Northwestern Medicine North: Lake Forest Hospital
Under development by Anthony Pick, MD
This is NOT an official NM sanctioned site
Official site: nm.org/lfh
Glucose Management: Page 2: nmlfh.weebly.com/glucose-management.html
Endocrinology Northwestern Medicine North Region Welcome LetterEndocrinology is a specialty of internal medicine focused on disorders of glands, hormones, and metabolic disorders. Common complex, chronic disorders we manage or provide consultation services include diabetes mellitus, lipid disorders, obesity, thyroid gland disorders, and osteoporosis. We strive for outstanding, compassionate, state of the art and individualized care.
Programs:Programs in development include cardiometabolic wellness, diabetes related disorders, bariatric (weight management) medicine, women’s health (PCOS, pregnancy related endocrine disorders, menopause, wellness, fracture prevention), and general endocrinology (including thyroid disorders, bone health, pituitary, and adrenal disorders). These programs are based on a population health, multi-disciplinary, team-based approach using innovations in health care delivery.
Pre-Visit process:Prior to visits we strongly urge new patients to arrive 30 minutes prior to the scheduled time to be able to start the clinician visit on time, such as completing registration, complete pre-visit clinical information gathering forms, check vital signs, perform point of care testing, and interrogating monitoring devices. The pre-visit information gathering is vital to maximize the value of your consultations. If you arrive 15 minutes after the start of the scheduled visit start time your visit will be rescheduled unless you can be accommodated based on physician judgement and availability. For return patients we recommend arriving at least 20 minutes prior to your appointment start time.
We require all relevant medical records be available at the time of the consultation that includes medical records not available via the Epic electronic medical record system, laboratory studies and imaging studies. Ideally, the images should be provided and not just the summary report. For osteoporosis patients we require a current bone mineral density study within 2 years. For patients with thyroid nodules and thyroid enlargement (goiter) we require the actual images.
Communication:We strongly encourage patients to sign up for the communication portal called MyNM (MyChart) that can be used for prescription refill requests, appointment requests, clinical and administrative queries and obtaining results of studies. This requires an email account and can be done on a smartphone or web browser. Please see the support documents.
The practice can also be reached at 847-535-7647, [email protected] and Fax: 847-535-8109. We strive to return all non-urgent messages by the end of a workday and there is a 24/7 emergency phone service. If communication with a physician directly is requested, then please provide specific questions or requests. If you are unable to provide the specific reason for this request, the message will be handled by the nursing staff first. There is additional information at www.nm.org/locations/lake-forest-hospital-endocrinology. Our Facebook page is…
Health Care Team:We are a consultation and specialty service and do NOT provide primary care. We do not offer pre-operative clearance (we will assist with the endocrine specific pre-operative adjustments as indicated), routine preventive health maintenance and intercurrent care with no relationship to endocrine issues.
Medications:For any medication prescribed by our endocrine practice we require at least an annual visit or more frequent monitoring as required based on the condition and medication. This will be specified in the after-visit instructions or condition specific resources we provide.
Laboratory testing:We offer point of care testing (available within about 15 minutes during the office visit, including a small drop of blood from a finger stick sample) of glucose and A1c. Testing can be requested prior to consultations. All results will be posted to the patient portal. If you do not use the patient portal, results will be made available to you at a follow up visit at your request. A team member will contact you if an adjustment to your medication or a follow up study is required between scheduled visits. We will strive to provide explanations for significant results. If results are posted without comment this indicates that the studies are normal, or no current action is required. You are always welcome to call or message with questions about studies. If the communication requires medical decision making, we may request a follow up visit be scheduled or we will contact you between visit communication. Please be aware these between visit services are billable interactions. The default for laboratory testing will be at Northwestern Medicine facilities. These orders are placed electronically and do not require printed requisitions. We can order studies via Quest or other facilities selectively. If Quest is used please ensure the Northwestern Medicine account number is entered so these results can be processed electronically.
