Monique Ramsey (00:02):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. I have back in the studio with me today, Dr. Jerry Haas. He's one of our anesthesiologists and the director of our skinny shot program. It's called The Signature Skinny Shot. Say that five times fast, at La Jolla Cosmetic. Welcome, Dr. Haas.

Dr. Haas (00:25):
Good to be here, Monique. Thank you.

Monique Ramsey (00:26):
So we're going to talk not about your normal day job, you're just your new day job. So your normal day job, you're providing anesthesia to our wonderful patients and helping them have a nice, calm, sleepy time while they're having their surgery. And then now this other part that you're going to head up for us is the directorship for this signature skinny shot. So tell us a little bit about your background that sort of leads you to be a great director for this group.

Dr. Haas (00:58):
Well, I started out in internal medicine, so I have some background in internal medicine. And I mean, I'm sort of embarrassed to say this, but 35 years ago I was working in weight loss medicine while I was in the Navy, I was sort of a side job and obviously weight loss medicine has come a long way since that time. I mean, back in those days it was before Fen Fen and I mean we were giving patients pregnancy hormones to lose weight. So it was a long time ago and things have come a long way, but this is pretty exciting what's going on now with the GLP one agonists.

Monique Ramsey (01:38):
So talking about your role within the program as the director, what are you going to be doing and where will you be meeting the patients?

Dr. Haas (01:46):
So once a patient fills out a questionnaire and has lab work drawn, so they've decided to go through the program, I'll be interfacing with them via Zoom and we'll have a consult via Zoom and come up with a plan for which medication. There's two main medications that we'll be offering and the initial dosing of those medications. So that'll be my interface. And then there'll be monthly that will be occurring with the staff.

Monique Ramsey (02:19):
And let's get into sort of the science of the skinny shot and people you've probably, those of you who are listening, you've heard about it online, you've heard about it on TV or the radio, maybe your friends might have been on it. And it's sort of this idea of whether it's Wegovy or Ozempic or Zepbound or there's a whole bunch of 'em. But because they're shortages, they, the FDA has allowed compounding pharmacies to allow these drugs to be prescribed. So tell us a little bit about these skinny shots. And let's start with I think maybe some of the names that people know the best, maybe the Ozempic and Wegovy, the Semaglutide and what that is.

Dr. Haas (03:07):
So which is the medication that's in Ozempic and wegovy. And then Tirzepatide is the medication that is in Mounjaro and Zepbound. They really started out as diabetes medications and they're really worked by stimulating the pancreas to secrete insulin. And what these drugs are is they're really peptides that are released by your own gut, the cells in your gut specific cells, and they work as a feedback loop to tell your stomach that it's full and to tell your brain that you've eaten and that you don't need to eat further. So these medications are really just mimicking those peptides and they work at for Ozempic or the semaglutide works at the GLP one agonist works at that receptor and then Mounjaro works at the GLP one receptor, but also the GIP receptor. So it works at two different receptors.

Monique Ramsey (04:10):
So for the lay people in the audience on those receptors, I mean that's probably the main difference. But in what case would you say, okay, we're going to start you over here on the semaglutide versus the tirzepatide or in what cases might you prescribe one over the other and is one better than the other?

Dr. Haas (04:31):
Well, I think for a lot of people, glide might work and it does work. Tirzepatide was just FDA approved for weight loss late in '23. So the studies look awesome. I mean there's more weight loss with the tirzepatide and with fewer side effects, so more weight loss, fewer side effects, it does cost slightly more and it works at two different receptor sites instead of one. So it's really up to the patient initially what they would like to try. And then from then on, it's just based on their experience. If they're tolerating whichever drug they choose, we would just stay with that and we gently increase the dose over a period of months as they tolerate it.

Monique Ramsey (05:20):
So one doesn't necessarily work better for the other for everyone. It might be more for one person that might work better versus somebody else. And that's interesting. And so the dose, you said you kind of go up slowly how slow is slow or how fast is fast?

