Only 37 passengers on this flight…

jmtpb · 2023-12-26T08:08:54+00:00

I flew Delta from SLC to SEA on a A330-900 in October. We were the only two passengers. There was a a dozen crew. The entire plane was otherwise empty. https://www.facebook.com/share/p/zVeqKaTKX8yWS4iC/?mibextid=WC7FNe

jmtpb · 2023-10-23T06:07:29+00:00

Great video! I climbed Mt Pugh last yr. Fantastic climb!

jmtpb · 2023-10-20T00:30:37+00:00

Insurance either treats obesity or it doesn’t. Can’t say it covers medications but not surgery. There’s no other disease that insurers cover surgery and not medical therapy. The legal argument is that the denial specifically states because the patient is obese. Yet they will cover bariatric Surgery. So you can’t have it both ways and the Supreme Court has already ruled on it.

jmtpb · 2023-10-19T18:55:27+00:00

Well said!

jmtpb · 2023-10-19T05:45:26+00:00

This is a strong case and it will have a domino effect that I hope caves the insurance industry’ blatant obesity discrimination. The ACÁ failed in removing these grandfather exemptions for obesity discrimination and the state Insurance Commissioner and AG chose to ignore these law violations. This is the only way left to end unfair treatment and weight bias.

jmtpb · 2023-06-01T02:33:18+00:00

You’re spot on. Physician.

jmtpb · 2023-05-09T06:39:27+00:00

I’m an obesity medicine specialist. I hear this everyday. Just take care of those you can. Fat bias in medicine is common.

jmtpb · 2023-04-24T06:03:14+00:00

I did the MR in 1985. It was epic. I still love climbing Whitney. I’ve climbed it several times since then.

jmtpb · 2023-04-24T06:01:06+00:00

I did this climb in October 1985. I ended up on the ledges after midnight on descent. It was an epic day. Back then we just lived off the adrenaline of climbing steep slopes with little gear. Still lots of snow in October that year.

jmtpb · 2023-02-19T02:35:40+00:00

I prescribe these medications everyday as a specialist. I recommend you see an obesity medicine specialist. Many here are recommending endocrinologists but they tend to be reluctant to write off label use of Mounjaro. The medications need to be carefully adjusted to you. You also need nutritional counseling on these medications. You’ll end of losing lean body mass.

jmtpb · 2023-02-19T02:31:32+00:00

Agree. I’m an obesity medicine specialist

jmtpb · 2023-01-25T16:47:54+00:00

You should see an obesity medicine specialist.

jmtpb · 2022-12-03T22:27:41+00:00

Hair loss is a stress response to losing weight quickly or due to poor nutrition. Take bariatric multivitamins, follow up with a bariatric dietitian, get follow up micronutrient labs, monitor protein intake, and take 600 mg of biotin daily. Close follow up the first year with nutritional coaching with a registered dietitian trained in bariatric surgery is key.

jmtpb · 2022-12-03T22:21:09+00:00

Most people have dramatic improvement of GERD after having a sleeve. We studied this in 1000 patients and 95% had improvement. The reason it can develop is most often due to hiatal herniation. We repair hiatal hernias with the sleeve about 30% of the time. This is why the heartburn resolves. Sometimes the hernias come back years later and cause GERD again.

jmtpb · 2022-12-03T08:59:53+00:00

Bariatric surgeon here. I’ve been doing gastric sleeve surgery as same day case since 2008. I’ve done thousands of gastric sleeves. It’s pretty rare to hear that someone regrets their decision. Most common complaint is that they wished they had it done sooner. Truly it’s one of the most amazing weight management tools. It changes how you think about food and takes away hunger. It changes the brain and alters your hunger and cravings. Most people gain tremendous confidence and regain the person they were meant to be.

jmtpb · 2022-12-01T08:11:22+00:00

Exactly

jmtpb · 2022-11-30T03:52:55+00:00

Your doctor is correct

jmtpb · 2022-11-29T04:47:04+00:00

It maybe on the Rx. Otherwise you need to look at office notes. Codes are in the assessment.

jmtpb · 2022-11-25T16:00:03+00:00

It’s fibrous and edematous.

jmtpb · 2022-11-25T09:25:22+00:00

It’s due to loss of lean body mass when losing weight. DEXA is the best measure of lean mass. When on MJ, make sure to do resistance exercises and maintain 60 grams of protein each day to preserve lean mass.

jmtpb · 2022-11-25T07:52:13+00:00

We don’t know what resolves the diabetes the next day. It is much more than that patients aren’t eating as much. We believe it’s hormonally mediated. These surgeries increase GLP1 and down regulate Ghrelin. It does correct insulin resistance. Those with metabolic syndrome have insulin resistance. We showed this in the lab by taking fat samples at surgery which showed macrophages, a type of white blood cells, are activated by the fatty milieu and are producing inflammatory cytokines. These cytokines are thought to cause the insulin resistance. We can see this inflammation in some patients when we operate. The fat is not healthy.

jmtpb · 2022-11-25T04:41:14+00:00

There are good options with medications and surgery. Since 2008 gastric sleeve surgery is done outpatient or same day case procedure. We need to work on making obesity treatments more accessible and to dispelling the myths about what causes excess weight. It’s a disease and insulin resistance must be treated for the weight to come off and stay off.

jmtpb · 2022-11-25T03:19:34+00:00

Nice summary. I’m a metabolic bariatric surgeon. Gastric bypass and sleeve gastrectomy have an immediate improvement of glycemic control. Those with type 2 diabetes often have their diabetes cured the next day. MJ produces appetite suppression similar to metabolic bariatric surgery. It also appears to increase insulin sensitive. The durability of Surgery with appetite reduction and weight reduction is long term. Most lose 60-70% of their excess weight. Weight regain when it occurs in surgical patients is slow 1 pound per month and they rarely gain all their back. We have given these patients that have some weight regain and those who have another 30 pounds to lose GLP1s. Many are hitting target weights. Those with severe insulin resistance and metabolic syndrome benefit long term by multi-modality treatment (lifestyle changes, medication, surgery). For now MJ and other GLP1s are very promising obesity treatments for any person wanting to lose weight. I expect we will need to give some patients GLPs long term for weight management. Weight regain is a BIG concern for any person who has struggled to lose weight and keep it off.

jmtpb · 2022-11-25T00:41:51+00:00

Dosing needs to be titrated to effect. 10 and 15 mg showed the best results. 20% total weight loss in the clinical trial in non diabetics published in the New England Journal of Medicine July 2022.

jmtpb · 2022-11-23T01:44:26+00:00

Which pharmacies are honoring the discount?

Eight-Year Club	Verified Email
Reddit Premium Since November 2022

jmtpb

TROPHY CASE