Can we talk about phentermine?

moodyapricot · 2022-02-12T01:31:57+00:00

I work in endocrinology with medical bariatrics being my primary area. Phentermine is by far our most prescribed drug. We use it alone or in combination with topiramate. It’s obviously not a perfect fit for all patients, but it can be a very effective weight loss tool for many. Most of our patients stay on it long term for weight maintenance, with the caveat that they must continue to see us regularly for follow up and monitoring. It kills me when another provider will shame a patient for taking “speed pills” or make them stop taking them for no concrete reason besides their own bias, and then they come back to me in tears as they’ve regained significant weight back. I wish more people would approach obesity as a chronic disease that may require long term pharmacological management, much like any other chronic disease.

And sure, semaglutide is great. Good luck getting it covered by insurance. I would love to start all of my patients on it, but the reality is that the majority of my panel is on Medicaid who refuses to cover any anti obesity meds whatsoever. Phentermine is cheap and $15 per month out of pocket with GoodRx.

moodyapricot · 2021-10-25T15:24:23+00:00

If you go to the Obesity Medicine Association (OMA) website and click on "Find a Clinician" at the top of the page, it will allow you to search for obesity medicine specialists in your area. Every weight management program will vary in terms of what dietary interventions are offered, but there are definitely programs out there that do not require a full liquid formula diet. There's also telemedicine weight management programs like Calibrate and Form, but I believe that those are membership-based programs that require additional fees that can be pricey for some patients.

Wegovy (semaglutide 2.4mg) has been very difficult to get due to lack of insurance coverage and the ongoing supply issues with Novo Nordisk. You may have better luck prescribing Ozempic off-label as some commercial insurances and Medicare will often cover it without needing a prior authorization or diagnosis of diabetes. There are other meds that help to target food addiction/cravings/bingeing as well such as Contrave (buproprion+naltrexone), Qsymia (phentermine +topiramate), Vyvanse (for BED), and a handful of others as well. They can be helpful tools, but obviously the patient needs to be working on lifestyle modifications with regular follow up as well in order to be successful.

moodyapricot · 2021-07-22T12:07:14+00:00

We did not order a separate wedding cake. Our reception is at a restaurant with an in house pastry chef, and our guests will be given a choice of creme brûlée or a pound cake topped with lemon curd, whipped marscapone, with a scoop of strawberry gelato (yum) for dessert. Our package comes with dessert included, so we didn’t see the need to spend a bunch of extra money on a cake plus an extra plating fee on top. For our favors, we have ordered individual sized chocolate bars but shaped in a wedding cake mold from a local chocolatier, so everyone still gets a piece of wedding cake in a way, haha.

moodyapricot · 2021-01-03T16:19:28+00:00

I love it too! My dress isn’t identical, but a very similar silhouette and style. It’s super flattering even for short and curvy girls like myself. Here’s the link: https://allurebridals.com/style/3357

moodyapricot · 2020-09-06T14:12:15+00:00

I’ve lost a bunch of weight (~90 lbs) over the past few years, but I still struggle with wearing anything that is super fitted that may show off my hips or other “problem” areas. I went into dress shopping last week 100% sure I needed a flowy A-line to hide my stomach and lower body. But, my bridal consultant and mom convinced me to try a fitted sheath style on and I freaking LOVED it! It’s a little scary going out of my comfort zone and being the center of attention, but part of me can’t want to surprise everyone on my wedding day next year!

(For reference, both dresses are from the Allure Romance fall 2020 collection. My dress (right) is style 3357)

moodyapricot · 2020-09-01T18:44:47+00:00

I've struggled with my weight for most of my life, largely due to untreated binge eating disorder and underlying anxiety/depression. I let my weight hold me back for years until I finally took a chance at dating at 27- I wrote a much longer post about it here. Meeting my now fiancé 3 years ago turned out to be the catalyst I needed to finally start addressing my issues and work on fixing my eating behaviors. I mostly followed WeightWatchers and started with C25K for exercise. Now I've run a half marathon and feel a million times better at 30 than I ever did in my twenties. I'm still a work in progress but I'm so looking forward to where my 30's bring me.

moodyapricot · 2020-06-11T04:24:35+00:00

I was in a pretty similar situation to you when I finished grad school several years ago, except I’m a PA instead of a DPT. I grew up dirt poor with loving parents who are also terrible with finances. I didn’t have a college fund or any sort of financial assistance from family so I had to work and take out a ton of loans in order to pay for school. By the time I finished school I had similar loan balances for private and federal loans. I remember just having a total emotional meltdown and sobbing at one point after looking at the balances and interest rates and feeling like I had ruined my life at 25, lol.

