Webinar Recording on Ozempic, Wegovy, Mounjaro Q&A

Jonathan Kaplan:
Thanks everyone for joining. Again, those of you in the Zoom community, some of you on Instagram Live and TikTok Live, so if you see my head moving around, that’s looking at each of the cameras, but we’re going to be talking about Ozempic and Wegovy today. We’ll get to all your questions, so please submit questions through Instagram Live, TikTok Live and Zoom. Whenever you think of the question, just put it in and then we’ll eventually get to it.

Pacific Heights Plastic Surgery

Again, I’m Jonathan Kaplan. I’m a board certified plastic surgeon in San Francisco. We do all kinds of full body surgery, upper and lower eyelids. We do the SIMI necklift, a necklift that I developed, a single incision, minimally invasive necklift for appropriate candidates. We do breast augmentations, tummy tucks, lots of body contouring procedures, and because of that, about a year ago, a little over a year ago now, we found that some patients were coming in for tummy tucks. They were really trying to lose weight with the tummy tuck and that’s not really a weight loss procedure. They’re asking to get liposuction to help with weight loss. Again, liposuction is not a weight loss procedure. These are all body contouring procedures, and their BMI was a little bit too high. They weren’t really good candidates.

Risk of High BMI

If your BMI is higher, then you have potential risk with DVTs and blood clots in your legs that can travel to your heart. You have complications associated with anesthesia, so we don’t want to operate on people that have a BMI that’s too high, but rather than turning them away, we started a weight management program to help them lose some weight. Then, eventually, if they got to a weight that they were happy with, it was more appropriate for surgery, and when they wanted to proceed with surgery, then great. Sometimes patients just lost weight and then they were happy. Their skin tightened up on their own and they didn’t need any of these body contouring procedures that I’m talking about.

Anyway, that’s why we started the weight management program about a year ago. The thing is that we were providing patients with phentermine, coaching, our nurse practitioner was helping with virtual and in-person coaching on diet and exercise, providing with phentermine when appropriate. The problem with phentermine is that it’s only really FDA approved for 90 days. People do use it for more than 90 days. That’s okay. It’s just considered off-label. It’s not illegal, but phentermine has its drawbacks. It does suppress appetite, but you might not want to take it forever. There were other oral medications that we could provide that would help patients with some weight loss, but only in the last few months have we gotten access to these new diet medications that you’ve heard of, like Ozempic and Wegovy. That’s what I want to talk about today. I want give an overview of those medications and how they’ve really changed things and I’ll get into how we have access to it. They’re not the brand name. They’re the active ingredient Ozempic and Wegovy, semaglutide. We’ll get into all that. Keep asking your questions and we’ll definitely get to all of those answers.

Incretin Mimetics

To start off, this whole class of medications that you’ve heard about, Ozempic, Wegovy, they are all termed incretin mimetics. It’s a fancy term, but all it is is that your body has these naturally occurring gastrointestinal hormones that when you eat your intestines release these hormones. They’re called a glucagon-like peptide, gastric inhibitory polypeptide. What they do is, among other things, is they help increase insulin release from your pancreas. They also contribute to satiety and make people feel full, that they don’t want to eat anymore. Now, those are naturally occurring. This whole class of drugs is mimicking those hormones. Whatever receptors those hormones bind to have their effects, these new medications bind to those same receptors on cells to help increase insulin to shift sugar into the body so you can use it as energy. It also helps with satiety and suppressing appetite.

The reason it helps in type two diabetes is when patients are eating a lot, taking in lots of sugar, they keep having these insulin spikes, the insulin tries to act on the end organ tissues to shift sugar into the body. The problem is that if you keep having these huge insulin spikes from taking in so many carbs and highly refined carbs, then the end organ tissues, the body tissues that the insulin works on, they become insensitive. They become resistant to insulin. You’ve heard of insulin resistance. That’s the idea is that the insulin is just hitting these tissues over and over again that they become less responsive to the insulin. That’s when you became type two diabetic is that your pancreas is releasing so much insulin and then the end organs aren’t responding to it, that the insulin gets burned out. These medications help secrete and enhance more secretion of insulin from the pancreas when it doesn’t want to release anymore because you’ve become a type two diabetic.

GLP-1 Receptor Agonists are not new

This whole class of medications that people think are new because they’ve only been hearing about them recently. Keep in mind this class of medications, the first one, Byetta, which you may have heard of, that first came to market in 2005, so that’s almost 20 years. If it came to market in 2005, that means that the research behind it, the studies to get it FDA approved and everything that started well before 2005, so these medications have been around for 20 years, and that’s why people feel pretty comfortable, like researchers and doctors feel pretty comfortable with these medications because they seem like if they’ve been on the market for over 20 years, we know what the side effects are and we hopefully won’t have any surprises. They’ve been on the market for 20 years. This is not just something that just came on the market in the last couple of years or just when you started hearing about it.

Ozempic

Let’s talk about specifically Ozempic, one of the ones you may have been hearing about. On the right it’s just a clip of a TikTok or a series of TikToks I’ve done on the subject, but Ozempic was approved in 2017 and that was specifically for type two diabetes, was released by Novo Nordisk. This is a glucagon-like peptide receptor agonist. That just means it’s a medication that acts on those same receptors that those naturally occurring gastrointestinal hormones act on that cause people to feel full and also to help secrete insulin to shift those sugars into the tissues. The active ingredient in Ozempic is semaglutide. You may have also heard of that. It’s a once per week injection. There is an oral version of semaglutide called Rybelsus, which you’ve probably also heard of or seen commercials for. The problem with Rybelsus is that it doesn’t contribute to as much weight loss as they were finding in Ozempic as an injection. Even though everybody would like to avoid an injection for these weight loss medications, the oral unfortunately doesn’t seem to work as well for weight loss.

Semaglutide

Anyway, Ozempic, semaglutide, once per week injection. Its mechanism of action is it suppresses your appetite possibly in the hypothalamus in the brain, delayed gastric empty. What that means is that the food goes more slowly from the stomach to the intestines. Because it stays in the stomach longer, you feel more full, you eat less, you lose weight, but that can also contribute to some of the side effects that we’ll talk about in a second. Then again, it acts on the pancreas to cause it to release insulin, which leads to satiety as well. Ozempic did so well with treating type two diabetes, and also in the process they found that Ozempic was causing people to lose weight that Novo Nordisk said, well, let’s re-market this, get this re-approved specifically for the indication of obesity.

Wegovy

That’s when Wegovy came on the market in 2021. It’s the same thing as Ozempic. It does go up to a higher maximum dose than Ozempic, and this has really been amazing as far as the weight loss. The average weight loss over 68 weeks at… this isn’t in a month, it’s not six months, but in 68 weeks, the average weight loss in the studies was 15.1% of body weight, approximately 35 pounds. It’s pretty incredible.

Now, it doesn’t work for everybody, but in that next bullet you might see that 83% of adults taking Wegovy loss greater than 5% of their body weight. That means that 17% of the people may not have had any response to it. That is unfortunate, but we are aware that it might not necessarily work on everybody, but 83% is pretty significant. Then 30% of people lost over 20% of their body weight. Really incredible when you compare that to a placebo, not the real drug. Only 2% of those people lost it with just diet and exercise is basically the point there.

