Posts Tagged ‘ patientblogorangecounty ’

PATIENT BLOG ORANGE COUNTY OZEMPIC

By editor
May 19, 2023

The Doubting Doc- Ozempic, Wegovy, Mounjaro...Oh My! Weight Loss FAQ's

Let’s play a short game of Jeopardy…
 
Answer:
I need to lose weight
I'm overweight
I'm obese
I'm fat
I'm going to stop eating carbs
No, meat
No, gluten
No, dinner
I'm going to exercise more--at least twice a week
 
Question:
What does a typical doctor hear 99 times a day from their patients?
 
Especially post Covid, we are seeing more obesity than ever. Recent studies put at 80% the number of people over their ideal body weight.
 
With obesity comes obesity humor. While its felt to be in poor taste to fat shame anyone, since MY BMI is teetering around 30, maybe I should poke fun at myself.
 
Why does me remembering my diet not kick in until my 10th donut?
or
My wife and I went on a diet and lost 10 pounds combined...she lost 20 just herself!
 
We define obesity as a BMI over 30. (All you need to calculate your BMI is your height, weight, and Google.) As doctors, our advice has been very simple over the years- diet, exercise, reduce stress, and if all else fails, have surgery to shrink the stomach.
 
But weight loss surgery seems a bit extreme for most, and diet pills had their share of issues- some are not safe or are addictive. Others have poor long-term results. Most were only good for 20 pounds. Few were FDA approved for weight loss.
 
Introducing…the current game changer for weight loss in patients who need to lose 25 or more pounds!!
 
GLP-1 agonists.
 
In plain English, they reduce hunger and food intake at the biochemical level. They are considered by the medical community to be safe and effective.
 
The three most popular choices are Ozempic, Wegovy, and Mounjaro. Since we don't have a horse in this race, let’s discuss each one to see if any may be right for you or a loved one. Remember, Caduceus never allows drug "detailing,” so no Laker tickets were used in preparation for this blog. Not even a coffee cup.
 
Ozempic (Semaglutide)
 
It is FDA approved for Type 2 Diabetes---it is NOT FDA approved for weight loss, but patients who take it tend to lose weight---10-15% of body weight is common. Many patients have been able to reduce or go off diabetic, lipid, and hypertensive medications with the weight loss. It requires a weekly shot and a monthly follow-up. Once weight loss is established, it is safe to continue taking it long term. In fact, going off of it risks returning to you to your original weight.
 
Wegovy (Semaglutide)
 
It is an identical version of the drug Ozempic - with a few differences. For one, the dose used can be higher, resulting in higher weight loss. For another, it IS FDA approved for chronic weight management, and NOT for diabetes. You will need a BMI of 30, or 27 plus a "co-morbidity" such as hypertension or high cholesterol for FDA approval and insurance payment. Otherwise the cost, weekly shots, and monthly long term follow-ups apply to both.
 
Mounjaro (Tirzepatide)
 
It is a GLP-1 agonist plus it inhibits a second peptide that curbs appetite and produces "early satiety"--i.e. you feel fuller faster. It is FDA approved for diabetes but has an application into the FDA for approval for weight loss. It is expected to be approved, which would give it the distinction of the only medication that is FDA approved for both diabetes AND weight loss. In fact, the FDA has agreed to "fast-track" its weight loss approval. It also is the same weekly shot story, but the dose can be pushed even higher than the semiglutides. In head-to-head studies, Mounjaro has the highest weight loss, but the most side effects. The cost is comparable.
 
There were "Hollywood whispers" that Adele, Rebel Wilson, and Kim/Khloe Kardashian all have used these medications successfully---but in fact all four, they deny it loudly, saying diet and exercise were the methods for their weight loss. Being trusting, we will take them at their word. We do caution our readers that it is very difficult to get a 30-pound weight loss (or more) with diet and exercise alone, especially keeping it off.
 
Since nothing is too good to be true, what are the downsides to taking these meds? I counted five right off the bat.
 
1. They are expensive unless you allow us to get insurance approval. About $450/week, maybe half that if you try to use a compounding pharmacy (see BEWARE below). That is just for the drug itself. Most office visits may be paid for by the insurance company if there is medical necessity.
 
