Ozempic Webinar: Breakdown, Live Patient Stories & Q&A

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Speaker 1 (00:02):

So again, so welcome to the webinar. This is going to be on Ozempic from a plastic surgeon's perspective. So a little bit about me. My name is Dr. Martin Jugenburg. I'm a plastic surgeon. I'm a founder of the six surgery clinic here in Toronto. I'm a board certified cosmetic plastic surgeon. I've been doing plastic surgeries since 2001 up until now, 10,000 plus surgeries. 

We have a clinic in Toronto, in Dubai, Kuwait, and coming soon to Miami. So this presentation is going to be, or this webinar is going to be about ozempic. What is ozempic? We're going to introduce the topic of Ozempic, talk about side effects, the effectiveness, dosing treatments. 

We'll tell you about our own experience, we'll talk about ozempic versus surgery, dieting, exercise and those other things.

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(01:12):

We have actually a few actual ozempic patients that come and join us and share their stories with us and then we'll open the q and a and you guys can open, ask your questions there. 

So diet and exercise, 97% of dieters tend to fail and regain everything.

 The problem is most people can't really maintain their diet, their lifestyle modifications, and as a result of weight gain being obese, obesity is becoming an epidemic.

 We have a picture of Opera here, a famous person who has been pretty open with her struggles with weight gain, weight loss, she's done all the different diets, has lost the weight, gained weight back, and it's been a struggle for opera.

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(02:01):

This is an actual patient. She has tattoos. You can take a look at her tummy. You can see the tattoos are the same, so they're sure in one shape on the left and one on the right. And so I'll leave this picture with you for a while. We will get back to this a little bit later. You can look at it and think like what's going on in here? Is this weight loss? Is this surgery? Is this filters? Is this Photoshop? Moving on to weight loss. 

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Are you considering Weight Loss?

A lot of lot patients approach us about weight loss and people come to plastic surgeons asking for weight loss. So plastic surgery is an option for weight loss. I want to make it very, very clear. Plastic surgery is not weight loss surgery. Plastic surgery is something that you do after you've lost the weight. After you've lost the weight, you come to a plastic surgeon to do body contouring, things like tummy tuck, things like liposuction.

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(02:59):

They're not meant to reduce your body weight. They're meant to reshape your body, ideally after you've lost the weight or if you're already in a great shape yourself. So of course everybody knows diet exercise are the best way to do this. Unfortunately, as I mentioned earlier, 97% of patients fail. And if this was really easy, we would not have obviously epidemic all around the world. So when diets fail, people want the next best thing. They tried weight loss drugs. Unfortunately in the past, weight loss drugs have failed to achieve any significant results. Next step is bariatric surgery. So bariatric surgeries, weight loss surgery such as gastric bypass. And these have been able to achieve some dramatic amazing results. People lose tremendous amount of weight. Now this is a very invasive procedure and so it's reserved for people that are morbidly obese. People have very high BMI who really need to lose weight and it's a matter of life and death for them. So bariatric surgery is reserved for very, very severe cases.

(04:04):

But let's go back to drugs. Drugs in the past did not do so well. That has changed. Everybody's has heard of ozempic. 

What is Ozempic?

You guys are here because you've heard of ozempic. Ozempic has been a bit of a game changer. Ozempic is a brand name for a medication. It's medical term is semaglutide. It is a drug that belongs to a class of GLP one receptor agonists. These are medications that have been used in the past for diabetic patients to help control their blood sugar. And while they were being used, researchers noticed that these diabetic patients were shedding pounds. And so they've discovered that maybe this also has weight loss implications.

(04:44):

Ozempic Terminology

Before we move on and talk about the whole thing, I just want to cover some terminology. Some of you may have done lots of research and know all these terms. Some of you may be new to this and I want to make sure everybody understands what I'm talking about. So semaglutide semaglutide is a drug that is being marketed as ozempic. Everybody's heard ozempic. There's also the name Vego, which is a newer drug and rybelsus, A newer one is something called tirzepatide, which is known as MNO or zep. And of course I mentioned GLP one, which is glucagon-like peptide one. And this is the key to all of this.

(05:19):

So GLP one or glucagon-like peptide one, it's a hormone that is secreted in your intestinal cells and has been used to treat diabetic patients. However, through research we found that receptors for this hormone, meaning that this hormone has receptor cells elsewhere, works elsewhere, covers many different areas. As the diagram shows receptors are found in the brain, in the heart and the kidneys and liver muscle bone. So this is a drug that affects many different tissues and because of its usefulness in diabetic patients, drugs have been created based on this. So these are drugs that mimic GLP one and from one to seven, these are some of the names I pulled up. Different drugs that work on GLP one and every time they create a new version, the newer version seems to be more effective in its effect on diabetics and also in its weight loss.

(06:19):

We'll be talking specifically about number six, semaglutide. And I also want to mention tirzepatide, which is the latest one and it's a little bit different. So first let's talk about semaglutide again. Semaglutide is a medication that was developed to treat diabetes and it works by mimicking the GLP one hormone. It is sold as Ozempic, that's the name everybody knows. Now Ozempic is the injectable version and nobody likes to prick themselves. So they've tried to make it better, try to make it into a pill version, which is the Rybelsus great drug. The problem is that it's not well absorbed from the stomach. So in order to get comparable effects, you must use a much higher dosage. So people went back to injectable Ozempic. Ozempic has been around for many, many years and because of its application now for weight loss, the drug maker has developed a new formulation called Kovi, which is Ozempic is the same drug, but it's specifically marketed for weight loss and it's a higher dose than the one that's used for diabetic patients.