Imaging results:Studies will be posted to the patient portal. If you do not use the portal the studies can be made available to you at the next scheduled visit. If there is actionable information a team member will contact you, and/or this will be specified with comments attached to the study results. You are always welcome to contact us with questions. If additional communication requires medical decision making, we will schedule a follow up visit, or we will communicate with you. Physician communication between visits are billable interactions.
Locations:Lake Forest Hospital + Grayslake + Glenview + Deerfield + Vernon Hills + MFM
Team Members: Endocrinologists; Anthony Pick (Medical Director), Liz Kunreuther (director of Women’s health and bone health services), Disha Narang (director of obesity and culinary medicine), Harjyot Sandhu (director of inpatient and transition of care services), Jackie Cartier and Eve Bloomgarden (director of thyroid, adrenal and pituitary programs) and Wendy Tokarz, endocrinology advanced practice provider.
There is a dedicated team of registered dietitians (RD)/certified diabetes clinical education specialists (CDCES) that include Monica Joyce, Ryan Sanders, Mary Miller and Wendy Piekarz. We anticipate and strongly encourage that most patients with diabetes, prediabetes, metabolic syndrome and weight regulation challenges (overweight or obese) will work with the endocrinologists and the RD/CDCES with a team approach.
Caleen McGrath is a licensed clinical social worker who provides individual therapy, dog therapy and complex mental health care co-ordination. She assists in supporting group support programs.
Innovation:
We support state of the art diabetes technology that includes insulin pumps, closed loop (“artificial pancreas”) systems, continuous glucose monitoring systems, smart pens, patch pumps, and advanced applications (such as third-party solutions). We provide telemedicine services (unless an in person physical exam is required and based on patient preference), point of care retina disease screening, point of care A1c and urine microalbumin testing, remote monitoring, health coaching (in pilot phase) and asynchronous education and secure text-based support (in pilot phase).
Collaborative Care:The Cardiometabolic program is our flagship collaborative care model. We strive for integrated collaborative team-based care for suitable complex or high-risk patients. For patients with coronary artery disease and/or heart failure and metabolic syndrome/overweight or obesity/diabetes spectrum disorders there is a team approach with endocrinology and specialties including cardiology, nephrology (kidney disease and hypertension), sleep medicine, hepatology (liver disease such as fatty liver) and andrology (men’s health with low testosterone and erectile dysfunction). The maternal fetal medicine program sees patients with gestational diabetes or other endocrine disorders in pregnancy in partnership with high-risk obstetricians. For high complexity patients we collaborate and facilitate care with the Northwestern Memorial Hospital academic medical center or other tertiary care centers.
Lifestyle Medicine and Wellness:
A core philosophy of our programs is the vital role of a healthy lifestyle in endocrine and overall care. This will be combined with suitable use of medications, team members, innovation tools and procedures. The components of the wellness related programs include nutrition, exercise, sleep, mindfulness, and time in nature. Nutrition resources include registered dietitians, commercial programs, health coaches, asynchronous education and support resources and the culinary medicine program. Exercise resources include the Lake Forest Health and Fitness Center programs, cardiac rehabilitation (select patients), physical therapy, sports medicine, personal trainers, health coaches and third-party solutions.
Bariatric (weight management) Program:
We recognize obesity as a complex, chronic, relapsing disease and are strongly opposed to shaming, blaming and discrimination against individuals with challenges with overweight. We strive to provide compassionate, individualized care in a comfortable therapeutic space for patients. We recognize that obesity now impacts ~40% of the US adult population, implying a complex interplay between genetic and recent novel environmental factors. Our goal is to analyze drivers of weight gain (sleep disorders, endocrine disorders (such as PCOS, Cushing’s syndrome), genetic factors, life events and behavioral factors (stress eating, sedentary lifestyle etc.); screen and manage associated health problems (such as sleep apnea, fatty liver, metabolic syndrome, atherosclerosis, depression, eating disorders or disordered eating, hip and knee osteoarthritis etc.) and develop an individualized management plan with the primary goal of increased wellness (changes on the scale are secondary). We recognize that maintenance of weight loss is a major challenge and weight regain is a physiological process (the brain defends a higher body weight set point with slowing metabolism, muscles can burn less calories with exercise, appetite increases (Ghrelin hormone increases) and decreased satiety/fullness).
