Semaglutide & Weight Loss

This Podcast In Summary

Are you seeking a breakthrough in your weight loss journey? Look no further than our enlightening webinar, "Semaglutide & Weight Loss." This transformative online event offers valuable insights into the world of Semaglutide and its potential to help you shed those extra pounds.

Semaglutide, originally known for its role in diabetes management, has taken the wellness world by storm. In this webinar, we delve into its exciting applications for weight loss.

Discover how Semaglutide can be a game-changer in your battle against excess weight. The webinar explains the science behind Semaglutide, its mode of action, and how it interacts with your body to promote weight loss.

But we don't stop there! Our experts present real-world success stories that showcase the remarkable results Semaglutide has delivered for individuals just like you. Learn about the journeys of those who have achieved remarkable transformations in their lives thanks to Semaglutide.

The webinar also addresses common questions and concerns. We emphasize the safety and effectiveness of this groundbreaking approach, alleviating any skepticism you may have.

Finally, we provide a roadmap for individuals interested in incorporating Semaglutide into their weight loss regimen. Our expert guidance ensures you're well-informed and equipped to make the right choices for your health and wellness.

So, if you're eager to embrace a new chapter in your weight loss journey, join us for "Semaglutide & Weight Loss." It's your gateway to understanding how Semaglutide can be the catalyst for the positive change you've been waiting for. Don't miss this opportunity to explore a path to a healthier, happier you!

Transcript

Brittany:

Oh my God, we are live! This is amazing. With my girlfriend, Bimisa!

Dr. Bimisa Augustin, DNP:

How are you, Brittany?

Brittany:

Girl, I’m good. We're gonna dive into all things weight loss. This is probably the most fun when it comes to, you know, middle of the year, summer's here. What the heck are we to do, right? Those cravings and all the things.

Dr. Bimisa Augustin, DNP:

Absolutely. Time for the hot girl and guy summer.

Brittany:

Ha ha! That’s right, that's right. So for you guys who are just logging on, Brittany Nurse Practitioner with Thrive, it is a pleasure. And also my girl here is with me.

Dr. Bimisa Augustin, DNP:

Hi everybody. I'm Dr. Bimisa Augustin. I'm a Director of Clinician for ThriveLab, also Hormone Clinic Director at Opus Wellness. So go hormones.

Brittany:

That’s right, go hormones and that beautiful uterus behind you. Let's just take a moment.

Dr. Bimisa Augustin, DNP:

Oh yeah.

Brittany:

Have a moment of silence. Ha ha.

Dr. Bimisa Augustin, DNP:

We love our healthy uterus.

Brittany:

That's right! We love a healthy uterus. Love some good weight loss. We'll dive into it all. And you know, we kind of have an outline we want to follow, but we will answer questions. So this is live. Bear with us. But if you have any questions, we will see them in the chat and we will address them. But we wanna really start off with is, the semaglutide, that hot weight loss injectable. We hear about it with the movie stars, rapid weight loss. Everyone wants some semaglutide, okay? And one of the questions was, who is a good candidate for this? And so, Bimisa, I'll let you go ahead and start with this kind of as the beginning platform for our discussion. But what would you say is a good start for this and for who?

Dr. Bimisa Augustin, DNP:

Okay. So, basically we can start with patients that have a BMI over 30. Okay, across the board, yes, they are qualified. If your BMI is 27, 28, 29, you do have to have some metabolic conditions that are coexisting with that BMI. Like diabetes, high cholesterol, high blood pressure, cardiovascular disease, or non-alcoholic fatty liver disease. Okay, non-alcoholic fatty liver.

Brittany:

Thank you!

Dr. Bimisa Augustin, DNP:

Because alcohol is one of those medications that you, or one of those things that you need to avoid when you're on semaglutide.

Brittany:

Mm-hmm, absolutely. And you know, we talked about comorbidities too, like high blood pressure. I'm sure someone's thinking, well, what kind of blood pressure? Yes, we gotta have that range, no greater than 140 over 90. So the top number 140, if it's higher, oh, you got some high blood pressure, that will make it a category. And then also the bottom number, the diastolic greater than 90. And then two, even some research shows mood disorders. Right? Depression, anxiety,

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

sleep apnea. I know our criteria, if you've had severe COVID, unfortunately, we're kind of on the other side of that now, but you've had some chronic issues after COVID, it qualifies you. And then even some cancers, right? So

Dr. Bimisa Augustin, DNP:

Absolutely.

Brittany:

uterine cancer, breast cancer, things like that can actually help you in addition to a BMI of 27. Now, some people, it's always a question of like, what is your BMI? And that's your body mass index. That's the bittersweet of it. For our patients who lift heavy weights and they're told they're morbidly obese, although they're all muscle

Dr. Bimisa Augustin, DNP:

Right!

Brittany: 

or bodybuilders. But for example, like if your BMI is 30 or greater, I'm 5’5. Okay. So we'll just go off of that. If I was 5’5 and I weighed 180 pounds, that's my BMI being 30, right? 

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

My height to my weight ratio.

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

If we're looking at a BMI of 27, that is my height, for example, 5’5, but I'm 165 pounds and I have some comorbidities, high blood pressure, high cholesterol, depression. So there's a lot of things that we can get you in that range for. 

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

It comes down to safety, right? Like we need to have something to work with to make sense of this weight loss. So that's really kind of, you know, for who's a good candidate. And then that's the next question really is the BMI. Right, Bimisa?

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

We just kind of covered that, which is, you know, having the 27 or greater with those comorbidities or even having it 30 with none.

Dr. Bimisa Augustin, DNP:

Absolutely.

Dr. Bimisa Augustin, DNP:

Right, absolutely. Because a BMI basically of greater, 30 or greater does put you at risk of cardiovascular disease, of course diabetes, inflammation, I mean, all the things that can basically go wrong with your body, basically look at that BMI. So that way, you know, you can kind of make some lifestyle changes, some choices that will benefit you in the future, you know, and basically help you live longer.

Brittany:

Absolutely. That's the goal. Always.

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Dr. Bimisa Augustin, DNP:

That's the goal.

Brittany:

Live longer. Live your best life.

Dr. Bimisa Augustin, DNP:

Yeah. Right. And age backwards.

Brittany:

You know, and this is another question just kind of reading off. I want to be sure I hit on everything. Is, you know, this is a good question, right? So thrive we are our big thing is focusing on of course longevity and outcomes for patients to live their best life but also we prescribe hormones, right, from women older than 18, men older than 30, but there was the question of, if you're taking testosterone injections or progesterone capsules, does it affect those? Does our hormones with the semaglutide injection, does that affect, is there an interaction?

Dr. Bimisa Augustin, DNP:

Actually not necessarily an interaction. It does make the absorption and the metabolism of the hormones better. It teaches your body basically what to do with insulin. An increase of insulin can actually have a negative effect on your sex hormone binding globulin. I can't say that too fast. So with that being said, you'll have issues with, you know, production metabolism and absorption of your hormone. So, that's where semaglutide would come into play. And you can actually use them together, HRT and semaglutide.