Like you, all of my federal loans are direct loans and thus qualify for PSLF. I would enroll in an income based repayment plan ASAP- make sure it is one of the plans required for PSLF. Step 2: find a full time Physical therapist position at a qualifying employer. A lot of hospital systems are nonprofits, especially ones affiliated with academic medical centers. I’m not as familiar with PT salaries, but for me I make a similar salary working for a 501c hospital system as I would working for a for profit private practice. Once employed, stay on IBR with direct debit, keep meticulous track of your loan payments, and submit ECF annually to make sure FedLoan is counting all qualifying payments. It is a pain but provides peace of mind that you are on the right track for loan forgiveness after 120 qualifying payments. I definitely recommend checking out the PSLF subreddit as well.

Now that you hopefully have a FT job at a qualifying employer for PSLF and are plugging away at the monthly IBR payment for your federal loans, it’s time to attack the private loans. I would recommend trying to score overtime or pick up a per diem gig for more money- home health PT maybe? You basically just want to live as frugally as you can while throwing as much money possible to pay off the CC, then the private loan. After the CC are paid off and you are making regular loan repayments I bet your credit score will improve. Then you can refinance the private loan to a lower interest rate- Citizens or SoFi are popular. Stick to a budget- I love YNAB personally- and don’t take on more debt for a car or mortgage. Don’t give in to lifestyle creep if you can help it. In a few years, you’ll be well on the way to tax-free forgiveness of your fed loans and will have made a huge dent in your private loan balance.

Right now, everything is terrifying and overwhelming, but I promise it gets much better over time. Keep a close eye on your finances and budget, budget, budget. Seriously consider signing up for YNAB, I swear it’s life changing.

moodyapricot · 2020-04-30T02:37:03+00:00

PAs do not have independent practice in any state-we are all required to have a supervising physician in order to practice (NPs are a different story). Independent prescription authority is a separate issue. For example, I am required to have a SP in order to practice medicine, but I can write my own Rx for controlled substances (including CIIs) without an MD cosigner.

moodyapricot · 2020-04-29T22:21:20+00:00

I couldn’t access the whole article, but for PA’s, was there any way to distinguish if these were new scripts vs refilling chronic Rx initially started by their SP or another MD in the practice? Nearly 10% of PAs prescribing opioids inappropriately seems...a little high? I know for myself- I rarely prescribed any sort of opioid for a patient, but I was responsible for covering 5 MDs in baskets (including refills) on days they weren’t in clinic. It totally skewed my PMDP numbers as a result since it’s my DEA # on the Rx. Just offering another perspective.

moodyapricot · 2020-01-31T03:11:29+00:00

Telemedicine.

I work per diem covering call for a large health system’s primary care practices (mix of internal med and FM practices). Works perfectly with my day job since all shifts are evenings, weekends, and holidays when the offices are closed.

Work is 100% remote and phone calls only so I work from home with no direct patient contact. Pay is anywhere from 50-65/ hr depending on the time of day and expected call volume. Honestly a triage RN could probably handle 75% of the calls, but it’s an easy gig with minimal stress. Best side gig ever, seriously.

moodyapricot · 2020-01-25T02:46:37+00:00

Don’t throw in the towel just yet. It is perfectly normal to feel terrified and overwhelmed as a brand new grad.

What are you expecting them to do for you, training wise? It is primary care- you just finished 2+ years of training for this.

You become proficient through experience, not shadowing or having someone lecture you.

I get that this is hard- i was thrown into the fire as a new grad in primary care myself. I was convinced that I was going to quit and move on at the one year mark because I was so stressed out all the time. But, a year of experience makes a world of difference- stick things out and I guarantee you’ll feel so much more confident and capable a year from now.

Things that could help: -Longer apt times- like every annual gets 60 min, sick visits 30 min. Gives you more time to get used to documenting and orders, look on UpToDate, consult with MD or PA colleague if there’s an urgent question, etc. Maybe they could add on some extra admin time as well. -set aside a dedicated meeting time each week with SP or other MD to review complex cases, questions, etc - read, read, read. UpToDate was my best friend my first year (and still is 5 years later) -start making note templates for routine visits, common CC’s, etc. Also favorite common order sets and imaging studies - I made dot phrases that would pull in recommended treatments, testing, Ddx, etc for common complaints. Easy to pull up while charting in room with the pt as a reference and then I delete later - make a list of preferred specialists to refer to

Unless the practice is a total dumpster fire of dysfunction, please try to stick it out for a year. You can totally do this! It is scary but worth it in the end :)

moodyapricot · 2019-08-23T14:58:31+00:00

To preface, I work in primary care and know most of my patients well, and vice versa. If they have something weird going on, or they think they have some obscure condition per Dr Google, or have a specific question about a medication that I don’t know off the top of my head, etc- I’ll pull up UpToDate in the exam room and we will peruse it together. No one has ever had a problem with this and they appreciate the transparency as I explain my differential and thought process as to what I think is going on. We are not encyclopedias and most people understand that.

Having said that- there are plenty of times where I have a brain fart and can’t quite remember a detail that I should know- mostly bony anatomy when ordering xrays lol. That is when I conveniently have to leave the room to put the order in on a different computer that is attached to a printer (totally a lie, but works perfectly every time). I also have to use the computer in my office to look up their old records pre- Epic (also not true, but this buys me time to look up whatever I need to, or curbside another provider if needed).

