April 2008

Q. I was Dx with Graves Disease 30 yrs ago at age 31. Treated with radioactive iodine and on Synthroid (0.175 mcg for several yrs now) ever since. Gained weight and never could get rid of it. Over the years other meds I've accumulated are Hyzaar, Methotrexate for RA, & Vytorin. My PCP will only monitor my TSH. He said it is all that counts now and that T3 & T4 has nothing to do with my thyroid any longer. Is this true?

A. Believe it or not, the TSH really is the most reliable test. So many things can falsely impact the T3 and T4 however the TSH is extremely sensitive and reliable. The only question is what are your results? Every one feels best in a specific range. e.g. if your TSH is high normal and still feel "low", then studies have suggested you may need to increase your Synthroid dose somewhat. You are on a high dose - but everyone is different. If your pulse is not fast, your TSH normal, and you feel good, then all is well.

Q. I got your book a year ago or so, and in between I have been pulled this way and that by some new fad diet or other, which promises a stick thin figure if I just follow it religously. Well, I'm tired of all the super-strict diets and just want to stay healty, without becoming obsessed. I'm a pear shape, though my waistline isn't super small (waist is 77cm and hips 99). So, could you help me with one question that I have: How slim a waist should I aim to have in order to be healthy and avoid all those diseases related to having a thick waist? I've lost quite a lot of inches from around my waist since then, but now I've noticed that I've become a bit obsessed about reducing it even further... My waist is about 27.6 inches now (or a bit below 70cm), and since I now know that the "upper" limit for healthy waist circumference is around 30-34 inches, what would you say is the "lower" limit? (To keep me from stressing and worrying about losing even more weight...)

A. This is perhaps the most unusual email I have yet received. As you know, most people don't have your will power (will power gets stronger the more you "exercise" it). There is no lower limit of normal related to health as no studies have been done and it really isn't the issue - some visceral fat is critical to insulate and cushion the abdominal organs. What we DO KNOW is that a BMI under 18 is associated with poor health and increased mortality - for unclear reasons. If your BMI is in the normal range, 18-25, you are okay. There are a number of BMI charts on the web.

Q. My 22-year old daughter is an apple and also has celiac disease. Most of the bread/cereals available to her or that she makes herself seem to fall into the Wasted category for apples - low or non-existent fiber, often high in sugar, etc. Elite foods for apples are WHOLE wheat, multigrain, pumpernickel, oatmeal - non of which can she have. Can you help her/us with ways to eat that are supportive of her celiac disease and also in her best interests as an apple?

A. Thanks so much for writing. I fully understand the difficulties your daughter faces. I would suggest she contact the National Foundation for Celiac Awareness at www.DoIHaveCeliac.org. They provide educational programs to dieticians and certifying them in the care of patients with celiac and could perhaps help refer you to a dietician who is certified and/or give you the advice on high fiber foods that would be great substitutes on the elite list. Other great sits include www.amazinggrains.com and www.amys.com The bottom line for Susan: she needs plant-based high fiber foods that are unprocessed (and gluten free), plenty of fruits/vegetables, nuts, and healthy fats including all fats with lots of omega 3's (cold-water fish, fish oil capsules, etc.).

Q. I heard today your talk on good morning america news about tinnitus..i got it about 3 months ago in my right ear...can you please advise me how to get help?all my testings have being negative for a pathology except 30%hearing loss with the tinnitus....i got an appointment at University of Mryland in May to see an audiologist,that seems to me very far away and i am getting tired of taking Xanax to sleep..i have tried most advertised drugs in the market without any relief....I am myself a physician and had so much difficulties to get some releif sooner,and i feel sorry for the people who are not in the field and who can't afford expensive technology for that...please help me .....can i use any beneficial drug meanwhile?is there some body i can see as soon as possible? I appreciate your time.

A. There are no FDA approved drugs available or even ready for use in patients to treat tinnitus, although apparently there are some in very early development. I would contact the American Tinnitus Association for a referral in your area or if you can reach him, Dr. Richard Salvi, a professor at the State University of New York at Buffalo and co-director of its Center for Hearing and Deafness. He is very knowledgeable and proactively doing research in the area. Best of luck. I can't imagine how difficult this must be.

Q. I saw Good Morning America this morning and saw the segment on tinnitus. Thank you for being on the show, it was very informative. I have had tinnitus for 2 years now and obviously wish I did not have it. I am not sure if you answer e-mails but if so I have a quick question. You mentioned that research is being done (i.e. pacemaker in ear, etc.) to help patients eliminate tinnitus. Will it take awhile for this to happen? I know this is a very hard question and there is no definitive answer. Thank you doctor, and if you can not answer this I will understand.

A. Unfortunately the clinical trials are still ongoing and in the early stages. The Univ of Wisconsin with Dr. Kopell is conducting some of the studies although neurosurgeons from Jefferson Univ in phila and other areas are intrigued that it may not be far off. I am always worried however about coming out with a hopeful story too soon. Please keep an eye on the updated research at the website of the Amer Tinnitus Association (feel free to check out the section for professionals).

Q. On Monday's GMA you mentioned new drug therapies for Tinnitus coming out soon. As a severe Tinnitus sufferer, can you tell me exactly which drugs so I can tell my Doctor (Dr. Ian Storper at Columbia) to keep an eye out for them? Sleeping is my biggest problem and any drug that will aid that is greatly needed.

A. Unfortunately there are no FDA approved drugs available or even ready for use in patients to treat tinnitus, although apparently there are some in very early development. I would contact the American Tinnitus Association for a referral in your area or if you can reach him, Dr. Richard Salvi, a professor at the State University of New York at Buffalo and co-director of its Center for Hearing and Deafness. He is very knowledgeable and proactively doing research in the area. If sleep is the primary problem, then I would also consider sound therapy either through TRT (tinnitus retraining therapy) or the Oasis (costly however and I am not certain it is as effective for night use/sleeping.) There are a number of psychotropic medications that may help with sleep but an expert who treats many patients with similar sleep disruption due to tinnitus would be the best to judge.