Brittany:

Right.

Dr. Bimisa Augustin, DNP:

For a positive outcome. Mm-hmm.

Brittany:

Absolutely. And I think they are a great catalyst.

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

Semaglutide and hormones, we're talking you have a hormone imbalance. That's the number one thing I hear in addition to symptoms is weight, weight,

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

weight, weight. That's what really is the big factor.

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

It’s like you sprinkle some semaglutide in, woo! It is just an amplifier. So that's a really good point. And it even asks, does it help with weight fluctuating so much? My husband's gonna kill me. I don't care. If you see me on a ‘wanted’ sign, no.

Dr. Bimisa Augustin, DNP:

Ha ha!

Brittany:

But no, so we're expecting in August. And he has paternal like he's eating he kept snacking and I lost my dang eating partner. And I said, hey, it's cool. Let me get you some semaglutide. We'll get you on it, and girl. He's two months in feeling great, right? Losing weight, whatever. It doesn't matter. Yes, it helps with weight fluctuation. He's not going to be on it forever, at least until I join him after.

Dr. Bimisa Augustin, DNP:

Yes.

Brittany:

But no, I mean, it really can look however you want it to look like that trip coming up or an amplifier with hormones or you got your wife pregnant and you want to feel better.

Dr. Bimisa Augustin, DNP:

You want to eat everything?

Brittany:

It can really look however you want it to look like. But

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

yeah, I mean, it really does help with that fluctuation of weight and some patients can even find too that they're on it for one month. They kind of hit a good weight, then they kind of plateau and gain a little bit back and they sprinkle it back in. So heck yes, weight fluctuating, it helps with that.

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

And that's the next thing too is, well, how can we get the product?

Dr. Bimisa Augustin, DNP:

Well, if you want to go through, so actually if you want to get the product, basically you will do what's called a weight loss intake where there are thorough questions that are asked about snacking, what time you snack, dinner, the time frames, what was your highest weight, what age, you know, your lowest weight, what age, and what are your goals, right? So, after the intake is completed, then you will basically either, you will have another appointment with your provider to go over, you know, if you qualify or not. Sometimes when you're on the initial telehealth getting hormones, you know, it's a possibility that you might have time to even complete that at that point. And then a separate account, well not really account, a separate treatment plan will be set up for your semaglutide, you know, outside of your hormone therapy treatment plan.

Brittany:

Yeah

Dr. Bimisa Augustin, DNP:

So, ThriveLab.com.

Brittany:

ThriveLab.com, we can help you! Yeah, you can get it through that. And I think the cherry on top is, hey, you don't even go to ThriveLab and then wait for that mailman to deliver it to your door. You're gonna have it all there with all your

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

injections, supplies, everything. Your only job is to draw that baby up and start on it. So,

Dr. Bimisa Augustin, DNP:

Start injecting.

Brittany:

anyone can do it. Woo, y'all out there can do it. I promise it'll be good. So, and you know, we'll go into how much and like where to inject. My God, I had a patient that was nervous about it and said, oh, those needles. I said, look, at the end of the day, they want you to be on the medicine. They're gonna make that needle and the way that you inject it nice and easy so you keep coming back if you need it. So it's really straightforward. We'll go into how that is. But you know, starting back with the semaglutide, that was another question is, is it the same thing as ozempic, right? That hot, you know, big pharma injection out there that patients are on for diabetes, is that similar?

Dr. Bimisa Augustin, DNP:

With the same, with the wonderful song? Oh-oh-ohh, what

Brittany:

Yeah.

Dr. Bimisa Augustin, DNP:

was it? Yeah. Okay. So yeah, pretty much the same. You know, one is a brand name and one is a, you know, a generic name, I guess you would call it that. Yeah. Almost the same thing. Don't ask me about the pricing. I have no idea if they're separate, but I mean, sometimes a brand name could get you, you know, more of a cost, but I

Brittany:

Right.

Dr. Bimisa Augustin, DNP:

mean, yeah, pretty much the same drug.

Brittany:

Same drug. And I, you know, we work with compounding pharmacists and I know sometimes that's not the most enlightening. Some patients are like compounding. They're not making it in the basement, right? Where there's

Dr. Bimisa Augustin, DNP:

No.

Brittany:

qualifiers to be able to sell it. There are things that you

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

have to have guidelines for. And so really what Wegovy, which is like the cousin to Ozempic, really the sibling of Ozempic, those

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

are brand names for the semaglutide. So it's

Dr. Bimisa Augustin, DNP:

Yes.

Brittany:

all the same category, it's just what you're getting. And I think the biggest thing is, you know, the semaglutide belongs to a class of medication that

Dr. Bimisa Augustin, DNP:

Yes.

Brittany:

is a GLP-1. And that's like, well, GLP-1, am I in chemistry? Oh my God, no, we are not in chemistry. But we'll break it down. So the GLP-1 is more like a hormone that's released in the gut. That responds to your eating, that makes you fuller longer. So that's really what all those names are about. So you wanna pay the big pharma price or you wanna get the cousin that's a little cheaper and does the same thing.

Dr. Bimisa Augustin, DNP:

Absolutely. Yeah.

Brittany:

Whatever your wallet wants to do but we can get you there either way.

Dr. Bimisa Augustin, DNP:

We can get you there.

Brittany:

Absolutely. And you know, that was the next thing too is the semaglutide only for weight loss or does it improve the whole body well-being.

Dr. Bimisa Augustin, DNP:

Well, with weight loss comes whole body wellbeing in the first place. I mean, you won't become, you know, with weight loss you can decrease your chances of insulin resistance. Of course, cardiovascular disease. I mean, literally all the things I just listed. So overall, yes, it will improve, you know, whole body wellness, especially if needed. We use it, of course, religiously for diabetics. you know, to help them. And they've lost a lot of weight. I mean, because in some cases, if they're caring for themselves, it's absolutely reversible, okay? They're caring for themselves like they should with diet and exercise changes, just complete lifestyle changes, yeah. So yeah, that's my answer. Yes, yes, yes, yes, yes, across the board.

Brittany:

Absolutely. And I find too that, you know, we'll get into patients who are diabetic who are on it. Yes, it really helps slow the gastric emptying. I think the beauty of it too is what it does to the brain when it comes to cravings. It's quite fascinating,

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

but someone who likes a nightcap or someone who loves the popcorn and movie,

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

your receptors for that is completely shut off. Now you're still who you are emotionally and things like that but the cravings are declined.

Dr. Bimisa Augustin, DNP:

Yes.

