Author: Vukuzenzele

Today, we helped 30+ patients.

A happy Egyptian soon-to-be-mom and a proud husband.

Refugee families from Moldova and Russia – they don’t like the vaccines.

A big friendly refugee family from Zambia.

An even bigger refugee family – brothers (from Syria and Iraq) with their spouse and children.

A former Afghan police officer here on asylum.

A Cuban asylum family – mom, dad and their adorable boy. Father and son with matching outfits – black t-shirt, jeans, gold chain).

A Taiwanese-Chinese same-sex couple.

A very polite Indian family of four.

Chinese woman – works in business marketing. Obviously a smart lady.

Another Cuban – single guy, starting new job. Waiting for insurance to kick in.

Every single one – trying to make a new life here in America, the great land of freedom & opportunity.

I woke up this morning early before the kids to enjoy a cup of coffee in the cold morning here. While scanning the news, I saw a mention of “aortic aneurysm”, headlined on the CNN website – an unusual topic.

There is big news coverage of an exciting World Cup in Qatar (Morocco in its unlikely run for the title and Messi in the finals, his last chance for World Cup win).

One of the lead American reporters there, Grant Wahl, had unexpectedly died on Dec 10, 2022. A young man, apparently healthy, whose wife is a leading public health physician. It was a shocking tragedy amidst the festivities.

Many people, of course, wondered what happened. Today, it appears the autopsy report says he had an aortic aneurysm (sounds like it was in his chest).

What is an aorta? What is an aneurysm?

The aorta is the largest primary blood vessel carrying blood out of the heart and into the rest of the body. It travels, with all the blood of each heart beat, from the heart, upwards towards the neck briefly, then twisting downwards to the midline chest and towards the lower abdomen. Along the way, it splits off smaller blood vessels to supply the rest of the body.

The aorta is a high pressure vessel – so, like a rubber hose, it expands and contracts with the pressure. With age and some medical conditions, there’s an increasing risk that a part of the rubber hose becomes defective and causes an out-pouching.

That out-pouching is an aneurysm. An aneurysm can happen anywhere along the aorta – from the heart down to the abdomen. If it is in the chest, we call it a Thoracic Aortic Aneurysm. If in the abdomen, Abdominal Aortic Aneurysm.

Both can be very dangerous. Both can be fixed – if you can find it in time.

As a family medicine physician, I see patients for general wellness exams and for all sorts of complaints. The concern for aneurysms are often in my thoughts – why?

The literature describes an aneurysm as silent – meaning no significant symptoms – until it becomes large and suddenly rupture. Symptoms, if there are any, is not exact or precise – they describe chest or abdomen pressure, “tearing pain”, etc. The window for a diagnosis (the time between presenting symptoms and catastrophic rupture) is small. Even if the doctor found the aneurysm, there is still the time it takes to set up surgery & repair!

I remember a study estimating that 50% of patients with a ruptured aneurysm do not make it to the hospital. Of the 50% that make it to the hospital, half that group will not survive.

That is all to say, an aneurysm can grow to a dangerous size and rupture (kill) suddenly. Much better to find it ahead of time.

Who is at risk? The data below is for abdominal aortic aneurysm, but likely similar for thoracic aneurysm also.

• For men 55-64 yo, AAA <4.0cm prevalence is ~1%. Then increase by 2-4% each 10 years after. For men >60 yo, AAA is about 3-5% prevalence, some studies show as high as 9%.

• How about women? Less common than men. >60 yo women ~0.37-1.53%.
  • Age 60-70 yo ~0.43%. Age 70-80 ~1.15%. Age >80 yo ~1.67%.

• Smoking – the more cigarettes the higher the risk. If a person smokes 1/2 pack a day for 10 years – the risk is increased by 260%. If 1 pack a day or more for 10 years – the risk is increased by 1210%!

• If there is family history of abdominal aortic aneurysms – the risk is 200-400% greater. 

