The Person behind the Provider
Dear Friends, Family, and Patients, What humbles me the most in my practice is, hearing my patients’ personal stories and journeys that has led them to be in the seat across from me in my office. So, I thought, why not share mine? If my patients can be at their most vulnerable in front of me, then maybe I can too. To be fair, my story isn’t quite unique. There are lots of women out there going through similar versions of what I have experienced. But that just means, that my story is RELATABLE. Relatable to people struggling out there in this world defined by the words – fast, instant gratification, comparison driven, ___ (insert what you experience). During medical school and residency, I was binge eating to deal with stress. Also, my routines…wait, what routines? There was no room for a “routine” in residency. Which meant eat when you can, how much you can, what you can. Then immediately after, was my first pregnancy (YAY!). My breastfeeding journey was wonderful, but with one humungous side effect of wanting to EAT insatiably. And this was even worse after my second son. I would definitely eat wayyy over my caloric needs and didn’t know how to stop. Raising a toddler and a newborn, working full time, and starting a new business was not easy. I was done nursing my second child, but the hunger cues never went away. I was at my heaviest and felt the worst. I did not like looking at myself in the mirror or in any of my clothes. I was, simply put, – UNhealthy. I mean… my cholesterol was high for the first time ever and so was my A1c! Working out felt futile. GLP1s were taking the world by a storm at that time, so I decided to try it after consulting with my PCP. The changes I felt were remarkable. I started not having the same cravings. I felt satisfied with food faster. My portions were much smaller. I did not feel like I had to eat every time I was stressed. And overall, I lost weight. I fit into my clothes better. The person I was seeing in the mirror felt somewhat familiar again. One of the comments I received from someone was… “taking this medication for weight loss is like cheating to get skinny.” To that, my gentle response was, “I’m not trying to compete with anyone…I’m simply trying to feel better about myself.” I was happy with what I saw and felt, but knew that I was not done. As I knew – taking this medication was only 30% of the treatment. Once the “training wheels” came off, I still needed to practice mindful eating and not let my cravings get the best of me. Also, where was my muscle? If you are my patient, you know that when you are on a GLP1 medication, you not only lose fat, but also your muscle bulk. We NEED to increase protein in our diet AND focus on resistance training to build muscle. Working out was not optional anymore – it became non-negotiable. For that, I joined a gym. Yes, a gym. If you know me personally, your jaw would have dropped hearing this. I felt motivated to work out and to see the muscle-mass percentage move in the right direction. I workout so that I can be healthier. I workout so I can support my joints and bones as I get older. I workout so I can be off any meds. I work out so I can feel happier mentally. I workout so I can get some “me time”. I workout so I can tell that little “can’t” voice in my head that it can take a back seat. I workout so that my kids can see their mom get stronger. Thank you for coming along in this journey with me.
Managing Complications
One of the most common concerns of an aesthetic patient is: what happens if I get a complication? I believe every single patient should be extensively educated on the potential complications of any aesthetic treatment prior to proceeding with a treatment. The good part is – these are rare with a mindful and experienced injector. Let’s TOX about it: neuromodulators such as Botox, Disport, Jeuveau etc are relatively safe in the dosages we use. There tend not to be any irreversible complications per se. Rather, potential is for some unintended temporary effects. Such as: eyelid droop during forehead botox, difficulty using a straw or smoking after upper lip botox (which some people actually desire), changes in smile pattern, smile/eyebrow asymmetry, minor lumps/bumps for a day or so after treatment, and minimal bruising. Fortunately, all these effects are relatively mild and go away in days to weeks. Of note, there is no particular reversals as of yet for tox treatments. How about Hyaluronic Acid (HA) Fillers? Lumps/bumps can be felt at times after treatment but smooth out over a span of days to weeks. Bruising can be common, which can last up to a week. Fillers can migrate overtime, but can be mitigated by the type of filler used. Overuse of filler in a space can also cause migration, but this can be spot dissolved with hyaluronidase. In my acute care setting as a hospitalist, I have also seen a couple of cases presenting with an autoimmune reaction and granuloma formation in the injected area which can be helped by dissolving the filler, and systemic steroids. Infections can occur, but are very rare if proper aseptic techniques are employed. Main concern with fillers is a Vascular Occlusion (VO). This is when an injected filler goes into blood vessel and can cause a blockage of blood flow to that area, leading to tissue necrosis. That is why, a good injector is always on the lookout for any blanching of skin after injections, and will always follow up with you regarding how your treatment is settling in. You should never hesitate to reach out to your provider after a treatment if you have any questions of concerns. If a VO occurs, hyaluronidase can be injected to dissolve the filler and restore blood flow in that area. This also is useful to correct any undesired aesthetic results for a quick fix. What if I don’t like my filler results? – hopefully in a mindful experienced injector, this will be rare – but can happen. We can use hyaluronidase to dissolve it and restore the tissues. There are other types of fillers as well which do not have a reversal/dissolving agent, but if used cannula technique, the risk of VO is quite low. So overall – low risk, high reward? I like it! And the fact that all of this is temporary, is quite reassuring. Did this information help your concerns?