Treatment options include lifestyle change; group support; individualized meal planning; medical weight management; structured programs (Noom, Omadahealth, Virtahealth, others); meal replacement (Nestle Optifast: partial or complete meal replacement for stimulus narrowing, weight loss resistance, pre-surgical weight loss) and preparation or referral for bariatric/metabolic weight loss surgery (such as gastric sleeve or gastric bypass) for select individuals.
We use all FDA approved medications selectively, that include phentermine, Orlisat, Qsymia, Contrave, Plenity and Saxenda. The branded medication can be expensive, and we recommend checking with your health insurance plan if branded weight loss medications are covered and affordable.
Diabetes program:
We provide state of the art care for all forms of diabetes that includes type 1 diabetes, type 2 diabetes, gestational diabetes, and other forms of diabetes. We use a team approach with the diabetes education specialists as a vital and central part of the team approach. We also provide a diabetes tune up pathway to support primary care providers and strive to reverse or prevent type 2 diabetes, as far as possible. We offer group and individual diabetes education. We also offer periodic technology meetings with vendor support and patient led group support sessions.
Thyroid nodule and thyroid cancer program:
Thyroid nodules are common and usually benign. A key part of the program is to identity nodules with features suspicious for thyroid cancer that require fine needle aspiration biopsy, done in partnership with radiology, interventional radiology, and pathology. Thyroid nodules are monitored by physical examination and ultrasound studies. Nodules can be associated with overactivity (hyperthyroidism) and sometimes develop with underlying autoimmune thyroid disease associated with decreased thyroid activity (hypothyroidism), so testing of thyroid blood tests is part of the routine. For patients with thyroid cancer, we co-ordinate care with endocrine or head and neck surgeons and nuclear medicine physicians. For select patients, we participate in the multidisciplinary Northwestern Medicine thyroid tumor board led by our academic medical center colleagues at Northwestern Memorial Hospital.
Osteoporosis:
The osteoporosis program focuses on prevention or recurrence of fragility fractures (broken bones). We work in partnership with the dietitians, rheumatology, infusion centers and offer muscle and bone strengthening, balance and fall prevention with physical therapy, sports medicine and the health and Northwestern Medicine Health and Fitness Venter.
Medication and Formulary check:
Branded medications can be expensive. We encourage patients to check formulary access to branded endocrine medications.
Anti-Obesity Medications: Contrave, Qysmia, Saxenda, Plenity
Anti-Diabetes Medication: Ozempic, Bydureon, Trulicity, Victoza, Rybelsus, Farxiga, Jardiance, Steglatro, Invokana, Januvia
Lipid lowering therapy: Repatha, Praluent (PCSK9 inhibitors)
Anti-osteoporosis therapy: Forteo, Tymlos, Prolia, Reclast (infusions are covered by Medicare).
We work in collaboration with specialty and clinical pharmacists.
Checklist:
Arrive 30 minutes before new appointments (at least 20 minutes before return appointments).
Complete pre-visit information gathering forms (or with medical assistant).
Ensure that medical records are available at the time of consultations.
Check insurance coverage for specialty medications.
Sign up for patient Portal.
Check date, time, and location of appointment.
Specify if telemedicine appointment desired (in person is the default unless safety issues such as Covid19).
For patients with pre-diabetes (diabetes prevention goals), diabetes and obesity anticipate a team approach including visits with the registered dietitians/certified diabetes education specialists.
For patients in the weight management program please complete the intake form as completely as possible and indicate preferences for a treatment track or individualized approach. Please indicate if interested in meal replacement, weight loss medications of preparation for bariatric surgery.