Then the question is – among day to day clinics patients, who should we consider checking for an aneurysm? This is the “too-long didn’t read” section.

1. Family history of aneurysms. Aneurysms run in the family – due to genetically-programmed abnormal connective proteins forming the basis of tissue in the body. Some family genetics have a more “loose” connective tissue – leading to risk of aneurysms, joint dislocations, tendon ruptures, etc. If the family has a “connective tissue disorder” (Marfans, Ehlers-Danlos, etc.) or has a history of aneurysms (brain aneurysm, thoracic or abdomen aneurysm – especially at young age) – I would consider doing screening tests *see options below.
2. High risk persons – especially, older men who are smokers and has high blood pressure. I care for many East Asian patients, many of whom use tobacco – the tobacco (nicotine) damages blood vessels over time, weakening it. High blood pressure also increases the chance of out-pouching – think of blowing a balloon. Age also weakens the blood vessels, but we don’t have a medicine for that yet.
   • The USPSTF (see link below) recommends a screening ultrasound for ABDOMEN aortic aneurysm for MEN between 65-75, who has EVER smoked. In the US, this should be 100% covered by health insurance.
   • The USPSTF do not recommend screening test for women, even if they are smokers. However, I’ve spoken with vascular specialists who disagree.

Ok, what tests are available?

1. For abdomen aortic aneurysm – we use an abdominal ultrasound. In my area, it costs about $150 (2022) if no insurance. It is fast, basically no-risk, and there is no radiation.
2. For chest (thoracic) aortic aneurysm – it would be between an echocardiogram or CT-scan (with contrast). The vascular specialists and surgeons prefer CT-scan, but that is high cost and has lots of radiation.

What if an aneurysm is found?

1. Monitor the aneurysm. The bigger the aneurysm, the faster it grows and higher chance of sudden rupture. Depending on the size, it can be monitored with repeat imaging or if reaches certain criteria, will be referred to see the vascular surgeon for repair
2. Control the risk factors! (Talk to your doctor about specifics.)
   • Keep blood pressure under control.
   • Stop smoking.
   • Avoid exercises that increases chest & abdomen pressure (such as weight-lifting). 
   • Some medications – statins and baby aspirin – can reduce risk of progression & rupture.
   • Generally for my patients, I avoid fluoroquinolone antibiotics (Levaquin, levofloxacin, ciprofloxacin, moxifloxacin). This class of antibiotics may increase risk of rupture.

The main thing is I would remind every male smoker or former smoker that is 65 years or older, to ask their doctor about getting screening ultrasound. A simple, fast and affordable test that can save your life.

Reference:

1. USPSTF : https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/abdominal-aortic-aneurysm-screening

Oбъединяемся за Украинy (Unite for Ukraine); Медицинские Tребования 

Программа «Объединяемся за Украину» была создана ранее в этом году (2022) как гуманитарный ответ на российское вторжение в Украину. Эта программа в ускоренном порядке помогла украинцам, пострадавшим от войны. Когда они прибывают в США, USCIS (Служба гражданства и иммиграции США) опубликовала список медицинских требований. 

Как гражданский хирург (доктор), я недавно получил звонки от Unite for Ukraine беженцов и их спонсоров с вопросами об этих требованиях. По этому поводу не было опубликованных руководств или каких-либо уведомлений от USCIS для гражданских хирургов, поэтому у гражданских хирургов нет никакой дополнительной информации. 

После того, как я получил эти звонки, я просмотрел некоторые общедоступные документы из USCIS и поговорил с местными властями, и вот что я узнал на данный момент (обновлено 30.07.2022) о медицинских требованиях: 

*** ЭТО НЕ ИММИГРАЦИОННЫЙ МЕДИЦИНСКИЙ ОСМОТР I693 ГРАЖДАНСКИМ ХИРУРГОМ ***.  

• Иммиграционный экзамен Civil Surgeon I693 стоит 300-550 долларов в Портленде и не покрывается программой Medicaid или какой-либо страховкой.  
• Медицинские услуги Unite for Ukraine могут быть выполнены в ЛЮБОЙ поликлинике и покрываются страховкой или программой Medicaid.  
• см.: https://www.uscis.gov/humanitarian/uniting-for-ukraine/frequently-asked-questions-about-uniting-for-ukraine —> «Медицинский осмотр и вакцинация».  