Brittany:

And I even have patients who felt kind of emotional about it. Hey, I have a loved one. We like to have date night Friday. We're indulging and I'm not because I get sick if I eat too much. And so it's so much that you feel fuller longer which is a beautiful amplifier for weight loss. But with that decreases heart disease, decreases your A1C, your average blood sugar for three months, reverses those comorbidities. So, I mean, you said it perfectly, like, absolutely. It does more than just weight loss. It just amplifies

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

everything throughout the system. So yeah, that's a really good point too. And you know, that's another thing that they had asked as well is are there any other natural alternatives or equivalents to the semaglutide injection that you would say?

Dr. Bimisa Augustin, DNP:

Um, so yes, so there is a list that was sent to me and I can go over some of them. Um, well actually all of them. Um, so the Maritrim that's a blend. There's like, there's two herbs in it. Uh, seraphanthus indicus and Garcinia magnosium. Um, they do have positive effects on the metabolism. So literally you can take this like 30 minutes, it's almost taking like a thyroid medication, take it 30 minutes before a meal. Um, it can lower total cholesterol, lower triglycerides, lower your fasting glucose. And also, you know, it's taken at like 800 milligrams a day. Okay.

Brittany:

Right.

Dr. Bimisa Augustin, DNP:

Um, let me see. Berberine at 1200 milligrams a day, it's commonly used in diabetics, okay. So with increased cholesterol, with hypertension, this can regulate basically how your body uses sugar, almost like semaglutide, right? So, but this is, these are herbal supplements. The aloe vera increases your metabolism. So it increases the number of calories you burn. Who'd have thought drinking aloe vera, right? PhenQ, so apparently this is the best Ozempic alternative overall. It has ALA in it. It has cysteine based magnesium and cat's neck powder, which that's like a thermogenic. So, I mean, we were all hot to that, what is it? PhenQ, you know what it is? When it first came out. So yeah, this is gonna burn you up. Literally. Yeah. Let me see. So, Zotrim is an appetite suppressant. It has like six herbal supplements in it. And then, AltaBalance, it improves your blood sugar control. It also reduces inflammation and supports your metabolism. So yeah,

Brittany:

Yeah.

Dr. Bimisa Augustin, DNP:

there are some alternatives. That are herbal.

Brittany:

You know, and with these herbals too, like, I mean, I think there's some great alternatives, but then it's like, are you gonna remember to do it every day or before the meal? I mean,

Dr. Bimisa Augustin, DNP:

Nope. Nope.

Brittany:

what I love about the semaglutide is it's that once a week, and we'll dive into how it's administered, but I think there are other great, helpful alternatives, right, like

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

think there's, just depends on like, you know, it's not one shoe fits all, like what are you looking for? Do you wanna do it daily? Do you wanna do it before every meal? Or do you wanna sit back and... once a week and be done and have that effect for that whole week and not worry about this meal, that meal, this pill, you know, what have

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

you. So those are some really good alternatives. And yeah, I mean, a lot of them, right? Metabolism, blood sugar,

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

like pervading heart disease and fat, so those are some really good alternatives. Now that was the next question too, is, okay, we're talking about this semaglutide, what the heck is it? Like, how do I use it? We're kind of, you know, what does it look

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

like? So... semaglutide, it's subcutaneous,

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

right? And so,

Dr. Bimisa Augustin, DNP:

Right under the skin. Yep. In the epidermis.

Brittany:

right.

Dr. Bimisa Augustin, DNP:

So, I mean, it's an easy injection. It's used, you draw with an insulin needle, and the needle is really tiny. It's like a 30 gauge, okay? But I did have a question for you. So being that you prescribe it as well, is there a certain point where you actually see patients that don't really have to titrate up on it, or do you continuously titrate?

Brittany:

So what I do is with patients starting on it's always the titration. Now

Dr. Bimisa Augustin, DNP:

Okay.

Brittany:

this affects your GI system, gastrointestinal.

Dr. Bimisa Augustin, DNP:

Big time.

Brittany:

So what that looks like as you're working on the GLP1 is side effects of like nausea, like constipation.

Dr. Bimisa Augustin, DNP:

That's the patient.

Brittany:

Now my patients are getting that right. If my patients are getting that we don't really need to amp up as quick, right? I want you to lose weight happily and not be miserable. So we won't have to amp up that week. But I'm also hitting that gas pedal because we got that wedding or we got those munchies for the what-up, you know what I'm saying, to help get you to those goals. And so to answer your question, I don't find that everyone needs the titration up. If they're like, hey, I'm not eating as much and I'm feeling good with energy and I am not having a bag of popcorn every night and... three breakfast tacos, I'm down to one. Hey, you're cruising. Let's make this medicine

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

work a little bit longer. So definitely you don't always have to titrate.

Dr. Bimisa Augustin, DNP:

Okay, well, yeah, I wanted to ask that question because I haven't had a titrate in one year yet.

Brittany:

Yeah.

Dr. Bimisa Augustin, DNP:

Also too, in the clinic, what I suggest for patients to often do is grab some B6 supplements because it can actually help with nausea. It can, and some of those side effects.

Brittany:

Amen. Yeah, absolutely. B6 is super helpful.

Dr. Bimisa Augustin, DNP:

Are we back?

Brittany:

Yeah we are back. You know, I'm using the hospital Wi Fi

Dr. Bimisa Augustin, DNP:

Okay.

Brittany:

today, girl, you know, it hops

Dr. Bimisa Augustin, DNP:

Oh, I was like, uh-oh, I hope it's not the clinic.

Brittany:

on. So no, the B6 is phenomenal. And again, all you know, that's something my OB recommended in the beginning, right? So B6 is really, really good for nausea. Also ginger chews, you can have that. That's the same thing as kind of a B6 to help with that nausea, but it does get better. You're not going to be having, God forbid, vomiting or something like that. If you do that, that's you're ramped up. But that's why we do a titration.

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

We're slowly introducing it into your system. So definitely want to do that. Now, next question, how long do you need to be on it? Well, yeah, that's a great question.

Dr. Bimisa Augustin, DNP:

Well, everybody is different. And I say that every single time, literally. So some patients, you can start them off on the 12 week, 10 to 12 week program. They're done. They're done. Basically the max I would probably keep a patient on this is probably like a year and a half. But it can go, I mean, you could be fine, after about a month.

Brittany:

Yeah, and you know, and that's the thing too. You know, when it comes to things like, let's compare it to Ozempic, right? You have patients who are prescribed Ozempic for diabetes, same drug class, semaglutide, it's a GLP-1, right? They're on it for years, and that's to help control their blood sugar, but the more aggressive you get, the more you can lose weight and be on it. So you can have someone definitely on it for a year and a half for a year. My clinical patients, sometimes the patients I see are about, 400, 450 pounds they can be. And my goal at that point is yes, weight loss, but also the comorbidities to decrease.

Dr. Bimisa Augustin, DNP:

Control. Exactly.