According to the Wegovy package insert, who is a candidate for this? I know you hear people talking about that celebrities are taking it, people who aren’t overweight are taking it, but the thing that I’m noticing is people also getting a little confused and saying, people are just taking it for obesity and people are being judgmental about that on social media. The point I’m making is that Ozempic was for type two diabetes. It was re-approved with the FDA indication as Wegovy for obesity. If people are taking this for obesity, they’re not doing something inappropriate. They are taking it for the FDA approved purpose of obesity. Now, doesn’t mean that everybody is a candidate. You can’t just take it because you want to fit into a dress. Now, there are doctors that will prescribe it to people who have a lower BMI for one reason or another. I’m not here to judge. That’s not illegal. It is off-label by providing it for people who don’t meet the parameters, but it’s something that can happen. The doctors can prescribe it for people who don’t meet the parameters.

BMI parameters for Wegovy and semaglutide

Anyway, but the BMI parameters are greater than 27. You figure out your BMI, body mass index. You can do that online. Just Google BMI calculator, and that’s your weight in kilograms or pounds divided by your height in inches or centimeters. The calculators online make it really easy to do that regardless of what units you want to use, whether it’s kilograms, pounds, centimeters or feet and inches. Anyway, a BMI of greater than 27 plus an obesity related condition like sleep apnea, diabetes, hypertension, high cholesterol, or if you have a BMI of greater than 30, then you don’t need any of those other obesity related diseases to qualify on label to get Wegovy or semaglutide.

Must be a California resident

Now, just so you know that we have a program for this of course and that we’re providing the semaglutide, but you have to be a California resident. Hopefully that means not everybody’s going to jump off the call, they’re no longer interested, but even if you’re not a California resident, we can’t provide this medication for you. Please stay tuned because I think you’ll learn a lot from the rest of the presentation anyway. Also, people who are on TikTok Live and Instagram Live, if you want to see the presentation, I’m giving the actual slides, then you go to the link in bio and that’ll give you the Zoom link and you can check it out, check out the Zoom. you’ll be able to see the presentation. Otherwise, you can just listen to me here. It’s kind of like radio. I’m trying to make sure I clarify everything for those of you who aren’t able to actually see the presentation.

Now as far as these BMI parameters, I do want to clarify that we try to stick to these parameters as best as possible, but I have seen patients who have a BMI of 29.8 and they don’t meet the 30 cutoff, but they had a history of hypertension and diabetes during pregnancy, so they’re above the 27 and they had obesity related conditions so we will prescribe it to them if they’re close to the cutoff, like 29.8, 29.1. I’m thinking of specific patients. They didn’t meet the 30 cutoff, but they certainly were above the 27, and even though they didn’t currently have hypertension of diabetes, they did have it during their pregnancy so they have a susceptibility to it so we will prescribe for those patients. However, if you have a BMI of 24, we won’t be able to provide you with this medication. We’re just trying to keep a very strict standard and stay on label basically. If you’re a California resident and you have a California address, then we can ship the medication to you.

Moving on, we are not actually using the brand name Ozempic or Wegovy because as many of you may know, there is a lot of back ordering, shortages, and you can go to an FDA shortage list. It’s actually online. You Google FDA shortage list. You can see that all these medications are on shortage to some varying degree. Maybe they have enough of the 0.25 milligrams, which is what you start at, and then you go to 0.5 and then one, 1.7, 2.4. Of those medications, some are on back order, some are not, some are available, but overall the FDA says these medications like Ozempic and Wegovy, which is the active ingredient, and both of those is semaglutide, so the same thing, that those are overall on the shortage list.

Compounding Pharmacies and the FDA Shortage List

Now, when there is a medication on the shortage list, a compounding pharmacy, whether you’ve heard of a compounding pharmacy or not, they’re very much part of the pharmaceutical landscape in the country. Hospitals have compounding pharmacies, and one example that they often use, that the FDA often uses, what a compounding pharmacy does is that if there’s a medication you need to take, but it’s got an ingredient or a dye in it that you’re allergic to, then a compounding pharmacy can make a duplicate of that medication without that dye or that ingredient that you’re allergic to. Then that’s how compounding pharmacies work. Another example is when there was a big shortage of Tylenol, acetaminophen, because all these kids were in the hospital with the triple-demic, RSV, flu and COVID, compounding pharmacies were allowed to make acetaminophen in liquid form.

Compounding pharmacies are around, even if you haven’t heard of them, based on what I’m seeing on social media, people think compounding pharmacies are like the wild west. That’s not the case. They’re very much regulated by state pharmacy boards and the FDA, and specifically when it comes to medications that are on the FDA shortage list, then these compounding pharmacies are allowed to make duplicates of those medications without having to worry about patent infringement. Specifically with outsourcing facilities, it’s a specific designation by the FDA for the compounding pharmacy that we use that they still have to comply with FDA an enforced current good manufacturing practices. The processes have to be validated by the FDA. A lot of people will often say, but compounding pharmaceutical drugs are not FDA approved. That is true. They’re not FDA approved, but that also doesn’t mean that they’re FDA unapproved. These medications are legit, and the processes, their good manufacturing processes have to be validated by the FDA. If they’re not doing something appropriate, the FDA will find out.

In this case, compounding pharmacies are making the semaglutide for us, which again is the active ingredient in Ozempic and Wegovy. Because it’s on the shortage list, they can make it for us, and that’s where we’re getting access and we’ve been able to get access to it for the last two to three months. Now, it won’t necessarily be on the shortage list forever. I think this is going to be a rotating door of different medications within that class of incretin mimetics or GLP-1 receptor agonists that that will come on and off of the FDA shortage list. While semaglutide is on there now, it may not be forever. The other argument that I hear people saying is that semaglutide with an additive may be materially different. Even if it’s not on the shortage list, they can continue making it. For example, we get our semaglutide with B-12. I know some other compounding pharmacies add carnitine, excuse me. They’ll add carnitine, so that means that theoretically that they could continue making these duplicates without patent infringement issues because they’re adding something.

I don’t know that that’s really the case because I don’t know if just adding B-12 makes it materially different, so I’m not really counting on this to be available all the time if it’s not on the shortage list. Like I said, there’ll be other medications coming on the shortage list… excuse me… like tirzepatide. Tirzepatide is the active ingredient in Mounjaro. You may have heard of this one too. This one is currently only FDA approved for type two diabetes, but the company Eli Lilly is working on getting it approved for obesity. People are saying this one’s even better. It is a GLP-1 receptor agonist just like Ozempic and Wegovy, the semaglutide active ingredient that I talked about, but it also has a glucose dependent insulinotropic polypeptide. The combination of these two compounds lead to even greater appetite suppression, and compounding pharmacies are ramping up to duplicate this commercially available drug. We don’t have to worry about patent infringement at this point because tears tirzepatide is currently on the FDA shortage list.

UPDATE TO VIDEO: Guaranteed access to medications is no longer available with the 6-month coaching program if you signed up after midnight as Sunday night, June 4th turned Monday early morning, June 5th. If you read otherwise on this website, this disclaimer here takes precedence.