Как засвидетельствовать?  

• Каждый условно-досрочно освобожденный подписывает свой профиль / учетную запись USCIS, и где-то там есть возможность пройти самоаттестацию на вакцины (Meales, полиомиелит, COVID) и тест на туберкулез. Они верят условно-досрочно освобожденному на слово. 
•  *** НЕТ никаких документов (справка от врача, правительственная форма, результаты лабораторных исследований и т. д.), которые необходимо предоставить *** 

Каковы временные рамки?  

• Первоначально эти медицинские требования должны были быть выполнены в течение 14 дней, но с 13.07.2022 этот срок был продлен до 90 дней с момента прибытия. 

•  См.: (https://www.uscis.gov/newsroom/alerts/time-frame-extended-for-uniting-for-ukraine-parolees-to-comply-with-medical-screening-and) 

 Что требуется?  

• Вакцины: требуется как минимум 1 вакцина против кори, 1 вакцина против полиомиелита и 1 вакцина против COVID. Все эти вакцины являются сериями (более 1 вакцины, требующей ревакцинации), но вам не нужно завершать серию перед аттестацией.  
• Тест на туберкулез: тест T-SPOT или Quantiferon Gold TB.  
• *Есть несколько исключений для вакцин и тестов на туберкулез.  

• Подробности читайте по ссылке USCIS. См.: https://www.uscis.gov/humanitarian/uniting-for-ukraine/uniting-for-ukraine-vaccine-attestation.  

Сколько стоят эти вакцины и тесты, если у вас нет страховки или Medicaid?  

• Вакцина против полиомиелита = (ожидается цена/местоположение) — нечасто продается в аптеках.  
• Вакцина против кори (MMR) = 90-100 долларов США в аптеке с купоном Goodrx.com  
• Вакцина от COVID = бесплатно в аптеке.  

• Вакцины обычно на 100% покрываются программой Medicaid или страховкой.  
• Тест на туберкулез = ~140 долларов для незастрахованных пациентов в моей клинике. Есть также бесплатные варианты тестирования на туберкулез в округе. См. приведенный ниже список бесплатных тестов на туберкулез (НО НЕ ВАКЦИНЫ)  

Пожалуйста, пишите, если у вас есть вопросы (info@interstitium.me) или хотите назначить встречу – бесплатно для условно-досрочно освобожденных Unite for Ukraine. 

Контакты ресурсов 

Последнее обновление: 24.06.2022 

Область	Телефонный номер	Примечания
Clackamas County	503-655-8411	Бесплатное тестирование на туберкулез и прививки
Marion County	503-588-5342	Call Main clinic number to schedule blood draw M-Th
Multnomah County	503-988-3406	Позвоните, чтобы записаться на прием в QFT
Washington County	503-846-3594	Позвоните на основную линию и уточните статус UforU и потребность в IGRA

The United for Ukraine program was created earlier this year (2022) as a humanitarian response to the Russian invasion of Ukraine. This program brought over Ukrainians affected by the war under an expedited process. As they arrive to the US, the USCIS (United States Citizenship & Immigration Services) has published a number of medical requirements.

As a Civil Surgeon, I recently received calls from Unite for Ukraine parolees or their sponsors asking about these requirements. There has been no published guidelines or any notifications from the USCIS to the Civil Surgeons on this matter – so Civil Surgeons don’t have any additional information.