(07:20):

So again, these are different names for exact same thing, slight different variations. Next step, the one's making headlines these days is Teir Heide, also known as which came out recently. And because of its effect on weight loss and all the hoopla, ozempic, the company already came up with a formulation against exact same drug, but it's formulated now specific for weight loss, which is called zep bound. Now the difference between this and Ozempic is that Ozempic is a GLP one mimic. It mimics the form. This one does GLP one and GIP gastro polypeptide. And it seems that perhaps it's even more effective than ozempic. So I'm throwing out these terms, GLP one GP one, different acronyms. The point is these hormones act on many different tissues. And if you look at this S diagram, you'll notice that they seem to be working on the same thing.

(08:18):

So they work in concept probably explains why mogi non tirzepatide is more effective than ozempic or may turn out to be more effective. Now, as I mentioned previously, these medications were used for diabetics and while they were treating diabetic patients, it was an excellent finding. It was a side effect that I noticed that patients were losing weight and they noticed that patients will lose about 14 pounds in three months, which is what, one to two months pounds per week. And so this was a side effect. I need that side effect, but a good side effect that allowed this drug to transform and be used for other purposes.

(08:57):

So how much weight can you lose ozempic? Well, studies have shown that if you take ozempic ozempic injections, specific ozempic, you can lose up to 15% of your body weight, which is pretty impressive. It's actually comparable to bariatric surgery. Now, bariatric surgery, everybody knows and you've seen these dramatic transformations. So to be able to create that dramatic weight loss without the need for surgery is pretty groundbreaking. Quick little note again, remember, plastic surgery is not weight loss surgery. Bariatric surgery is weight loss surgery. I'm a plastic surgeon, I'm another bariatric surgeon, so I just want to make that clear. I'm not a weight loss surgeon, but we're talking about weight loss drugs. Now, before I move on to the next slide, we have picture of Oprah here. The reason I have the picture, everybody knows Oprah, everybody knows how much she's been struggling with her weight. And on top we have one of the older pictures and then more recent picture on the bottom to the right. She hasn't disclosed what exactly she's been doing, but she did say that she's doing a drug for maintenance. So we're all guessing at ozempic. It could be something else, could be monano, but she's clearly doing something and it has created a dramatic improvement for her. So good for opera.

(10:11):

So how does semaglutide or these GLP one drugs cause weight loss? As I showed you previously, the medication affects different body areas, different tissues. They work on a stomach, they slow down gastric emptying, they decrease absorption by the stomach. They also work on the brain to decrease suppressed appetite and cravings. All of this together leads to decreased intake of calories, provides better control of cravings and fewer weaker food cravings. And as a result you can have a tremendous amount of weight loss. Nine to 15% is very, very impressive. This as a diagram I took one of from all the studies that looked at the use of semaglutide, specifically 2.4 milligrams. This is the dosing that's in the semaglutide specifically for weight loss. So Wegovy uses 2.4 milligrams once weekly. And this was a question I put to the patient and you can see the improvements.

(11:12):

People felt less hungry, felt fuller, felt less of a desire to eat sweet foods or savory foods. They felt happy with the way they were. Food cravings were down cravings for dairy and food overall was down and they felt like they were in a better control of their food cravings. All of these are amazing because a lot of the struggles that patients have with weight loss is sticking to a proper diet because if it was really that easy, there would be no obesity and this drug seems to help with that. So can these drugs be combined with bariatric surgery? Because up until now bariatric surgery was the thing to do if you wanted to do dramatic weight. So yes, you can. GPR medications can be taken prior to bariatric surgery and sometimes they are to help bring down the BMI. Of patients that have morbid obese have very, very high BMI.

(12:04):

Interestingly there was a study that looked at this and in this study 69% of subjects six nine, that's a big number, lost enough weight while waiting to have their surgery that they withdrew from the surgical wait list. So that's pretty impressive. Also, questions I had from other patients was, can you take these drugs after the pediatric surgery? So you've already had weight loss surgery, can you take these GLP one medications to help you lose further weight? And the answer is yes. Studies have shown that after pediatric surgery has given you tremendous weight loss. If you take these medications you can lose additional 5% of body weight in addition to weight loss. What I find really impressive is that in addition to weight loss, we found that these drugs not only fight obesity but also obesity related health problems. There's a decrease risk of cardiac disease and from dying from cardiac events.

(13:00):

So heart attacks, cardiovascular accidents, hospitalization for heart failure, all of these things have been improved. Same thing goes for liver health. Non-alcoholic fatty liver is a major problem these days. This medication seems to help it. It improves liver enzymes. So the overall health benefits go beyond just weight loss. It's not just weight loss. Weight loss, people think it's for the looks. There's health benefits with weight loss in addition to health benefits. There's of course the side effects. Everybody wants to know about the side effects. So fact is side effects do happen. Up to 50% of patients experience some sort of a side effect. The most common side effects are digestive. So ous appetite, which is extreme desired side effect, nausea, vomiting, acid reflux, diarrhea, constipation, pancreatic problems. You can have problems with your kidneys, your skin. You can have elevated heart rate and other things.

