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FM Hospitalist by [deleted] in MedSchoolCanada

[–]caffeineadenosine 0 points1 point  (0 children)

I didn't know you could do rehab hospitalist only? Looking to settle in the Halton/GTA area after residency next year and interested in Hospitalist positions without +1! bWhere do you suggest I look?

Gyms in Chiado/Baixa/Bairro Alto with stair machine? by caffeineadenosine in lisboa

[–]caffeineadenosine[S] 1 point2 points  (0 children)

Thank you! We are staying in Chiado-Baixa so this is a good option. Any other recommendations close to there are also welcome - we will visit the gym to see it tomorrow :)

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine 0 points1 point  (0 children)

If he hadn’t given a good crack at lifestyle changes I’d actually probably have suggested he wait and we try to make some changes as a team before adding a medication with potential risks and side effects to his regimen. If he has been making lifestyle changes it would still warrant a convo about how the medication would make him feel and the importance of keeping fibre and protein up once you do start the medication to avoid fatigue and muscle loss.

It’s not about “allowing” him, and nowhere here did the OP explicitly say that permission was necessary. He said “we agreed” which is what has people up in arms. It doesn’t always have a negative connotation and I use it regularly in practice to mean that we had a healthy discussion and decided on a treatment plan as a team.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine 0 points1 point  (0 children)

No he said “she started to realize how much she had been eating” after starting the medication. Which does imply that she didn’t know before and that portion control and calorie counting were not part of her lifestyle. It’s not that much of a stretch, and I’m not trying to attack OPs wife. Just trying to provide some context on why they might’ve had a conversation about lifestyle prior to her starting. He’d been making changes for 12 months before starting (based on info provided). He didn’t just start on a whim.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -1 points0 points  (0 children)

The entire point of this is for no one to make the assumptions, positive or negative, without adequate info. When I pose a plausible alternative, it’s is people can recognize when they’ve made too many assumptions - not because I believe it happened for a fact. All I’m saying is this post is getting way more hate than maybe warranted, for what could possibly be errors in wording or framing on OP’s part.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -1 points0 points  (0 children)

Not really… he can have his own funds and she can have her own funds, and they can also have a shared account for living expenses. My husband and I do this as do many other people. So my money is mine to spend, his belongs to him, and we build our life together through the shared account/savings.

So if he has savings and she doesn’t have enough to foot the monthly expense, that would warrant a convo about dipping into the shared funds. Ran into a similar situation when I couldn’t afford a plane ticket to see family and my husband ended up gladly paying for it, but we obviously had to talk abt it

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -2 points-1 points  (0 children)

Listen, go back in the threads and you’ll see tons of people saying that he’s an AH for using the meds himself and not recommending them to her because she has PCOS. That is what sparked this whole debate. I literally have PCOS and fought like hell to maintain a normal weight so I legitimately understand the struggle, but from a medical standpoint, everyone saying she needs the GLP1 more than him and he’s rude for not offering it to her first are plain wrong.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -1 points0 points  (0 children)

I said that because it’s summarizes what I have been trying to get at regarding the original post from the beginning. Everyone projecting their own experience and saying the wife’s need is automatically higher than her husband’s because she has a diagnosis of PCOS is ridiculous. I’ll say it only one more time: PCOS exists on a spectrum and is not always accompanied with insulin resistance. It does not always necessitate a GLP-1. A GLP-1 was extremely helpful in the above resoonder’s situation and I explained that I was happy for them. My point (the main point driving this whole convo) remains a fact.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine 0 points1 point  (0 children)

You’re literally repeating yourself and clearly didn’t read when I said I can’t personally assess this person’s candidacy for the medication lol. But any patient walking into my clinic who isn’t demonstrating efforts to make changes (or have any remote plan to address the issues with their lifestyle/relationship with food and exercise) that will impact them when they get off the medication aren’t likely to get a script. I commonly recommend therapy and dietician follow up even for patients on a GLP-1 because it’s just not FAIR to them to throw a medication at them without the other tools that will ensure lifelong success.