Brittany:

Because semaglutide is gonna help with weight loss, but it's also gonna help decrease their heart disease, decrease their blood pressure, because they're losing weight, decrease their cholesterol, right? It's like a beautiful catalyst of all the other things that you're trying to address. So that's a really good question, or you can be like my husband. Oh, am I? I just have a little cravings and I just want to get back into my jeans and get ready for you know what I used to wear on the weekend. So it's really how it can be however it looks like for you. But you know we had a question come up that said once you start the medication do you have to be on it for life or what is the average time frame for people. I think we kind of hit on that maybe that came in after we discussed it but you know

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

it's whatever it looks like for you. I find that when my patients get to their goal weight, specifically, they go, you're not gonna take this all away, are you? I mean, it makes them nervous. And I call it almost like a blanket of security. Hey, we can keep you on it. Let's dial it back. Let's get you with a nutritionist or a dietician, get those maintenance calories on board. Let's see how you do. Because ideally when you lose weight, I personally, I'm not sure about you, Bimisa, I say lose about five to 10 pounds past your goal. Because when you get off

Dr. Bimisa Augustin, DNP:

Exactly.

Brittany:

this medication, you're not gonna have that buffer, right? You're

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

gonna be back, you know, yeah your stomach, you know, is shrunk down a little bit more and you're feeling better, but you're not gonna have that security blanket there. So I'm really not strip it all away. You met your goal and then I put a little bit of a buffer. So the average timeframe, you wanna lose 30 to 50 pounds titration dose, maybe one more month, three to four months to do it healthily.

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

Everyone's so different. But it's really based off your BMI body mass index, right? Height and weight plus comorbidities. Hey, let's reverse this high blood sugar,

Dr. Bimisa Augustin, DNP:

Blood pressure.

Brittany:

High blood pressure. Let's go deeper. And that's the goal. I mean, of course with Thrive, it's not, oh, hormones for everyone. It's like, hey, get your labs. What are your vitamins looking like? Right, they didn't know they were signing up for that.

Dr. Bimisa Augustin, DNP:

Right. Yeah.

Brittany:

Like ya’ll dig deep. Same thing with. We're digging deep, we want to cover all bases, and it's for longevity for your health. So the next question is, so this stuff can come with the other prescriptions given?

Dr. Bimisa Augustin, DNP:

So actually what we can do is we can

Brittany:

Yes!

Dr. Bimisa Augustin, DNP:

write- make recommendations. Most of us have full script accounts, so we can actually prescribe it from our full script dispensary like the B6 or B complex, Ashwagandha. I mean all of the above we can actually find it on full scripts and send it to the patient.

Brittany:

And you know, I love that you mentioned Full Scripts. Go into detail with that because this is something that's now getting a voice and it's like,

Dr. Bimisa Augustin, DNP:

Oh yeah.

Brittany:

wait, what is this? What is Full Scripts?

Dr. Bimisa Augustin, DNP:

So it's absolutely amazing. Katie Joe, my provider, uh, with ThriveLab. She actually,

Brittany:

Girl, we love you.

Dr. Bimisa Augustin, DNP:

You actually introduced me. I know we love you, Katie Joe.

Brittany:

Girl, we love you.

Dr. Bimisa Augustin, DNP:

She introduced me to Full Script. So I came on as a patient of hers about a year and a half ago. And, um, I lost 40 pounds, but it was all on hormones. Right? So she, when she introduced, even though I'm a naturopath, she introduced a lot of the, um, some of the other, um, herbals to me. And so she was like, set up an account on Full Scripts and order this. And I was like, okay. So I get on and I'm all confused. I don't know what in the world would do. So I was like, let me just set up and see. But then I saw where, you know, um, prescribers can actually sign up and have an account and I was like, okay, well, let me try this. So I did it with my first patient and they immediately did an order and they were like, we love it. Okay. You sent us the recommendations and a lot of the supplements that they use there, we actually use here in my clinic. So, um, it's, they have a lot of, lot of good herbal supplements. I mean, the nutraceuticals are amazing, like across the board on Full  Script.

Brittany:

Prescription grade.! Katie Jo, I'll never forget. So we had an a4m hormone conference. Thrive took us. It was a beautiful, beautiful week. And, you know, we-we learned full scripts. Katie Jo, a year later,

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

you got your Full Script, now, girl, I know about it. I have been set up. I'm hooked-Full Script. Call me. Hey, you know, all these recommendations. And so and what I love about it is I'm not knocking the fact that there aren't helpful over the counter herbals out there. There is, find what works for you and your budget and like for your lifestyle. But I can say there's nothing more than knowing what I'm sending my patient is prescription grade, it's quality, again, delivered

Dr. Bimisa Augustin, DNP:

Yep. Deliver it.

Brittany:

to the door. I'm like, what more can I ask for? I'm not saying get in your car, start it up, get some gas in there, drive now. No, it's all delivered. And

Dr. Bimisa Augustin, DNP:

All online.

Brittany:

also too, there's formulations and formats to help educate. This is why we're doing this, right?

Dr. Bimisa Augustin, DNP:

We can send you pamphlets. Yes, we can. We send you, yeah, white paper, literally with all the information on it that you need.

Brittany:

Yeah! It's amazing. And you know, God, I love it. But I'll have some patients D3 and B12. Okay, whatever. Right. You know, and then they get it. They go, Oh, my God, I even had a patient

Dr. Bimisa Augustin, DNP:

Great.

Brittany:

today. I started her on vitamin D3, which we could go on and on but this is a weight loss segment. She goes,

Dr. Bimisa Augustin, DNP:

Easy.

Brittany:

My bones aren’t hurting. I thought I was gonna be ‘80 years old for the rest of my life’. Not that 80 is old debilitating, but this girl is in her 30s. I mean come on

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

the things that vitamins can do to you, So yeah, we can definitely

Dr. Bimisa Augustin, DNP:

Absolutely.

Brittany:

do other prescriptions Full Script again if you're like me have it come to my door we can get you what you need. Let's see, ‘Brittany I just made my appointment with you to talk about this’. Awesome this

Dr. Bimisa Augustin, DNP:

Woohoo!

Brittany:

is the push I needed. We know summer is coming. It's getting hot out there. So while y'all are in

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

bikinis, I'll be in my little sundress. I'll be getting some vitamin D and letting them all be injecting, losing weight. It's okay. It's okay.

Dr. Bimisa Augustin, DNP:

Absolutely.

Brittany:

So what else? So I want to touch base too on who cannot take the injection. This was not a question. But this is something I think it's really important to touch base on. The margin for that is very, very small. But I think it's important to know moving forward, if you're amped up, I just kind of want to guide you towards, is it healthy for you? Right? And so safety first. The first thing is personal or family history of thyroid cancer. Now, grandfather, grandmother, mom, dad, what have you. The reason is, is because in animal studies, there were thyroid tumors in the rats. And so with that now, the clinical indication is if you've had thyroid cancer, no, nope, not at all, no family history. Also, you cannot even be on it. Not even if you even had a family history because of the rat studies. And I would like to proudly say that with patients who are on it to this day, we monitor for hoarseness, difficulty swallowing. We're not having you go get your thyroid scans or anything like that, but hey, if your voice changes, if you feel hoarse, monitor for that. But there has been no human study today that has shown because they were on a semaglutide, Ozempic, Wegovy, that whole umbrella, that they got thyroid cancer from this medication. So it's more of a safety thing. If so, if you have nodules or things like that, or if you have a first degree or a second degree family with mens syndrome. Very very rare people are like men what? Men in black? I don't know.