After I received these calls, I reviewed some of the public documents from the USCIS and spoken with local officials and here is what I learned so far (updated 07/30/2022) re medical requirements:

1. ***THIS IS NOT THE I693 IMMIGRATION MEDICAL EXAM by CIVIL SURGEONS ***.
   • The Civil Surgeon I693 immigration exam costs $300-550 in Portland and is not covered by medicaid or any insurances.
   • The Unite for Ukraine medical requirements can be done by ANY doctor’s office and is covered by insurance or medicaid.
   • see: https://www.uscis.gov/humanitarian/uniting-for-ukraine/frequently-asked-questions-about-uniting-for-ukraine —> “Medical Screening and Vaccinations”.
2. How to attest? Each parolee signs onto their USCIS profile / account and, somewhere in there, is an option to self-attest to the vaccines (Meales, Polio, COVID) and TB test. They are taking the parolee at their word.
   • *** There is NO paperwork (doctors note, government form, lab results, etc.) that needs to be submitted***
3. What is the time frame? 
   • These medical Requirements was initially to be done within 14 days, but as of 07/13/2022, this has been extended to 90 days of arrival. See: (https://www.uscis.gov/newsroom/alerts/time-frame-extended-for-uniting-for-ukraine-parolees-to-comply-with-medical-screening-and)
4. What is required? 
   • Vaccines: Need at least 1 measles vaccine, 1 polio vaccine, and 1 COVID vaccine. All these vaccines are series (more than 1, requiring boosters) but you do not need to complete the series before attesting. 
   • TB test: T-SPOT or Quantiferon Gold TB test. 
   • *There are a few exceptions for the vaccines & TB test. Read the USCIS link for details. 
   • See: https://www.uscis.gov/humanitarian/uniting-for-ukraine/uniting-for-ukraine-vaccine-attestation
5. How much do these vaccines & tests cost if you don’t have insurance or medicaid?
   • Polio vaccine = (pending pricing / location) — not frequently carried by pharmacies.
   • Measles (MMR) vaccine = $90-$100 at pharmacy with Goodrx.com coupon
   • COVID vaccine = free at pharmacy.
   • Vaccines typically 100% covered by medicaid or insurance.
   • TB test = ~$140 for uninsured patients at my clinic. There are also free county TB testing options. See list below for county free TB tests (BUT NOT VACCINES)
6. Please email if any questions (info@interstitium.me) or want to schedule an appointment – free for Unite for Ukraine parolees.

UforU TB Testing resource lines		Last Updated: 6/24/2022
County	Phone #	Notes
Clackamas County	503-655-8411	No cost TB testing and vaccinations
Marion County	503-588-5342	Call Main clinic number to schedule blood draw M-Th
Multnomah County	503-988-3406	Call to schedule an appointment for QFT
Washington County	503-846-3594	Call main line and specify UforU status and need for IGRA

I’ve gotten a lot of questions about immigration medical exams (form I-693, civil surgeon exams) and wanted to put up the answers to the most common questions here.

If you still have questions, feel free to call the office or send a message through the Contact page. I’ll try to answer if I can.

NOTE: USCIS & CDC policies change over time – this information below is updated 4/28/22

---

#. What is expected during the immigration medical exam?

The immigration medical exam (for form I-693) is a medical exam completed by a civil surgeon, over 1 or 2 visits, that follows specific guidelines set out by the CDC. The exam looks at medical conditions and history, vaccination history, mental health, and drug / substance use history. It also involves a thorough physical exam. For most cases, lab tests required as well. Once all the information gathering & testing has come back, the civil surgeon will complete the I-693 form, put it in a sealed envelope and given to the patient.

#. Where do I find a civil surgeon? Can my primary care doctor do the immigration exam?

Very easy – go to (https://my.uscis.gov/findadoctor). 

Unless the primary care doctor is also a civil surgeon (see the list above), they cannot complete the medical exam. Also do not ask them to order the labs for you – the labs will not be valid and will repeated by the civil surgeon. 

#. What to do I don’t have proof of vaccines?

