New endocrinologist at Crouse discusses hormone imbalance, online misinformation and how one of her roles is to help patients understand all the complexities of endocrine issues
By Chris Motola
Q: How long have you been with Crouse Medical Practice?
A: I started at end of February. Started seeing patients in March. So, this is my third month.
Q: What’s the experience been like so far?
A: Pretty good. I was in the Midwest for a long time and I trained in the Midwest, so it’s a change to be on the East Coast. But everyone’s been welcoming.
Q: As an endocrinologist, what kinds of patients are you seeing?
A: I see patients with diabetes, thyroid issues, osteoporosis, adrenal problems. Patients with high calcium, so parathyroid issues, pituitary problems.
Q: I get the sense that endocrinology is one of the more misunderstood medical disciplines by the public. People understand that hormones are very important and influence their health. But there seems to be a lot of mixed information circulating about what affects those hormones, what you can do about your hormone levels and when to be concerned. How do you handle this?
A: That is a great question. It’s something lot of us providers, especially in endocrinology, face every day now, previously with Google, now with AI.
Q: What is that?
A: There is information, but there is also a lot of misinformation with influencers and social media. And I see people coming in with labs being done every three months. They’re paying hundreds of dollars to get them. But there is no physiological basis for how these hormones are being tested. Like you said, it is hard for patients to understand that hormones have a lot of circadian rhythms. A lot of things influence hormone levels such as when they are tested, how they are tested. Things like were you fasting, not fasting? Did you just exercise and come in immediately after? All of it. Even things like were you sitting up or were you laying down when the blood was drawn can affect a hormone level. So, when we interpret these tests, we need to consider all of it. Then, when we see an abnormal result, are we actually seeing a true abnormality or just a lab result? Or is it the real reason behind how the person is feeling? So, putting all of that together can get complicated. Unfortunately, most of us are kind of stressed out about so many things, not feeling good overall. And patients out there are looking for answers why they feel the way they feel; they think it must be their hormones, but hormones are a very broad term. Is there an actual endocrine imbalance happening that’s leading up to these symptoms? A lot of the times I find our job is kind of working through all the information that the patient has gathered and trying to explain, “This is what happens normally when we do see these numbers. What test have you gotten and why?” And yes, if you’re seeing it, what does it mean? What do we do next?” And maybe the abnormal reading on the lab test is not the answer to everything that they’re experiencing.
Q: How about endocrine disruptors in the environment? Is there something there or is it largely overblown?
A: I think it’s emerging. I would say there is definitely data, but we don’t know everything about it still. I also see patients getting kind of like a screen for a lot of minerals elements as a blood test or a urine test then thinking that, ‘hey, my thyroid’s abnormal, because this one element in my blood work is abnormal.’ I don’t think we have sufficient data for now to say yes definitively. We need more research to explain and give definitive answers to our patients.
Q: What interventions tend to make the most difference with endocrine issues?
A: If I am talking about diabetic patients, GLP-1 ones are helping a lot of our Type 2 patients. For Type I, I think the biggest breakthrough is being able to start patients on automated insulin delivery systems. That’s an insulin pump and a sensor, which is life-changing for a lot of patients. Especially the younger patients. Their quality of life is much better and the pumps are getting more personalized. Now you can personalize it based on your activity level, the kind of food you eat, stressors, infections.
Q: That brings up an interesting point related to what we were talking about earlier, because with the insulin pumps patients are actually getting more real time feedback and information from these devices and their interfaces. And on the other hand, you have these tests that may be sending people down rabbit holes that don’t reveal much. What do you think is the right amount of information for people and how can they know that they’re in that zone?
A: So, if say, someone is on multiple doses of insulin and they have a sensor to look at their blood sugar all the time, that’s really helpful because it’s alerting them if it’s getting too high or too low. Helpful, but I think the question you were talking about is: “Say, I have maybe controlled Type 2 diabetes; my numbers are OK” or “I am someone who is trying to lose weight who just wants to be healthy and I want to look at numbers to see what food is doing.” For those people, if I’m looking at my numbers every five minutes on my phone, it can cause a lot of distress to some people to see their blood sugar spiking 10 or 20 points. It might even just be the sensor say, measuring plasma glucose rather than blood draw glucose, which is different. It can be normal. It’s physiological; it’s just the things happening in your body. So, educating them, walking them through that might be helpful is important and what’s useful for one patient may not be for another.
Q: How is building up a patient base here going so far? Is it mostly referrals?
A: Right now, I’m only referral–based. I think there is a crunch of endocrinologists as it’s seen all over the country. So, I am kind of getting all the backlog of referrals right now.
Lifelines
Name: Chaitra Gopinanth, M.D.
Position: Endocrinologist at Crouse Medical Practice
Hometown: Bangalore, India
Education: Medical school: Kempegowda Institute of Medical Sciences, India; Kansas School of Medicine. Fellowship: Kansas University, Kansas City
Affiliations: Crouse Hospital
Organizations: American Association of Clinical Endocrinology (AACE)
Family: Husband (a cardiologist), two daughters
Hobbies: Baking, reading fiction novels