Dr. Bimisa Augustin, DNP:

Like, what is that?

Brittany:

Mens Syndrome, very, very, very rare if you have that that's something not to- you can't start on semaglutide. And then my favorite part: pregnant, breastfeeding, near-term planning, or attempting pregnancy. You can't be on it. This is a category X medication, meaning do not touch it, it's harmful. It's never been studied on pregnant women or women who are breastfeeding, but ideally it is considered to not even look at it, which I'm not, I'm just keeping away. So those are the main reasons why you couldn't be on it. So... other side effects too, or things that you could have that you shouldn't be on it is gastroparesis. Gastroparesis is a GI condition that you already had issues slowing down with your gut. So

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

nausea, vomiting, usually a GI specialist is overseeing that treatment, but this medication slows down your gastric emptying already. We do not need to catapult that anymore. So you don't wanna be on it with gastroparesis and also pancreatitis. So that's why, you know, with heavy drinking, things like that, or even just having it in general, we want to steer away from that- that's inflammation of your pancreas.

Dr. Bimisa Augustin, DNP:

Mm-hmm. It will.

Brittany:

Other than that, those little five points, anyone else can be on it. So those are the small group of people where it's indicated that you cannot be on it.

Dr. Bimisa Augustin, DNP:

Okay.

Brittany:

Another question, can we be used while getting wellness injections like B12 or D3 or aminos?

Dr. Bimisa Augustin, DNP:

Lipovite. Absolutely.

Brittany:

Yes,yes, absolutely. I love patients on B12 and D3. I'm one of those B12 for everyone who wants one. I mean, seriously. And then the Lipovite and all that. No, absolutely. I think it's a great amplifier for those things.

Dr. Bimisa Augustin, DNP:

Yes, yes. Well, that's something we use a lot. Unless the patient has MTHFR and they can't methylate, I'd put B12 and everybody's back.

Brittany:

Yes, absolutely. No, that's a very good point. Yeah, you can't metabolize it. That's a really good point. Can you take it on Synthroid? Heck yeah. Bring it on. I love me some good Synthroid management with an injection like semaglutide because you're working on your master

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

metabolizer, your thyroid.

Dr. Bimisa Augustin, DNP:

Right. Exactly.

Brittany:

That's your energizer bunny, hair, skin, nails, everything. And then you're on the semaglutide to really maximize outcomes.

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

Game over. Absolutely.

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

There's really no drug interactions with semaglutide. I'd have to really research with that, but there's no major like heart medicines, cholesterol medicines. There's really no major issues when it comes to that. Now, the one thing I do wanna touch base on is if you are diabetic, and say you're on insulin and you want, hey, you know, Brittany or Bimisa, you're managing my hormones, I'm on XYZ, I'm diabetic, but I want some of that injection. Well, heck yeah, but if you're diabetic, we need to make sure that you're talking to your provider who's prescribing your insulin or diabetes treatment to see if you are okay to be on this. Now, the risk of hypoglycemia, which is a blood sugar that drops below 70, can make you feel weak and dizzy and things

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

like that, almost where you could faint. It can be deadly, it's

Dr. Bimisa Augustin, DNP:

Absolutely.

Brittany:

not something to mess with. We would need that to be addressed first. We're not going to, we all need to be on the same playing field, right? All the players in the game of treatment need to know what's going on. So we would want that clearance first, right?

Dr. Bimisa Augustin, DNP:

Right, right.

Brittany:

Provider, we're not gonna step on a diabetic regimen's playing field and because this helps diabetes, but maybe we can

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

switch something over.

Dr. Bimisa Augustin, DNP:

Right. And that's why it's so important to, um, to let your hormone provider know like the medications that you're actually taking, even though there's not a lot that have interactions. But if we're doubling up on these types of medications that drop your blood sugar, guess what? We can send you into a whole worldwind of other troubles if we're not informed that you're on other, you know, other medications for diabetes.

Brittany:

Right. Absolutely. No, we definitely need to know. And any risks to be aware of? What about pre-diabetes? These are some awesome questions. Okay.

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

There are, I think we kind of covered the risks, but Bimisa, right? Or what would

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

you have in addition to the risks when it comes to semaglutide? Like maybe I know some, there are more side effects than there are risks, but

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

what are your thoughts on that question?

Dr. Bimisa Augustin, DNP:

Um, um, okay. So one of the things is dehydration. Okay. Severe dehydration can cause pancreatitis, right? And guess what we want to avoid. We want to avoid pancreatitis. So we, if you already have it, we don't want to put you on this med, but we also don't want to precipitate either. Right. So that's some of the risks, dehydration, cause you're going to, you're going to need to pound down. I mean, don't overdo it, but you're gonna need to drink lots of fluid. I'm not just gonna say fluids, water, okay? So, because fluids is not incorporating coffee.

Brittany:

Oh ranch water! Down in the restaurant!

Dr. Bimisa Augustin, DNP:

Right, right.

Brittany:

Alright. H2O. Water.

Dr. Bimisa Augustin, DNP:

So yeah, right, right.

Brittany:

Literally zero.

Dr. Bimisa Augustin, DNP:

So we definitely don't want that.

Brittany:

We want you to see through it and then not to have alcohol in it. Yeah,

Dr. Bimisa Augustin, DNP:

Right, right, right. And also too, with the acute kidney injury, we're not trying to harm you here, we're actually trying to help you. So there's not a whole lot of risk, to be honest with you. So, and yes, it can help with pre-diabetes. Absolutely can.

Brittany:

Yeah, you're getting ahead of that diagnosis of diabetes,

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

which can be detrimental. I mean, diabetes is making your blood sugary. We're talking, oh, my blood sugar's high. That blood is sharp with the sugar of how it's in your vessels scratching up your eyes, making you have

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

vision changes, neuropathy, right? You can't feel your feet. I mean, this is like, if you can do it pre-diabetes, you are way ahead of that big wave

Dr. Bimisa Augustin, DNP:

Yeah, way ahead of the game.

Brittany:

If it's not, yeah, so hey, pre-diabetes, just don’t want to.

Dr. Bimisa Augustin, DNP:

Because insulin, and insulin basically helps move the sugar from your blood into other body tissues. So your body utilizes it as energy, right? So semaglutide is basically teaching your body what to do with insulin, right? So that way it will remove that sugar.

Brittany:

Yep.