Vaccines requirements vary by age. The civil surgeon has to show proof that each applicant has met the requirements – the vaccine records can help with that. If there are no vaccine records available, then the civil surgeon will help each applicant catch up on the vaccines OR draw labs to prove immunity.

#. How much does the immigration medical exam cost? Does insurance cover it? 

It varies widely – I’ve heard between $200-$700. Sometimes they include labs and vaccines, sometimes they don’t. 

I’ve never seen insurance pay for the civil surgeon exam. 

Insurance MAY cover the labs but cannot guarantee. They almost always cover the vaccines if required.

#. What to bring to the immigration medical exam?

The only MUST-HAVE is a non-expired government issued ID (usually passport or driver’s license). 

Vaccine records are very useful if available. Other things also would be helpful but not required on first visit – recent chart notes from the primary care doctor, a list of medications, any recent imaging results (like a chest X-ray), any mental health records.

#. How long does the immigration medical exam take?

I do the exam in 2 visits and usually spaced out about 1 week apart – the time is need for lab results to come back, review & complete all the paperwork etc. If the medical history is complicated or if the lab results show some abnormalities – the process will take longer. 

Some offices say they do it one visit, but even then labs take at least 3-4 days to come back so Im not sure how that works out.

#. What testing is required?

It depends on the age – less for children, more for adults. Adults typically need screening tests for syphilis, gonorrhea, and tuberculosis. If the civil surgeon is concerned about other issues, they may require additional testing.

In most cases, the tests come back normal – however, occasionally the TB (tuberculosis) test will come back positive and it would require a chest X-ray at that point —> *See below comments regarding latent TB.

#. I already had labs done by my primary care doctor or another civil surgeon – does that count?

Unfortunately, no – those labs do not meet CDC requirements. The labs need to be ordered by the civil surgeon that is completing the I-693 form. 

#. What can I do to save money if I don’t have insurance?

Outside the fee for the civil surgeon, the other costs are for labs and vaccines. Sometimes the laboratory (Quest, LabCorp, etc.) that the civil surgeon uses will have programs for uninsured patients. 

For children and vaccines, most states have free or sliding scale vaccines just for kids. Before seeing the civil surgeon, bring your kids to one of these state vaccine clinics and get them caught up. Call your county health department, they’ll usually tell you where to go.

For adults, you can see straight from the CDC (https://www.cdc.gov/immigrantrefugeehealth/pdf/Vaccine-Requirements-According-to-Applicant-Age-p.pdf) what vaccines are required. Ask your primary care doc to help you get caught up on the vaccines before seeing the civil surgeon (yes, these vaccines count). 

If you end up going to the pharmacy to get vaccines – use this free website (https://www.goodrx.com/) to get coupons for vaccines – not all pharmacies will accept the coupons, but most will and you can save something like 50%. 

#. What if I already had an immigration exam – do I need to repeat everything?

It depends. Per the CDC, if you return to the same civil surgeon, their labs & medical exam is valid for ONE YEAR but only for that civil surgeon. If you go to another civil surgeon, they’ll have to repeat everything.

If you need to repeat the I-693 form, I recommend patients call the initial civil surgeon and ask how much they would charge to repeat the exam / paperwork.

If you are caught up on vaccines, that does not have to be repeated of course. 

*If you are not sure when your interview date is, you may want to ask the civil surgeon how much it would cost to repeat a I-693 form (in case it falls out of the 60 day window – temporarily waived due to COVID, but this is … temporary). Some offices may require a completely new exam and fee, but some may offer a discounted price and/or shortened exam.

#. Do I need to have the flu vaccine?

You’ll need the flu vaccine only if your medical examination is between October 1 and March 31.

#. Is a drug test part of the medical exam?

Drug testing (as in urine drug test for illegal drugs) is NOT a standard requirement by immigration exam. However, evaluation for drug use is part of the exam – if the Civil Surgeon needs to get urine drug testing, they can order one. If the Civil Surgeon has no concerns, they may not order any urine drug tests.

