Dr Bergman Visit and Neck Ultrasound - 6/12/15

Saw Dr Bergman on 6/12/15 for regular 6 month checkup.  BP was 122/80.  Everything looked good.

Blood test that was taken on June 1, 2015. Thyroglobulin was non existent.  Thyroid AB were showing up but stable.  TSH was .06

Eventually he would like to lower my Synthroid level since I have been suppressed for 7 years without any problems.  His goal is for my TSH to be at the "tighter" end of the normal range at around 0.5.

He may eventually want me to get a bone density test to establish a baseline.  Add weights to my regimen to help with bones.

He wants me to get an ultrasound and then see Dr Patel.  If ultrasound is good and visit with Dr Patel is good then Dr Bergman will look to start lowering my Synthroid level.  He does not see a need for any scans in the future.

I got my ultrasound done on 6/12/15 on the 8th Fl after my appt with Dr Bergman.  He should have the results by Monday.  Ultrasound results were stable for my neck.  They emailed me a copy of the results via MyChart

Email Dr Bergman after my appt with Dr Patel at michael.bergman@nyumc.org

Computer was down so I still have to call to make a follow up appt with Dr Bergman for Dec 2015. I made an appt using MyChart...

My next appt with Dr Bergman is on:
Provider: Michael Bergman, MD
Date: 12/08/15
Time: 9:00 AM

Appointment with Dr Bergman and Dr Patel - 12/12/14

Dr Bergman - Very happy with my scans ultrasound and blood work.  Felt a slightly enlarged lymph node on my left side of my neck underneath jaw but not worried

Stay on the 137 level.  Can stay at this level for several more years without the side effects of over suppression

My thyroglobulin levels were unmeasurable even after taking the Thyrogen stimulation.  This is with the new more significant blood test that is able to test the thyroglobulin separate from the antibodies so we can trust that my thyroglobulin level is really non existent

Dr Bergman thinks I may not need another WBS again since this was another clear scan.  Next appt is 6/12/15 at 9am.

BP 128/80 in Dr Patel's office

Dr Patel felt my neck and felt no problems.  Next appt 6/29/15 at 9am

Ultrasound done in Suite 8N on 12/12 and results were sent to me at my home address

Whole Body Scan Process Begins on 10/16/14 at 9AM

Just spoke with NYU on 8/15/14:

I scheduled my Thyroid Thyrogen Whole Body I 131 scan.  Day 1 will begin on Thursday Oct 16th.  My first Thyrogen injection is scheduled for 10/16/14 at 9AM.  The second injection is scheduled for Friday 10/17/14.

The guy (Stephen) I spoke to on the phone from NYU Nuclear Medicine said that there was no precertification needed for the scan or the Thyrogen.  However, I need to make sure that Thyrogen is covered by my insurance.

I followed up with someone else and NYU and got confirmation that since no precertification is needed for the scan or the Thyrogen, then I am all set.  NYU orders and administers the Thyrogen and therefore I do not have to order the Thyrogen myself.

I spoke to someone at Cigna to see if I am covered for Thyrogen or not.  Cassandra at Cigna said that as long as NYU orders and administers the Thyrogen themselves as part of the scan process (which they are), then I am covered.  Cigna covers scans at 100% and the Thyrogen would therefore be covered since it is part of the scan process.

So, as of this moment, it looks as if I am all set.  Day 1 of my Thyrogen injection is scheduled for Thursday 10/16/14.  The Thyrogen is ordered and administered through NYU and I don't have to do it myself.  I am covered for the Thyrogen since it is part of the scan process that NYU is administering and I do not have to purchase it myself.

Dr Bergman Appointment - 7/10/14

Dr Bergman 7/10/14

BP- 118/70
Recommends that I get a total body scan since I haven't had one in 4 years.  This will help guide future treatment.

Check my schedule and then call Josie in Dr Bergman's office to start the preauthorization process of the total body scan. UPDATE: I already did this and she called me back to tell me that she spoke to my insurance company and no preauthorization is needed for the scan.

