Dr. Michael Lee graduated from Stanford University with honors and received his medical degree from the University of Chicago in 1996. Dr. Lee completed his internal medicine residency at Mount Auburn Hospital, a Harvard Medical School teaching hospital.

Medications I use for weight loss

I thought I’d summarize some of the medications I use to help people lose weight.

Appetite Suppressants diethylpropion (Tenuate), phendimetrazine (Bontril), phentermine (Adipex-P) are a stimulants which suppress your appetite. Think about them like a strong cup of coffee. Common side effects include palpitations and insomnia (so it’s better taken earlier in the day).

Antidepressant buproprion (Wellbutrin) is an antidepressant which is also commonly used to help people stop smoking. I find that many people who are overweight suffer from depression and/or anxiety will self-medicate with food.

Insulin Sensitizer metformin (Glucophage) is commonly used in diabetes, but can be used to promote and maintain weight loss even if you don’t have diabetes. People who are overweight have higher insulin levels which increases weight gain since insulin increases hunger. Metformin helps by increases your sensitivity to insulin resulting in lower insulin levels. One study showed that combined with a low-calorie/carb diet, women loss 20 to 30 pounds in a year. Even those with no dietary changes lose 12 pounds.

Meal Replacement Shakes (Optifast 70, Medifast 55) are 80 & 90 calorie liquid shakes that are used 5 times a day or 3 times a day with dinner.

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A Cold vs the Flu

This post was inspired by marmite’s question that went something like this,

“I’ve got the flu a stupid cold, should I take Nyquil?”

Many people use the term flu to mean a bad cold which is partly correct.

A Cold is a viral infection of your nasal passages which causes a runny nose. At night, mucus can run down your throat (post-nasal drip) and make you cough from a gagging reflex. In the morning, you’ll often have a sore & scratchy throat from the mucus which improves after taking a shower or gargling with salt water.

I’ve become a fan of a prescription nasal spray called Atrovent for a runny nose.

For nasal congestion (feeling blocked), I usually recommend Sudafed during the day since it can cause insomnia. Start with half the recommended doses to avoid over drying out your nose which is unpleasant. Make sure to get Sudafed and not Sudafed PE (which doesn’t work as well). You’ll know you’re getting the right medicine if you have to show your driver’s license (to prevent people from converting it into methamphetamine).

My mom’s favorite remedy is snorting salt water up your nose which actually has been studied and found to work well.

The Flu is also caused by a virus with the same symptoms as a cold (cough, sore throat, runny or stuffy nose), but you usually have a sudden attack of high fever, headaches, muscle aches, and extreme tiredness. You feel like you’ve been hit by a mack truck.

The big difference between a cold and the flu is that there is anti-viral medication (Tamiflu) for the flu. Tamiflu can reduce your symptoms by 3 days if you take it in the first 12 hrs or 1 day if you take it in the first 48 hrs. Some insurances don’t cover it. It costs around $93 if you’re paying cash so you’ll have to decide if it’s worth it to you.

In addition to bedrest, if you don’t have an ulcer and you haven’t had stomach problem with medicines like Advil, consider taking double doses of ibuprofen (Motrin, Advil) 4 pills 4x/day or naprosyn (Aleve) 2 pills 2x/day with food. At these dosages, you will get an anti-inflammatory effect in addition to pain and fever rellief which is better to control muscle pain. You can take Tylenol on an empty stomach and it’s good for pain and fever, but there is no anti-inflammatory effect.

Last thing, the cough in a flu is partly because the virus causes you to shed the lining of your large airways. One complication of the flu is that you’re a setup for bacterial pneumonia a few days after your attack of flu.

Flu Shots There’s plenty of flu shots for everyone these days. I advise it people who are exposed to sick people, have other medical problems like asthma, or who can’t afford to miss a day of work. It can make you a bit sick after you get it so I have people hold off if they’re going on a trip or have an important event coming up.

Cold Medicines usually have a combination of this and that which increases the risk of side effects like sedation. I usually recommend just taking the specific drugs you need to relieve your symptoms. I should also say that I think Robitussin without codeine (a narcotic) is not helpful.

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CRP – a new marker for heart disease risk

One of the things I love about medicine is that our understanding of the body is constantly changing. We’ve known that cholestrol drugs called statins reduce the risk of stroke and heart attacks in people with high cholesterol. Now, a study called Jupiter has shown that a blood test, CRP (C-Reactive Protein), can show if you’re at risk even if you have normal cholesterol. If your CRP level is high, taking a statin can reduce your risk of a heart attack or stroke by around 50%.

Practical Implications
1) Men over 55 and women over 65 who are not already taking a statin should check their CRP level.
2) If your CRP is ≥ 2, you should consider taking a baby aspirin and a statin to reduce your LDL cholesterol 50% as well as substantially reduce your CRP.
3) Remember that exercise, weight loss, and smoking cessation all lower CRP and cardiovascular risk.

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Vertigo

In the past few weeks, there have been an unusually large number of patients coming to me with a complaint of vertigo (a sensation of spinning) when rolling over in bed or looking up.

As you watch the animationepley.jpg, keep your eye on the black ball rolling in one of the semicircular canals. It represents a stone that has gotten trapped. When you turn your head or look up, the stone moves causing vertigo. You can see after the patient has been rolled around, the stone drops out of the canal where it no longer causes a problem (like rolling a bead out of a hole in a hoola-hoop).

For some reason, I haven’t found many doctors who are aware of this condition (Benign Positional Vertigo) or how to treat it. Most patients I see have already been treated with antibiotics. Many have had MRIs and hearing tests.

In my experience, at least half of patients I see improve with the Epley manuever.

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