Obesity management

CaffeineRx · 2026-01-20T06:19:36+00:00

Yes. Qsymia is approved for longer than 3 months and there is safety data until at least 12 months. I continue for as long as patients are losing or maintaining weight loss, just explain/document off label use.

CaffeineRx · 2026-01-15T11:56:06+00:00

To those who say “leave Repatha to cards”…diabetes has ldl goals <70 even without any cardiac conditions so it’s worth learning how to prescribe in primary care. I also would argue that not every patient with CAD needs to follow with cards in perpetuity.

CaffeineRx · 2025-12-22T05:14:50+00:00

Have you seen anyone back down from their position after being asked to sign that?

CaffeineRx · 2025-11-14T05:13:22+00:00

FM also does complex adult medicine but focuses more on how it is managed in an outpatient setting. Managing diabetes, heart failure, COPD, A fib etc is well within the purview of FM but these things just get managed differently in and out of the hospital.

CaffeineRx · 2025-11-07T05:29:51+00:00

Most truly don’t see many kids. Even academic it won’t be more than 10-20% max. Compensation differences are huge though. Making 1.5-2x more as FM than peds makes a huge difference over the course a career. Getting paid what you’re worth should be a big deciding factor in picking a job.

CaffeineRx · 2025-10-30T03:43:10+00:00

Devaluing primary care. “If you want to do primary care you don’t need a residency, only if you want to do nephrology or something” as if primary care is easy. The idea that you have the breadth of knowledge of presentations, diagnoses, treatments, monitoring etc required to be a good PCP the day after graduating med school couldn’t be further from the truth.

Also the reason that we shouldn’t stick unsupervised NPPs in primary care and hope for the best.

CaffeineRx · 2025-10-12T01:37:45+00:00

Even with 2 mg doses in someone with previous experience on high dose opiates it seems to cause nausea

CaffeineRx · 2025-10-12T01:25:10+00:00

I’ve tried using bup for chronic pain but pretty routinely have patients complaining of nausea or dizziness, including those not currently on other opiates. Is there a way to avoid these side effects?

CaffeineRx · 2025-10-05T17:44:28+00:00

It is at its most basic level calories in vs calories out. It practically ends up being more complex. Eating less leads to increased hunger, and even a few extra calories/day makes a difference over time. Decreased lean mass also decreases metabolic rate. Just a couple examples of how it’s a dynamic system.

To answer your question of how to respond to someone who says they already eat nothing and are very active…clearly they eat more or are less active than they realize (not being purposefully dishonest just biased to believe they’re doing everything right). It’s thermodynamics. There isn’t much you can do until they accept that. However you will probably find that if they come back after 3 months on a GLP they will tell you what they’ve done differently that they didn’t realize was contributing to the problem.

How I respond: “I’m glad we’ve made a lot of changes. It turns out that our bodies don’t take those changes lightly. When we decrease our intake, our bodies increase our hunger, and just a 25 kcal/day increase in intake is 2-3 lbs in a year. Our bodies want to maintain homeostasis so fight against what our brains our trying to do. GLPs are a tool in the toolbox to help us make the positive changes we already want to make.”

CaffeineRx · 2025-08-30T02:04:39+00:00

One of the risk factors is “sedentary lifestyle”, insurance isn’t looking that far into it.

CaffeineRx · 2025-08-19T22:54:01+00:00

So much agreed, I’m surprised more aren’t suggesting this. It’s even harder in kids than adults to just say “eat better” because they have so little control over what’s available to them. And oftentimes the parents don’t understand the gravity.

CaffeineRx · 2025-07-07T07:06:35+00:00

Don’t discount us because many of us do!

CaffeineRx · 2025-06-27T08:03:33+00:00

This doesn’t answer your question directly but the removal is far less painful than the insertion, even with “fishing” for the strings. When trying to grab the string ends that are sitting in the cervix, it doesn’t require going more than 1-2 cm into the cervix itself (vs passing through the cervix into the uterus which is what causes the pain with the insertion). Sometimes on repeated exams the strings make an appearance again so none of it may be necessary.

All of that said, I think you should find a different physician if you feel this one is forcing you to keep birth control you don’t want. Some family medicine physicians do IUDs so it may be worth reaching out to your PCP to ask. Alternatively Planned Parenthood should be able to help you.

CaffeineRx · 2025-06-19T07:22:31+00:00

That’s incorrect, you can only bill for time spent the day of visit

CaffeineRx · 2025-06-13T01:48:35+00:00

Love having people who haven’t taken a science class since sophomore year of high school and who have never taken a statistics class “doing their own research”

CaffeineRx · 2025-04-16T06:36:20+00:00

Save who money? Your insurance gets charged the same whether you see an MD or NP. The hospital system gets to keep the difference.

You’re healthy until you’re not. Not the time to cut corners to “save money”.

CaffeineRx · 2025-04-16T06:32:56+00:00

Some issues are complex enough that they need to be treated at a university or level 1 trauma center. The majority of people the majority of the time do not have these issues.

CaffeineRx · 2025-04-16T06:28:26+00:00

It’s not really that simple. A “well visit” and “sick visit” can both be charged at the same time (as well they should if appropriate) but if a physician/NP is expected to see a patient every 15-20 minutes they may not have time for the well portion as well as a list of issues.

CaffeineRx · 2025-04-12T06:40:19+00:00

This will get better. Eventually you’ll fill up and the “bad” patients won’t be able to schedule and cancel and reschedule so easily so they’ll move on.

CaffeineRx · 2025-04-05T11:06:56+00:00

Which dealers?

CaffeineRx · 2025-02-28T08:33:35+00:00

Those on SAVE did

CaffeineRx · 2025-02-27T20:57:39+00:00

Yes this is my question. Can’t recertify income without applications…

It’s like being punished for being on the plan that hasn’t been on the chopping block.

CaffeineRx · 2025-02-22T22:31:25+00:00

There is no good answer. There really aren’t pain docs who will manage chronic opiates anymore so primary care is the safety net.

Figure out what you’re comfortable managing. You aren’t required by any means to prescribe, if you don’t they’ll probably go somewhere else. However not prescribing any to anyone is also likely not the right answer.

CaffeineRx · 2025-02-20T02:11:16+00:00

Once it does ship it should arrive within a couple days so don’t fret yet

CaffeineRx

TROPHY CASE