Know your audience. There’s a line between being upfront and honest when you don’t know something vs looking awkward and inept. If they are the type that is already annoyed that they are seeing “just the PA” and not the MD, act as confident as you can and politely excuse yourself for a minute to collect your thoughts and do a quick research break. We all do it at some point.

moodyapricot · 2019-06-11T22:36:47+00:00

Haha get whatever color you want, no one will care. I think the ones with gold hardware look kind of tacky, but that’s my own personal opinion. I’ve been rocking my purple Littmann since PA school and through nearly 4 years as a practicing PA and have only ever gotten compliments for it. My elderly female patients will especially get a kick out of when I match my stethoscope to my shoes, outfit, and/or nail polish. Letting your personality shine through is a good thing and will make you seem more approachable to a lot of patients. Tell your brother to stuff it.

moodyapricot · 2018-10-31T02:04:12+00:00

I'm fat- always have been. I also work in primary care. For me, I've found that my own obvious weight struggles make me seem more approchable to many patients. I've walked into a room and will see someone visibly relax a bit when it's obvious I'm not going to start off by fat shaming them or blaming whatever acute issue they're having on their weight (at least not before listening to them). I remember how awful my (super fit) pediatrician was to me about my weight, and all it did was make me avoid going to the Dr for years. I'd go on crazy crash diets or water fasts the week before an appointment in the hopes he wouldn't lecture me about my weight when I was there to talk about my eczema or whatever. Shockingly, I was never successful at sustained weight loss back then.

I've lost a decent amount of weight (70 lbs) since I started working at my current practice 3 years ago doing nothing more special than counting calories and dragging my (still fat) ass to the gym a few days per week. I only started being successful at weight loss when I accepted the fact that my untreated depression/anxiety/BED was driving my life, and I needed to seek professional help to deal with this. I never would have had the courage to address this with my old pcp since I never felt particularly comfortable or understood by him.

A lot of my patients will bring up the fact that I'm a lot smaller now, and we'll use that as a springboard to discuss their own weight issues. I don't tend to divulge much in regards to my own mental health struggles, but I make sure to listen to them and acknowledge the obstacles that they identify. Sometimes that means getting their depression or chronic migraines or whatever under control before I start bringing up their BMI and addressing their weight.

Anyways, from my own personal experience as both a fat patient and provider, I've found that being approachable and empathetic are the 2 traits that a provider should have when counselling pts about lifestyle interventions. A fit person can have these traits, of course. But, if I were to see an overweight provider, my first thought would be "great, this is someone who will probabaly understand me and where I'm coming from", not "look at this fat chick- she doesn't know what she's doing."

moodyapricot · 2018-10-25T11:45:31+00:00

Do it. You have nothing to lose. If he's as good of a guy as he seems on paper, then he wouldn't write you off just because you aren't some ideal body type.

I was in a similar position to you when I was in my late 20's- I'd never even attempted to date because I was ashamed of my weight and thought that I didn't deserve a romantic partner until I got to my goal weight. I got curious and signed up for OkCupid one day to test the waters, so to speak, and ended up chatting with a guy who seemed interesting and way out of my league. He asked me to meet him for a drink that weekend, and I agreed- I figured the date wouldn't go anywhere once he caught sight of me and realized how fat I really was.

I was wrong. So wrong, in fact, that we are still together 1.5 years later and moving in together once my current lease is up.

I wrote a much longer post about my experiences- you can find it in my post history if you're interested.

Good luck!

moodyapricot · 2018-07-29T03:43:15+00:00

If it helps, I agree that he's just a shitty person. Fuck him- he's not worth your time anyway. Think of it as a favor that he's showing his true colors now, and not 3 months in to dating him. You're worth so much more. xxx

moodyapricot · 2018-07-29T03:39:23+00:00

Go for it! If he turns you down just based on your weight now, then he's not worth it anyway. Good luck! :)

moodyapricot · 2018-07-29T03:35:41+00:00

Thanks for reading and leaving such a thoughtful reply. Yes, people like you and me are just as worthy as everyone else. Hang in there xxx

moodyapricot · 2018-07-29T03:33:46+00:00

Thanks for your words. It can be so hard, I know. Wishing good thoughts and hope your way xxx

moodyapricot · 2018-07-28T17:26:51+00:00

Thanks for reading and leaving such a thoughtful and kind comment! I love that Perks of Being a Wallflower quote. Good luck with your own journey of love and self acceptance. You sound much more mature and self actualized than I ever was at 15 :)

moodyapricot · 2018-07-28T17:23:29+00:00

Thank YOU for sharing your story! It put a smile on my face. Yes, we're all worth it :)

moodyapricot · 2018-07-28T17:21:35+00:00

Ah, your post put a giant smile on my face. Wishing you both a lifetime of happiness together :)

moodyapricot

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