#. Is marijuana use a class A (non-admissable) condition?

Yes – despite it being legal in Oregon and many other states, it is still illegal at the federal level and considered in the same class as cocaine, heroine, methamphetamines, etc. It will be categorized as Class A non-admissable.

As a primary care physician, I do a lot of yearly check up exams – vitals, mental health routine labs, cancer screenings, etc. Towards the end of the visit, I tell patients about some almost universally useful items and general measures that might to contribute to their quality of life.

Here are the things I’m mentioning most frequently for this Fall & Winter.

1. COVID home testing kits – I’m still surprised not more people are aware of these kits. They are available at most pharmacies (Fred Meyers, Walgreens, CVS, etc.). The kits cost $20-25 and has 2 test cards. You collect the nasal swab sample yourself, and run it on the card with a reagent dropper – get +/- results in 15 minutes. The most common brands I see is BinaxNOW and QuickVue. These tests are not as accurate as a PCR test (which takes a a couple days to result), but these are fast and convenient. Keep in mind that these are sold out very quickly at the stores.
2. Vitamin D supplement & SAD light – if you are living in the Pacific NW, just go ahead get a bottle of Vitamin D3 2000IU (usually people take 1 daily) and a “SAD” light (SAD stands for Seasonal Affective Disorder). The SAD light runs $40-$60 and a common brand is called Verilux. They all should be about 10000 lux intensity. Within 30 minutes of waking, put the SAD light about 1-2 ft away from your face for about 20-30 minutes. These lights will help keep a balance wake/sleep cycle and likely reduce seasonal affective symptoms.
3. Blood pressure machine and a pulse oximeter – in the age of telemedicine, you want to be able to provide vitals to your doc. An automated BP machine costs about $30, a popular brand is OMRON, make sure to get it for your arm and not wrist! Keep in mind there are different size cuffs, you might need to order a bigger or smaller cuff. A pulse oximeter costs about $20-$30, it goes on the end of your finger, immediately gives you an estimation of your blood oxygen levels and heart rate. Your doctor will thank you.

I’ll update if I think of more things. Stay safe this cold & cough season.

For our clinic patients – we are doing PCR COVID tests if you need it (seeing results come back within 24-48 hours), we can collect at your home or drive-by at the office, including weekends & after-hours if necessary.

Just a few weeks ago, I was having my morning (black coffee) and saw big headlines at NPR and other news outlets about this new drug “Wegovy” – with bold claims about weight loss.

I was pretty excited about this for my weight management patients – its not common to get new medications for obesity. 

We had Qysmia in 2012 and Contrave in 2014, both excellent options – good safety profiles and are both effective. Here in my clinic in Portland, we use Qysmia or Contrave along with intermittent fasting or slow carb / carb restricted diets, we can typically reach about 15% and sometimes 20% weight loss in 6 months or so. 

Wegovy’s data is showing that it might be 3-4x as effective as both these other drugs though – which is very impressive. 

Let’s take a closer look. 

What is Wegovy?

Wegovy is a new formulation of a previous medication, semaglutide. Its given as an injection under the skin (at home) once a week. It comes in an easy-to-use pre-filled pen. 

Semaglutide belongs to a drug class called GLP-1 agonists and has been around since 2012, under the name Ozempic and Rybelsus. It was initially developed to treat type 2 diabetes and, in contrast with insulin – which causes weight GAIN, semaglutide and the GLP-1 class actually caused weight LOSS.

Novo-Nordisk (the company behind Wegovy) ran studies (details below) to see if a higher dose of semaglutide could, for patients without diabetes, help with weight loss. 

The answer was yes and the FDA (June 2021) gave the green light for this high-dose semaglutide to officially be used for treatment of obesity. 

What did the study show?