Is it your first time too?
“Everyone’s doing it, but I’m nervous.” “I don’t want to look fake.” “I don’t like needles.” …And so many more concerns I hear almost on a daily basis from patients who have never had any aesthetic treatment, but have been thinking of starting. I get it! It can be nerve-racking and overwhelming, especially when you don’t know what to expect. I am so grateful that so many of my patients have trusted me to be the kickstarter of their aesthetic journey. In this blog, I want to address a few of the first time concerns. Just like I do during my consultation appointments. So let’s address the top few: “I don’t know where to start” ~ That’s A-OK! that’s why your injector is a specialist in recommending different treatment approaches based on your aesthetic concern as well as your budget. They can determine the time it will take to achieve your aesthetic goals, as well as the upkeep needed to sustain your desired results. And keep in mind- it’s okay to ask for a consultation appointment without any commitments. And if you are still unsure, get a second opinion! “I am afraid of needles” ~ you’re not alone! Nobody really “enjoys” being poked by needles. If you’ve ever gotten blood work done or have taken your blood sugar levels, these injections can be similar or even less intimidating. We do multiple distraction techniques to get you through the appointment. We also have topical numbing creams that we can use. Rarely we need to do a nerve block. Most people do just fine. The needles are very fine; plus the treatments are fairly quick. “I don’t want to look like I got work done” Or “I don’t want to look weird” “It’s expensive “ ~ yes it can be. But the longer you wait, the more expensive it will be because you may need more treatments or higher dosages. Once you’re at a steady state, maintenance treatments are much more cheaper. You can take advantage of Allē or Galderma and other rewards programs, and always keep a lookout for seasonal specials. At the end, the more information I am able to give you, the more at ease you are about your journey. And remember: good Botox looks like you don’t need Botox.
BROtox
“That stuff is for women,” I overhead a couple of men say while talking amongst each other at a coffee shop while I happened to be working on my aesthetics business plan. I used to hear that a lot. I still do. BUT – women aren’t the only ones getting Botox. Times are changing, oh yes! Men are increasingly adding cosmetic procedures to their aesthetic routine. Botox being a common one. Men are getting more in-tuned to their appearances, especially in terms of aging. As the wrinkles slowly set in- to where they appear on the face even without making an expression- is a pretty common sign when I see men starting to take the next steps. Many times, it is pointed out to them by their own significant others. Other treatments for men also include neurotoxin for hyperhidrosis and headaches. A lot of men’s concern is the “overdone look” of medical aesthetics. This is surely valid. But in my practice: well-done Botox looks like you don’t need Botox! Once they are reassured of this, they feel much more at ease regarding the treatment. Other than that, we just let the results speak for themselves
Continuous Glucose Monitors
Glycemic index. Hypoglycemia. Hyperglycemia. Insulin dump. Fasting glucose. Hypoglycemic unawareness. Fingerstick…and on and on. Ever heard of these terms thrown around and wonder what they are about? How they relate to your body? Most of us who have been actively putting some intention into our day-to-day food choices, often wonder what our body is doing in real time. I know I do. I find that it is so much easier to be mindful about putting the right things into my body when I know how my body reacts to it in real time (at least in glycemic terms). Realistically, there are many facets of understanding the breakdown absorption of nutrition by our body. No single measurement can accurately provide our body’s “health status”. But one crucial component is blood glucose fluctuations which can reflect how your body processes the key components in our food. I could delve into the mechanisms of insulin resistance and diabetes/prediabetes and the normal values – but for that this blog would turn into books with volumes! (and there are plenty of those with credible authors). I want to focus on the value of continuous glucose monitors (CGMs). These are devices that attach to the back of your upper arm and stay there for 14 days at a time and are able measure your blood glucose in real time, with pretty close accuracy. The technology now connects to an app on your phone via Bluetooth. I recommend these to my patients who are interested in knowing their blood glucose trends in reaction to their diet. I recommend, that for the first 14-30 days no changes to be made to your normal diet. This allows you to truly see what your body has been doing on your current eating habits. Don’t forget to make notes! And after that, during the next block of time, start making intentional changes and re-evaluate. Will you need to make major changes to your food choices? Or minor changes may be just as impactful? You may be surprised!!