For patients with osteoporosis please ensure bone mineral density study within past 2 years
For patients with thyroid nodules or enlargement (goiter) please ensure actual images are available
To do:
Website update
Facebook page
Group support programs: Obesity, Cardiometabolic/post cardiac rehab and DM
Brochures: Fibroscan, CAC, HFC, Optifast, Weight loss medications, diabetes medications etc.
Education materials: handouts, web page content, app based, brochures etc.
Share this:
Programs:Programs in development include cardiometabolic wellness, diabetes related disorders, bariatric (weight management) medicine, women’s health (PCOS, pregnancy related endocrine disorders, menopause, wellness, fracture prevention), and general endocrinology (including thyroid disorders, bone health, pituitary, and adrenal disorders). These programs are based on a population health, multi-disciplinary, team-based approach using innovations in health care delivery.
Pre-Visit process:Prior to visits we strongly urge new patients to arrive 30 minutes prior to the scheduled time to be able to start the clinician visit on time, such as completing registration, complete pre-visit clinical information gathering forms, check vital signs, perform point of care testing, and interrogating monitoring devices. The pre-visit information gathering is vital to maximize the value of your consultations. If you arrive 15 minutes after the start of the scheduled visit start time your visit will be rescheduled unless you can be accommodated based on physician judgement and availability. For return patients we recommend arriving at least 20 minutes prior to your appointment start time.
We require all relevant medical records be available at the time of the consultation that includes medical records not available via the Epic electronic medical record system, laboratory studies and imaging studies. Ideally, the images should be provided and not just the summary report. For osteoporosis patients we require a current bone mineral density study within 2 years. For patients with thyroid nodules and thyroid enlargement (goiter) we require the actual images.
Communication:We strongly encourage patients to sign up for the communication portal called MyNM (MyChart) that can be used for prescription refill requests, appointment requests, clinical and administrative queries and obtaining results of studies. This requires an email account and can be done on a smartphone or web browser. Please see the support documents.
The practice can also be reached at 847-535-7647, [email protected] and Fax: 847-535-8109. We strive to return all non-urgent messages by the end of a workday and there is a 24/7 emergency phone service. If communication with a physician directly is requested, then please provide specific questions or requests. If you are unable to provide the specific reason for this request, the message will be handled by the nursing staff first. There is additional information at www.nm.org/locations/lake-forest-hospital-endocrinology. Our Facebook page is…
Health Care Team:We are a consultation and specialty service and do NOT provide primary care. We do not offer pre-operative clearance (we will assist with the endocrine specific pre-operative adjustments as indicated), routine preventive health maintenance and intercurrent care with no relationship to endocrine issues.
Medications:For any medication prescribed by our endocrine practice we require at least an annual visit or more frequent monitoring as required based on the condition and medication. This will be specified in the after-visit instructions or condition specific resources we provide.
Laboratory testing:We offer point of care testing (available within about 15 minutes during the office visit, including a small drop of blood from a finger stick sample) of glucose and A1c. Testing can be requested prior to consultations. All results will be posted to the patient portal. If you do not use the patient portal, results will be made available to you at a follow up visit at your request. A team member will contact you if an adjustment to your medication or a follow up study is required between scheduled visits. We will strive to provide explanations for significant results. If results are posted without comment this indicates that the studies are normal, or no current action is required. You are always welcome to call or message with questions about studies. If the communication requires medical decision making, we may request a follow up visit be scheduled or we will contact you between visit communication. Please be aware these between visit services are billable interactions. The default for laboratory testing will be at Northwestern Medicine facilities. These orders are placed electronically and do not require printed requisitions. We can order studies via Quest or other facilities selectively. If Quest is used please ensure the Northwestern Medicine account number is entered so these results can be processed electronically.
Imaging results:Studies will be posted to the patient portal. If you do not use the portal the studies can be made available to you at the next scheduled visit. If there is actionable information a team member will contact you, and/or this will be specified with comments attached to the study results. You are always welcome to contact us with questions. If additional communication requires medical decision making, we will schedule a follow up visit, or we will communicate with you. Physician communication between visits are billable interactions.
