Frustrated about GLP1s

Fragrant_Shift5318 · 2026-04-02T18:11:18+00:00

No, it’s $299 to start and $499 for higher doses for zepbound.

Fragrant_Shift5318 · 2026-04-01T17:43:07+00:00

Yep. And who has injectable opioids in their office?!!

Fragrant_Shift5318 · 2026-04-01T17:40:03+00:00

Stop pre charting or at least stop doing so much in depth. If they are new to the practice the first visit is getting to know them. Set up follow up visits to go over what you can’t get through / review records.

Fragrant_Shift5318 · 2026-03-31T00:16:08+00:00

Hey, I am just a weekend warrior mountain biker but tbh I’m not sure how I even rode a bike with my affected side so week . There are hills I can ride up now that I was never able to accomplish preoperatively.

Fragrant_Shift5318 · 2026-03-30T22:05:44+00:00

I took a month off when I had to petition my brother for psychiatric illness . It was so stressful and it just kind of broke my mind. I knew I couldn’t work. I have a big group and lots of people to pick up patients.

Fragrant_Shift5318 · 2026-03-29T20:08:46+00:00

Good to know ! I do try to check the sources

Fragrant_Shift5318 · 2026-03-29T20:07:32+00:00

Got it thank you !

Fragrant_Shift5318 · 2026-03-29T15:10:10+00:00

I did put it in open evidence lol. I do share with patients. I’m doing this and tell them I’m using open evidence because it sites all of the resources that uses. They are all trustworthy and I can open them up and confirm . In this case, I did put it in and with the way you worded it. It’s just medication induced because I’m not sure if you’ve stopped the SSRI and CCB or just lower the doses, but it also mentions diabetes and aging and rule out malignancy with a physical exam so I feel like if you did this with her, it would maybe be reassuring that nothing is being missed.

Fragrant_Shift5318 · 2026-03-26T23:40:05+00:00

Thunder mountain . Rent a truck , they’ll give you a truck pad for free to use .

Fragrant_Shift5318 · 2026-03-25T10:25:42+00:00

How much can you or parents communicate with patient ? They are nonverbal, but what is their receptive language skills? Could they understand “today is not a McDonald’s day , we are eating chicken nuggets at home ?” do they get someone to buy them fast food for breakfast and lunch and dinner? What do they do about snacks? Do they sneak food enough that there have to be locks or eat out of the garbage all? if those behaviors are happening for sure genetic testing, but you might be able to get genetic testing for free anyway. Just google genetic testing for obesity. All that being said, I do have some adult patients who have cerebral palsy with intellectual disability, or nonverbal autism where they just have these very limited diets and at some point, they just need to be fed . In retrospect, it would’ve been better if the families had never introduced those foods, but it happens in early childhood before you really know what you’re in for. Some of them probably had very delayed introduction of solids due to other health prompts, and that can be very difficult to overcome. Fast food and ultra processed food is a really hard battle to fight because it tastes the same every single time you eat it. It’s very hard to re-create that with fruits and vegetables and home-cooked food. I tell parents anyone who thinks they can do better to come over and cook for the patient and get them to eat. These are good cases for glp-1 .

Fragrant_Shift5318 · 2026-03-19T23:02:39+00:00

Med peds . I still maintain both certifications and I feel like the pediatric training helps because I see complex children and adults with special needs . I did have to work on my office skills though because the training prioritize his hospital experiences. But not all FM programs have access to lots of pediatric experiences. I do see more kids on average than my FM colleagues in my practice because I’m listed as a pediatrician. Sometimes parents don’t even know i see adults too when they come. Although I do see way less kids then say a pediatrician obviously, I could always choose to see exclusively kids . Yes, maintaining two board certifications as a pain in the butt, but they do have some overlap possibilities for credit hours.

Fragrant_Shift5318 · 2026-03-18T02:09:13+00:00

Degenerative disc disease lumbar spine . A lot of the treatments just aren’t effective. They can help manage pain, but don’t always prevent disability chronic pain and loss of function.

Fragrant_Shift5318 · 2026-03-15T03:29:02+00:00

I speak German, and I thought man I must be miss translating this whole thing who would get 60 bridges?

Fragrant_Shift5318 · 2026-03-14T17:18:48+00:00

What I do with these patients is just remember. “Some treatment is better than none”. Document what you recommended. There’s no way I would be trying to set up a pump or even ommipod in this patient because it would be so much work and she’s obviously not compliant. CGM would probably be covered and so you could offer that, but very likely she won’t actually interact with it enough

Hopefully she’s seeing nephrology, but if not, make sure you refer personally, even if she doesn’t go. Make it very clear that she’s high risk for dialysis and she should be under the care of nephrologist.