Side effects of semaglutide, the active ingredient in Ozempic & Wegovy

Let’s talk about some of the side effects or risks. As I mentioned already, one of the ways the medication works is it makes you feel full by slowing how fast food goes from the stomach to the intestines. You feel full, you eat less, you lose weight, but that can also lead to burping, nausea, vomiting, abdominal pain. The insulin secretion that is affected by these medications that acts on the pancreas to release insulin, and because it’s acting on the pancreas, it could cause inflammation on the pancreas or a so-called pancreatitis. It can also lead to dehydration. If you have preexisting kidney problems, that dehydration could affect your kidneys, but as long as you’re well hydrated, which you should be doing anyway, then you should be okay.

Then the other risk that people talk about a lot, and I think it gets maybe unnecessarily more attention than it should is because of the risk, the actual risk it poses to humans, the rats that were being used in the studies for these medications, some of the rats taking the medication were found to have medullary thyroid cancer, but some of the rats that were taking the placebo as part of the control study that weren’t taking the medication also got medullary thyroid cancer. They’re worried about whether humans will start to get medullary thyroid cancer from these medications. Remember, these have been on the market since 2005, and I certainly haven’t heard of a rash of medullary thyroid cancer, which is a very, very rare thyroid cancer. Most people who have thyroid cancer, it’s usually the follicular or papillary type. Medullary is very rare to begin with, and it seems to remain rare even in the face of these medications.

The other thing is that there is something very different about the rat or rodent thyroid that makes it more susceptible to developing Medullary thyroid cancer from these medications that is different than the human thyroid. In fact, the things that make the rat thyroid susceptible, those receptors that are making it more susceptible on the rat thyroid, those receptors do not exist on the healthy human thyroid. If it’s an unhealthy human thyroid, it might be a different issue.

When I say unhealthy, I’m saying that it’s just not normal. It presents these receptors that may make you more susceptible to medullary thyroid cancer, but it is just not turning out to be a rash of medullary thyroid cancer at this point, but if you have a history of MEN type two, which is a genetic disease of multiple endocrine neoplasia type two or a history of medullary thyroid cancer, then they won’t let you take the medication to be safe. Even if you all have a history of those things, we do encourage patients to check their neck once a month to see if they have any lumps or bumps that weren’t there the month before. Then we can obviously address that issue if they do find something like that on their thyroid.

Ozempic Face

Now, Ozempic face, which you’ve heard a lot about in the news, this is a little bit of nonsense. The idea is that Ozempic is causing certain changes in your face when you lose weight. Those facial changes happen regardless of how you lose weight. As long as you’re losing a lot of weight, you’ll lose fat in your face. Some people will lose fat in other places before they’ll lose it in their face. It’s just how you’re genetically predisposed to lose weight. With Ozempic face, it’s not the medication that’s causing you to have this facial wasting. It’s the weight loss that’s causing you to have some facial wasting or giving you a thinner face. It’s not the same thing as HIV and the medications for HIV. That was known to cause lipodystrophy of the face and cause some facial wasting. The medications or the HIV virus itself, it was known to cause those problems.

That’s why the Sculptra… some of you may have used Sculptra for facial volumization. Sculptra was originally approved on the market to treat patients with lipodystrophy who were taking the HIV medications or had HIV. This medication is not causing it in the same sense that those medications were. Ozempic face is just you’re losing weight and if you lose it, if you’re predisposed to losing your weight more in your face more, then that’s what’ll happen. You’ll look thinner in your face.

Weight Management Program

The other thing I mentioned earlier about phentermine is that that was only approved for 90 days, and these medications as of right now are approved indefinitely. With our program, we’re hoping that we can help people get to their goal weight and then they can eventually get off the medications, but technically you could stay on these medications forever. That’s a good segue into talking a little bit more about our program now that we’ve talked about the medications and things like that. Our program, and you’ll see different programs around the country and you can compare and contrast, but the initial consult is 100 dollars, where we evaluate you to make sure that you don’t have any kidney issues, pancreas issues or thyroid issues. Then if you decide to move forward, then you pay the balance of the weight management program, which is $1099 for a total of $1199. That six month program includes a Bluetooth-enabled scale, a journal. We do get baseline labs and then for that six month program, you’ll have coaching with a nurse practitioner on diet and exercise.

Increasing dosages

Dosage adjustment, as I mentioned, we start at 0.25 and move up from there to a max of 2.4. We will be monitoring side effects. If you’re not available to meet once a week virtually or in person, then the alternative we’re providing for patients is we do send out monthly surveys so they can let us know how they’re doing. Once we’ve checked your labs, everything looks like you’re good to go, then we’ll send you a link to actually sign up for the medication. We do this as a medication subscription. We charge $500 every 28 days, $20 is for shipping, and we send you four prefilled syringes of semaglutide that we’re getting from the compounding pharmacy.

Medication injection

We ship it to you as those four prefilled syringes because we actually heard other programs are having the pharmacy ship a vial directly to the patient. Then that means the patient has to know how to drop the right amount of medication from the vial in a syringe. It’s one needle to pull up the medication. It’s a different needle to inject the patient. We felt like that was too many steps. Then if I wasn’t in healthcare, I would be very nervous about pulling up medication out of a vial, making sure I was getting the right amount. That’s why we do the four prefilled syringes to make it as easy as possible.

Then after six months, the medication cost does go up to $520. We don’t make you re-up for the whole $1199 weight management program again after six months. You don’t have to pay that fee again, but the cost does go from $420 to $520. That additional $100 is like a concierge fee so we can continue working with you, can still coach you indefinitely. Our initial program results are still what we’re actually waiting on tabulating, our second month results, but after four weeks, the lowest dose of semaglutide, which is 0.25 milligrams, our average weight loss has been 7.7 pounds.

Weight loss results

Now if you look at this graph, people on TikTok Live and Instagram Live can’t see it, if you want to go to the link in bio, you can switch to Zoom and you can see the presentation and see this graph, but everybody is trending in the downward direction. It’s really great to see. On average, in the first four weeks, lowest dose, 7.7 pound weight loss on average of all of our patients in our cohort. This patient even had a 22.8 pound weight loss, that particular person right there. We had another person who lost 19 pounds, so it’s really exciting to see.

The thing is that even if you’re not losing weight in the first couple weeks, remember it’s the lowest dose. Even if you don’t lose weight in the first month, remember it’s the lowest dose. The thing I’m hearing from patients is that they are actually experiencing this loss of the food noise even after their first injection. They can tell that they are not thinking about food as much. They’re not thinking about their next meal or where it’s coming from or where they’re going to be eating or what they’re going to be eating. They don’t feel the same cravings when they see food commercials. It’s pretty incredible how even if you’re not losing weight initially that you can tell the medication’s working because your appetite is suppressed and you’re not triggered by the food and the commercials and things like that. Really happy to see that and we will continue to follow our patients, continue to track their weight loss and continue to publish results as we get them. Like I said, we’re about to collect our two-month results and we’ll post those as soon as we have them.