Locations:Lake Forest Hospital + Grayslake + Glenview + Deerfield + Vernon Hills + MFM
Team Members: Endocrinologists; Anthony Pick (Medical Director), Liz Kunreuther (director of Women’s health and bone health services), Disha Narang (director of obesity and culinary medicine), Harjyot Sandhu (director of inpatient and transition of care services), Jackie Cartier and Eve Bloomgarden (director of thyroid, adrenal and pituitary programs) and Wendy Tokarz, endocrinology advanced practice provider.
There is a dedicated team of registered dietitians (RD)/certified diabetes clinical education specialists (CDCES) that include Monica Joyce, Ryan Sanders, Mary Miller and Wendy Piekarz. We anticipate and strongly encourage that most patients with diabetes, prediabetes, metabolic syndrome and weight regulation challenges (overweight or obese) will work with the endocrinologists and the RD/CDCES with a team approach.
Caleen McGrath is a licensed clinical social worker who provides individual therapy, dog therapy and complex mental health care co-ordination. She assists in supporting group support programs.
Innovation:
We support state of the art diabetes technology that includes insulin pumps, closed loop (“artificial pancreas”) systems, continuous glucose monitoring systems, smart pens, patch pumps, and advanced applications (such as third-party solutions). We provide telemedicine services (unless an in person physical exam is required and based on patient preference), point of care retina disease screening, point of care A1c and urine microalbumin testing, remote monitoring, health coaching (in pilot phase) and asynchronous education and secure text-based support (in pilot phase).
Collaborative Care:The Cardiometabolic program is our flagship collaborative care model. We strive for integrated collaborative team-based care for suitable complex or high-risk patients. For patients with coronary artery disease and/or heart failure and metabolic syndrome/overweight or obesity/diabetes spectrum disorders there is a team approach with endocrinology and specialties including cardiology, nephrology (kidney disease and hypertension), sleep medicine, hepatology (liver disease such as fatty liver) and andrology (men’s health with low testosterone and erectile dysfunction). The maternal fetal medicine program sees patients with gestational diabetes or other endocrine disorders in pregnancy in partnership with high-risk obstetricians. For high complexity patients we collaborate and facilitate care with the Northwestern Memorial Hospital academic medical center or other tertiary care centers.
Lifestyle Medicine and Wellness:
A core philosophy of our programs is the vital role of a healthy lifestyle in endocrine and overall care. This will be combined with suitable use of medications, team members, innovation tools and procedures. The components of the wellness related programs include nutrition, exercise, sleep, mindfulness, and time in nature. Nutrition resources include registered dietitians, commercial programs, health coaches, asynchronous education and support resources and the culinary medicine program. Exercise resources include the Lake Forest Health and Fitness Center programs, cardiac rehabilitation (select patients), physical therapy, sports medicine, personal trainers, health coaches and third-party solutions.
Bariatric (weight management) Program:
We recognize obesity as a complex, chronic, relapsing disease and are strongly opposed to shaming, blaming and discrimination against individuals with challenges with overweight. We strive to provide compassionate, individualized care in a comfortable therapeutic space for patients. We recognize that obesity now impacts ~40% of the US adult population, implying a complex interplay between genetic and recent novel environmental factors. Our goal is to analyze drivers of weight gain (sleep disorders, endocrine disorders (such as PCOS, Cushing’s syndrome), genetic factors, life events and behavioral factors (stress eating, sedentary lifestyle etc.); screen and manage associated health problems (such as sleep apnea, fatty liver, metabolic syndrome, atherosclerosis, depression, eating disorders or disordered eating, hip and knee osteoarthritis etc.) and develop an individualized management plan with the primary goal of increased wellness (changes on the scale are secondary). We recognize that maintenance of weight loss is a major challenge and weight regain is a physiological process (the brain defends a higher body weight set point with slowing metabolism, muscles can burn less calories with exercise, appetite increases (Ghrelin hormone increases) and decreased satiety/fullness).