2.They are so popular, no one takes them anymore (Thanks to Yogi Berra for the inspiration) --meaning their popularity has caused severe shortages in some areas. Finding the meds may be tough depending on the doctor and pharmacy you pick. Hopefully the shortages are being fixed.
 
3.The main side effects are GI- nausea, cramping, etc. Some report an intolerance for alcohol. Rare reports of hair loss. These seem more pronounced with Mounjaro.
 
4.To maintain the weight loss you probably will take the medication long term--and still diet and exercise. Seems there's no getting around that advice.
 
5. You ideally need an experienced provider who can help select the right medication,  know how to get insurance approval if necessary, and correctly adjust the dose monthly.
 
And now for this commercial break---endorsed by the CEO and CMO of Caduceus:
 

  • At Caduceus and PDQ Urgent Care and More, we have trained providers to assist you if you feel you may benefit from these medications.
  • We can do most of the visits via Zoom telehealth if preferred. 
  • We will assist in selecting the medication best suited for you depending on your health conditions and weight loss needed, plus the financial situation. Also, we will work hard to obtain insurance pre-authorization.
  • If a compounding pharmacy is to be used, we will vet them for you.
  • If you need a quick lesson in giving the subcutaneous shots, we will teach that to you.

My BMI is so high, when I contracted a case of flesh-eating bacteria -they died from exhaustion.


Certainly, there are various options for getting this prescription--let us offer a few cautions.

  1. There are hundreds of "online weight clinics" offering these meds with a quick ten-minute video visit. There are too many other legit choices to resort to these; we plead you to use caution.
  2. Many "clinics" offer just one drug, and have you enroll in a "subscription" model where you pay one monthly or even yearly fee to cover the compounded medication, office visits, blood work etc. Where subscriptions are great for your TV streaming, beware of using them with your health care. Most legit doctors do not need to resort to a subscription gimmick that ties you down to that provider long term.
  3. Beware of providers that do not require blood tests, do not ensure you are up to date on your screenings, or decline to offer to teach you how to give the shots. These are signs of a "mill" and should be avoided.
  4. "No need for preauthorization" advertised. Either they may be dispensing counterfeit medications, or using a compounding pharmacy that may or may not be legit.
  5. The FDA has announced they will be investigating these meds from compounding pharmacies - why?

Semaglutide is governed by the regulations that restrict compounding pharmacies from making replications of patented therapeutics.

In defiance of these regulations, some compounding pharmacies have compounded semaglutides with other medications, thinking that gets around the FDA scrutiny.

It doesn't. 

If this is all Greek to you, we get it. Just be very careful accepting "cheap" or "generic" semaglutides. If you cannot vet them, be sure your doctor can.

I for one, am not offended when I am called overweight-- I'm much bigger than that.


In Summary:

  1. At least three newer medications are available to assist with chronic weight loss management and may be FDA approved and/or covered by insurance.
  2. These medications are not addicting, not short term solutions, and recognized as safe and effective by most doctors.
  3. They all require a weekly shot, a monthly follow up, and serial blood tests - as well as diet and exercise.  
  4. There is NO evidence any celebrity has ever used any of these medications. 
  5. Be aware of possible shortages, inexperienced doctors, shady online weight loss clinics, unvetted compounding pharmacies, or poor technique at giving your own shots.

I'm so obese my blood type came back "gravy." 


Gregg DeNicola MD CEO & Chairman
Caduceus Medical Group & PDQ Urgent Care & More 


If you feel you or a loved one may be a good candidate for these medications, please reach out to us TODAY:

  • Call our dedicated appointment line at 844-807-8558
  • Request an appointment through your patient portal account
  • Live chat from the Caduceus website or app

PATIENT BLOG ORANGE COUNTY Colorectal Cancer Awareness

By editor
May 19, 2023

As we near the end of Colorectal Cancer Prevention Month, Caduceus would like to highlight for our patients that awareness of gut health is just the beginning.  With proper education and screening, colon disease can be treated, defeated, or avoided altogether.