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

It's quite fascinating. Never loved chemistry, but this part of it I do.

Dr. Bimisa Augustin, DNP:

Huh? Right.

Brittany:

Ha ha ha ha. Chemistry was like, ah, but no, what it does with the body is quite fascinating. And that's something, can you explain chemically? Oh geez, no, I'm just kidding, it's gonna be fine.

Dr. Bimisa Augustin, DNP:

Ha ha!

Brittany:

Biologically, how semaglutide attacks the fat cells and increases metabolism. So I'll be honest, what I know about what it does is it really helps the body produce more insulin. which then produces your blood sugar. And for that reason, we have the semaglutide that can really help the GLP 1 in higher amounts, which is the semaglutide, the injection we're giving. It interacts with the part of the brain that helps decrease, suppress your appetite. And when your appetite

Dr. Bimisa Augustin, DNP:

That's right.

Brittany:

decreases, you're not eating as much. And so it really signals your brain that you feel full. I'm not sure if I explained that well, but I'll kind of backtrack.

Dr. Bimisa Augustin, DNP:

So, you did.

Brittany:

Yeah, the GLP 1, what it does to the brain.

Dr. Bimisa Augustin, DNP:

So, yeah. So basically it was kind of dumbed down to me a little bit. So basically it turns, not turns off, it decreases your reward center in your brain. So you're like, okay, I mean, I guess I am full now. So you're not rewarded a lot by eating more. You know, you get to a point where you're just like, okay, reward center is full and then it's off, you're done.

Brittany:

I love that way that you explained that. Reward center off.

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

Cause have you ever just sat down and had some good old dessert? I mean, those chemicals in my

Dr. Bimisa Augustin, DNP:

Woo, ate the whole pie? Yeah.

I mean, I can testify for, I mean, it's like, holy cow, this is so good. And you, that reward system. But yeah, I mean, that reward system, when that is full, it's full. I really, really love that explanation. So I think that, that's chemically what it's doing on the brain is just your reward center is full. And

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

really that, then reduces the risk of cancers and diabetes and heart attacks and all those things because we're not overflowing the reward system with all this sugar, which then catapults

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

the diabetes and all these things. So that's a really great explanation and a really good question. Explain how semaglutide needs to be supported with healthy lifestyle choices too. Great question.

Dr. Bimisa Augustin, DNP:

Oh, okay. Well, of course nutritional choices, you know, we want to lower the not really calories, but like lower the sugar intake, you know sugar causes inflammation, okay.

Brittany:

Right.

Dr. Bimisa Augustin, DNP:

Lower the unhealthy fats, okay. What are some of your other-

Brittany:

What I find it's really, when it comes to a healthy lifestyle, I find it comes with the injection because the script is switched. Patients

Dr. Bimisa Augustin, DNP:

Well, yeah.

Brittany:

are now like, I'm not hungry, so I'm not really eating. Hold up, we are not trying to have you go into starvation mode.

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

I want you to eat every two to three hours; half of a protein shake, half of a banana, in case you're working out the banana for the fuel during those workouts.

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

You know, half of a protein bar. I want higher protein foods. I don't want you going, I'm not that hungry. Ooh, I feel like having some chips because chances are you are not gonna be grabbing for chips. You don't really care. And so I really want patients to be every two to three hours high

Dr. Bimisa Augustin, DNP:

Conscious!

Brittany:

protein foods because you want your body to not go, we're in starvation mode and start holding onto fat more because

Dr. Bimisa Augustin, DNP:

Just anything, yeah.

Brittany:

you’re not gonna lose fat fast. So we have to fuel and reward our body, especially with patients who are like, I'm on this injection, I'm not hungry, I'm working out five times a week. Great, what are you doing to reward your body back?

Dr. Bimisa Augustin, DNP:

Exactly.

Brittany:

You have protein back, your body

Dr. Bimisa Augustin, DNP:

Exactly.

Brittany:

is so in tune with you emotionally and physically, and

Dr. Bimisa Augustin, DNP:

Exactly.

Brittany:

there's stress, there's work, and there's all these things, we have to fuel our body back. And so

Dr. Bimisa Augustin, DNP:

Exactly.

Brittany:

I tell them that a really healthy lifestyle is also knowing that, you know, we're used to having to eat and finish our plate and find these things. And now it's like, well, I'm not finishing. That's okay, don't finish your plate, but be sure

Dr. Bimisa Augustin, DNP:

It's okay.

Brittany:

to eat enough. But when I want you looking for food, I want high protein. I don't want

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

the high carbs.

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

I want you to put nutrients back to your body to help you push through that day, or you're

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

gonna be tired. I can get you B12 and D3 and some other things from Full Script.

Dr. Bimisa Augustin, DNP:

But it’s not gonna do anything with it. Yeah.

Brittany:

Yeah, it's not gonna be utilized. So... It's really important to have that because the goal is as much as we can help you, we don't want you injecting semaglutide for the rest of your life. I mean, God forbid, 20 years, hey, still injecting, not knocking it.

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

But the goal is a healthy lifestyle outside of this. This is the catapult. This is like the sprint to get there. And you want to have those healthy lifestyles on board with you or for what? Right. And so it's really

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

a way to help, you know, maximize outcomes to get you there. And so you take those tools as you're losing weight along the journey. So it's sustainable, right? And so

Dr. Bimisa Augustin, DNP:

Absolutely.

Brittany:

this is more like a building block for your outcomes to help

Dr. Bimisa Augustin, DNP:

Absolutely.

Brittany:

it stay that way. Not a

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

band-aid, this isn't a band-aid. It's

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

a fun band-aid to start with, but we don't wanna have it forever, right? It's

Dr. Bimisa Augustin, DNP:

Right, right.

Brittany:

just a way to slow things down a little bit and then make those long-term outcomes.

Dr. Bimisa Augustin, DNP:

Right, and in order for us to help you, you have to help yourself as well. So it's going to take work to continue, you know, to lose weight and you need to maintain it after you're even, you know, weened off of semaglutide. So in order to maintain it, you have to make those happy lifestyle choices instead of, you know, going towards the ones that taste better, you know, or make you feel better. You know, so you're gonna, you're really gonna have to maintain it. And also too, your heart is a muscle. So you have to be active in order to keep it strong and keep it going, you know, and pumping that wonderful blood. So

Brittany:

That's real. That healthy blood.

Dr. Bimisa Augustin, DNP:

you definitely do. That healthy blood. Yeah, right.

Brittany:

That's right. No, absolutely. What about women who are trying to get pregnant? Girl, after childbirth, how soon? I need to start a support group. No, I'm just kidding. No, so I'll talk from experience. Semaglutide, I love, obviously that's my line of work, is reversing patients' concerns about life and getting them to their goal. It's fascinating to witness, and so. Women who are wanting to start pregnancy and to start a family, clinically, you should avoid any kind of GLP 1s for two months before conceiving. If you're wanting to get pregnant, it's a beautiful, obviously thing. I am currently six and a half months pregnant. It is short-lived, it's flying by. You will get through that. If you're not breastfeeding and you're not wanting to start a family, you can be on it. But I say if pregnancy and having a child is on your heart and something you’re wanting to do in the future I would clinically recommend not to do it.