Role of GLP1 analogues in my practice
“I don’t know what else to do!” “I keep trying and trying and nothing works!” “I just need some help!” are a few statements amongst many I have heard from people who have been on the weight loss journey. Sure, for many people weight loss is the primary goal – but the overall intention is also longevity, which can afford you qualitative healthier years as well. The western diet is heavy in highly processed foods, and can lack key nutritional components such as complex carbohydrates, good fatty acids, fiber, and healthy proteins. This can cause hormonal disruptions resulting in interference with hunger cues, overeating, craving more of the same foods and ultimately poor gut health. This happens in variety of biochemical ways, creating a vicious cycle which can be heard to break. Enter weight loss medications. Medications such as phentermine, orlistat, bupropion-naltrexone have all been used and continue to be used. But the rebound weight gain with many of these meds can be disheartening. GLP1 receptor agonists (GLP1-RA) are now also FDA approved for weight loss in individuals who are overweight or obese (BMI >/= 30; or BMI >/= 27-29 with at least one or more weight-related comorbidity). Along with appropriate lifestyle changes, studies have shown that patients have lost between 5 to 22.5%^ of their initial weight on these medications. These medications have shown cardiovascular benefits as well over long term. Many patients use these medications as a bridge to reset and get back to a healthy weight and are able to stay off the medications. Some patients are able to wean to a maintenance dose and frequency after they have achieved their goal weight and continue on their long-term health journey. During your consultation, we will go over your expectations and goals, which medication is right for you, duration of treatment, side effects, and much more! ^Up-To-Date; Obesity management
Let’s start with the basics.
For decades there have been hundreds, if not thousands of books, articles, and magazines which talk about diets, exercises, fads, lifestyle modifications and so on. So may this blog be different? It may be not. But, I like to focus on keeping things practical. After having grown up with a background that believes in non-western medicine and holistic foods, and then being immersed in western food/lifestyle/medicine, I have seen the sharp transition of diet related effects on mental and physical health. During medical school, I was able to learn the intricate biophysical processes which are involved in processing nutrition. Over time, I have found the following three books which have had a positive impact on my life and I want to share with you. There is a wealth of information in these books which, I feel, are readily implementable in our pace of lifestyles. · Fiber Fueled by Will Bulsiewicz, MD · Outlive by Dr Peter Attia · The Blue Zones by Dan Buettner To illustrate a couple of highlights that have stayed with me: 1. Gut health is extremely important to your overall health and is often ignored. Take care of your gut and it will take care of you. Fiber fueled gives a beautiful, detailed explanation of why gut health is important and what you can do for it. And subsequently, how a truly healthy gut can help your longevity. 2. ‘Outlive’ underscores the importance of preventative aspects of medicine – as Dr Attia likes to call it – Medicine 3.0. I also love his prescription of Continuous Glucose Monitors (CGMs) and its use in your transformative journey –> keep an eye out for another blog with more information on this! 3. While reading the book ‘The Blue Zones,’ one pearl that has stuck with me is the “80% rule.” This is – eat until you are 80% full. This technically is very easy to implement in each meal – eating slow, and intently listening to your body when it is “almost full” and then stop eating. It is a muscle that we can all develop with practice. The book illustrates why this can be so important. Have you read any of these books? Would you be interested in learning more?