(13:56):

But most commonly these are digestive problems. These tend to be short-lived, they tend to occur with starting medication and then whenever the medication dosage is increased, unfortunately some patients these side effects can be severe to the point that they're unable to continue the treatment. And about five to 10% of patients who are taking these medications just find that it's just too much and they have to be drawn and give up their GLP one medications In addition to medical side effects. As a plastic surgeon, I want to talk about cosmetic side effects. Now, weight loss results in reduction of body fat, but it does not cause stretched skin to shrink skin. Stretching that happens during obesity is not reversed by weight loss and at leaves patients with skin laxity, which no amount of diet exercise will ever correct. And these issues though are not ozempic specific. This is what happens anytime you lose weight. So I'll say these are cosmetic side effects, not necessarily ozempic but massive weight loss.

(15:03):

So plastic surgery offers weight loss patients body conting procedures to help them complete the weight loss transformation. You've lost the weight, you're healthier, you feel better. But now you left with a lot of loose skin and that's where procedures such as stomach tuck, arm lips, thigh lips, butt lips come in. Patients have lost volume in their breast, deflated saggy breasts. So the breast lips, breast lamentations are useful. People tend to get skin laxing on their face. So face lips and neck lifts and other procedures. I'm sure people have heard of the ozempic phase that's making some rounds on social media. It's a sensational term, but really ozempic phase is really a weight loss phase. This is the appearance that you would get regardless of what way you've lost the way, whether it's through bariatric surgery, whether it's through your own diet exercise or if it's ozempic, you will have some skin accident. You will lose some volume in your face. And

(16:02):

Weight gain or plastic surgery is something to correct it. So when someone has signs of weight loss, you can see on the before and a half the pictures here, this is a patient had a facelift neck lift. You can slip of sagging skin, deflated face, and I think she's here about six or nine months after her facelift. You can see just looks more rejuvenated lifted. Skin looks a little bit tighter. When people lose weight, they lose volume in their breasts. Breasts look deflated, they lose saggy. This is a patient who had a breast limitation and a breast lip. So we've lifted her breast and added volume to restore her breast volume. And of course tummy attacks. When people lose weight, typically everybody know you have lots of loose skin on your tummy. Here's a patient who was overweight prior to surgery. She lost a lot of weight and there she's after tummy attack and breast mutation, breast lift, you can see skin laxity on the picture on the surface to the left and afterwards, one year after weight loss leaves you with skin laxity.

(17:03):

Skin that has been overly stretched, has lost elasticity, doesn't shrink, looks damaged. And unfortunately there's no amount of that exercise that you can do to fix this. There's no creams for this. Only surgical tightening through something like a tummy tuck would help this. Now going back to cosmetic surgery, our goal, the reason why we are here is or why we've started offering ozempic to our patients is to help our patients decrease their BMI. We often see patients who want to undergo cosmetic surgery procedures, but their BMI is too high. In order to have surgery with US, patients must have A BMI below 30 30 is a cutoff where safety becomes an issue. When your BMI is over 30, risk of complications, infections, blood clots, fluid collections and other things increases significantly. So for our patients, they need to be below 30 and we see patients who are above 30 and we try to help them.

(17:57):

So in the past we would ask them to just leave, reuse the weight on their own and then come back when they lost their weight. Well now with this medication, we're able to help them achieve their goals. I tell my patients the more weight you lose, the safer the surgery and the better results we can give you. And the reason that that is is because understand you have internal fat and external fat. Internal fat is the fat inside the abdominal cavity. External fat is this fat on the skin so that we can liposuction, we cut out, but fat it's internal. We cannot liposuction, we cannot cut it out. You need to lose it through weight loss and this is where Ozempic and other drugs like that can help you. I want to share with you an actual patient of ours who went through weight loss.

(18:39):

So this is an actual patient. She started at about 20 pounds. Her BMI was very, very high. So in order to even see us, she went ahead and lost some weight. She brought her that weight down to 158 pounds that brought her BMI to 29. So below 30, these are the pictures from her consultation when we saw her. So BMI below 30, she's good for surgery but we ask her, you know what? Lose more weight, continue to lose weight, the more weight you lose again, the safer the surgery and nice results we can give you. So she continued to lose weight and between now, and this is the day of surgery, she went from 158 pounds to 137 pounds. Her BMI went down from 25 to 29 and now she was ready for surgery. So we did a breast lamentation, breast lift, tummy tuck, lipo and muscle repair.

(19:25):

So this is her on the day of surgery with surgical markings. And here she's several months after we performed breast lamentation, breast lift, tummy tuck to tighten up the abnormal skin, muscle tightening and little liposuction, just a takeaway. Residual fat that she had in her left handles. This is a result that would not have been possible had she not lost the weight. And this is very important for everybody to understand. Plastic surgery is not weight loss surgery. This patient needed to lose the weight before we could create something like this. So this is a picture I showed you early on. Again, this is when she started her journey and this is a picture she sent us from the beach. Loving her results to go from left to right is not cosmetic surgery, this is weight loss, significant weight loss before surgery and then cosmetic surgery. And then she continued healthy lifestyle and diet and exercise. There's no way I could create this without her losing the weight first. There's no plastic surgeon that could take the patient on the left and create patient on the right. And that is why I tell my patients, the more weight you lose before cosmetic surgery, the better results we can give you.