How our program works

The program, if this flow chart makes it any easier, the whole process is that you pay the $100 consult fee, you have the consultation in person or virtually, you pay the balance of the program, which is $1099, and then we ship out the journal and scale to you directly. If you happen to be in the office in person, we can actually give it to you. Then we place an order at LabCorp, and you can go to any LabCorp in the United States. Maybe you’re traveling, you’re normally in California, but you’re traveling. You can go to any LabCorp in the United States, walk in, give them your name and they’ll have an order waiting for you. They draw your blood and then we get those results as quickly as sometimes the next day. Then we review your labs and then we send you that link to go to the website to actually sign up for the program so it can be all automated and you actually just pay for that medication subscription online, that $470 I was talking about.

Then once the medications are shipped out to you and you get the medications, then we ask you to give us a call. We can do an injection training online or in person, make sure you know how to do it. Then between the injection training and your first coaching session a week later, we ask you to put information into your journal about what you’re eating, when you’re eating and what kind of exercise you’re doing. That is the process, and you start your first coaching session. Then every 28 days you get automatically charged. Every 28 days we ship out four prefilled syringes with the new updated dosage.

Keeping it simple

Now we try to make this as easy as possible. I’ve just heard of other programs where it’s a little bit more cumbersome. We do try to make this easy for you where you can book online at pacificheightsplasticsurgery.com/contact. You can actually pay for your consult online at the link in bio on TikTok and Instagram. You can actually pay online for the consult online at the link in bio in TikTok and Instagram. You can actually pay online for the consultation. Then you choose whether you’re going to get an in-person or virtual consultation. We can do it via Zoom or FaceTime.

Cost of body contouring procedures

Again, if you go to our website and you’re curious about pricing on anything, our surgical procedures or the weight management program, there’s a get a quote now button in the top right, which will bring you to a price estimator. There’s a chat-bot on the homepage that makes it easy to check pricing. Very transparent about all that. We have a price estimator that you can go through, look at all the categories of the services we offer, whether it’s body contouring or wellness for the weight management program. Then you just input your information and you’ll get an automated email to you so you can actually purchase online or you actually just get a price, you get the estimate and you can follow up with us as needed. You get an automated email that shows you the estimate and you even have links for financing if necessary.

Medication Subscription: Like Netflix but you lose weight!

The benefit, I feel like, to treating this like a Netflix subscription where you go to a website and you upload your credit card details is that you’re securely uploading your credit card. We’re not keeping your credit card on file at the office and you’re automatically charged on schedule without delay every 28 days. That way, by the time you need your next dose for the second month, you’ll have your medication already shipped to you in the mail. If you have any issues with your credit card, like something’s broken down or something like that, you can… by the way, this screen right here is just how you log in and subscribe to the medication, but if you do have an issue with your credit card, it’s easy. You get notified of it and you’re able to update your credit card online. You don’t have to call the office and do all that regular roll. It’s all just really online, the way everything should be to some extent.

We try to make it as easy as possible for you to get as much accomplished before you actually interact with anybody at the office to make it as streamlined as possible. In conclusion, before we go with all the questions, I’m excited about this, and Leslie’s going to come in and help me parse through these questions on Instagram Live and TikTok Live and the Zoom, that if the medication goes off the shortage list, compounding pharmacy can’t make it anymore, then what we’re doing is we are guaranteeing you a six-month supply if you sign up for the six-month program.

Six months worth of medication

Basically we’re stockpiling it for you. We’ve checked the expiration dates are far out enough that that’s fine. If you’re on the six month program and it goes off the shortage list and then the compounding pharmacy can no longer fill new orders, we’ll have enough to help you complete out your six month program. Because I am still a plastic surgeon and that is our main thing is plastic surgery procedures, if you do decide down the road, if you have to lose weight that you want to get a future body contouring procedure, then that $1199 you paid towards the six month program, that’ll go towards your contouring procedure. It doesn’t really counts towards upper eyelids and breast augmentation. It’s really a body contouring procedure like a tummy tuck, liposuction or mommy makeover.

Then we are still waiting on our compounding pharmacy to ramp up and start producing tirzepatide, which is the active ingredient in Mounjaro. Once that’s available, we’ll start to offer that to patients. We don’t know what the pricing will be yet, but we do try to provide a concierge experience with the medication access and administration of it because I’ve talked to people who have insurance, have gotten their insurance approved for this medication, but they can’t get it because it’s so back ordered. We make it really easy. We have, it seems like a plentiful supply of the semaglutide from the compounding pharmacy, and the people are saying they’re having trouble getting it at the pharmacy. They don’t automatically think that the compounding pharmacy is another option.

Anyway, also, we have a flexible coaching schedule. If you’re not available every week for coaching, if you just want to fill out the monthly surveys, that’s fine. Of course, the whole program can be virtual if you need it to be, but to get started and then we’ll take questions, to get started, you can go to the link in bio on Instagram and TikTok, or you can go to our website and you can actually pay and schedule the consultation right now whenever you’re ready. That’s the $100 and we’ll do the consultation and move on from there. If you have any questions, you can email me directly at the email address at the bottom of the screen if you’re on Zoom. Then if you have any questions now on TikTok Live or Instagram Live, we’ll start to take those.

What if the pharmacy is out of Ozempic?

This question is, this patient’s on Ozempic, but the pharmacy is out for six weeks and now can’t get back in consistently and feel stuck. That’s when you would want to reach out to your doctor to call in a prescription to a compounding pharmacy in your state. If you’re in California, we can obviously do it with the program here, but a compounding pharmacy, the doctor can call in the prescription of semaglutide to the compounding pharmacy and sometimes you might have to be delayed to get your insurance to cover it, but insurance will cover it even if it’s from a compounding pharmacy if they choose to.

If you feel stuck and you’re not able to get it, then a compounding pharmacy is an option. We definitely have lots of California residents coming to us. As I said before, with insurance, it’s covered, but they’re just coming to us because I know they’re paying out of pocket, but it’s less expensive than having to pay out of pocket at the pharmacy and they can get it immediately. We have plenty of it for whoever. Multiple patients are from Kaiser. Somebody just commented, Kaiser won’t cover it. One, Kaiser won’t cover it. In some places they won’t cover it, so they come to us. Some places Kaiser won’t cover it, but they can’t get it and so they’ll come to us.

What’s the correct starting dose for Ozempic or Wegovy?

Let’s see. What’s this next question, doctor Put me on 0.25 of Ozempic. Is that good starting dose? Yeah, 0.25 is the standard starting dose. That’s what we start patients on is 0.25. Even if you don’t feel like it’s working, you’ve got to be patient. The reason they start a low dose is because they want to make sure you’re not having some crazy side effects if they started you on the highest dose. I talked to a patient… not one of ours. I talked to a… I didn’t prescribe it to her, but I talked to a patient who had previously got whatever Ozempic doses she could. She got the two milligram dose, the highest dose for Ozempic, and she had horrible side effects, like nausea, vomiting. She was so sick. That’s why we start at the lowest dose to get you more comfortable. Then as we increase, then hopefully any side effects dissipate.

Can you take metformin with Ozempic or Wegovy?

