Index   --   WPGYN Newsletter  --  Volume 12, Issue 1,  January 2015

Happy New Year!

Medications Can Help With Weight Management!

New Menopause App—MenoPro

41 Superfoods

Happy New Year!

 Once again, we find the New Year is upon us, a chance to reflect on the past and plan for the future.

Health care continues to undergo changes, most of which are designed improve patient access to care while maintaining the security of medical records.  It is now easier for you to schedule appointments online and to see your lab results online.  If you have not yet signed up for Patient Fusion, please do so.

One caveat in regards to scheduling online – if you need to be seen urgently, then call for an appointment rather than using online scheduling. Each day, we reserve a spot for emergencies that we don't fill until that day or the day prior, but those slots don't show up on the online schedule.

Unfortunately, many patients have been facing higher deductibles and copays which has led to postponing doctor visits or needed testing.  Many preventative services like gynecologic exams, contraception, and mammograms are well covered, so please do not neglect these important services.

Unique Laboratory Services—Theranos

Many of our patients have been pleased with visiting Theranos for lab testing.  Most of your blood tests there can be done with a finger stick instead of the usual blood draw.  The prices are also much reduced which helps with the high deductibles.  At the present time, the only Theranos site is at the Walgreens on University Avenue in Palo Alto.

On A Personal Note... 

I always appreciate the nice holiday notes I get from my patients keeping me up-to-date with their families and activities.  I thought I should respond in kind and let you know some of the highlights of my family and my year.

My wonderful husband, Richard, and I celebrated our 42^nd anniversary with a trip to the Grecian Islands.  Our older daughter, Mona, has now been living in Panama City, Panama for 10 years where she works for Adidas in web-based marketing and search engine optimization.  Our younger daughter, Jayna, is a licensed attorney in California currently specializing in elder financial abuse.  If you know of someone who could use her services, she can be reached at jayna@jaynasutherlandlaw.com.  The family was all together this summer and enjoyed kayaking in Elkhorn Slough. 

Medications Can Help With Weight Management!

Are your efforts with diet and lifestyle just not working?  This might be the year that your resolution regarding weight loss could be successful!  We finally have more tools in our toolbox to help you.  Over the past 2 years, the FDA has approved 4 new medications for weight management.  There is finally a realization that will power alone, the old “push yourself away from the table” advice, simply isn't enough for many people.  We each have a unique biochemical and hormonal make-up, and for some people, those chemicals are constantly fighting your best intentions for weight loss.  I know many of you are frustrated after years of trying but not really making much progress.  If what your're doing isn't working, then it's time to try something different.  You may be a candidate for one of these FDA approved weight management meds.   

Are You a Candidate?

You could be a candidate for one of these medications if your BMI (Body Mass Index) is  = 30 kg/m2 (obese), or = 27 kg/m2(overweight) in the presence of a weight-related health issue (e.g., hypertension, high cholesterol, type 2 diabetes).  If you know your height and weight, you can calculate your BMI here.

Which Medication is Right for You?

All of these medications have potential for risks and complications.  Some will work better for some patients than others.  Some require lab testing before starting and during follow-up.  Dr. Sutherland or Barb Dehn will be happy to consult with you and prescribe these medicines but only after a dedicated appointment that allows a complete discussion.  A brief summary of some of the key points is below. 

Qsymia (combination of phentermine and topiramate)

Contraindications – Pregnancy, high thyroid, use of MAO inhibitors, allergy to ingredients
Drug interactions – Birth control pills, CNS depressants including alcohol, some diuretics
Side effects – dizziness, tingling, insomnia, constipation, dry mouth or funny taste in mouth
Loss of >10% body weight at 1 year-- 47.7 %
Discontinuation due to a side effect – 17.4 %

Belviq (lorcaserin)

Contraindications – Pregnancy
Drug interactions – Serotonergic drugs (SSRIs, SNRIs, tryptans, bupropion, MAO inhibitors);  most antidepressants and migraine medications
Side effects – dizziness, headache, fatigue, nausea, dry mouth, constipation
Loss of >10% body weight at 1 year-- 21.9 %
Discontinuation due to a side effect – 8.6 %

Contrave (naltrexone and buproprion)

Contraindications – uncontrolled hypertension, seizures, alcohol withdrawal, benzodiazepines (Ativan, Xanax, Valium), barbituates, antiepileptic drugs, chronic opioid use, MOA inhibitors
Drug interactions – MAO inhibitors, some antidepressants, some antipsychotics, beta-blockers, some antiarrhythmics, clopidrogel
Side effects – suicidal thoughts, nausea, constipation, headache, dizziness, insomnia, dry mouth, diarrhea
Loss of >10% body weight at 1 year-- 25.2 %
Discontinuation due to a side effect – 24 %