(20:47):

So let's talk about plastic surgery on ozempic. Can you take ozempic before and after plastic surgery? And the answer is yes. You can take it before, you can take it after. However we ask our patients to please stop it. Now the guidelines of so fluctuating, the latest guidelines are stop it at least one week before surgery. And the reason for this is because I previously mentioned one of the effects of ozempic or all these GLP one drugs is they slow gastric emptying. They slow empty of your stomach. And so before surgery you should have an empty stomach and that's why before surgery are always told have nothing to eat eight to 12 hours before surgery. Patients who are on ozempic and have a slowed down gastric empty may still have stomach contents inside when they come for surgery and they're at risk of aspiration because when you're lying down and you completely paralyzed, you can regurgitate food and that can be potentially fatal.

(21:42):

So it's absolutely crucial that you have nothing in your stomach. And so if you are on ozempic and you're going for surgery, make sure that you let your surgeon know you're taking ozempic and ask them when you should stop it. At our clinic, we are asking our patients to stop one week before surgery. Once the surgery is over, you can go back on it immediately, but you need to stop it. And sometimes people are scared because people are scared to stop it because they think if I stop ozempic, I'm going to regain weight. Well, you will not. Ozempic sticks on your system for quite a while. So stopping for one to two or three weeks is not going to cause rebound weight gain. How long should you take ozempic? Well, in our clinic approach it's about short-term use of ozempic to help our patients get to the BMI that they should be at for cosmetic surgery. However, for patients that are looking for long-term weight loss, this may be a chronic drug.

(22:36):

Studies have shown that to sustain a prolonged weight gain and prolonged health improvements related to ozempic, you may need to be on this for a long, long time. How long? Difficult to say it's still a new drug. It's been around for a few years, but we don't have long-term studies. We don't really know what happens or how long. There are no guidelines on how long you should be on ozempic. Generally you want to be on it until you reach your goal weight and then maybe scale back a little bit. You can try to stop and see what happens. So what happens when you stop? Well, there's a study that looked at it and found that one year after stopping on ozempic patients regained two thirds of their prior weight and all the improvements in their cardiac and liver status and everything else was reversed. So this suggests that this requires ongoing treatment to maximize your weight loss and health improvements.

(23:30):

And some people might think this is bad or scary. Well, the way I look at it, it's like, it's like people with high blood pressure. They own medication for long time diabetic, they own medication for their lifetime. So it may be one of those medications that you may need to take for a long, long time or maybe for the rest of your life. So who is candidate for weight loss medication? In our clinic, our goal is to help patients lose weight prior to their cosmetic procedures. So to be able to be prescribed this medication by us, you must be overall healthy. You should not have diabetes, heart, liver or kidney issues. You shouldn't have any history of thyroid or pancreatic cancers or issues. Your BMI should be over 25. We do blood work. So your blood work should be all good and you should commit to a lifestyle change.

(24:15):

Again, we are going to be prescribing these medications for short-term and the need to maintain the results through lifestyle changes themselves costs about less. People often want to know how much this costs. So ozempic is not a cheap drug, especially if you have to take it for a long time, weekly, monthly, the cost range between two 50 and $300 a month and expect that you'll be on this for a long time. At our clinic we provide a treatment plan which is $2,000 a month. This includes the medication dosing adjustments. We do weekly health assessments, we do monthly blood work and we monitor for putting for side effects. We mentioned side effects previously, any side effect if left anterior for long time can become serious. So we want to be able to monitor our patients and manage any potential side effects that may occur.

(25:10):

Can you treat yourself? Can you just get this drug and just do this all yourself? So we don't recommend it and the reason for this is that treatment dosages may need to be adjusted, increase or decrease based on how things are going. You should have a professional that examines I regularly. You should be monitoring regularly. There should be blood work to make sure there's no abnormalities. Again, this is a powerful drug. We don't really know all its potential effects and so we should be monitoring all our patients to make sure that they remain healthy. These are contraindications or reasons why someone should not take this medication. So people that have these specific medical issues, diabetic retinopathy problems with their eyes, if their blood sugar is very low, if they have gallbladder dysfunction, if they have problems with their pancreas, kidney is not working well or if they have medullary thyroid cancer. These are patients that at this time are instructed to not take GLP one drugs.

(26:12):

So I'm going to get towards the end of my talk just to summarize again, Ozempic, is this a wonder drug? It's pretty impressive. Ozempic and other drugs promise to fight obesity and obesity related illnesses, side effects can be overwhelming. Overwhelming, everybody's going to have some or up to 50% of patients will have some side effects. Most of 'em are very, very minimal, but some people may be excessive side effects when it comes to safety of this drug. It appears be safe, but the fact is all these studies that have been done on safety have been done on diabetic population and we don't have specific studies yet on weight loss population.