Can you take metformin with it? That’s interesting. Metformin is another diabetes medication. It’s not in the same class but originally, initially when these medications came on the market, they were secondary drugs. They were added to metformin, so you can definitely take these medications with metformin if your doctor prescribes, it if you have diabetes. Now these medications are not a secondary additive to metformin. They’re often sometimes being used in place of metformin because they have a really good side effect profile, meaning they have a relatively low risk of side effects and they work really well and you can take them for as long as you need to.

Have you seen pancreas issues with Ozempic or Wegovy?

Have you seen that many patients have pancreas issues taking semaglutide? I’ve seen no pancreas issues. We’ve been doing this for two to three months now so I might not have seen it yet, but the side effects that we’ve seen, nausea, some vomiting, so we encourage patients to take some over-the-counter medications if they’re really having bad nausea. We can prescribe a Zofran for them, which is a great anti-nausea medication. That’s the situation as far as side effects that we’ve seen, but no pancreas issues, certainly no thyroid issues, no kidney issues. Just the nausea, and vomiting, and headaches. Headaches. Not everybody, but some patients.

We can ship medication to anyone in California

Somebody’s asking, hi, can you get it if you’re in California? Just reach out to us. The link in bio, you can schedule a consultation and pay online for the consultation we can see you. Then if you’re a candidate, then we can start shipping it out to you, but you have to fit within the parameters.

Wegovy is FDA approved for obesity

What is the correct way to ask for medication to help lose weight and manage it? The correct way to ask for it is that remind your doctor, they may not be aware of it, but that you’re looking for Wegovy, which is FDA approved for obesity. If you’re trying to get Ozempic, that’s only FDA approved for type two diabetes, so your insurance may not cover it if you don’t have type two diabetes and you’re taking it for obesity. For insurance to cover it or more likely to cover it, you need to be asking for the medication that is relative to what your issue is. If you have type two diabetes, ask for Ozempic. If you have obesity, ask for Wegovy.

Is burping an issue with Ozempic or Wegovy?

Have I seen a lot of people having burping? Yeah. No, we’ve had some patients talking about having the burps, which is a known side effect and it only means the medication’s working because it’s the delayed gastric emptying. Food’s going more slowly from the stomach to the intestines. You feel more full, you eat less, you lose weight, but that feeling of fullness can also lead to bloating and burping and abdominal pain.

Google semaglutide doctor near me

I cannot work with out of state patients. We can only prescribe the medication in California, but if you are out of state and you’re looking for somebody, Google semaglutide doctor near me; semaglutide doctor near me. Google that in another state and hopefully you’ll be able to find somebody.

Do you have to be on Ozempic or Wegovy long term?

Do you have to be on the meds long term? Our program is six months. We suspect people will be on it longer than six months to get to their goal weight because all those numbers I mentioned, the 15.1% average weight loss, that was over 68 weeks, which is over a year, so certainly more than six months. In our program, we’re trying to hope that with the coaching and for diet and exercise, the behavioral changes with the medication that once you get to your goal weight that you’ll be able to get off the medication, but you’re going to have to go full tilt with the diet and exercise for the rest of your life to try and maintain that weight to minimize the chance of it coming back. If you don’t really stick to the diet and exercise and you go off the medication, you absolutely will gain it back.

That’s not unreasonable. Think about any medication that you go off of. If you go off your hypertension medications, you’re going to get high blood pressure again. Go off your diabetes medication, you get diabetes again. Go off Botox, you’re going to get wrinkles back again. This isn’t a unique drug in that sense. Alrighty. Are we taking new patients? Certainly, yeah. As long as you’re in California, all you have to do is go to the link in bio and you can pay for a consult online, which will notify us that you want a consult. Then we’ll reach out to you and follow up and get all that scheduled.

Metformin for weight loss

Can metformin be prescribed for weight loss or only diabetes? It could definitely be prescribed for weight loss. It’s definitely been used for weight loss in kids. It may be off-label depending on the age group, but you can definitely be prescribed metformin for weight loss. It seems to be, based on the data, that Wegovy and Ozempic, these GLP-1 receptor agonists are much better at weight loss, the semaglutide active ingredient that I’ve mentioned.

Let’s see. This person’s in San Diego. Okay, yeah, so we’re definitely available. We have people throughout the state of California. Since everything’s virtual, it’s not a problem. I am in San Francisco. Does Ozempic help lower blood pressure? Not directly, but because it helps you reduce your weight and you lose weight, that could get you off your hypertension meds. That’s what’s kind of incredible, because they used to be thinking of everything as we’ll treat the diabetes, we’ll treat the high blood pressure. Now they’re realizing that if we treat the obesity, it might get rid of all of it.

Liver transpant and Mounjaro

I’ve had a liver transplant. Is Mounjaro safe for me? There are no side effects specific to the liver with Mounjaro, but obviously you’d want to check with your doctor first to make sure, not a TikTok doctor.

Does diet and exercise alone still work?

Everybody says to lose weight the old fashioned way with diet and exercise alone. Yeah, unfortunately it’s more complicated than that. They’re treating obesity more as a chronic disease now. The thing that I had a little bit of issue with the chronic disease mentality initially was that people weren’t really obese before the 1970s, or a large majority of people weren’t. Now it’s like 40 something percent in the United States, maybe 41% of the United States. 11 million people are considered obese in California.

Anyway, the idea was that we always started getting obese in the 1970s once the FDA started recommending these food pyramids that encouraged breakfast of cereals and bread and pastas and things like that, so we started this high carb, refined sugar diet. That’s when we started getting obese. I’m thinking, well, how is it a chronic disease if this really is just related to the food we were eating and that that’s kind of in our natural American diet?

The idea is, and there’s been studies and data and experiments to test this idea, that the high fat, high carb diet actually physically changes the synapses in the hypothalamus or somewhere else in the brain that increases your body set weight. Basically it increases your thermostat of what your weight is. If you’re eating less or eating more, exercising or not exercising, your body has a thermostat where it always tries to return to that body set weight. With those highly refined sugars, it increases that body set weight, so then you start to gain weight. Those changes based on that diet make physical changes in the brain that increases your body set weight, and that’s how the idea is it becomes a chronic disease.
It’s not just because it started in the 1970s. It’s our diet. If you can avoid that type of diet your whole life, then maybe it won’t, or reset your body set weight, but that’s the problem is that with our natural American diet that the body set weight is increasing and that’s why they’re treating it as the disease now because there’s a physical change in the brain.

Do you have to have diabetes to get Ozempic, Wegovy or Mounjaro?

Somebody’s asking, would you give Ozempic or Mounjaro to someone without diabetes? That’s kind of what we’re talking about here is that those medications, these GLP-1 receptor agonists, they can be prescribed. Ozempic and Mounjaro could absolutely be prescribed off-label for obesity because they’re for type two diabetes, but then Wegovy is FDA approved for obesity, so it’s totally natural and appropriate and on-label to prescribe Wegovy for patients for obesity that don’t have type two diabetes. That’s totally fine. I know people online get upset like, the Wegovy patients, obesity patients are taking it away from the type two diabetics, but the thing is the obesity patients are eventually going to get type two diabetes and high blood pressure. If we can keep them from getting those, then that’s appropriate, and the fact that it’s FDA approved for obesity is appropriate. Mounjaro, just like Ozempic re-marketed and got approved, Wegovy, for obesity, Mounjaro is actively getting approval from the FDA for a new drug with a new name that I’m not familiar with yet that is going to be a Mounjaro specifically for obesity that’s FDA approved.

