Diabetes is the development of elevated blood sugar in pregnancy.  Certain hormones produced by the placenta can lead to elevated blood sugar later in pregnancy.  This problem can be diagnosed by doing a glucose tolerance test near the end of the second trimester.  If untreated, GDM, can lead to excessive fetal weight gain and prematurity.  GDM can be treated with dietary modifications and many times, insulin.

In 2015, it was estimated that 1 out of 3 adults has Pre-diabetes.  Pre-diabetes can be diagnosed by checking a fasting blood sugar or by measuring the hemoglobin A1c (a 3-month average of blood sugar).  People who are overweight or who have a family history of Diabetes are at high risk for Pre-diabetes (and for Diabetes).  Most people with Pre-diabetes don’t know that they have this condition and it can only be diagnosed with a blood test.  50% of people with Pre-diabetes develop overt Diabetes in 10 years unless they are treated.  The primary treatment of Pre-diabetes is exercise and weight loss.  A 7% weight loss and the equivalent of 30 minutes of walking for 5 days of the week haven been shown to reduce progression of Pre-diabetes to Diabetes by nearly 60%.  A medication, Metformin, is also frequently used to treat Pre-diabetes.

95% of people with Diabetes have Type 2 Diabetes.  In 2015, it was estimated that 1 in 9 adults had this type of Diabetes.  Type 2 Diabetes in usually diagnosed in the adult years though it can be seen in (usually overweight and sedentary) children.  In Type 2 Diabetes, the cells that make insulin, beta cells, don’t produce sufficient amounts and there is also resistance to the effect of insulin on the body.  Many people with Type 2 Diabetes can improve their blood sugar with weight loss and exercise alone.  Others require treatments, which range from pills to injections of insulin and other injected medications.  Successful treatment of Type 2 Diabetes has been shown to prevent or delay complications of Diabetes.  People with Type 2 Diabetes are also at higher risk for heart diseases and treating their heart disease risk factors is important.

5% of people with Diabetes have Type 1 Diabetes.  This type of Diabetes is usually diagnosed in childhood, yet many times it is diagnosed in adults, even in adults over the age of 50.  People with Type 1 Diabetes take insulin for treatment since their beta cells (the cells that make insulin) no longer produce insulin due to auto-immune destruction.  People with Type 1 Diabetes take insulin by injection or via an insulin pump.  People with Type 1 Diabetes can lead a full, healthy life with proper management.  Successful treatment of Type 1 Diabetes has been shown to prevent or delay complications tied to Diabetes.

This is a more advanced type of testing that measures the actual lipoproteins in the blood and looks at some of the genetic risk factors associated with cardiovascular disease. Lipoprotein levels have been shown to be better predictors of risk than traditional cholesterol levels alone, especially in patients with diabetes or metabolic syndrome.

This is a basic group of tests measuring the levels of cholesterol and triglycerides in the blood; it is a good starting point but does not always give enough information.

This is commonly called the “good” cholesterol because the cholesterol carried around inside the HDL particles may have been removed from the artery walls.

This is commonly called the “bad” cholesterol because the cholesterol carried around inside the LDL particles can get deposited into the artery walls.

Atherosclerosis is a disease of the arteries caused by buildup and deposits of fatty materials into the artery wall.

Treatments include controlling all modifiable risk factors such as treating high cholesterol/lipids, taking care of Diabetes, treating high blood pressure, and not smoking. This can include lifestyle therapies such as exercise and healthy diet as well as medications.

Symptoms can be typical such as chest pain or shortness of breath, but sometimes a person will not have symptoms until major damage has occurred. Prevention is key!

CAD occurs when plaque forms in the arteries that supply the heart with blood. Plaque is made up of fat, cholesterol, calcium, and other substances in the bloodstream. The buildup can restrict bloodflow to the heart. Sometimes a plaque can rupture or burst which can cause a blood clot that completely blocks the artery—this can cause a heart attack or a stroke. If the arteries are damaged by smoking, diabetes, high blood pressure, or high cholesterol this process occurs more readily.

A term that describes a number of conditions that impact the heart; however the most common type is coronary artery disease (CAD). This is also the leading cause of death in the United States among men and women.

  • Calcium supplements
  • Vitamin D3
  • Weight-bearing exercise.
  • Fall prevention
  • Medications that help put calcium BACK into the bone.

Typically, there are no symptoms.  Osteoporosis is detected by a special x-ray called a DEXA.  It is ordered by your doctor and can be used to track the degree of improvement with treatment.  Unfortunately, some people are only diagnosed after a spine or hip fracture.  This condition is painless.

Patients are at risk for osteoporosis if they are:

  • Post-menopausal
  • Female
  • Low body weight
  • Have taken steroids
  • Have digestive problems
  • Had kidney stones
  • Have a family history of bone loss or fractures
  • Above the age of 70

The weakening of the bones caused by a reduction in the calcium normally stored there.

Please schedule an appointment with your provider to discuss if this is something we will consider filling out.