(27:00):

These medications again will help lose patients' weight and that may lead to more plastic surgery patients as an un unintended side effect. Moving on, I want to share with you some examples of actual real people. Patient number one is a lovely lady. She's 27 years old. She was going to join us and share her story. Unfortunately, she stuck. Her flight got rescheduled and she's flying in the air somewhere, so I'll just share some pictures of her. She's 27 years old. She went from 160 pounds to 128 pounds and almost big. Then she continued to lose weight to 115 pounds. She did stop ozempic because her side effects were pretty severe. She was feeling nauseous, she was not feeling well and she decided to stop the medication. However, I asked her, if you regained the weight, would you be willing to go back on the medication? And she wholeheartedly said yes, yes I would. The benefit of it was awesome. Some more pictures again, we can go through these. You can see her at 160 pounds. And then as she was losing her weight, 228 pounds, 2 1 24 pounds. And the most recent picture while she's been off ozempic, she continued to lose weight and she's down to 115 pounds.

(28:22):

We'll move to our patient number two. This is a lady who is 52 years old. She was on Ozempic for two months. It's been two months that she's been on. She started 0.25 milligrams, she's now on 0.5 milligrams and she's gone from 156 pounds to 145 pounds. I'm going to get her to join us. Give me a moment. I'll try to figure out how I can do this. And she's going to share with us her story of her weight loss if I can. Let's see. I'm going to ask our patient number two to start her video. I think that's going to make her pop up through the top. So I'll see her. There she is. I'm going to unmute you. There you go. So hello. Thank you. Thank you for joining us and thank you for sharing your story with us. So I'll let you take over and tell us a little bit about yourself.

Speaker 2 (29:31):

I, I'm 53 years old and I have been healthy most of my life, but past three years I gained extra 30 pounds and it just became a uphill battle to lose that weight. I tried many different diets and failed. I tried meal plans, I tried exercising and I was just not able to lose the weight on my own and it started affecting my mood. I felt depressed and at that point I decided I needed to go out and get help from a professional. So I consulted with my family doctor and we decided together that I should give Zopa a shot.

Speaker 1 (30:32):

You mentioned you've tried something. So what types of diets did you try? Initially? I

Speaker 2 (30:35):

Tried Dr. Bernstein. I tried keto diet, I tried Mediterranean diet, I went and got meal plans for three months. I will lose two, three pounds and then gained back five pounds and it was just sort of a usual effect.

Speaker 1 (30:58):

Any thoughts of why you think those diets failed?

Speaker 2 (31:03):

I think diets don't work. I don't think they work,

Speaker 1 (31:09):

They're great. But as we mentioned earlier, 97% of patients tend to bounce by unfortunately. Let's talk about your ozempic. How long have you been on Ozempic?

Speaker 2 (31:19):

Just for two months. Two

Speaker 1 (31:20):

Months, okay. And you lost It was about

Speaker 2 (31:24):

Over 10 pounds, over seven pounds.

Speaker 1 (31:26):

So five pounds a month. Awesome. And you started 0.25 and then you moved on to 0.5 milligrams.

Speaker 2 (31:33):

That's it. The plan was that I would do 0.25 for one month and my doctor would monitor for any side effects because I was really scared to try a new drug. So we decided we're going to monitor and if something goes wrong and I'm not feeling good, then I would just get off it.

Speaker 1 (31:53):

So how was your experience with the drug? How did you feel taking this medication?

Speaker 2 (32:03):

Initially I felt nauseous for about two weeks.

Speaker 1 (32:10):

How bad was the nausea?

Speaker 2 (32:13):

It, it wasn't too bad, but I'm sensitive person so I felt it, but it got better and then after four weeks I changed the dose to 0.5, then I felt a bit nauseous again for about a week. But now I don't feel anything. Any nauseous or any headache or any other side effects.

Speaker 1 (32:42):

When you increased your dose from 0.25 to 0.5, did you get side effects again? Did you feel nauseous again? I

Speaker 2 (32:47):

Did. I did for about a

Speaker 1 (32:48):

Week. For about a week. Awesome. Yeah.

Speaker 2 (32:50):

Okay.

Speaker 1 (32:53):

How do you feel only how are your cravings? Because one of the things that people struggle with is cravings food. Have you noticed a change in your food, in how you approach food, how you think about food, how you take food?

Speaker 2 (33:08):

I don't have cravings. I don't think about food. I eat when I'm hungry and it's great. The cravings are gone. A craving is what gets you right and I can still have a habit of making a full plate, but when I'm full I don't want to have that extra food. So I'm eating everything but a smaller portion and not any cravings at all. And I feel great that I lost 11 pounds.

Speaker 1 (33:47):

How much more weight do you want to lose?

Speaker 2 (33:50):

My goal altogether is to lose 30 pounds.

Speaker 1 (33:53):

And what happens after that?

Speaker 2 (33:57):

Healthy lifestyle exercise.

Speaker 1 (34:00):

So will you stop taking ozempic?

Speaker 2 (34:02):

My plan is to get off a pic slowly with the help of my physician. So I would go to 0.25 and wean myself off.

Speaker 1 (34:14):

Okay, awesome. Alright, thanks for sharing. Thanks for coming on and sharing this. Well

Speaker 2 (34:19):

Thank you so much for having me.

Speaker 1 (34:20):

Thank you.

Speaker 2 (34:21):

Alright, thanks.

Speaker 1 (34:25):

I'll move. I skipped to the next slide. Let me go back. Yeah, we have another patient missing a slide for is we have a patient number three. If you can turn on your camera so you pop up to the top. Oh, there you are. No. Oh, there we go. I see you there.

Speaker 3 (35:04):

Hi. Think I should there.

Speaker 1 (35:05):

Hello. Hi. Hello. Thank you for joining us.