Is it ok to take Ozempic or Wegovy to lose just a few pounds?

Some people are taking it to lose 15 or 20 pounds and that’s not okay. Well, it depends on what their B M I was before. If they fit the parameters for a BMI and they lose 10 to 20 pounds and they’re losing weight and they’re getting off other medications, then I can’t disagree with that if they met the parameters beforehand, but if somebody’s below the parameters, like significantly below 27 BMI without other obesity related diseases, then we wouldn’t be prescribing it because that would be considered off label, but it’s not illegal.

Will sugar drop too low with Ozempic or Wegovy?

Should I worry my sugar will drop on Wegovy since I’m not by a diabetic? Excellent question. These drugs, these glucagon-like peptides or glucose dependent insulinotropic polypeptide, those different compounds, those GI hormones that these medications are mimicking, they actually adjust your insulin dosage based on how much glucose is in the bloodstream to avoid or minimizes the chance of you having your sugar drop too low. Certainly always a risk, but these drugs work really well. They have these good feedbacks where the body has a great feedback system where if it feels like the sugar’s getting too low that it won’t continue to increase insulin production even though you’re taking the medication. The body actually has a stopgap measure for that or a safety measure.

Thoughts on someone with kidney issues taking this? That is definitely a known issue that if you take these medications, they can make you dehydrated, which could affect your kidneys, and if you already have kidney dysfunction that could make you susceptible to that problem. What we’re mostly telling everybody is that and what the drug inserts are telling people is that just stay well-hydrated on these medications to minimize the chance of that happening, but it is certainly a known side effect that there could be some kidney dysfunction because of dehydration from the medications.

Are there long term side effects with Ozempic or Wegovy?

Long-term side effects with Wegovy, well, they’ve been around for 20 years. They found that the rats that were on it for long periods of time were at increased risk of getting medullary thyroid cancer. Not all of the rats. Again, some of the rats that were taking placebo, not actually taking the drug in the studies, even they got medullary thyroid cancer. If you’re taking based on what the rats are experiencing, then theoretically, the longer you’re on it, you may have an increased risk of medullary thyroid cancer, but it’s really not translating in a one-to-one ratio with humans. It’s just not based on the data.

Ozempic and weight loss surgery?

I’m about to have weight loss surgery and I’m still on Ozempic. That’s actually happening with a lot of people who are getting bariatric surgery. They’re starting people on these weight loss medications, but they do stop it a couple weeks before surgery to minimize the issues with nausea, vomiting and things like that, but that’s not unheard of that bariatric surgery patients are on these medications before and after surgery, just not right before surgery or they hold it for two weeks. There’s some talk that Mounjaro is giving people weight loss that’s consistent with bariatric surgery results, so that’s kind of crazy if that was really possible.

Pancreatitis with Ozempic or Wegovy?

A lot of people are just saying thank you and nice things. I’m just looking for an actual question. I had pancreas pain at one milligram. Is this normal? I don’t want to say pancreas pain is normal, but it is certainly a known side effect of these medications that you can have pancreatitis, inflammation of the pancreas, which you can diagnose with abdominal pain and lab studies to see if the pancreas is inflamed or not.

Is semaglutide, Ozempic, Wegovy a shot or a pill?

Is this a shot or pill? Again, Ozempic, Wegovy, the semaglutide we’re getting from the compounding pharmacy, those are once per week injections. Saxenda is a daily injection, just to give you some background. Saxenda and Wegovy are both approved in kids for obesity now from 12 to 17. Saxenda has been approved for kids 12 to 17. Wegovy just got approved for kids 12 to 17 with obesity, but it is a daily injection for Saxenda. As far as the pill form, as I mentioned earlier, Rybelsus is an oral version of semaglutide, and that does not seem to work as well as far as the weight loss because again, the drug was originally for type two diabetes, but if we could get an oral drug that worked as well as the injections, that certainly we’d want to do the oral. Based on what I’m seeing, the Rybelsus oral medication, semaglutide active ingredient in Ozempic and Wegovy, not as effective as the injectable version.

Insurance coverage for Ozempic and Wegovy?

I do so many prior authorizations for this medication in a day. Yeah. That’s the benefit. I know $470 a month is more expensive than most people want to spend on this possibly, but it does work and you are paying for the convenience of not ever having to deal with prior authorization, not having to be delayed by the insurance, not sitting on hold with the insurance company and not having to go to the pharmacy and realize that they don’t have any of the medication you need. $500 for the convenience of getting it when you want it, when need it, getting it on time every month without fail, there’s something to be said about that.

Trulicity for weight loss?

Does Trulicity work? Trulicity is another GLP-1 receptor agonist and that one works as well. This person had severe gas pain caused by Ozempic. That’s part of the delayed gastric emptying, the bloating. What happens when people stop taking the medication? Well, just like with anything, there’s the risk that you would gain it all back. Just like if you stop taking your blood pressure medication, you get your high blood pressure again, but that’s why our six month program, we really try to help with behavior changes with diet and exercise so that eventually when you get your goal weight and you want to get off the medication that hopefully with going full tilt for the rest of your life on diet and exercise, the not easy part, then you can hopefully keep from gaining all your weight back.

Reputable compounding pharmacy?

How do you find a reputable compounding pharmacy? If they have a license from the State Board of Pharmacy, I’d like to say that they’re reputable, but the one we’re using that’s making these duplicates, they’re a 503B compounding pharmacy. I’ll just go back. If you’re on Zoom, if anybody’s on Zoom, I can go back to this and show you, but the compounding pharmacy that we’re working with, the 503B compounding pharmacy is considered an outsourcing facility and that means they’re registered with the FDA and you can actually go and find all the compounding pharmacies in the country that are registered outsourcing facilities, 503B outsourcing facilities, that are on the FDA website where you can actually see, and then you can see if any of those compounding pharmacies are in your state. Even if they’re not in your hometown, you should be able to get them shipped to you and get the doctor to write the prescription for you if you’re outside of California. If you’re in California, then you just reach out to us and we can get the medication for you.

How long until I see results with Ozempic or Wegovy?

On Wegovy. Just started. How long until you see results? Everybody’s different. Like I said, in first month, we’ve had some patients lose 22.8 pounds. Some patients lost no weight, but people didn’t gain weight and they could tell that the food noise was gone and that they didn’t have any issues with… they weren’t feeling those cravings from food. Mounjaro was denied even though it’s half the price of Trulicity. That’s another thing that people were telling me is that they’re getting these $25 coupons for these medications. Just keep in mind that the medications are maybe less expensive initially, but then eventually the coupons run out and then they go back to the regular place, which could be $1,100, $1,300, $1,400. Just be prepared that the $25 gravy train may not last forever. Then hopefully you can get insurance to cover more of it, or if you’re in California, we can help if you pay out of pocket because ours may be less expensive without insurance than what your copay might be. Keep that in mind.

