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Thomas B. Repas, DO, FACP, FACE, CDE, is an endocrinologist, lipidologist and physician nutrition specialist in clinical practice at the Regional Medical Clinic Endocrinology and Diabetes Education Center in Rapid City, SD. Dr. Repas is the former chairman of the professional diabetes advisory committees of the Wyoming and the Wisconsin Diabetes Prevention and Control Programs. He is board certified in the areas of endocrinology, diabetes and metabolism, clinical lipidology, internal medicine and nutrition, and is also a certified diabetes educator.
Tuesday, December 11, 2012
Thomas B. Repas, DO, FACP, FACE, CDE
A young man was referred to me for evaluation of low testosterone and gynecomastia. The initial total testosterone was 57 ng/dL; results of a repeat testosterone assessment were even lower. Prolactin was normal, but follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were both undetectable. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were previously normal but were now both over 200. His total and LDL cholesterol levels were high; his HDL was low.
He was muscular, physically fit and an avid weight lifter. I questioned him about the use of anabolic steroids. He had not knowingly used any product that was marketed as an anabolic steroid for a few years. He seemed sincere and I believed him.
Wednesday, June 27, 2012
Thomas B. Repas, DO, FACP, FACE, CDE
One of the endocrinologists with whom I work was called by an internal medicine colleague who practices in another state. The internist has a patient who is 31 weeks pregnant with a thyroid-stimulating hormone of 3.31 and a free T4 < 0.1. She is seeing an endocrinologist who has been treating her with intramuscular thyroxine therapy.
We have no other information regarding the patient or her situation. Is there non-compliance involved? Is there severe gastrointestinal malabsorption? I do not know.
Tuesday, September 20, 2011
Thomas B. Repas, DO, FACP, FACE, CDE
... Continued from previous blog.
Thursday, May 19, 2011
Thomas B. Repas, DO, FACP, FACE, CDE
I came across an interesting article last week while searching the literature regarding another topic. It was the title which caught my eye: “Is there hardening of the heart during medical school?” The authors determined that there is loss of vicarious empathy during undergraduate medical school training, with differences related to sex and specialty choice.
Tuesday, August 10, 2010
Thomas B. Repas, DO, FACP, FACE, CDE
One of the most difficult challenges of clinical endocrinology practice is inspiring our patients to adhere to recommendations for dietary modification, lifestyle change and pharmacotherapy.
Tuesday, June 8, 2010
Thomas B. Repas, DO, FACP, FACE, CDE
Most endocrinologists are exposed to research in one form or another during their fellowship training. However, few continue to be engaged in research after their training, except those of us who choose a career in academic medicine. Being a clinical investigator is not for everyone. There is a growing shortage of qualified clinical researchers, however, which means there are opportunities for those who are interested.
Monday, October 26, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
Last week, I took my internal medicine maintenance of certification exam. I travel frequently and usually go alone, however, on this trip my wife and son joined me. We stayed at a hotel of a well-known national chain and looked forward to spending some time together.
Tuesday, October 6, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
One of the most frequent misunderstandings I come across when speaking with physicians and coders is how to code based on time.
Tuesday, September 29, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
Many of us are asked to give grand rounds or CME presentations. Some even have the privilege of speaking at regional or national conferences. Unfortunately, being an expert on the subject does not guarantee effective speaking ability. Over the years, I have learned what makes the difference between a mediocre vs. a great presentation:
Tuesday, September 1, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
The patient and their family are waiting. The imaging study and pathology results are in your hands, and you review them one last time. It does not look good. Someone, you, must inform them of the results and explain what it all means. Taking one last deep breath, you enter the room.