Dr. Haas (05:39):
It really is just a communication between us and the patient. And if their rate of weight loss is fine, we may keep 'em at that dose for a few months. We may not necessarily go up every month if they're tolerating it fine. There is a balancing act with side effects. So some of the normal side effects are burping or nausea or vomiting or diarrhea, constipation. A lot of people don't have these, but if you do have these, then that would lead us to be more judicious with your dosing. And then also what type of diet you're eating, avoiding alcohol. There are certain things that you want to do when you're on these medications, so you tolerate them as well as possible.

Monique Ramsey (06:27):
And how long have these drugs been around?

Dr. Haas (06:30):
Yeah, I mean the first GLP one agonist was approved for diabetes back in 2005. And if you think about the process that a drug has to go through to become FDA approved, I mean these medicines have been around for over 20 years, so they've been well vetted. And as time goes on and newer drugs are developed that are in the same class, they tend to be more effective and have fewer side effects. So I think people can feel confident that these drugs are well vetted and have been around for a long time.

Monique Ramsey (07:08):
I think they can be very life changing. There's a lot of people on our team who've tried them for different reasons. I happen to be one of them, but I have type two diabetes, so I was prescribed ozempic and it's actually kind of exciting because I've lost 45 pounds and

Dr. Haas (07:26):
Congratulations.

Monique Ramsey (07:26):
My A1C's come way down and now I'm technically probably not type two diabetic, but I still have to watch it. But I think it also, it works differently on your brain somehow. I don't know how to explain it, but it does make you, even if you have the urge to have that late night snack or you have an urge for food that isn't really because you're hungry, you can't really entertain that urge because you feel full or you might feel sort of nauseous and you're like, no, I'm okay. I don't think I want to go there. So have you yourself used it at all?

Dr. Haas (08:03):
I did use it some last year and I'm actually getting ready to start back on it here in a few days, but I lost about 15 pounds and just using it sort of intermittently, not in a consistent way, but I know what you're talking about, that sense of you might go to a restaurant and order some food that you are like and enjoy, but you'll just eat a third or a half of it and you're just not interested in the rest of it. And it just makes it so much easier to lose weight. I mean, we really haven't had something like this before. So it's really a game changer.

Monique Ramsey (08:41):
And unlike what you mentioned earlier, Fen Fen, phentermine and something else, but that was like speed. I think people who took that, I remember hearing stuff in the news and people were bad. Things happen. And so have you really heard of any major, other than obviously some of these side effects you're talking about with being nauseous or whatever, are there any big kind of scary things that people need to be worried about with these? Are they pretty safe?

Dr. Haas (09:11):
They really are pretty safe. I mean, of course any medication we give people, there is always a very, very small amount of risk that they could have a reaction. And for these medicines, there are some cautionary notes. If you have a history or a family history of thyroid cancer, a specific type or you have a history of pancreatitis or you have a history of renal dysfunction, then you might not be the right candidate for this class of medication. So there's always some restrictions with every medication, but by and large, it seems like the vast majority of people are really doing well on these medications.

Monique Ramsey (09:57):
And then how do you see this fitting in to our everyday practice?

Dr. Haas (10:03):
I think it's just it's going to be synergistic. I think we have over the years seen that so many patients that want to have lipo sculpture or body contouring procedures and maybe they need to, ideally they would lose 30 or 40 pounds before surgery to really get that ideal result. And this is going to help them do that and then they can have their surgery and really get to that ideal point that they really want to be at. And we all know in adulthood or middle age or whatever you want to call it, it gets really hard to lose weight. So this works and it can help people really get weight off in a period of three to six months and get to where they want to be and then have that surgery for excess skin or skin laxity and at the end point would be much better.

Monique Ramsey (10:57):
Yeah, I think when we were talking earlier last year about these different drugs and thinking, is that something we should be doing? And when you can't ignore the success any longer, that's when you have to be like, yeah, I think we need to do this because it is something

Dr. Haas (11:15):
Here we are.

