What Should I Do Next? Finding a TRT Clinician ...

Discussion in 'Dr. Stephen Nagler (MD)' started by Kevin Reeder, Jun 3, 2014.

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    1. Kevin Reeder

      Kevin Reeder Member

      Atascadero CALIFORNIA
      Tinnitus Since:
      Hi Dr. Nagler.

      Welcome back and I hope you enjoyed your vacation!

      I'm new to TT, and it has really been a blessing to be able to talk to people who also suffer from Tinnitus. In all the years that I have had it, almost 14, I could count on one hand the people I've met who have it and actually understand. So I'm very grateful to be here around Doctors and people who know what I'm going through.

      My personal journey with T is a long one. I used to work in very loud environments, and sometimes when I went home my ears would be ringing. It never worried me too much because I used to go to the shooting range with my dad as a kid, so I knew it was natural for your ears to ring after exposure to loud noises. It would sometimes last into the night, but for the most part it would always be gone by morning. This was around 97-2000. In 2001 I was put on paxil to manage my depression and that was when it became constant. Soon it got so bad that it started throbbing and the volume would spike with each time it throbbed or pulsated. When I decided I wanted to get off the paxil because I believed there was a correlation it got even worse, the volume spiking got louder the throbbing seemed to get harder, and it became painful each time it throbbed, similar to an electric shock. After a while all the shocking and throbbing stopped, and it turned in to what it is today, a constant ring, about a 6 on a scale of one to 10, and for the last 2 years there have been two different pitches it rings at that can be heard over anything.

      I've tried lots of different things to alleviate my tinnitus. Changes in my diet like no salt, no caffeine, and lots of exercise. That didn't work, in fact when I exercise I think it gets worse for some reason. I also tried Lippoflavinoids (sorry about the spelling) and that didn't help. I've been to an audiologist who was able to tell me that I have some very minor hearing loss in the high frequency range, and through a suggestion I got from someone here I checked out an ACRN website where I was able to duplicate my tinnitus to find out that it rings at about at about the 9500-10500 Hz range. ACRN is helpful but only provides relief while it is on. It is the only masking method that works. I have a sleepmate and an app on my phone that plays nature sounds, but I have to play them so loud to match my ringing that they end up getting on my nerves. I've also been to The House Ear Institute in LA where they told me there was no damage to my inner ears, and that it would be pointless to get an MRI because I've had it for so long that if it was something physiological in my head I would have been dead by now.

      Anyway that's my story. Sorry about the length, but I wanted to make sure you had my info before asking you to make any suggestions. Also, I was told you could possibly help me find a TRT doctor in my area. I've been looking on the internet, and I talked to the audiologist, but I haven't had any luck. I live in San Luis Obispo county in California and my zip is 93422.

      Thank you,
    2. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Atlanta, Georgia USA
      Tinnitus Since:
      Thank you for your inquiry and for sharing your story.

      As I see it, you have had tinnitus for some 14 years and have tried innumerable "things to alleviate [your] tinnitus," all to no avail. Seems to me that it may be time to look at the problem differently, indeed I suspect that it is long past time.

      Unfortunately it is rare that efforts directed at mitigating the tinnitus itself meet with lasting success. Tinnitus sufferers keep trying and trying - that's only human nature, but they are rarely successful in effectively addressing the tinnitus signal itself. That is one of the two reasons that I encourage folks with severe intrusive tinnitus to consider TRT, which focuses instead on changing the way your brain classifies your tinnitus. I have written in some detail about the rationale behind TRT on a number of occasions over the years, most recently HERE. The second reason I encourage folks to consider TRT is that in knowledgeable and experienced hands it is highly successful in achieving what it purports to achieve - not perfect of course, but highly successful nonetheless.

      The second part of your question - how do you locate a "TRT doctor" in your area - is a little delicate for me here on the Doctors' Corner, but I have decided to stop dancing around the issue and face it head-on. [If the moderators feel that my response is inappropriate, I hope they will let me know.]

      In the piece I referred to in the link above (HERE), I gave some general questions to ask - but I sense that a more direct response is indicated at this point.

      Since TRT can be very effectively conducted long-distance (after one in-person office visit), for the most part geographical restrictions become largely irrelevant. What you are really looking for in a TRT clinician is somebody with a lot of knowledge, a lot of experience, a lot of compassion, and a high ethical standard - regardless of where that clinician might actually be located. While there are likely a fair number of TRT clinicians who fit that description, I only refer to those clinicians whom I know personally and whom I have actually seen treating patients. In other words, when I make a referral, I feel my own reputation is on the line - and I need to be able to personally and unconditionally vouch for the clinician.

      Until recently, there have been only three TRT clinicians worldwide who fit that standard. (Again, it is a very specific standard given that I have had to have personally witnessed the clinician evaluating and counseling tinnitus patients.) Those three clinicians are Gail Brenner in Philadelphia, Paula Schwartz in Minneapolis, and Jacqui Sheldrake in the UK, all of whom are truly outstanding TRT clinicians and are able to conduct long distance TRT after one in-person visit. I would be less than candid if I did not now add a fourth name to that list, which would be Stephen Nagler in Atlanta. Having retired from the corporate world last year, a few months ago I decided to start seeing tinnitus patients again on a limited basis - and if I couldn't unconditionally vouch for myself, how could I look myself in the mirror!

      Hope that helps.

      Dr. Stephen Nagler
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