Dr Patel Appointment - 12/28/15

Questions I had for Dr Patel on 12/28/15, based on the results from my most recent ultrasound on 12/15/15 which indicated 2 additional lymph nodes which were not discussed on previous ultrasounds:

1. It is one thing to have 1 or 2 enlarged lymph nodes, but 4 seems like a lot?  Is that true?  Do these worry you? - it did change things a little bit which is why he took the ultrasound himself so he can decide which course of action to take.
2. Are the 2 additional nodes new or do you think they already existed before? Does this matter? - they were not new and were stable
3. Does the quantity of nodes worry you or is the size more important?
4. Does the fact that my Tg is still undetectable supersede or lessen the worry of having 4 enlarged lymph nodes? - the bloodwork is a good sign but is not the only indicator which is why he wanted to check things out for himself.  
5. At what point is it time to worry (size of nodes, quantity of nodes, etc.)?  What would the course of action be - surgery or radioactive iodine? - didn't discuss, but the first step would be to do a biopsy of the node to see if it was cancerous but he did not see anything suspicious enough on his own ultrasound to warrant one. A biopsy was not conducted during today's visit
6. Should I get an ultrasound in 3 months as recommended? - get one in 4 months towards the end of April 2016 before I see Dr Patel

Saw Dr Patel on 12/28/15
Wants to see me in 4 months - 4/25/16 @ 9:15am (already scheduled)
Wants me to get follow up ultrasound in 4 months

Dr Patel took an ultrasound of my neck himself in his office.  He did see the nodes on both the left and right sides but did not see anything suspicious or concerning on either side.  The left side was not suspicious at all, and he looked closely on the right side nodes but was not concerned. He said that he would have taken a biopsy of one of the nodes on the right side to be safe but did not see anything suspicious enough to warrant one.  The nodes could just be regular reactive nodes and not cancerous at this point but doesn't know without biopsy.  Just in case, he wants me to get a follow up ultrasound in 4 mo instead of 6 mo, and then to come into see him for an appt a couple days later.

He read my ultrasound results from 12/15/15 before seeing me and did acknowledge right away that there seemed to be more nodes than in the past (4 instead of 2, including a node on the left side which wasn't indicated in the past).  The additional two nodes did exist before and were stable and were not new (one of which is on the left side; all prev ones were on the right).  They have changed the people who read the ultrasounds.  People in the past were good but not great (Dr. Patel's words), and they strive to now be great (ugh). Therefore, the ultrasound results will be more extensive than in the past as evidenced by my most recent ultrasound.

My bloodwork, as I expected, looked good to him given that my Tg is still undetectable.  This is a good sign given the fact that the lymph nodes show up.  If my cancer exists (it may not) and spread, my Tg would have spiked which has not occurred.

Next appt with Dr. Patel: 4/25/16 at 9:15am

Dr Bergman Appt on 12/9/15 - Lower Synthroid to 112

I saw Dr Bergman for my regularly scheduled 6 month appointment on 12/9/15.  He had me take a bunch of blood tests beforehand as usual including Lipid Panel, CBC, Urine Analysis, etc. in addition to my Thyroid tests.

He said to stay on 125, he may lower me to 112 after he gets my Thyroglobulin blood work back. He told me to check for an email in NYU Smartchart in a few days.

He says that I am doing well.  TSH is 0.077 and wants to eventually get me to 0.5 and not be suppressed any longer.

On 12/14/15, Dr Bergman wrote me a note on NYU Smartchart to lower my Synthroid to 112 and then take blood tests again in 2 months

"Hi Took a while to get back. The Thyroglobulin is unmeasurable which is of course very good.

Please decrease the synthroid dose from 125 to 112 mcg and repeat labs in about 2 months.

Will send in new dose and requisition for labs."

My head and neck ultrasound is scheduled for Tues 12/15/15 at 9am at NYU on the 8th Floor.

My next appt with Dr Bergman is scheduled for Weds 5/4/16 at 9am.

UPDATE:

I received the ultrasound results.  The two existing lymph nodes on the right side remained stable.  However, there are two "additional" lymph nodes that appeared on the ultrasound (one on the right and one on the left side).  The ultrasound notes indicate that the "additional" lymph nodes were likely there before based on previous films but just not measured.  Based on past films, it looks as if the "additional" nodes were stable and did not change in size.  This all looks pretty good but I am eager to get Dr. Patel's opinion based on these new findings.  Is he worried about these two "new" nodes?  Does this change his course of action?

Changed Synthroid Level to 125mcg on 7/14/15 - Get Follow Up Blood Tests in September 2015

Started Synthroid 125 on 7/14/15 - lowered from 137

Brett Saffer

To Bergman, Michael

Jul 13

Great, thank you.  My pharmacy is the CVS on 1290 Lexington Ave.  I believe your office has it on file.  I will follow up with blood tests in September 2015 (or end of August).

Best,

Brett

Sent from my iPhone

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On Jul 13, 2015, at 2:42 PM, Bergman, Michael wrote:

Hi

We can decrease the dose to 125 mcg and repeat labs in 6-8 weeks. I’ll take care of the Rx and lab req.

Take care

mb

 ===============================================================================

From: Brett Saffer [mailto:brettsaffer2002@yahoo.com] 

Sent: Monday, July 13, 2015 2:36 PM

To: Bergman, Michael

Subject: Brett Saffer - Synthroid

Hi Dr. Bergman-

Per our conversation, I am following up with you via email after my latest visit with Dr. Patel.

I had my appointment with Dr. Patel on 6/29/15 and I told him to email you after my visit.  I told Dr Patel that I had a visit with you on 6/12/15 and that depending on the findings of my visit that you would be looking to possibly lower my Syntrhoid level to 125.  Did Dr. Patel write to you?  Do you want to lower my Synthroid level to 125 or wait until a later time?

My next appt with Dr Patel is on 12/28/15 at 9am.

Thanks.

Best,

Brett Saffer

Visit with Dr. Patel on 6/29/15

BP 130/80: Pulse 56

My bloodwork from June 1st looked good

He read my ultrasound from June 12th and saw that the level 4 node is still there but the size has remained stable.  As before, he mentioned that the worst case scenario is that there is remaining cancer cells in that node.  For now it is nothing serious and he would not recommend taking it out especially since I am not having any problems and it is stable.  Keep on watching it.

I mentioned that if my visit went well that Dr Bergman wanted to lower my Synthroid level to 125.  Dr Patel mentioned that there is data supporting that someone with a low grade cancer like me should not be suppressed forever due to potential bone and heart complications down the road (Bergman said the same thing).  Dr Patel didn't have a problem with lowering my level if I can tolerate it.  He is emailing Dr Bergman.

Next appt is 12/28/15 at 9am

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.