Speaker 3 (35:08):

Thank you.

Speaker 1 (35:10):

So I'll let you introduce yourself. Tell us a little bit about yourself. Tell us what's going on with you.

Speaker 3 (35:16):

Yeah, hi, my name is Fatuma. I'm 35 years old. I recently just had my second child, he's 16 months. So I've been very busy in my motherhood life.

Speaker 1 (35:31):

And what happened with your weight loss? Weight gain?

Speaker 3 (35:36):

So for the last five years I've been having children, so I had a loss before I had my daughter. And so due to the loss, I gained a lot of weight due to grief and then I started to have kids and then once I was done it was a lot of weight that I had put on. So at that time I started to try different options. I tried in Mississauga, there's a clinic called Dr. Poons. I went to that. I also went through a bariatric program where I was on the shakes and even though I did lose a little bit of weight with that, I was never able to keep it off and it was really hard to drink shakes for three months straight was really difficult. So then I turned to Ozempic because I had heard a lot of people saying really good things about it. So I had turned to my family doctor and my doctor, he referred me to a weight loss doctor and then they recommended it to me. Yeah, so it's been really great. I've been on it for about three months and I've lost, I mean my overall weight loss, I've lost over 50 pounds.

Speaker 1 (37:10):

Congratulations. Thank you. Lemme just see if I can adjust the presentation. I want to find your slides. There you are. Let's get back. There we have you. Perfect. So you went from three 20 to two 50 pounds. Amazing. Can you guys see that? Hopefully yes. Can you see it Fatima? Can you see the,

Speaker 3 (37:35):

I can see.

Speaker 1 (37:36):

Beautiful. So let me ask you a couple of more questions. So I'm curious, did you have any side effects, any problems with taking ozempic?

Speaker 3 (37:44):

So yeah, so I'm somebody who's really nauseous to begin with. So when I first started taking it, I also was on the 0.25. So I started off that. I actually asked to be on 0.25 a little bit longer just to get my body ready. And then after about a month I went to the 0.5.

Speaker 1 (38:08):

Okay. When you were switching doses, did you notice any side effects or any flare up of side effects?

Speaker 3 (38:16):

Yeah, so again, the same thing kind of at the beginning when I had taken it, the nausea had returned. I mean anyone who's been pregnant, it's basically a little bit like that, but it went down after I think about a week or two. I was no longer of the nausea unless you ate really bad, you feeling bad.

Speaker 1 (38:38):

What were your cravings like or your approach to food? Did you notice a change in your hunger and cravings?

Speaker 3 (38:44):

I did. So usually I crave foods. So sometimes at the beginning what was happening is my body and my mind were still craving these foods and then I thought, okay, I'm going to eat it and then I would eat it and then I wouldn't feel so good. My body was almost rejecting it. When

Speaker 1 (39:05):

You say not good, you mean nauseous or what did you feel?

Speaker 3 (39:08):

Just nauseous. Yeah, just like nauseous. But then eventually I stopped craving it. I haven't craved fast food in at least two months.

Speaker 1 (39:21):

Awesome. Amazing. Yeah, the way this medication works is on the digestive system, it slows down absorption movement of nutrients to your system and also on the brain affects cravings and hunger. So different pathways linked to weight loss. So awesome. So thank you for sharing.

Speaker 3 (39:39):

Thank you so much.

Speaker 1 (39:42):

Let you turn off your camera, you to mute. We'll go back to the presentation. So now comes the fun part, the q and a. I'm going to ask you guys, you can submit your questions in the chat. If this is a private question you don't want me to answer here publicly, you can always send us an email us@infotorontosearch.com and we'll send you answers to your questions. Again, I'll give you some generic answers. This is not meant to be specific medical advice. If you need specific medical advice, you need to be seen in person, have a proper assessment and have a proper consultation and it's best you should be seen and assessed by a qualified medical professional. So I'm going to go to the chat and you guys should be able to see there. You can write your question. I'm going to scroll through these and see what questions we have here. Don't be shy Again, if you are shy, if you have a very private question, just send us an email. Hello Costa Rica. Okay, hello Rosanna.

(40:56):

So a question is where do you get ozempic? So for can patients, you can speak to your family doctor, they can start you on this. You can go to a weight loss clinic or you can come to a clinic such as ours to be assessed to make sure that you're a good candidate, you're healthy, that you qualify, and that this can be prescribed. Is it for life? To be honest, I don't have the answer to that. It may be a chronic medication like I said, like for diabetic that take the diabetic medication for life. Like hypertensive patients take the hypertensive medication for life. There's a chance that you may need to be on this for life. There's also a chance that this medication may help to kickstart your weight loss. You may reach your desired weight, your goals, and then lifestyle modifications. So a good healthy diet, good exercise, good lifestyle is going to be able to maintain your weight results and if it fails you can always go back and start the medication.