First, let's talk about the late form to be avoided: colorectal cancer. It's the third most common cancer in both men and women in the United States, but the good news is that it's also one of the most preventable. Screening tests can detect abnormal growths in the colon, such as polyps, before they become cancerous.

The US Preventive Services Task Force recommends that people with an average risk of colorectal cancer start regular screening at age 45. I know, that likely sounds too young for something like this. But for people with a higher risk, such as a family history of colorectal cancer, screening may need to start earlier.

Others who should be screened earlier are people with:

  • Inflammatory Bowel Disease
  • Personal or family history of colorectal cancer or colorectal polyps
  • Genetic conditions like familial adenomatous polyposis (FAP) or Lynch Syndrome

Now you might be thinking that screening sounds like a good idea, but you’re dreading that right of passage exam.  We’re here to get you through to the other side.  While colonoscopy is the most common and often the preferred method (yes with the option for medication), there are other routes including stool tests, flexible scopes, and virtual colonoscopy.  These can be discussed with either your primary care doctor or your Gastroenterology specialist.

But screening isn't the only thing you can do to prevent colorectal cancer. You can also make lifestyle changes that can reduce your risk, such as:

  • Eating a healthy diet that's high in fiber and low in red and processed meats
  • Maintaining a healthy weight
  • Exercising regularly
  • Quitting smoking
  • Limiting alcohol consumption

You should also know that colon cancer has started to skew younger: a new study from the American Cancer Society found that 1 in 5 cases diagnosed today occurs in adults younger than 55, compared to 1 in 10 in 1995.  While no one cause has been identified – genetics, the microbiome, and low screening rates are all believed to play a factor.

So in addition to keeping up with your screening be sure to watch out for worrisome symptoms: abdominal pain, unexplained weight loss, changes in the frequency, size, or appearance of stools, and rectal bleeding.

In the end, trust your gut.

Taking care of your colon is an important part of overall health. By maintaining a healthy lifestyle and getting screened regularly, you can reduce your risk of colorectal cancer.  

If your health plan requires a referral, please schedule an in-office visit or Zoom call with your primary care provider (PCP).  You can book directly from the button below or request an appointment through your patient portal.

If your health plan does not require a referral, you can book a Zoom call with our GI advanced care practitioner for your colonoscopy screening, that would be needed prior to booking your procedure. You can request an appointment from the button below or request directly through your patient portal. 


Nathaniel DeNicola, MD, MSHP, FACOG
Chief Medical Officer | Caduceus Medical Group

CMO PATIENT BLOG ORANGE COUNTY- RSV FAQ's AND WHO IS HIGH RISK?

By editor
January 13, 2023
Aw-chew!
Uh oh.  Well maybe it’s nothing…
 
Aw-chewww!
Ok that was a good one.  That’s it, get it all out of the system.  Two sneezes and off to wor…
 
Aww-chewwwwy!
Oh boy.  What do I do now?
 
You’ve come to the right place.  Here at Caduceus & PDQ Urgent Care we have you covered.
 
The first thing to know is that respiratory viruses are still on the rise – yes, other than COVID-19 – particularly Respiratory Syncytial Virus, or RSV.  This is a highly contagious virus that can cause severe respiratory illness in children, pregnant women, and older adults. 
 
RSV is a leading cause of bronchiolitis and pneumonia in young children and can be particularly dangerous for premature infants and those with underlying health conditions. Pregnant women and older adults with weakened immune systems are also at increased risk for severe RSV infection.
 
Symptoms of RSV infection may include coughing, difficulty breathing, and a runny nose. In severe cases, the virus can lead to hospitalization and, in rare cases, death. 
 
But not to fear, because the next thing to know is that it is preventable.  The best way to prevent RSV infection is to practice good hygiene, such as washing your hands frequently and avoiding close contact with sick individuals.