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

Now, if you find you are wanting to get pregnant but you are overweight or you are obese and you're wanting to get healthy for that pregnancy, I would say great start on that now. Start on contraceptives, you know, you don’t want to get pregnant, wait two months and then conceive, that's fine. But if pregnancy is on your heart, after childbirth, no breastfeeding at all, then you can safely be on semaglutide, but I would want your OB to be aware of your plan.

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

So again, same playing field, everyone's aware, but if you're trying to get pregnant, it'll be here after baby's born and you've got your OB clearance.

Dr. Bimisa Augustin, DNP:

It's not going anywhere. Right, right.

Brittany:

It's not going anywhere.

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

And so, but yeah,

Dr. Bimisa Augustin, DNP:

Yeah. Or you could have, you have the option of doing the herbal supplements. I mean, they are,

Brittany:

That's so good, dear.

Dr. Bimisa Augustin, DNP:

you know, they might take a little bit longer, but they do

Brittany:

Right.

Dr. Bimisa Augustin, DNP:

work, you know,

Brittany:

They might take a little bit longer.

Dr. Bimisa Augustin, DNP:

herbal run. Absolutely.

Brittany:

Right. Absolutely. No, that's a really, really great point. And you know, some OBs can be a little bit more conservative and you know, if you are, you know, just avoid everything beyond that prenatal. That's what they preach. My goodness, which is great for outcomes for baby. But yeah, I would say, hey, the herbals, the other ones we reviewed earlier in the video, which this is recorded, you'll have, you'll be able to watch back on, um, Dr. B went through a great outline of them and what they do. Hey, look into that too. That's right, there's other options.

Dr. Bimisa Augustin, DNP:

Yes, there are.

Brittany:

Absolutely. So let's see here, any other questions? We covered the overall ones that we could do, the berberine and all that. Do you recommend any of those herbals that were listed? Like... PhenQ and berberine and all that.

Dr. Bimisa Augustin, DNP:

So, I would say PhenQ first, but I mean, actually, I like all of them, but I would say PhenQ, PhenQ first. I can't say one is my favorite. None of them are really my favorites, but I would start with PhenQ. Mm-hmm.

Brittany:

Okay, okay. Yeah, you know, I'll be honest. I'm not, I'm familiar with some of the names, berberine, I'll definitely

Dr. Bimisa Augustin, DNP:

Yes.

Brittany:

tell patients about if they have high, like high cholesterol. So high cholesterol, your total cholesterol, if it's over 200, that's considered clinically high. Triglycerides that are elevated over 200, or even having

Dr. Bimisa Augustin, DNP:

Yes.

Brittany:

the LDL, the bad cholesterol be high.

Dr. Bimisa Augustin, DNP:

Yes.

Brittany:

I’ll give them some berberine. It almost reminds me of metformin on how it works in the body. And then

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

it also find patients lose weight, they feel fuller quicker with it. And so it's an amplifier. But yeah, I mean, that's the one I'm most familiar with and practice with.

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

And then, so, we can go into dosing too. So just to kind of touch base on that, with our formulary, we have the titration dosing.Titration is another word for how we're kind of incrementing this medication higher and higher and higher in your system so you don't have as many side effects. So what does that look like when it comes to dosing?

Dr. Bimisa Augustin, DNP:

So we have a 12 week program here, basically. So you're starting off at the lowest dose on weeks one through four, okay? And that is actually like 0.25 milligrams. I mean, it's like nothing, okay? But it has a big effect, it can.

Brittany:

Right.

Dr. Bimisa Augustin, DNP:

And then at weeks five through eight, you go up by 0.25, you're at 0.5 milligrams weekly. And that is for four weeks, okay? And then weeks nine through 12, you're going to do, you can titrate up to one milligram weekly. You know, yeah. So I think max, let me see max is yes, between weeks- so if you go beyond 17 weeks, the max is 2.5, 2.4 milligrams. I probably won't see anyone that’s going to reach that high. So

Brittany:

Right. Right.

Dr. Bimisa Augustin, DNP:

not mine right now, but yeah, it's four week increments at the same dose.

Brittany:

Absolutely. And you can go higher with it. You know, there's some compounding pharmacies, I would say all semaglutides throughout everywhere. There's- there's different compounds. I mean, my compound pharmacy I work with, they have B12 in it because that helps renew. You find ways and B12s that energize your vitamin, which research shows you have good B12, you have weight loss, they go hand in hand. They catapult together.

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

But when it comes to the semaglutide, I mean, if there's anyone like, wait, I do how much, when, what, who? Hey, we got pharmacists that will call you into a consult. We got video appointments that we can do to help show you how to measure it up and inject. And when it's that subcutaneous needle, it's in the fat the body. So you can just pinch your lower stomach and 

Dr. Bimisa Augustin, DNP:

Inject it. Mm-hmm.

Brittany:

it in the back of your arm and inject. You know, for all those family members that are like, ooh, I wanna stick my spouse. Needle's not that big, it's not worth it, okay? It's real small.

Dr. Bimisa Augustin, DNP:

I'm not gonna cause any damage.

Brittany:

So it's very small, but I mean, it's just like a little, little needle. And so it's very, it's very tolerable. And so any kind of side effects with nausea or things like that, let your provider know. But when it comes to the measurements and kind of being concerned about that or what week. Providers, you can always make an appointment with one of us or even have a pharmacist call you and consult you. Of course, safety is key, but the support

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

is definitely needed. This is also foreign.

Dr. Bimisa Augustin, DNP:

Yep, yep.

Brittany:

So just know that. Don't assume. Get with your provider. Get with us. We'll go over it with you. But yeah, we do the increments of the first three months. And that is the initial weight loss program with Thrive.

Dr. Bimisa Augustin, DNP:

Absolutely.

Brittany:

Yeah, we went over those things. Let's see. Oh, and if you miss a dose-

Dr. Bimisa Augustin, DNP:

So we have a question. I think we have a question. Does it cause the Ozempic side effect of saggy face? I don't think, I've never heard of the saggy face. Is it like rapid weight loss and then you have a saggy-

Brittany:

If I'm honest, I heard it through like a social media platform, where they’re like, oh, the Ozempic face, right? Because like you're losing this drastic amount of weight loss and you just look thin and haggard. 

Dr. Bimisa Augustin, DNP:

Oh.

Brittany:

Have you-? I've heard of this, saggy face but I’ve never seen it. You get loaded up on B12 and all that stuff. You're just glowing. I'm like, God, I want- you know, it's like, no, it doesn't.