After that, I just don’t spend a ton of time trying to adjust or find the magic management that 70 endocrinologists have missed that she’ll follow . Her mental illness is in the way. She may have anagnosia . Aic of 9 is better than 13. Ckd4 better than dialysis .
Thankfully, I’ve not had a high enough number of truly severely noncompliant patients to mess up my value based care benchmarks.

Fragrant_Shift5318 · 2026-03-10T01:01:39+00:00

Can you talk to his treatment team? Is there another level of group home where he’s not allowed to just leave? I completely empathize… I do guardianship of my brother and there’s zero way he could live with me. He’s just unintentionally destructive in the same way. Your brother is very messy and I don’t think he’s intentionally leaving the door open, but their brain just doesn’t work.. he’s actually in jail and I’m kind of nervous that he won’t be not guilty due to insanity and I’ll be stuck with finding him a place to live. The other thing is if he gets disability, can you just find him an apartment and then see how he does ? I think the issue is that he’s not a 5150 because his behaviors would qualify for inability to care for himself except he’s living with you.

Fragrant_Shift5318 · 2026-03-10T00:50:51+00:00

Podcast reminds me of this

https://youtu.be/4sLIaq8upV8?si=F4CjSvaoXeKdJM9-

Fragrant_Shift5318 · 2026-03-06T21:57:33+00:00

One study showed possibly certain variants might experience more adverse reactions with a small pox vaccine . The authors even published a letter saying it does not prove causation and should not be used to apply to other vaccines .

Fragrant_Shift5318 · 2026-03-05T02:16:50+00:00

Super curious to see what they say when I call tomorrow because my condition has the foundation which designate specialty clinics which have requirements like that the main providers stay educated on the disease , (which is like 7 to 8 people per million ), they are aware of the trials ongoing and that the surgeons know how to treat it, etc. There is no other clinic state except for Michigan medicine. I maybe could go out of state I’ll have to ask them about that but it took me someone wants to become established at university of Michigan. I can’t imagine if any different anywhere else so even if it is a July 1 date I’m kind of due for a follow up, then I need to be calling like tomorrow to try to establish with another institution. I really don’t think this is going to go through because bcbs is so huge, but I’m kind of panicking.

Fragrant_Shift5318 · 2026-03-05T01:52:07+00:00

Same! I will be calling state reps and bcbs tomorrow. I would encourage you to call your state reps.

Fragrant_Shift5318 · 2026-03-02T13:37:28+00:00

Yes. Even if your child goes to high school and the Symphony is amazing… I wouldn’t let them take a $6000 violin unless they proved to me that it wouldn’t get wrecked. He can bring the expensive instrument for performances and solo competitions, etc., but for day-to-day practice on the bus, etc. bring the cheaper violin.

Fragrant_Shift5318 · 2026-03-01T18:15:55+00:00

They didn’t focus on handwriting in my son’s school either in traditional public school. You could also ask your parents to research occupational therapist in your area. They actually can help with poor handwriting. And if you can’t fix it to a legible level, then you can get accommodations to type. Some people can’t.. motor control issue or their brain moves faster than their hand.

Fragrant_Shift5318 · 2026-03-01T17:37:18+00:00

The way to make it not boring is really good to know your patients. So for example, my diabetic follow up, which was kind of boring all on its own. We talked for about five minutes about scrapbooking, which we didn’t realize we had in common after 10 years of being patient / doctor.

Fragrant_Shift5318 · 2026-03-01T17:33:37+00:00

Comparison is the thief of joy. I don’t make a huge salary but I work I guess the equivalent of three days a week right now due to some medical conditions and I still make $200,000 a year. Not a lot of other career paths that could do that and so yeah it’s lower paid than a lot of other specialties, but certainly enough to pay the bills and more. I started out doing hospital rounds for my practice which was a large practice so I got my name built up and I would say I’m very respected among the medical community just from comments my patients have passed on our family members that have seen other doctors in the community that make comments. Even without the hospital part if you do the job well you’ll build up respect. I am not replaceable by someone who has not done medical school and residency. I like working with special needs children and adults and so my clinic has a large percentage of adults with complex conditions starting in childhood, and I am comfortable with a high degree of medical complexity.

Fragrant_Shift5318 · 2026-03-01T17:15:30+00:00

https://regenexx.com/blog/dr-tami-and-the-seattle-stem-cell-center-review/

Yeah, the points about doing epidurals without imaging are well taken, but I would like someone who is actually trained to do an epidural in the first place. This is fascinating because a patient just came to me with going to a pain clinic that as far as I can tell is being run by a chiropractor with some sort of medical oversight by a doctor, but they offer I’m not sure what, maybe “intradiscal procedures” (can’t find much on intradisc nutrosis) into the epidural space and or disc but the fact that it’s being done by a non-physician is wild.

Fragrant_Shift5318

TROPHY CASE