(42:02):

Any issues with medication shortages? So yes, because it became so super popular, it just excluding all over the world, people are using it for diabetes, people are using it for weight loss and as such there are shortages. It varies in different areas. In the states for example, you can get around it. The shortage is not in the medication itself but in the delivery system. So the medication, the raw material that's required for this can be obtained by pharmacies, compounding pharmacies that can create alternatives. This is legal in the states. There's a law that allows pharmacies to create alternatives. When there's shortage. There's no such thing in Canada that I'm aware of. So in Canada patients may struggle with shortages. Now there's other drugs coming out such as montejano or zep bound, but because they're also popular there may be a shortage of those medications as well. How often do you take injections and what about when traveling? So this is a once a week injection. Current ones, there's a pill form for ozempic called rybelsus. So you take that daily and there may be different variations come in the future, but right now the most commonly way of taking this medication is once a week injection. It's a pen. I will, let's see if I can scroll up here.

(43:36):

There we go. So that's a pen. So you can see the ozempic pen, it comes with little needles, very, very fine needles. You stab yourself, you poke yourself. And this pen carries quite a lot of medication in it. So you can take this with you if you travel and self-administer these injections while you're away. Other studies on long-term side effects, organ damage, negative impacts that we should be concerned about. So there are studies, these studies however are diabetic patients. As of last week I was doing my lit review. I'm not aware of any study in weight loss patients specifically. So although it seems to be safe in diabetic patients, I can't tell you specifically it's safe in weight loss patients. It seems to be all the studies so far seem indicate, but there's no definite study yet.

(44:30):

There are certain contraindications which I mentioned previously. I'll jump over to that slide. So these are specific contraindications. So if you have one of these conditions, you should not be taking this medication because the medication can make things worse. If you look on the bottom right, there's medullary thyroid cancer. So this is a big one that people talk about it. Oh my god, you can get cancer from ozempic. So this comes from lab or rat studies. There was a very recent study actually came out in October of 2023 that looked at, I think I don't have the number off top of my head, but I think like 45,000 patients or 45 or 75,000 patients, a very, very large number. And they've looked specifically at incidents of cancer and they found none. They found no increased incident of cancer in these patients. So even though at the moment we still say patients with history or personal or family history of thyroid cancer should not be on this medication, it seems like cancer may not be something to worry about.

(45:38):

Follow F from Sudbury, ZA in town Toronto. I can't speak for pharmacies, I know we can still get it. It is a struggle but yes, and you switch to Mona perfect. It's an alternative. Mona is a newer drug and actually because it does not just GLP one but also GIP, that may be the reason why it actually may be even more powerful. I mentioned that with ozempic. Studies show that you could lose up to 15% of your body weight with ular. No studies have shown up to 20% so it may be more powerful. So that may be a good thing.

(46:15):

Question about the first girl's weight loss or the young lady. So this was a healthy young lady who was in a pretty good shape but wanted to lose some weight. She went on ozempic, she did develop side effects, nausea, vomiting to the point that she stopped. But even after stopping she continued to lose the weight and I asked her, given that this happened, you stopped. If you regained the weight, would you go back on the medication? And she said yes, she would go back and do it again. So the side effect was to the point that she was happy with her weight loss and decided to stop it but it wasn't something that would prevent her from doing it again.

(46:59):

Can someone BMI of 25 or below go on ozempic? Someone is stuck. You can. It is possible. At our clinic we do have the 25 cutoff but there's no specific cutoff. I guess if you BMI is below 18, then maybe you should definitely not be doing this. But if you're about 25 or so and you still want to lose weight, maybe a short-term course of ozempic or GLP one medications could be beneficial to help you achieve your goal. Next question. Does it work on everyone? No. Yes and no. It works but to a different degree to the point. And some people it may have very minimal weight loss effects.

(47:44):

So you say you have two girlfriends that had amazing results, 15 that had zero results. Again, difficult to say about, I don't know who these people are. Some people may not have been able to tolerate it may have very, very minimal results. Difficult to say. People complain of double weight gain when they get off. Well studies that I've looked at show that people regain about two thirds. There's the odd report of somebody double gaining, but these are the rare cases. This is not typical rebound that you would get when you stop the medication. What dosage do you guys do for surgery? So there's no dosage for surgery, it's more dosage for weight loss. You start basically at 0.25 and work your way up. Although this is the old protocol with ozempic. The semaglutide, it's specifically for weight loss comes prepackaged already at 2.4 milligrams. So you jump directly to that. Now we haven't used the 2.4 milligram. We're using ozempic and slowly working your way up and the goal is get through dosage that you're comfortable, that you don't have side effects or minimal side effects that you can tolerate and that allow you to lose weight. Can you take the CVA thyroid nodule?

(49:04):

As I said, there's a study that looked at cancer and found no association, but at the moment still because of the fact that the official guidelines are anybody with thyroid issues should not be taken, I would say avoid it. Don't take it yet. Our staff was telling patients to be off for four weeks. Yes, that was the guideline upon very recently and we've adjusted a guideline to one week. The guideline is these guidelines were based on the fact that in Canada there were reports in Quebec of patients who are on ozempic for quite a while, were having general anesthesia and regurgitated food and this is potentially dangerous as I mentioned. So the official guidelines came out and said you should be off for four weeks. And again this is an always evolving situation. The guidelines have recently changed to one week, although our anesthesia are not a hundred percent sure they're happy with it. But for now we've changed from telling our patients four weeks to one week. And again, I apologize if you're so in between, it's an ever evolving field.

