Jason Hollander wanted, for his children, the bucolic Princeton childhood that he had enjoyed. So he left the medical fast lane of Manhattan to locate his endocrinology practice in Princeton, yet he “keeps his hand in,” so to speak, by doing cutting edge research. He is also among the few doctors who encourage patients to keep in touch with him by texting, E-mailing, or using a secure web page.
Hollander speaks on thyroid issues in women at the Seventh Annual Women’s Wellness Day staged by Heart to Hearts Inc., a women’s wellness advocacy group (see story page 34).
Neither of Hollander’s parents was a doctor — his mother was a teacher and his father a manager — but while completing his residencey at Mount Sinai Hospital in New York he met and married one, Sarah Werbel, whose practice, Lawrenceville Medical Associates, is located at 3100 Princeton Pike. Hollander went to Princeton Day School and then to Princeton University, graduating with honors in 1994. After medical school at UMDNJ (also graduating with honors) he completed his internship at Mount Sinai, serving as chief resident from 2002 to 2003. He worked in the emergency room of one of the city’s busiest hospitals, St. Vincent’s, and then proceeded to become board certified in endocrinology, internal medicine, and pediatrics.
Although many endocrinologists offer nutritional information to their patients, Hollander is one of the few who is also board certified in both clinical nutrition and nutrition support. Recently he wrote four chapters on healthy eating for all ages for a book to be published this year. His practice, Endocrinology Associates of Princeton, is located at 166 Bunn Drive (www.princetonendocrinology.net).
Hollander actively pursues research opportunities, often working with former colleagues in New York. The topic of one of his recent papers is a harrowing read because it involves patients with chronic critical illness syndrome (CCIS) who are at death’s door but — thanks to recent medical breakthroughs — might yet survive. Their bodies have been under such stress that vital organs are damaged. In randomized controlled clinical trials, Hollander tried to use osteoporosis drugs to combat the widespread tissue damage. “We looked at biphosphonate use, infusing Boniva to see if we could slow it down,” he says in a telephone interview.
But most of the time Hollander treats healthier patients with such common diseases as diabetes, osteoporosis, and various disorders of the thyroid, the butterfly-shaped gland that is positioned in front of the trachea just below the Adam’s apple.
For instance, someone with an underactive thyroid (hypothyroid) may have low energy, be gaining weight, be intolerant to cold, and/or have both dry skin and a poor memory. Those with an overactive thyroid (hyperthyroid) tend to have some of the opposite symptoms (weight loss and intolerance to heat) plus increased anxiety, tremor, and heart palpitation.
The most under diagnosed and under treated disease in men, Hollander says, is low testosterone, which — in addition to low libido and poor erectile function — can cause fatigue, depression, diminished concentration, and weight gain. He strongly believes in normalizing this hormone.
Another little known but crucial element is Vitamin D. Surprisingly, Vitamin D is not just a vitamin, says Hollander, but also a hormone that plays a role in calcium metabolism, helping to maintain bone health. It may also protect against certain diseases. Hollander helps those with disordered calcium metabolism by using high frequency ultrasound to identify diseased parathyroid glands.
In contrast to the little-known diagnoses, the most talked about topic is thyroid cancer. “Everybody has a sense that thyroid cancer is on the rise,” he says. “It is three times as common in women as in men. Because of the boom in imaging, you are starting to see a lot more diagnoses of thyroid cancer that may never have become evident before.” Thyroid nodules might appear, for instance, on a carotid scan.
“But the biggest factor is radiation exposure. I have a lot of international patients, and many were actually exposed at Chernobyl,” says Hollander. “Alternatively, those who have had cancer at a young age get a ton of radiation and are now at risk for thyroid cancer.” If you were a child in the 1940s, your tonsillitis might have been treated with radiation, and you are also at risk.”
Even though 80 to 90 percent of thyroid cancers grow slowly and are not fatal, the average person should have his or her thyroid palpated at an annual exam, he says. “But if you have had a first degree family member with thyroid cancer, it is reasonable to have an ultrasound scan.” Last year he performed 300 ultrasound-guided fine needle aspirations, an in-office procedure that can accurately diagnose worrisome thyroid nodules.
Hollander does not discourage his patients from doing their own research on the Internet, but he offers two caveats:
Read only reputable websites for information about thyroid diseases. He suggests www.endocrineweb.com. Don’t read blogs. “That’s where the misunderstandings come from,” he says.
Acknowledge the difference between a testimonial and research. “Patients will frequently listen to what they want to believe. When you don’t feel well, the testimonials sound really good.”
Though he has a rudimentary website now and has started E-prescribing, that’s just the beginning of his technology plans. Some patients text him to report their blood sugars, and he does not find that intrusive. “I know who will respect that kind of access. I am very accessible, more than most endocrinologists.”
Hollander says he is going to be unveiling “a very high tech website, a patient portal, where patients can get the results of their labs and be able to send secure E-mails. But I’m going to make it very clear that if you are getting detailed labs, you are not going to get an E-mail or a phone call. We need to do that face to face. But if it is a simple, up or down result, we can respond that way.”
Hollander’s office technology makes 24/7 doctor/patient communication more efficient. That’s especially necessary for those with diabetes. “My patients know they can get in touch with me 24 hours a day,” says Hollander. “Because of that I probably get fewer calls than people who are unreachable. They know there is no middle man.”