When A Doctor Listens - VA NY Harbor Healthcare System
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VA NY Harbor Healthcare System

 

When A Doctor Listens

Dr. Helena Guber, Chief of Endocrinology at VA’S Brooklyn Campus and Veteran Willette Gittens

Dr. Helena Guber, Chief of Endocrinology at VA’S Brooklyn Campus and Veteran Willette Gittens

By Dr. Margaret Dessau, Volunteer Writer, Public Affairs
Tuesday, November 29, 2016
Dr. Helena Guber, Chief of Endocrinology at VA’S Brooklyn Campus, treats a wide gamut of metabolic and hormonal abnormalities. These range from common diabetes to lipid and bone abnormalities like hyperlipidemia and osteoporosis, to adrenal tumors, amenorrhea, endocrine reasons for low testosterone and infertility.

Among the patients Dr. Guber treats, thyroid disease is also a frequent problem, including over and under activity of hormone production, as well as benign nodules and thyroid cancer. Talking about thyroid disease, Dr. Guber explains that diagnosing and treating hypothyroidism is truly a complex art, especially in patients who become hypothyroid after being treated for hyperthyroidism.

The challenge for the physician goes well beyond simple blood tests and scans measuring thyroid function levels. This is symptoms such as low energy, constipation, dry skin and weight gain are very non-specific and more often than not are due to issues unrelated to thyroid disease. There also may be intangible cognitive and memory symptoms which are difficult to measure.

Willette Gittens, a 50-year-old, retired career Army Veteran from Guyana, served in Desert Storm. She was diagnosed three years ago with Graves’ Disease, an autoimmune hyperthyroid condition, which in her case was associated with eye complications. Her illness had been initially misdiagnosed as depression.

After she requested that her hormone level be tested, it was discovered that her symptoms were due to an over-active thyroid. At this period, Gittens was on active duty in Ft. Jackson, S.C. She noted chronic fatigue, loss of appetite and continuous crying for no reason. After being treated with radioactive Iodine to inactivate the thyroid gland, she was placed on synthetic thyroid hormone replacement.

Despite that treatment, she still felt fatigue and joint pains, gained 60 lbs. and developed double vision with bulging eyes. Gittens says she’s lucky to have been transferred to Ft. Drum, NY after several months. “The doctors in Syracuse did a brain scan and found compressed optic nerves. They operated immediately and saved my eyesight although I still had double vision and was legally blind till this July, 2016 when I got strabismus surgery.”

Even with this treatment, Gittens continues to feel low energy although “I always push myself, after all I was a drill sergeant,” she says. Gittens walks two to three miles daily and although she’s lost 15 lbs. she still does not feel back to the "normal self” she recalls from four years ago.

During a recent clinic visit, Dr. Guber discussed the patient’s complaints, possible reasons her symptoms, and treatment options. Dr. Guber agreed to increase Gittens’ dosage of replacement thyroid hormone by 17%, although the blood tests were normal. She will also monitor her again after six weeks.

Dr. Guber says “I make the patient a partner in their care and give them choices. It is important to listen to the patient’s concerns and tailor the treatment to every individual. I suggested to Ms. Gittens that perhaps she didn’t remember exactly how she felt four or five years prior to being diagnosed with hyperthyroidism, and that, that abnormal subtle hyperthyroid state had become her “new normal.”’

However, Gittens was sure about knowing her own body and was grateful that Dr. Guber respected her input. Now, waiting for the test of time, Dr. Guber has forged a trusting doctor - patient relationship with significant and adjusted medication in the way that her patient believes will help her cope better with daily life.

“It is important to note,” said Dr. Guber, “that I would not make any changes to treatment if I thought it posed a risk to the patient, regardless of how fervent the patient’s request.”

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