(50:21):

I have a patient who says on it since August lost 20 pounds. Most interestingly it wiped out any interest in alcohol. So yes, that is one of the side effects is that not only is it about food, it's also about alcohol. People have less cravings for alcohol intake. Is it okay if you have no gallbladder? Yeah, we're not affecting your gallbladder. More generals on back order. Yes it is. These drugs are very popular. I don't want to say, I don't want to use the term want the drugs, but they seem to be doing amazing things and so they're being very, very popular.

(50:59):

Will lemons and apple cider cause impact on how works? I have no idea they shouldn't because whatever is inside your stomach is not affecting the fact that these medications are being injected subcutaneously. They affect your stomach motility and absorption. So although I can't say, I can't say for sure, I don't believe there should be any effects. Alright you guys, it's almost nine o'clock. I have a feeling that our webinar will cut us off at one hour. I'm going to refer to my technical support. Are we going to be cut off at one hour or are we going to go on for a few more questions? Where's my assistant?

(51:52):

We'll try to keep this going in case we get cut off. Guys, I want to say preemptively thank you very much everybody for joining us and my assistant here, my technical support. What do we do? Are we able to go on or should I say thank you and conclude? Try to go on. Alright, I'm going to pull up some more questions If you guys follow us on social media, I'm guessing that's probably where you found us. We will. DR six I posted, I posted and ask people to submit questions. I'm going to pull up those questions that people submitted over there. Give me a moment here.

(52:39):

And again, if for some reason this cuts us off, please email us info at torontos com and we'll answer all your questions. Okay, these questions? Alright, found them. Okay. Someone mentioned that they use ozempic for six months prior to surgery, those three pounds and still working. Amazing should you lower your dose if you're trying to maintain. So I think yes, you can try to lower your dose and see if you're able to maintain your weight and potentially wean yourself off and see what happens. There's a question about injection take once a month or once a week. It's once a week. I hope I didn't say once a month. It's a once a week injection.

(53:38):

Question is, is this age restricted? There's no official age restriction I'm aware of. However, at our clinic you've got to be 18 and over to take this. Is this for life or can you wean it off after weight loss? So again, same question. You can try to wean off, you can try to minimize it. And once you reach your goal weight, maintain a goal weight through lifestyle modifications. So healthy diet and exercise. All those studies do show that once you've stopped this you may gain a weight back. You're no longer taking the medication. So the impact on the brain on the way your brain works is diminished and you may develop cravings again and you may have to fight cravings. And that's one of the biggest issues with weight loss. Weight gain though you your diet is that people struggle with cravings and that's one of the beautiful things of this medication. It doesn't only work on your gut but also works on your brain and fight these cravings.

(54:40):

There's a question about how do we sign up for these plans. So for hours please contact us. Again the email is info@torontosurge.com. I'll go to the back. There it is. There's the email. Send us an email, we'll get you to come in for a consultation, we'll assess you, we'll send you for some blood work to make sure you're a good candidate and then we'll start you on the plan. The plan does require you to participate. It's not just us prescribing the medication. You do need to come into our clinic and to be seen regularly. And then blood work once a month.

(55:13):

Question about what follow-up tests are done while you're on the medication. So we see you in person, we do assessments when we see you and then once a month we send you full blood work. And again, we want to make sure that your blood work is not changing, it's staying at all in healthy ranges. And we see improvements if you have any abnormal blood work. Question is what can you do to complement one milligram dosage of ozempic? I'm not sure understand the question. I guess what more can you do? Well what you can do is you can increase dosage. The weight loss dosage that's officially coming from Ozempic or Wegovy is 2.4 milligrams.

(55:58):

Alright, I think that's all the questions. Let's see. There's a question about nja or ozempic. So I'll go back to a slide on that. So I ozempic and most of these GLP one receptor a risk medications work on the GLP one. Muno is different in that it works on GLP one and the GIP. And as you can see, again, they work in a similar fashion. They may be working together and that may be a reason why initial studies seem to indicate that majano is actually more effective and maybe more effective in weight loss. Its safety profile, we don't know it. It is a new medication, hasn't been around as long as Ozempic, but it seems to be working in a similar fashion. So we are making assumption that it's similarly safe, but we don't know until actual studies come back.

(57:13):

There's a question about side effects again. So I presented this drug as almost a wonder drug. And again, I don't want to use the term wonder drug. I'm not trying to sell this drug as this miracle, but it does have F effects beyond weight loss, which I think are impressive. And I don't know whether this is the drug making your heart and liver and everything else better or these are byproducts or weight loss because we know obesity is not a healthy thing despite all this thing about body positivity. Positivity and people like Lizzo promoting very large bodies. Truth is this is not normal, this is not healthy. Being obese is known to decrease life expectancy, increase cardiovascular disease and all kinds of illnesses and weight loss is a good thing. So again, I don't know whether all these other additional things are biproduct weight loss or if the medication itself is making your heart, your liver and organs better. But it seems to be doing a great job. So that's amazing. This is beyond weight loss. This is not just weight loss, this is about health.

(58:21):

Alright, I think I've went through all the questions. The rest is sort of repetitive. All of people are asking a similar questions. Is there anything else you guys want me to talk about? Any other questions that you have? If you do, please put 'em in the chat. If you want to submit a private question, you don't want to talk about it here, private, you want to do it privately, email us again, email down here, info@torontosurge.com and I'll be happy to answer. And again, thank you very much for joining us. I hope you guys enjoyed it. I hope you found it very useful, helpful, and thank you guys. Have a great night.