Monique Ramsey (11:16):
Here we are. Well, and having patients who trust us already with their health, and it's kind of a perfect, we're going to do this in such a safe way, where you're overseeing their care. If you have a problem, you just pick up the phone and we're going to be able to talk you through it. And you have a team rather than something online where they're shipping it from Canada or whoever, who knows where this is coming from. And I think something else that I wanted you to talk about is where are we getting these drugs, these two medicines that people can take? Where's that coming from?

Dr. Haas (12:02):
So the companies that make these drugs cannot meet demand at all. And so these medications have been placed on the FDA shortage list and that allows compounding pharmacies to manufacture those medications. And we have three different compounding pharmacies that are well vetted. They use all USP certified product. They're FDA approved facilities. The product is tested and over a hundred different plastic surgery offices are using these sites for their medication. So I think people can have a lot of confidence that it's the real thing and it's pure. And then we're going to also be there to medically follow and guide them through the process.

Monique Ramsey (12:49):
And I think some people will ask, is this covered by my insurance? And even if it were, which unless you're somebody who is diabetic, it's really hard. And me being somebody who is and getting these drugs over the last year with the shortages, even if my insurance pays for it, which they are, I can't always get it. And this is the hard part. It's like, gosh, okay, I get it. I can get it, but I can't get it. They can't give it to me. They don't have any. And so one of the things that I think is really wonderful is not only is there the flexibility of the two kinds of drugs, but then there's also what level you need to be at and you're going to help them with that. It's not some sort of cookie cutter thing, but then you won't run out of it because there's these compounding pharmacies and that they're very, it's not some back room down the alley.

(13:49):
It's with a mortar and pestle mixing it up. It's a legit place. And I think that's why, like you said, why now here we are bringing this to our patients because we found a really good source. We have you, Dr. Haas, to guide our patients through. We want it to be safe and we're doing it the level that we've done everything. Absolutely. We spent 35 years doing things the right way. And so there's no exception here. So as people start to lose weight, other things might start to crop up. And I happen to know one of them is like the skin underneath my neck is a little looser. Things like that, body skin's a little looser. I feel great. I can put so many different things in my closet and it's no longer this torturous event to try on clothes or bathing suits or go shopping. But other things start to become apparent, which is you're getting healthier body and at a much better weight, but then the extra skin. So tell us a little bit about things that people might not expect when they lose that weight.

Dr. Haas (15:05):
It depends on how much weight I think you have to lose and your age, but people's skin elasticity changes as they get older. And it can be also due to sun exposure or alcohol use, but people's skin doesn't always retract like it might when you were younger. And so then there's a variety of things that can be done either surgically or in the med spa with different procedures in the medical spa to help people with taking care of those problems. So I mean the nice thing about getting plugged into a weight loss program here is we're here to take care of those issues once if and when they occur.

Monique Ramsey (15:47):
Now back to the medicine, have you heard any stories or misconceptions? I know there's a lot in the media right now. Have you heard any misconceptions that people might have about the medicine?

Dr. Haas (15:58):
I think people need to remember these drugs are very well vetted. They've been around a long time. I think the media tends to focus on anything that may come out negative about a certain medication or device, whatever it might be, whether it's, I think recently there was a thing about suicidal behavior and then that's been sort of dispelled pretty quickly. So I think really the drugs, the take home is that they're very well tolerated. And I think you have to compare that to if you maintain, if you continue being overweight and you have high blood pressure and high lipids in your bloodstream and you're developing coronary artery disease, there's a lot of known risk with that as well. And these medications really help turn that around. And I think we always look at risk and benefit. And here the benefits are great, the risks are small. So I think that's how we have to look at it.

Monique Ramsey (17:10):
Now in terms of people saying, well, you can take that and you'll lose weight, but you're going to gain it back. Is the, I mean obviously we all have to check ourselves as we go through life and we do lose weight. How do you see patients helping to wean off of these medications and then achieving some good healthy habits?