Dr Bergman says nuclear medicine takes care of all the administrative aspects of ordering the Thyrogen but I will believe it when I see it.

Preauthorization is usually good for 90 days.  I may want to get this done before Eoin leaves.  NOT NEEDED.

Next appt with Dr Bergman Oct 10th at 9am

Saw Dr Patel on 6/2/14

Saw Dr Patel on 6/2/14.  See him again in 6 months on 12/1/14.

We went over my ultrasound.  There is a slightly enlarged lymph node on the lower right side of my neck.  It had been present for 3 years but hasn't changed in size.  Based on my past history, it is likely that it has been there all along.  Dr P's instinct is that it is probably malignant but it is so small in size that there is really nothing much to do about it right now.  If it is was cancerous and taken out, it wouldn't change my prognosis at all.  He wants to continue to monitor it and will take an in office ultrasound next time when I see him in December 2014.

He examined my neck but didn't feel anything abnormal.  He didn't feel anything on the lower right side of my neck where the slightly enlarged lymph node is.

Might be tough to biopsy since near my carotid artery and jugular.  If we were to do anything, we would have surgery to take it out rather than biopsy.

Enlarged lymph node tells us that there is something in it causing it to be enlarged - can be malignant or benign.  His gut is malignant but I could be fine with it for years. Before ultrasounds, people have cancerous cells in their lymph nodes for years with no ill effects. Taking it out won't change my prognosis.

If Dr. Patel does do surgery to take out lymph node, no RAI would be needed, just remove node and tissue and that is it.

BP was 130/80 after running to the office from the bus.

Thyroid Ultrasound at NYU - 5/28/14

I had my neck and thyroid ultrasound at NYU on 5/28/14 at 8AM.

I heard back from Dr. Bergman's receptionist regarding the results:

Spoke to Dr Bergman's receptionist regarding my neck Ultrasound from 5/28 - saw small lymph node but no change in size.  Everything looks stable but wanted Dr Patel to give his opinion on the results just in case.  I am seeing him anyway on June 2nd.

Note to self - Make sure to ask Dr Patel's opinion when I see him on June 2nd.  While I am there, ask about need for scan in the future.

Dr. Bergman Appointment and Blood Tests: 1/10/14

I went into see Dr. Bergman on 1/10/14 for my routine 6 month appointment.

My blood pressure was 128/70 at his office which was taken before seeing Dr. Bergman.

We talked in his office first to go over my ultrasound from Dec 2013 and past bloodwork.

My current TSH level has been around 0.01 to 0.05 for the past year (I had one reading at 0.08, but overall my levels are low) and Dr. Bergman eventually wants my TSH level to get up to 0.1.  Over time, it is now good to have such low levels and can lead to a bunch of undesired symptoms (rapid heart rate, loss of weight, bone issues, etc.).  Since I have been over suppressed for 5 years now, he will look to gradually raise my dosage over time

For now, he still wants me to get a neck ultrasound twice per year, but will probably lower that down to once per year soon.

I read my blood test results last week, but finally spoke to someone at Dr. Bergman's office on 1/21/14 to discuss my results:

• My TSH level was 0.016.  I need to revise my Synthroid regimen to 137 everyday, instead of switching off between 137 and 150.
• My Vitamin D levels were low (20.2 in Jan 2014 and 28 in Nov 2013; the low end of the normal range is 30).  He recommended that I take 2000 units of Vitamin D each day.  I started taking them on my own approximately 1/18 (but have only been taking 1,600 units)
• Thyroid protein was once again undetectable
• Platelets were slightly low but I have always had that
• Receptionist on the phone said that I may need another total body scan eventually since my last one was back in 2010.  This seems a bit weird since I have asked Dr. Bergman about this before and he said that the neck ultrasounds should be fine and that I probably would not need another scan.

Next Steps:

1. Start taking 2,000 units of Vitamin D
2. Change Synthroid intake to 137 micrograms every day
3. Repeat blood tests in 2 months - approximately the end of March 2014
4. Get a thyroid and neck ultrasound in either April/May 2014
5. See Dr Bergman 7/10/14 at 9am