Does Ozempic or Wegovy affect fertility?

Does it affect fertility? There’s no evidence that it affects fertility. The one other thing I’ll mention also related to kids is that according to the government lactmed website, which shows what kind of drugs go through breast milk and what drugs are safe for to breastfeed on, they say that semaglutide, that it’s such a small molecule that it may not even get into the breast milk and that even if it gets into the breast milk, it probably just gets destroyed in the baby’s stomach acid, so you can actually breastfeed on these medications according to the lactmed website.

Does Ozempic and Wegovy reduce cravings for alcohol?

It cut my craving for alcohol, which is good. That’s a lot of calories. Did you address how to prevent Ozempic face? That really all comes down to when you lose weight, where your body will lose weight, where you’re typically going to lose weight from. Maybe more people lose weight in their hips, their thighs, maybe more people lose weight in their face. Whatever weight loss you’re doing, it doesn’t matter what drug you’re taking. If you’re losing weight and you tend to lose weight in your face first, lose fat in your face first, then you could have what’s called Ozempic face. There’s no way to avoid that if that’s where you are predisposed to losing weight is in your face, but the way to treat that, of course, is with fillers and things like that, which sounds like an upsell, but I don’t mean for it to be.

Ozempic and Wegovy get rid of the “food noise”

People like the idea that no food chatter in my head. Yeah. I’ve heard it from a lot of patients. I’d never heard that before until we started working with patients on semaglutide. It is very satisfying to get that insight into what patients are dealing with. How much are the injections? As I mentioned, if you’re in the program, that’s $1199. Then the medications are $500 every 28 days. $20 is for shipping and that’s $500 every 28 days for six months. Then after six months at the end of the weight management program, we don’t make you re-up for the whole weight management program, but the price does go up from $500 to $570, so basically it’s a concierge fee, an extra $100. We still continue working with you, but you don’t have to keep coming up with that $1199.

True food obsession is gone. This is really great to hear that. It’s very great to hear patients that these drugs are really apparently living up to the hype. Now, it’s unfortunate for the 17% that according to the study that didn’t have a result or any effect, but I’m happy for the 83% that are having some effects or benefits.

Delayed gastric emptying with Ozempic and Wegovy

People are asking about the slow gastric release or the delayed gastric empty. Yeah. That’s partly drug works. The drug works in three ways; semaglutide works in three ways, semaglutide being the active ingredient in Ozempic and Wegovy. they all act in this way. They help increase insulin, which contributes to satiety, suppresses your appetite we think in the hypothalamus. Then third is delayed gastric gifting, so food moves more slowly from the stomach to the intestines. You feel more full, you eat less, you lose weight, but yes, that can contribute to burping, bloating and abdominal pain, nausea, and vomiting. That’s certainly a possibility. Then hopefully you can treat that with over-the-counter medications or Zofran. We can prescribe Zofran for you if you’re in California, but then the other thing is that keep in mind that even if you are having some of these side effects, as long as you feel like the benefits outweigh the risks, then you can continue the medication. I see GasX is a great over-the-counter medication for those with burping and abdominal bloating.

Avoid sugar while on Ozmepic or Wegovy?

Should you avoid eating sugar? Certainly you don’t need sugar to live. If you’re trying to stay on a healthy diet, then sugar’s not great, but that does lead me to another point, is that you want to avoid foods that do cause bloating, things like beans and lentils, things that you know cause bloating. You should avoid those foods because the medication can cause bloating and you certainly don’t want to compound that.

Bloating with Ozempic or Wegovy?

Do I find that Ozempic is more of the bloating and heartburn versus Wegovy versus Mounjaro? Well, I wouldn’t believe that there’s any difference in Ozempic and Wegovy because there’s the same active ingredient, semaglutide, but I have not heard if it’s worse or better as far as the bloating and heartburn with Mounjaro. That’s in the same class of medications, but it is a different active ingredient, so I don’t really have an answer for that. Definitely helps people with PCOS. We have a lot of patients who are overweight with PCOS and they’re losing weight with it.

Getting off Ozempic or Wegovy after hitting maximum dose

Someone’s been on 2.4 milligrams, the highest dosage. If you’ve gotten your goal weight, then you can try to get off, and as long as you’re doing diet and exercise, but if you’re not doing diet and exercise the way you should be and you get off the medication, you’re going to regain the weight.

Is obesity a chronic disease?

It’s hard to get a prescription. Yeah. The other thing I’ve heard from people is that doctors aren’t prescribing it because some of them don’t believe that obesity is a chronic disease, which is the new thinking. I’m not really telling these doctors what they should be thinking, but there’s obviously a shortfall in telling people that diet and exercise is all you need to do. This is a medication that works.

I know we’re worried about getting more dependent in this country on other medications, but if this medication really helps you lose weight and you get off the diabetes meds, you get off the hypertension meds, you get rid of your sleep apnea, you’re sleeping better, you’re performing better at work, you’re more productive, it’s kind of hard to say that’s a bad thing, but it is hard to get a prescription because some doctors won’t give it to you, but that’s the benefit of going to a doctor that… I know people don’t necessarily want to pay out of pocket, but you get what you pay for and you get the convenience of not having to wait in lines with the pharmacy, not having to stay on the phone with the insurance company.
I get that not everybody has $470 a month, but that is the truth is that with that additional cost of paying out of pocket, not going through insurance. keep in mind that $470 is way less expensive than what the out-of-pocket cost is if you just buy the name brand drug, so it’s still less expensive than that, but you definitely have the convenience of getting it shipped to you, not having to wait in line at the pharmacy or not waiting on hold at with the insurance company, not having to be told by the pharmacy that your medication’s not available because it’s back-ordered.

Gallbladder issues with Ozempic?

Does not having a gallbladder a problem with Ozempic? No, that’s not a problem. Would you recommend a mommy makeover after bariatric surgery? That’s something we do a lot as far as surgery. After bariatric surgery, after massive weight loss the way we term it, after massive weight loss, once your weight is at a stable level for about three months, then you’re a candidate for a body contouring surgery, which is like a tummy tuck, removing the excess skin. If your breasts are really droopy after breastfeeding after massive weight loss, we can do a breast lift, put in implants. Yeah. We do a lot of mommy makeovers after massive weight loss. The patients have to understand that it may take multiple stages because they might have a lot of sagging skin everywhere. Their arms, their thighs, their breasts, their abdomen, their back, their buttocks might be sagging. We can lift the buttocks, we can remove the excess skin in abdomen. We can remove the excess from the arms. We just can’t always do it all at the same time, so it may take multiple stages. Good question.

Ozempic and Wegovy for type 1 diabetics?

Is it okay for type one diabetics? The thing is that these really are not prescribed for type one diabetics. Type one diabetics are insulin dependent. Type two diabetes, like over 90% of those patients, their type two diabetes is from obesity. By taking this drug, if you have obesity, you can avoid getting type two diabetes is the idea and hopefully avoid getting a high blood pressure and all the other things that go along with obesity. That’s the benefit of this medication. It can avoid those things, but with type one diabetes, that’s insulin dependent.