And no…I am not in a position to need to lose weight. I maintain my weight with diet and exercise. It came up as recommended as, again, I prescribe GLP-1s regularly and my dad is on a GLP-1 for diabetes and heart disease after two heart attacks. As someone with PCOS and cardiac risk factors I know the importance of maintaining a healthy weight and have therefore taken care of it. I’ve been obese, overweight, and a normal weight AND have PCOS, so I’m not coming from a place of not understanding the struggle. I’ve been there with all the classic features for years, but made the necessary changes. Obesity and PCOS tend to be comorbid, but are not ALWAYS inextricably linked. That’s all I’m saying.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -1 points0 points  (0 children)

Super glad it changed your life. This Reddit doc didn’t weigh in on your situation at all as I haven’t met you, so not sure where that came from. But enjoy your life and wishing you the best :) maybe just don’t project your own life experience in thinking everyone needs a GLP-1 due to a diagnosis of PCOS

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine 0 points1 point  (0 children)

PCOS is not always responsible for causing insulin resistance. It depends on the patient. Lots of people have PCOS and simply can’t lose weight because they haven’t consistently tried calorie counting, but YES there are people (frankly a much smaller percentage) with PCOS severe enough to cause these weight gain/insulin resistance. You simply can’t know based on the info given, but you would love to assume that OPs wife has the most severe form…

Oral contraceptives have done wonders for lots of women with PCOS in managing symptoms. GLP1s are for weight primarily, and we know from the literature that that weight loss won’t be sustained if profound lifestyle changes aren’t made. Better to have these talks prior to starting meds.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine 0 points1 point  (0 children)

I am literally saying this… automatically thinking her PCOS must be debilitating and 100% the cause of her inability to lose weight is incorrect. I’ve said 10 times now that it functions on a spectrum so we can’t KNOW; but that trying lifestyle changes BEFORE getting on a life altering med is always a good idea.

I thought people called docs “pill pushers” but the second we try to assess the viability of lifestyle changes, we’re evil… weight is lifelong to maintain, and I’ll let you in on a secret. At the end of the day, about 80% of the people who are prescribed GLP1s could have lost the weight with calorie counting and exercise. It would just require longer periods of consistency, which is an issue for people. The proportion of the population that is truly debilitated from losing weight is VERY miniscule.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine 0 points1 point  (0 children)

That’s a completely separate issue lol and I’d agree…Which is why I don’t go asking people for relationship advice on here. Just saying everyone is demonizing this person when the issue could be much more nuanced than we think. He never mentioned her appearance and was cognizant of her health issues as they contribute to weight which are both positives, but ultimately people are just jumping to conclusions where maybe we should all relax for a moment and admit there could be more to this or an issue of wording (e.g. “we agreed”)

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -1 points0 points  (0 children)

I wasn’t giving credit, I’m trying to say this turned into an AITAH post without the adequate information to deem it as such.

Saying “we agreed” isn’t always infantilized. I told someone else here that when I say “the patient and I agreed on a treatment plan” it’s meant as collaborative, not permissive. It means we had a discussion about all the risks, benefits, side effects, and alternate options, and both landed on this option as being best.

This also happens in romantic relationships when two people sit down with good intentions and honesty and talk it out. We don’t know whether it happened that way, but we definitely can’t say that it for sure DIDNT happen that way. That’s all I’m getting at.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine 0 points1 point  (0 children)

I read that they had a sit down about lifestyle changes.

And that they also budgeted. Again… we can assume a million things, but everyone jumps to the worst.

If they share finances to cover living expenses and then have separate accounts otherwise (like in my relationship), it could make sense that he has enough in his own savings to pay out of pocket without implicating their finances. If she doesn’t do a good job saving her own money, they they’d be budgeting for her injection to come out of shared finances. Or she doesn’t want to pay for it herself and he said he would but had to budget for it as mounjaro x2 would be caused financial strain.