Dr. Haas (17:36):
Well, I think we all know that this is a lifelong sort of battle maintaining a healthy weight, at least for the majority of Americans. I mean the majority of Americans are and obese even. So it's a lifelong struggle. These medicines really help kickstart the weight loss. And then during that time that the weight loss is going on, there is a focus on proper diet exercise, maintaining your lean muscle mass, staying well hydrated to help avoid side effects and also behavioral therapies, whether it's finding ways to deal with stress, it might be meditation or yoga or different things that people can do so they can not rely on eating the wrong types of food to deal with the stresses of life. So it is a balanced approach and there is counseling that will occur as the program is going on. And then I think after a period of time when people do reach their ideal weights for some period of time, there might be a period where you're just taking the medications once a month or once every other week to help keep the weight where you want it to be and you wouldn't be on a shot every week.

(19:00):
So those are some of the ideas and the thinking that are going on right now with these medications.

Monique Ramsey (19:07):
And back to, I was thinking about cost because there's a cost to everything we do in life. These medications cost money. But I know, and we will have links in the show notes to your monthly cost and it does depend on which medication you decide to try. But you know what I found is that it's really funny, I love my Mexican food. I'm not going to change that, but I'll go to Don Carlos down the street and I'll get a burrito and I swear I get three meals, three meals out of one burrito. And that's just the new reality. So you could be spending a lot in food when you're overweight and that is going to go away. You could have a lot less. And when you're trading off that expense for the medicine, and I think something else you said was really good for that, people who have high blood pressure or people who are having other health concerns because of their weight or that extra inflammation.

(20:14):
I think I'm somebody who has a lot of inflammatory issues as well. And it really, I don't have the same amount of pain that I used to have, and that's been, I didn't think that, I didn't know that would, you're going to lose weight and your clothes are going to fit differently or you're not going to fit in the big clothes and you get to get new little clothes. But that my blood pressure medication has lowered and maybe I'll be able to stop it at some point, but it's gone way down. And just other things that I get out more and I walk more because I feel more comfortable in my own. And I think those are the kinds of extra benefits around the edges of the weight loss that you're going to have be healthier, but then also feel better. And you'll have these little side benefits that you weren't necessarily planning on, including three meals out of one burrito.

Dr. Haas (21:07):
There was a recent study that just sort of a retrospective where people were saving about $250 a month on their groceries. So I mean it was significant and can take that off the cost of the program.

Monique Ramsey (21:24):
Yeah, that's true. So the net cost is a lot less. But one thing I was going to ask you, the reason maybe that the Tirzepatide is more expensive, do you know what that might be?

Dr. Haas (21:35):
Well, since the tirzepatide works at two different receptors and it is more effective and it does have fewer side effects, and it is going be even in greater demand than the semaglutide that Mounjaro and Zepbound for Eli Lilly is already their biggest drug of all time. They're not going to be able to meet supply for years. So there's a huge demand for tirzepatide and the cost to us is higher as well. So I feel like our pricing is very fair, but the tirzepatide is a little bit more expensive than the semaglutide, but more effective.

Monique Ramsey (22:17):
It might be worth it too. I think I want to try it. So anything else about the program that you want to talk about?

Dr. Haas (22:26):
I just want people to know that it's a real medical program. I mean, we're going to check your blood work, we're going to take your history. We're going to have you weigh in and follow you and help you manage side effects by how we change the dosing from month to month. So you're not just getting on a website and getting something in the mail and you don't really have the supplies to deal with it. That's all going to be done for you. It's just going to be very convenient. It's going to be very safe, and we're just going to be very thorough. So I look forward to it.

Monique Ramsey (23:04):
It's very exciting times I have to say. And just having, you've had a little experience with it, I've had my experience with it and it's really transformative. And so I'm very excited that we're going to be bringing this to all of our patients. So if you're listening today and you have questions or you need information about our signature skinny shot about the pricing, we're going to have introductory pricing on the website. So we'll put that link in the show notes. And then if you're ready to get started, all it takes is a consultation. It's really easy, really easy to get going though. Anyway, check our show notes for links and we hope you liked today's podcast that you'll maybe share it with a friend, why not share it with a friend? So we will all see you on the next time. And thank you Dr. Haas.

Dr. Haas (23:53):
Thank you Monique. Good to be here.

Monique Ramsey (23:55):
Good to be with you.

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