Treatment options include lifestyle change; group support; individualized meal planning; medical weight management; structured programs (Noom, Omadahealth, Virtahealth, others); meal replacement (Nestle Optifast: partial or complete meal replacement for stimulus narrowing, weight loss resistance, pre-surgical weight loss) and preparation or referral for bariatric/metabolic weight loss surgery (such as gastric sleeve or gastric bypass) for select individuals.
We use all FDA approved medications selectively, that include phentermine, Orlisat, Qsymia, Contrave, Plenity and Saxenda. The branded medication can be expensive, and we recommend checking with your health insurance plan if branded weight loss medications are covered and affordable.
Diabetes program:
We provide state of the art care for all forms of diabetes that includes type 1 diabetes, type 2 diabetes, gestational diabetes, and other forms of diabetes. We use a team approach with the diabetes education specialists as a vital and central part of the team approach. We also provide a diabetes tune up pathway to support primary care providers and strive to reverse or prevent type 2 diabetes, as far as possible. We offer group and individual diabetes education. We also offer periodic technology meetings with vendor support and patient led group support sessions.
Thyroid nodule and thyroid cancer program:
Thyroid nodules are common and usually benign. A key part of the program is to identity nodules with features suspicious for thyroid cancer that require fine needle aspiration biopsy, done in partnership with radiology, interventional radiology, and pathology. Thyroid nodules are monitored by physical examination and ultrasound studies. Nodules can be associated with overactivity (hyperthyroidism) and sometimes develop with underlying autoimmune thyroid disease associated with decreased thyroid activity (hypothyroidism), so testing of thyroid blood tests is part of the routine. For patients with thyroid cancer, we co-ordinate care with endocrine or head and neck surgeons and nuclear medicine physicians. For select patients, we participate in the multidisciplinary Northwestern Medicine thyroid tumor board led by our academic medical center colleagues at Northwestern Memorial Hospital.
Osteoporosis:
The osteoporosis program focuses on prevention or recurrence of fragility fractures (broken bones). We work in partnership with the dietitians, rheumatology, infusion centers and offer muscle and bone strengthening, balance and fall prevention with physical therapy, sports medicine and the health and Northwestern Medicine Health and Fitness Venter.
Medication and Formulary check:
Branded medications can be expensive. We encourage patients to check formulary access to branded endocrine medications.
Anti-Obesity Medications: Contrave, Qysmia, Saxenda, Plenity
Anti-Diabetes Medication: Ozempic, Bydureon, Trulicity, Victoza, Rybelsus, Farxiga, Jardiance, Steglatro, Invokana, Januvia
Lipid lowering therapy: Repatha, Praluent (PCSK9 inhibitors)
Anti-osteoporosis therapy: Forteo, Tymlos, Prolia, Reclast (infusions are covered by Medicare).
We work in collaboration with specialty and clinical pharmacists.
Checklist:
Arrive 30 minutes before new appointments (at least 20 minutes before return appointments).
Complete pre-visit information gathering forms (or with medical assistant).
Ensure that medical records are available at the time of consultations.
Check insurance coverage for specialty medications.
Sign up for patient Portal.
Check date, time, and location of appointment.
Specify if telemedicine appointment desired (in person is the default unless safety issues such as Covid19).
For patients with pre-diabetes (diabetes prevention goals), diabetes and obesity anticipate a team approach including visits with the registered dietitians/certified diabetes education specialists.
For patients in the weight management program please complete the intake form as completely as possible and indicate preferences for a treatment track or individualized approach. Please indicate if interested in meal replacement, weight loss medications of preparation for bariatric surgery.
For patients with osteoporosis please ensure bone mineral density study within past 2 years
For patients with thyroid nodules or enlargement (goiter) please ensure actual images are available
To do:
Website update
Facebook page
Group support programs: Obesity, Cardiometabolic/post cardiac rehab and DM
Brochures: Fibroscan, CAC, HFC, Optifast, Weight loss medications, diabetes medications etc.
Education materials: handouts, web page content, app based, brochures etc.
Share this:
Lake Forest Hospital, IL