Some insurance plans do require a referral in order to have your visit covered. Please contact your insurance carrier to confirm if your plan requires you to obtain a referral to see a specialist. To learn more about our referral process, select the following link: Referrals

If your copay is not listed on your insurance card, please contact the 1-800 number on the back of your card to check your benefits.

We will be happy to provide you with any procedure codes that are to be billed so that you may confirm with your insurance plan that it is covered

We accept most major insurance plans, including Medicare. Please contact your insurance to verify that Texas Diabetes & Endocrinology is a contracted provider.

If a person has diabetes and is on medications, or has high blood pressure on medications, then these medications may need to be reduced as a person loses weight.  We advise a visit with one of our health care providers for people with diabetes and/or high blood pressure prior to starting the program for medication adjustments and then 2-3 visits after starting for monitoring and further adjustments.

Yes.  Weight loss is the most effective way to prevent diabetes in people who have pre-diabetes.  Exercise is also a vital part of preventing diabetes.

We selected the Ideal Protein program originally to help our patients with diabetes.  A low carbohydrate weight loss approach lower blood sugars effectively and many of our patients with diabetes have been able to reduce or even stop some of their diabetes medications.  Of course, the program is very effective for people who don’t have diabetes as well.

Our Clinical Research Department specializes in Phase II-IV clinical, observational, and device trials.

We are currently seeking LVNs and/or RNs to fill Clinical Research Coordinator roles at our Central Austin office.  Working under the supervision of the Principal Investigator(s), Site Director/Operations Director and Study Coordinator(s), this position will coordinate the conduct of clinical research trials from study start-up through close-out procedures.

Key duties include:

  • Responsible for the integrity and overall quality of assigned clinical research trials
  • Serves as the primary contact for study subjects and sponsors, communicating daily as needed
  • Reviews study protocols and brochures; creates study document binder (sponsor, site, CRO, IRB/IEC correspondence), and prepares source documents including study and subject information folders
  • Completes study start-up through close-out procedures:
    • recruitment and patient enrollment
    • informed consent process
    • pre-screening, screening, and study visits in conjunction with Physician/Investigator
    • documentation of patient progress in response to investigative agents
    • coordination of monitor visits source documents and case report forms
    • as needed, oversee preparation of physician orders to ensure protocol compliance
    • maintain communication with physician regarding study requirements, dose modifications, and adverse events
  • Other related duties as assigned

Requirements:

  • At least 2 years of progressive experience in the medical field
  • Excellent multi-tasking and organizational skills. Able to excel in a fast-paced environment.
  • Exceptional interpersonal and communication skills.
  • Must be self-sufficient, detail-oriented, and able to identify problems and solve them.
  • Must be able to handle confident information and meet objectives in compliance with all legal, regulatory, and protocol guidelines

Preferred:

  • Prior experience in the pharmaceutical industry or in a clinical research setting; Working knowledge of research methodology/medical terminology.
  • Experience with e-MDs, InForm System, Medidata Rave, or similar

Position is full-time (40 hours per week). Salary: dependent on experience

Our Clinical Research Department specializes in Phase II-IV clinical, observational, and device trials. We are currently seeking an individual with strong recruitment skills to fill our full-time Assistant Clinical Research Coordinator/Recruitment Specialist role at our South Austin office.
Some Key duties include:
• Participant recruitment – develop and implement recruitment plans, conduct thorough phone screens and in-person interviews discussing medical history to determine patient eligibility, set up advertisements for upcoming trials, welcome patients for research appointments, and complete daily reminder calls
• Assist senior Clinical Research staff with study case reports
• Assist with patient care visits (blood draws, vital signs, performing ECG’s, processing specimens)
• Other related duties as assigned
Requirements:
• Recruitment experience and be confident in communicating with potential participants, medical staff, and discussing sensitive medical topics
• Be able to assist with patient care visits/patient work-up
• Be outgoing, enthusiastic, and proactive in seeking out potential participants
• Skilled in effectively meeting deadlines, multi-tasking, and working well with team members
• Be organized and detail-oriented
• Must be able to handle confidential information and meet objectives in compliance with all legal, regulatory, and protocol guidelines
• Microsoft Office proficient – Outlook, Word, Excel
Preferred:
• At least one year of experience in a similar role
• Prior experience in the Medical field
• Working knowledge of research methodology/medical terminology
• e-MD’s experience

Position is full-time (40 hours per week). Salary: dependent on experience

Our office in South Austin is seeking an experienced and dedicated Medical Assistant to join our team.

Duties include obtaining vital signs, collecting patient history, entering data into e-MDs, assisting with thyroid FNA’s, administering injections, and cleaning/stocking rooms and patient work up areas. May need to work at our other office locations as needed.

Requirements:
• Excellent customer service and communication skills with patients and providers
• Team player with top notch time-management skills
• Comfortable with e-MDs or similar EMR, detail-oriented, and able to handle sensitive information

Preferred:
• At least 2 years of experience in a Medical Assistant role; prior experience with Endocrinology or Diabetes is a strong plus

For more information, visit: https://texasdiabetes.com/
Position is full-time (40 hours per week). Salary: dependent on experience