Saxenda (liraglutide)

Contraindications – medullary thyroid cancer or multiple endocrine neoplasia syndrome. Other glucagon peptide 1 medications, incl Victoza (same medication but approved for type 2 diabetes)
Drug interactions – none known, but delays emptying of the stomach so may affect absorption
Side effects – thyroid C tumors in rats, nausea, diarrhea, vomiting, hypoglycemia, constipation, pancreatitis, gallstones
Loss of >10% body weight at 1 year-- 31 %
Discontinuation due to a side effect –  7.8 % (for Victoza, lower dose used for diabetes treatment)
Special issue – daily injection

Xenical or Alli (orlistat)

Contraindications – malabsorption, gallbladder removal or malfunction, pregnancy and nursing, liver and pancreas disease
Drug interactions –  cyclosporine, amiodarone, HIV medications
Side Effects – oily and loose stools, increased gas, leakage of stool, urgent bowel movements, liver damage, kidney damage, malabsorption of fat soluble vitamins
Loss of > 10% body weight in a year – 16.4% to 24.8%
Discontinuation due to a side effect – 8.8%
Special issue – Alli can be bought over the counter

Will these Medications be Covered by Insurance?

Every insurance policy is different in regards to specific benefits, so you should check directly with your carrier as to your benefits.  Some of the pharmaceutical companies offer drug discount coupons which you may be able to download from the medication's website. 

We are hopeful that coverage will be improving.  In March, 2014 the federal Office of Personnel Management, which governs federal employee health benefits, announced that federal insurance plans may not deny coverage of FDA-approved weight loss medications. The announcement noted that obesity could not be considered a "lifestyle" condition or that weight loss treatment was "cosmetic."  Commercial insurance providers may take note and follow suit with this decsion. 

What Else Should you do for Successful Weight Loss?

 Of course, none of the medications will be effective unless they are combined with a diet and exercise program.  Many of you could write your own book on diet and exercise, but sticking to the things you know you should do can be very challenging.  I encourage anyone who it serious about weight loss to participate in a formal weight loss program.  Studies show that such programs are linked with greater success.  We have had excellent success rates with the Women Physicians Weight Management program.  If you would like to learn more about this program, please call the office at 650-988-7550 to schedule an appointment for a consult with Barbara Dehn, RNP. 

New Menopause App—MenoPro

The North American Menopause Society (NAMS) has designed a free app to help women with the complex decision of how to safely manage their menopause symptoms.  You will find algorithms and decision support to help you apply your personalized situation to what is known about risks and benefits so you can understand your best options.  The app also has links to other sites with specific information on risks of other diseases such as breast cancer, osteoporosis, and heart disease.  Currently, the app is available for iphones and ipads, but not android devices.   To learn more about this app, visit MenoPro: A Mobile App for Women Bothered by the Symptoms of Menopause.

41 Superfoods

I’ve shared with many of you how much I love my Kale Salad which says right on the package that it’s packed with 7 superfoods.  I was surprised to learn that some of those 7, such as cranberries and sunflower seeds, didn’t even make the list below of 41 superfoods.  The list below was developed by Jennifer Di Noia, PhD and published by the CDC as Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach.  Powerhouse fruits and vegetables (PFV), foods most strongly associated with reduced chronic disease risk, are described as green leafy, yellow/orange, citrus, and cruciferous items, but that description still leaves consumers wondering what to choose.  Dr. Di Noia developed a classification scheme to quantitate the nutrient density as compared to number of kcals. 

I still love my Kale Salad!  After all, none of us are expected to eat watercress all day.  Maybe I’ll try to add in some collard greens.  I loved those when I was growing up in Florida, but my father always cooked them in a pan full of bacon grease.  I doubt Dr. Di Noia would approve of that!

We Need Your Help

· Please bear with us as we train our new medical assistant.

· Parking continues to be a major problem.  Please allow adequate time to park, and fill out paper work before your scheduled exam.  

· Please request other providers to copy us on your lab and radiology results. 

· Sign up for Patient Fusion which will give you direct access to  your pap smears and  most lab tests which we order.   This can be done during your next appointment

Information on this website is for educational and reference purposes only and should not be interpreted as specific medical advice.

Copyright © 2010

Women Physicians Gyn Medical Group

650.988.7550