That’s another thing that people are getting confused on social media. They’re saying that people are dying because they can’t get their Ozempic. Well, type two diabetics aren’t dying because they can’t get Ozempic. A type one diabetic who can’t get insulin, yes, they would die. They have to have it. They are dependent on insulin for their life. A person who can’t get Ozempic, there’s multiple other medications within this class of drugs, incretin mimetics, the GLP-1 receptor agonists. I’m not saying it’s convenient to switch from Ozempic to Trulicity to Saxenda or Byetta, these other drugs, but there are other drugs within this class, whereas insulin, it’s insulin. That’s all you’ve got. These drugs are not specifically not for type one diabetes.

Questions from Instagram Live

Let me pull up Instagram Live here and see what questions we have here. All right. Yeah. if somebody’s having nausea, can they stay on the low dose and then get something for the nausea? Yeah. People who are getting nauseated from any dose, the low dose including, that you can stay on the low dose because if you’re having nausea at that level, we don’t necessarily want increase it and you might have worse nausea, but what we can do is keep you at the low dose, give you some Zofran to help you with the nausea, which I hate having to add on other medications, but you want at least see if you can tolerate this before giving up on it too soon.

Anyway, if you are on the low dose and you have nausea, then we can prescribe a Zofran for you and then we can wait and see if the nausea eventually dissipates and then we can increase from there, but you may still have some weight loss even at that lowest dose. We provided Zofran as our anti-nausea medication of choice. It’s really great. You put it under your tongue. Even if you’re throwing up, like how can you keep it down? Well, could you put it under your tongue and it dissolves, so Zofran’s great for that.

There’s people who have reflux or nausea intermittently before these medications and they’re already taking over-the-counter medications for that. You can continue taking those over-the-counter medications even once you start these medications, just in case the nausea maybe gets worse or stays the same. This patient says Zofran works great. She has nausea from her Mounjaro, but the Zofran works great for the nausea.

More information on body contouring

How can I get information on body contouring surgery? I’m two years off from my bariatric surgery. You can just go to our website, realdrbae.com. The same handle as Instagram Live, same handle as Instagram, TikTok, R-E-A-L D-R B-A-E, not B-A-Y. R-E-A-L D-R B-A-E dot com, and you can read all about body contouring on our website and schedule a consultation there. Is this a lifelong medication? As I mentioned before, we’d like it not to be. You can take it forever. That’s the difference between this and phentermine, which you can only take for 90 days on label, but these medications are allowed to be taken forever, but we really hope that we’ll be able to help you with behavioral changes in our program to get you down to your goal weight with diet, exercise, and medication. Once you get off the medication, as long as you stick with the diet and exercise, then hopefully you’ll be able to maintain your weight.
Let’s see. Do you do video consults? Yeah, our entire program is virtual. We do consults on FaceTime if you have an iPhone. If you don’t have an iPhone, then we offer Zoom. Yeah. I’m in California. Where can I get a consultation with you? Yeah. If you’re in California, it’s very easy. Just go to the link in bio. You’re on TikTok right now. Go to the link in our bio. You can actually pay for the consult online and then we’ll reach out to you, get you scheduled as soon as possible for a video consultation if you’re not nearby. Even if you’re nearby, I do consultations virtually with patients who are right here in the city in the same neighborhood. It’s pretty convenient. We’ll be able have these virtual consultations. As long as you live in California we can help you, but if you’re in Iowa, then Google semaglutide doctor near me; semaglutide doctor near me, and see if you can find something in Iowa. I cannot prescribe to people outside of California.

Wow. Lots of questions here. All right. Okay, we are at 10:00. It’s been an hour. I have a patient actually right now who’s actually doing an injection training, I believe a virtual injection training, which means that they did the consult, decided to move forward with the program, went online, purchased the medication subscription for the $470 every 28 days. She got the medication. She reached out to us, let us know that she got the medication, so now we’re showing her how to do the injection. Again, these are four prefilled syringes that we send every month with the new higher dose. We don’t send it to you as a vial and expect you to pull up the right amount of medication from the vial and then inject it with a different needle. I’m afraid that’s just too confusing if you’re not in the healthcare field, so we do send the four prefilled syringes and we show you how to do the injection virtually or in person, but everything, the entire program is potentially via video or virtual.

Program cost

The program cost, it’s $100 for the consult. That’s applied to the $1199 six month program fee, so that brings that down to $1099, so the total for the six month program is $1199 and then the medications are $470 every month for the first six months, and then it goes up to $570 per month after the six months, but we don’t make you re-up for the whole program management fee, the $1199 after the six months. You only do that once.

Gaining weight after stopping the medication?

Yeah. Somebody’s asking if you get to your goal weight but you’re afraid of gaining weight, can you lower your dosage to maintain your weight? That’s one option is you can lower the dosage to maintain your weight. The other option that I hear people talking about is they’re actually doing the medication, instead of doing it every week, they’re doing it every other week. Once they get to their goal weight, if they’re afraid of going off of a cold turkey, you absolutely can go and just do it less frequently. That’s totally okay.

Compounded version of Mounjaro, Tirzepatide

Will you be offering the compounded version of Mounjaro or tirzepatide? We’re waiting on our compounding pharmacy to release that. They are ramping up right now. Once that’s available, we’ll let you know and we’ll make that available. We’re not sure what the cost yet. Is this recorded? Yes, this is recorded. You’ll get an email with a link to the recording, I think tomorrow you’ll get it.

Somebody starts the program above 30 and then they drop below 27. Can they continue the medication? They can because obviously they started when they were above the parameters, but then you have to decision to make. What is your goal to get to and can you maintain that without the medication on diet and exercise alone? If you can avoid giving yourself weekly injections, I think it’s worth trying. I would say that maybe you taper off to see if you can maintain your way with diet and exercise with just doing it once every other week and then go from there and then eventually maybe tapering it off completely.

Is it possible this will be offered in pill form? Right now it’s available as in Rybelsus. If you’ve heard of the drug Rybelsus, that is the oral version of semaglutide, but the weight loss does not seem to be as effective. If somebody comes out with another semaglutide or another oral form of a GLP-1 receptor agonist that has great weight loss, then yeah, that will be the route of choice. People would like to avoid an injection if they could. Will those of us on semaglutide be able to switch over to tirzepatide? We will make it available. There may be a price difference. I don’t know yet. I don’t really like the idea of feeling like we’re upselling people to a more expensive medication, but according to everything I’m reading Mounjaro or tirzepatide, it works even better than semaglutide.

Pricing for tirzepatide

Once we know the pricing, we will let our existing patients know that that is an option to switch them over to tirzepatide, but we would probably need to get some document signed in writing showing that you understand that we are switching you to your new medication. We don’t want anybody to feel like they didn’t know they were being switched over. It would definitely require your approval and your consent to switch over and then we would let you know, but we would definitely make that an option for you for sure if we have access to tirzepatide, which hopefully will be soon. UPDATE: Tirzepatide available for $600 subscription, charged every 28 days.

All right. Well, thank you all so much again. I appreciate everybody’s attention. Yeah. This will be recorded so you’ll get it in about a day. Take care.

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