Best Practices To Prevent Transmission of RSV

-Wash your hands frequently with soap and water for at least 20 seconds, especially before touching your eyes, nose, or mouth.
-Avoid close contact with people who are sick, and stay home if you are feeling unwell.
-Cover your nose and mouth with a tissue or your elbow when you cough or sneeze, and dispose of used tissues immediately.
-Clean and disinfect frequently-touched surfaces, such as toys, doorknobs, and light switches, daily to help prevent the spread of germs.
-Avoid touching your face, especially your eyes, nose, and mouth, as this is how the virus can enter your body.
-Avoid crowded public places, especially during peak RSV season, which typically runs from late fall through early spring.
-Keep infants and young children away from people who are smoking or who have recently been in contact with smoke, as the virus can be inhaled in cigarette smoke.
-Avoid placing an infant in a car seat or stroller with a blanket, as the blanket can trap smoke and other pollutants close to the infant's face.
-If you are a parent or caregiver of an infant or young child, do not allow them to share pacifiers, bottles, cups, or eating utensils.
-If you are a healthcare worker or caregiver for high-risk individuals, wear a mask and gloves. 

Let’s examine more who should be most careful during this RSV season.  
 
Children are at the greatest risk for RSV infection, especially those under the age of two. Premature infants and those with chronic lung or heart conditions are particularly vulnerable to the virus. It is important for parents to be aware of the symptoms of RSV and to seek medical attention if their child is showing signs of infection.
 
Pregnant women are also at increased risk for severe RSV infection, as the virus can be transmitted from mother to baby during delivery. Pregnant women should take extra precautions to avoid exposure to the virus, such as avoiding crowded places and washing their hands frequently.
 
Older adults, especially those over the age of 65, are also at increased risk for severe RSV infection. This is because the immune system weakens with age, making it harder for the body to fight off the virus. Older adults should take steps to protect themselves from RSV, such as getting vaccinated and practicing good hygiene.

GroupRisk for RSV infection-

-Children under 2 High
-Premature infants High
-Children with chronic lung or heart conditions High
-Pregnant women High
-Older adults over 65 High 

In terms of treatment, it’s important to know that there is no specific cure for RSV infection; which is why prevention is so important.  Early monitoring by a health professional for those at high risk is the best approach.  You can augment your monitoring at home with a pulse oximeter: typical numbers should be above 95% – and contact your healthcare team right away for numbers less than 90%.  
 
Supportive care for fever and pain can be provided with medications like acetaminophen (Tylenol) and non-steroidal anti-inflammatories (Ibuprofen, Advil, Motrin).  Most individuals with the virus will recover on their own within a few weeks. However, severe cases may require hospitalization and supportive care, such as oxygen therapy and fluids.
 
Also remember, your cough and sneeze might not be RSV at all.  As a recent LA Times article advised us, we are currently facing a triple threat of respiratory viruses: RSV, COVID-19, and Influenza.  While the symptoms may be similar, there are some key differences between the three infections.
 
Symptoms of RSV infection may include coughing, difficulty breathing, and a runny nose.
 
Symptoms of COVID-19 may include coughing, difficulty breathing, and fever. Other common symptoms include loss of taste or smell, body aches, and fatigue. 
 
Symptoms of influenza, or the flu, may include fever, body aches, and a cough. Other common symptoms include chills, fatigue, and a sore throat. 

Infection    (Common symptoms) (Incubation period)
-COVID-19  (Coughing, difficulty breathing, fever) (2-14 days)
-Influenza (flu) (Fever, body aches, cough) (1-4 days)
-RSV      (Coughing, difficulty breathing, runny nose) (1-7 days)

One key difference between the three infections is that some individuals with COVID-19 may not have any symptoms at all, while symptoms of influenza and RSV infection are typically present. Additionally, the incubation period (the time between exposure to the virus and the onset of symptoms) is typically shorter for RSV and influenza than for COVID-19.

In summary, RSV is a highly contagious virus that can cause severe respiratory illness in children, pregnant women, and older adults. To reduce the risk of infection, it is important to practice good hygiene and avoid close contact with sick individuals.  To have that cough or sneeze examined we at Caduceus & PDQ Urgent Care are here for you with our online chat, same-day urgent care appointments, and telehealth checks from the comfort of home. 

Nathaniel DeNicola, MD, MSHP, FACOG
Chief Medical Officer | Caduceus Medical Group
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