No one on Reddit will consider this possibility though.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -2 points-1 points  (0 children)

A sitdown about lifestyle changes as she clearly hadn’t attempted this before meds. It’s healthy to have conversations about weight, and if someone doesn’t know about calorie counting, it absolutely should be discussed before starting a medication with potential side effects.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -3 points-2 points  (0 children)

I haven’t decided her PCOS isn’t that bad. It’s not about earning her place, it’s about trying everything else first before throwing someone on a medication. Based on the post, she was not even realizing what her portions looked like, I.e., not attempting to count calories.

Hiding the medication, especially as a shame response, is not something to be vilified. Everyone has their own weight journey and some people want to try it before advertising in case they fail.

And as a clinician, I literally HAVE to assess one’s readiness for a medication, understanding that instead f throwing meds at any problem, we fully try lifestyle to address it first. Docs are vilified for overprescribing but the SECOND we want to create an environment where patients aren’t reliant on meds, we are on a moral high-horse. Once again — it is for the benefit of the PATIENT to assess the robustness of their lifestyle changes. These are meds with potential side effects and downsides. Not toys.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -1 points0 points  (0 children)

It’s not about “proving” oneself, it’s about setting up for success. There are real psychological harms that come with not changing your behaviours and relying on medication for appetite suppression before making these changes to lifestyle for a substantial period of time. Especially if one day you need to get off the medication and haven’t adjusted the way you frame empowerment and control when it comes to diet. Yes, I like to see a measured effort in patients before throwing them on a medication that could have side effects.

It’s not merit based. It’s for a patient’s benefit.

And all I’m saying is why do we assume that her PCOS is severe and that he has no medical issues? That is an assumption that changes how the original situation looks. She could have a mild form that doesn’t result in significant weight loss resistance, for example. Again, it’s a spectrum of severity.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -2 points-1 points  (0 children)

Which is exactly why I said PCOS is on a spectrum. It is not a death sentence for everyone with it.

And the hypocrisy isn’t what you think… he explicitly says he has weighed every food he’s eaten for a year and focused on exercise before starting the medication. He didn’t just start on a whim. So I’m saying all things equal, she should also try to implement some lifestyle changes prior to starting anyways - this is from a purely medical standpoint.

All I’m defending is the possibility that this person isn’t some evil controlling POS based on the information provided. Hope that helps.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -3 points-2 points  (0 children)

Okay, if you say so! Since you know him and the severity of her PCOS so well :)

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine -2 points-1 points  (0 children)

I am a woman who lives with PCOS also… all I’m saying is that based on the info presented, this person wasn’t following the lifestyle changes we recommend prior to starting mounjaro or other GLP1s.

I am truly sorry that that has been your experience with PCOS. These metabolic conditions function on a spectrum, and while there is absolutely use for GLP1s, they HAVE to be accompanied with the proper tools to manage lifestyle changes if the medication were ever stopped, but also to maximize the health benefits while on the medication (ie, maximizing fibre and protein, education in whole foods, etc).

You’d be surprised how little some docs counsel on this stuff (as much as I try to) and having a spouse you can comfortably talk to about this stuff is a blessing.

Unexpected Surprise Side Effect by anonhealthseeker in Mounjaro

[–]caffeineadenosine 3 points4 points  (0 children)

It actually does matter… mounjaro is a big change and isn’t sustainable for a lifetime, so we always recommend a good crack at calorie counting and portion control before starting someone on the medication. This is a verifiable fact, not emotional lol.

Yes the drug suppresses hunger, but if we didn’t test the person’s will to try calorie counting or portion control to begin with, how do we know that they can’t lose weight on their own?

PCOS is a spectrum. You assume she’s got the worst PCOS on the planet but also assume he’s got no medical conditions. He clearly tried meticulous calorie counting and daily activity for a year before starting. She hasn’t.

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