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Doctor Q&A for Dr. Aaron Neinstein

A 56-year-old member asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
No: These are both from the same medication class, beta-blockers. It would be extremely unusual for a physician to prescribe these simultaneously and could be potentially very dangerous. You should absolutely clarify with your physician whether this was intentional and if so, what the reason was for prescribing them both together.
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A 52-year-old male asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
Probably not: People with graves disease typically have a low TSH along with high free T4 and/or high free t3 (liothyronine). Most people also have a high tsi titer, though not everyone does. If you have a low TSH and high free t4, you may have mild early hyperthyroidism, and it is possible that it is graves, so it is something to follow-up in the future. A more accurate antibody test than tsi is the TSH receptor antibody.
A 52-year-old female asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
Don't worry about it: As long as your hemoglobin is normal, don't worry about your mch, as it doesn't really matter. If you don't have an anemia, then the MCH is not important. Mch stands for mean corpuscular hemoglobin, which is the average mass of hemoglobin in a red blood cell.
A 42-year-old female asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
It depends: You should see an endocrinologist to discuss this further. The main question is whether your blood sugar actually gets low or whether you just feel like it is low. This needs to be tested first. There are a lot of possible causes of hypoglycemia, including kidney disease, liver disease, medication side effects, and others.
A 29-year-old female asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
Nothing if treated!: If treated appropriately, you do not have to have any long-term consequences from hyperthyroidism. If left untreated, the most serious concern is a heart problem like rapid or irregular heartbeat. Longstanding hyperthyroidism can cause osteoporosis (fragile bones) and fractures. If untreated, other issues can be psychiatric disease, weight loss, trouble sleeping, or eye disease.
A 26-year-old male asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
Might be Gilbert's: A relatively large portion of the population has something called gilbert's, which is completely harmless, and causes elevated indirect bilirubin in times of stress or illness. If you are completely healthy and just have an elevated indirect bilirubin from time to time, it is almost certainly gilbert's. Ask your doctor what he/she thinks.
A 36-year-old member asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
T-scores different: Osteoporosis is defined by a t-score of less than -2.5 on a bone density test (dexa). T-score compares your bone density to that of a healthy 30 year old woman, and describes the number of standard deviations you are away from that score. It is a disease where you have an increased risk of fracture. Osteopenia referred to a t-score between -1.5 and -2.5, but its use has fallen out of favor.
A 43-year-old member asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
Check thyroid levels: To tell if your thyroid medications are working, you should see your doctor to a) discuss how you are feeling and b) get your thyroid levels checked through a lab test (typically a TSH test). Obviously the answer will depend on the specifics of your personal situation.
A 61-year-old female asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
Yes: You probably mean 500 mg per day, as it does not come in 50mg pills. This is a very low dose of metformin. Also, it depends how long after your meal you are measuring your blood sugar. Typically we like to use the 2 hour post-meal blood sugar. If your 2 hour post-meal blood sugar is 200, that is too high and you do need to address it with your doctor to work on getting that lower.
A 44-year-old member asked:
Dr. Aaron Neinstein
Internal Medicine 14 years experience
No taller: At age 44, taking hgh (human growth hormone) will not make you any taller. Once your growth plates, or epiphyseal plates, have fused (closed), you cannot grow any taller.
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