The double-blinded study enrolled 1961 patients with obesity (BMI >30 or BMI >30 plus a weight-related condition). Note that none of these patients had diabetes. Some of the patients got semaglutide once a week, the other got a placebo. Both groups received a life-style intervention program to help with weight loss. These patients were tracked for more than a year (68 weeks total).

At the end, the patients that got the semaglutide ended up averaging about 15% weight loss from initial body weight compared to the placebo group only had about 2.4% weight loss.

Looking at it from another angle, the rates of successful weight loss also was much higher with semaglutide.

For somebody  that is, say ~250lbs to start off, if this person takes semaglutide over a year – they would have about 86% chance of reducing their weight by 13lbs, 69% chance of losing 25lbs, and a 50% chance of losing 38lbs. The placebo & lifestyle intervention group achieved 32%, 12%, and 5% respectively – still not bad!

In this study, the main side-effects from semaglutide were nausea, GI upset – occurring in about 86% of patients. Interestingly, the 63% of the placebo group also complained about GI upset.

How does Wegovy (and these GLP-1 agonists) work?

GLP-1 is a natural messenger peptide (small strip of protein) produced in the GI tract (small intestines). As you eat a meal and food comes in, the GI tract senses this and produces GLP-1. It travels the body and communicates with the pancreas, the stomach, the brain, among other organs of the body.

GLP-1 tells the body to produce more insulin and less glucagon in response to food – basically helping normalize how the body handles the glucose (sugar) from the meal.

GLP-1 also tells the stomach to slow down digestion and tells the brain when it has enough to eat – preventing over-eating and excessive calories.

Semaglutide and the other medications in this class, basically acts like GLP-1 peptides in the body – helping the body respond better to carbs and sugars in meals and reduce appetite and food intake.

What are the side-effects and risks of Wegovy?

Just like the rest of the GLP-1 drug class, there are a number of possible side effects. The most common issues is nausea, vomiting, diarrhea – occurring in about 7-10% of patients. We can usually avoid these effects by starting low dose and letting the body get used to the medication.

Much less common but more serious risks include possibly pancreatitis (irritation of the pancreas), gallbladder problems, and renal insufficiency.

In animal studies – there was an increase in thyroid tumors, but it is not known whether this is also true for humans. We avoid any GLP-1 agonists for patients with history of thyroid tumors (specifically medullary thyroid carcinoma) or family / personal history multiple-endocrine neoplasia syndromes (MEN2). 

Bottom-line : Will Wegovy work for you? 

If it is paired up with lifestyle (i.e. dietary!) changes, I think there’s a great chance it would work. 

I treat many diabetic patients and patients w/ obesity. Using the lower dose semaglutide, we’ve been able to get quite a number of patients off of insulin and other oral medications while getting better control of sugars AND achieving significant weight loss. I’ve had some patients with nausea and had to some the medication, but not many. 

I think trying the higher dose Wegovy is worthwhile for most patients battling obesity with or without diabetes.

The bigger question now is if insurance is going to cover it! We will see.

=====

Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

Ref: https://jamanetwork.com/journals/jama/article-abstract/2777025

Early in the COVID-19 pandemic – early March 2020, there was a massive shortage in personal protective equipment for all of healthcare personnel, but especially acute in the outpatient clinic setting which held lower priority compared to hospital inpatient services. A good friend of mine, Alex Theodore, and I came up with a crazy idea to build out a clear wall with built-in gloves and examination equipment which would provide protection w/o additional use of disposable PPE. At his shop (Millfinish.com), Alex built out an exciting prototype and I put it to use. The feeling was that it could help clinicians continue care for critical patients and also help keep their doors open.

After it was built out, we were excited to see something similar in Korea – dubbed “Phone booth” COVID testing.

I used the prototype in my clinic for some time but as PPE availability improved and insurances covered telemed visits, the examination wall became unnecessary. As the COVID vaccine rolls out, we hope for a quick end to this pandemic and I keep this project in storage for many years.

More photos & videos are here.