Dr. Bimisa Augustin, DNP:

Oh, I think we lost her. Okay, there she goes.

Brittany:

Oh my goodness.

Dr. Bimisa Augustin, DNP:

All right, gotta love it.

Brittany:

My internet's are you there? Yes, I'm here. I just get going and going. But yeah, I haven't heard of, I've heard of saggy face, but I have not witnessed it in patients.

Dr. Bimisa Augustin, DNP:

Right, I've never witnessed it either.

Brittany:

So I would say no. But I think another good point is if you miss a dose, like what do you do? And so that really should be given within the four days of the planned dosing date. If it's been five or six days, just skip it.

Dr. Bimisa Augustin, DNP:

Stop. Yep.

Brittany:

That four day window, that's really, really good. But yeah, that's an interesting question, the Ozempic sagging face. But I find too, Ozempic based on the dosing and what you're having, I mean, you could rapidly lose on Ozempic with the titration.

Dr. Bimisa Augustin, DNP:

Oh yeah.

Brittany:

Ours is definitely a little bit more subtle and conservative. But then, you know, that brings me to, I think my patient might be listening because she had a concern of Ozempic, also the semaglutide, she hadn't had like a lot of weight loss yet. But she was feeling better. She really wasn't, you know, her clothes were fitting differently. She, and I'm like, you know what? I think there's so many measurements of what weight loss can look like. And I think we focus so much on the scale

Dr. Bimisa Augustin, DNP:

That scale, right?

Brittany:

it’s something that- we want metrics, right? Like numbers do something to our brain where we know it's working. Measurements, the scale, right? And so I find if the scale isn't budging, that's fine. I want you to do measurements. I want you to see how your clothes are feeling because you're headed in the right direction. I mean, we're not like, it's, I mean, it's gonna do something. And if you're eating less, that's less intake, that's less calories. So it's gonna get there, but some people's bodies adjust a little bit slower.

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

I find when you're in that titration period, as those levels are getting higher and higher, your body's getting used to that. So give yourself some grace. And I like you, you know, this isn't an overnight thing. God, do we not love overnight anything?

Dr. Bimisa Augustin, DNP:

Right. Quick fix.

Brittany:

It's really- quick fix, quick fix! You know, it's not like it’s  Amazon on an injection, right? Like,

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

boom, I mean, you will get there. Either way you're closer than you were before. And so

Dr. Bimisa Augustin, DNP:

Absolutely. So one thing I do, I do educate my patients on that, especially if they're already on TRT or testosterone replacement therapy. What does testosterone do? It builds muscle mass, right? So the thing is you're going to plateau on the scale. You are definitely gonna plateau because at that point it's like your body now has more muscle mass, which weighs more than fat, but they're not really paying attention to how their clothes, the fact that they have to go by a smaller size now than what they were in before. So I do educate them on that, especially being on TRT, because

Brittany:

Absolutely.

Dr. Bimisa Augustin, DNP:

you're going to plateau on that scale.

Brittany:

Right, absolutely. But you know, it's interesting because I'll hear the plateau and I'm like, how are you feeling? Oh my God, I feel good.

Dr. Bimisa Augustin, DNP:

Right. Feel great.

Brittany:

I did this, da da. I did this, I did that. And it's like, well, that trumps what a number says. I mean,

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

and then, oh, my clothes are fitting loose. So I say the scale is one small increment of the bigger picture on how you feel and two, I mean,

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

before and after photos and all of that. So. I like that point though, it's true.

Dr. Bimisa Augustin, DNP:

Yeah, yeah. So it's almost like we need a self-assessment for the weight loss program as well, because some patients can't even tell that they were like, well, I'm not really feeling anything on their hormone therapy. And I'm like, well, have you seen your self-assessments? Like you went from a 39 to a four. So, I mean, and so they're shocked to hear that. So it's just, you might not feel the major changes, but they're there. You know they are.

Brittany:

Right.

Dr. Bimisa Augustin, DNP:

So I think we probably need a self-assessment for that.

Brittany:

That is a really good point. And that's another thing too, is you kind of, I think patients, you kind of get used to those minor changes happening. And then we have life and work and family and all the things. And it's like, yeah, I feel pretty good. And it's like, well, your numbers were this. And now it's this- it’s the same with semaglutide. Like, oh, like even patients in my own practice. I'm like, well, last month you mentioned grazing at night. Are you? Oh no. Well, last time you mentioned that, you know, breakfast was three tacos. Now it's one. Yeah. And that, oh, it's like, sometimes we don't

Dr. Bimisa Augustin, DNP:

Yep.

Brittany:

know until it's laid out for us. And that is okay. That is our job is to show you, hey, like we're, you know, this is,

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

this is the plan. This is how we're getting there. These are the changes that are made. Um, but hey, IT I know y'all are listening. We need a little self assessment. Get in my little chat. We need a self assessment. So those little snacks, those little grazing, or you know, I had a patient, my husband always brought me M&Ms and I would eat them. And I had the whole stash next to the couch.

Dr. Bimisa Augustin, DNP:

Yeah, I don't even want them anymore. It cuts down on those cravings.

Brittany:

Yeah, those little things. That's a really, really great point. We need a self-assessment. Do we have any more questions? Let's see what else we can cover.

Dr. Bimisa Augustin, DNP:

No more questions.

Brittany:

That's really, you know, the overall thing. Of course we'd like to have labs before getting you started on this. And what that really looks like is just baseline labs, right? How does your kidney function look, liver

Dr. Bimisa Augustin, DNP:

Mm-hmm.

Brittany:

function, you know, your A1C, your average blood sugar, just to kind of have metrics in the sense of measuring how further away we're getting from some of the comorbidities that could be shown, right? Fatty liver.

Dr. Bimisa Augustin, DNP:

Right.

Brittany:

non-alcoholic fatty liver. So there's a lot of things we're trying to reverse, but this is really it in a nutshell. And this has been awesome. This has been fun. Yeah, are there any more questions?

Dr. Bimisa Augustin, DNP:

I don’t think there are anymore.

Brittany:

That was perfect. Okay, Bimisa, as always, this was awesome. It was

Dr. Bimisa Augustin, DNP:

Yeah,

Brittany:

fun.

Dr. Bimisa Augustin, DNP:

we always have the most fun.

Brittany:

It's always like girl time.

Dr. Bimisa Augustin, DNP:

Yeah.

Brittany:

And then we had some chats in here too, and some questions which really tied it together. But if ya'll have questions, thrivelab.com, you can always just message and chat on there. They can help guide you into the next steps of wanting to meet with a provider for information on semaglutide, or even if you're wanting to know more about hormones. We have wonderful webinars that you can look at when it comes to information on that. So as always, until next time.

Dr. Bimisa Augustin, DNP:

Until next time, go ThriveLab!

Brittany:

Go ThriveLab. We will be in touch soon.

Dr. Bimisa Augustin, DNP:

Bye now.