What does an Annual Physical Exam consist of?
Annual physical exam, consists of a thorough review of a patient history as well as a physical examination and review of systems. Based on those, then we will proceed with blood work which usually consists of fasting blood sugar, blood count, thyroid function test, cholesteroli check, metabolic panel and any other tests that are recommended based on the physical examination and history. We do not routinely perform electrocardiograms (EKG) with annual physicals unless it is indicated based on a patient's history. Majority of insurance companies now are required to cover an annual physical examination visit based on the Affordable Health Care as an Annual Wellness Visit. However, laboratory services as well as other tests such as EKG, Pulmonary Function test, visition test, or audiometry might not be covered and if you want any of those tests to be performed, you need to first check with your insurance carrier. We will also review immunization history and recommend updating the immunization per general guidelines based on one's age and medical condition.
Do you draw blood or do laboratory test in your office?
Yes, we draw blood, urine stool or culture of wounds and send the tests to outside laboritories. Most of the laboritories we use are a part of insurance company networks. We provide them with the samples as well as information of each individual patient and their insurance information. They subsequently perform the requested tests and bill the insurances based on the information that was provided to them and bill each patient directly for the remaining balance based on each individual's insurance coverage. A list of the laboratory companies we use can be asked during each visit. If an individual wants to use a laboratory that is not used by us, it is OK as long as the results are provided to us and the patient is aware of the insurance coverage of that laboratory.
Do you perform X-rays or Ultrasounds at your office?
No, we do not perform X-rays or Ultrasound at our office but utilize in-network, local facilities for our patients and usually can get patients to have the procedures the same day.
What does a Weight Management Consult consist of?
A weight management consultation is usually a 45-60 minute visit with Dr. Shafipour. It consists of a thorough history related to weight, family history, lifestyle, habits, eating pattern, prior diets and medications. We also recommend all of the patient to have a resting metabolic test, fasting cholesteroli, blood sugar, Uric Acid, thyroid panel and metabolic panel to rule out common metabolic causes of weight gain. In some cases, an electrocardiogram (EKG) or referral to a sleep specialist for evaluation of sleep apnea are also recommended. After this visit, when all the information is available, we will go over the results and recommend a diet and lifestyle plan consisting of detailed food plan, exercise plan, dietary supplements and behaviors to look for. The diet is very personalized and varies between different patients.
I was recently diagnosed with early stage diabetesi and am hesitant to go on medications, do you have any recommendation?
A 66 year-old gentleman with history of heart diseasei, walked into our office in June 2013 with a new diagnosis of diabetesi by his primary care doctor. His primary care doctor had told him he HAD to be on medications and he could not lower his blood sugar and hemoglobin A1C with diet alone but the patient was determined. We evaluated him and provided him with a diet plan. With great adherence to the program, in November 2013, his blood sugar, Hemoglobin A1C and cholesteroli levels were all normal, not even pre-diabetic!! Pre-Diabetesi and early stage-diabetesi are the best times to take action and reverse the disease once and for all. With our expertise in Batiratric Medicine, after a thorough evaluation, we will recommend a personalized diet to help you manage your blood sugar and either avoid medications or get off oral diabetic medications. If you have a higher stage diabetesi and are on insulin, you would need to be managed closely by Dr. Shafipour to make sure your blood sugar levels are not dropping to low while on the diet. With the rise of diabetesi, we have a special passion to catch patients at these early stages and help them reverse the course of the disease. Please spread the word and recommend anyone with early diabetesi or pre-diabetesi to take ACTION NOW!
I constantly feel tired and am gaining weight but my doctor checked my thyroid function and told me it was normal. I still think my metabolism is slow and whatever diet I follow, I cannot lose weight. What do you recommend?
A 33 year-old lady presented to our office for weigth gain, fatigue and slow metabolsim. When we checked her resting metabolic rate, it was slightly slow, but her blood tests did not show any signs of low thyroid function or any other metabolic abnormalities. She exercised daily by doing the Insanity DVDs and did not lose any weight! After thorough history, we discovered she had a lot of chronic stomach issues, since the age of 12 when she had contracted an infection on an overseas trip. We performed a comprehensive stool analysis which showed a parasitic infection as well as high level of certain gut bacteria which has been linked to obesityi. With change of her diet, gut bacteria and treatment of the parasite, she is now more energetic and has been able to lose 20 lb. without trying!!
This is one of the most common issues we encounter in our patient population. Normal TSH (Thyroid Stimulating Hormone) but patient feels sluggish, tired, can't lose weight and is frustrated and feels hopeless! First of all, thyroid gland is not the only endocrine gland that controls the metabolism and there are many factors for weight gain. Age, genetic background, hormone levels, diet, level of physical activity, ethnicity, pancreas function, and gut bacteria to name a few. We will sit down with you, take a detailed history and conduct a thorough physical exam. Based on those, we will proceed with a detailed laboratory test which will include checking the thyroid function (not just the TSH!), other hormones, blood sugar, gut bacteria, urine, etc. Based on those, we will come up with a plan to tackle the fatigue and weight gain.
How do you diagnose and treat "hypothyroidism" (low functioning thyroid gland)?
Diagnosis and treatment of low thyroid function varies greatly between traditional Western doctors, endocrinoloigists and integrative medicine doctors. There are many medical conditions and medications which can lower the function of thyroid gland. A thorough health history often gives us clue to this. The most commonly done blood test is Thyroid Stimulating Hormone (TSH) which has a wide range (0.35-4.5 uIU/mL) and many people with normal levels still have symtpoms of low thyroid function. For symptomatic patients, we test the actual thyroid hormone levels, thyroid peroxidase antibodies as well as Reverse T3 levels and Vitamin D levels and based on those will make a decision whether to treat hypothyroidism with supplements, medications or both.
Treatment of hypothyroidism also varies between different individuals. Many patients who can convert inactive T4 to T3 regularly, do well with levothyroxine. However, some patients do not convert T4 to T3 well and require T3 replacement and some patients prefer more natural medications such as porcine thyroid (Armour thyroid or NatureThroid). Again based on patient's symtposm, blood work and a discussion with the patients, a recommendation regarding treatment is made. Many patients stay on levothyroxine but take vitamin supplements that will enhance converstion of T4 to T3 and do well with that. After any new thyroid medication, we check the hormone levels every 6 weeks to come up with the correct dose. Once a dose has been obtained, then we will check the levels every 6 months.
I have taken prescription strength diet pills before which have failed. What are your thoughts on diet pills?
The term "diet pills" can encompass a few classes of medications. However, for the most part, diet pills refer to appetite supressants which are stimulants. If taken solely without change in eating habits and lifestyle modification, they do not cause a significant weight loss. However, if taken as an adjunct to a program with the main focus of long lasting, sustainable weight loss rather than a quick, fix they can be an effective adjunct when patients hit a plateu in weight loss.
In our programs, appetite stimulants may be used as an adjunct in parts of some of our programs to stimulate metabolism or take someone out of plateau; however, they are not the main focus of any of our programs and are used for a short term.
I have been on multiple commercial and doctor directed medical weight lossi programs, why should I join a clinic like yours?
The focus of our program is to use every resource available so our patients can achieve a long lasting, sustainable weight loss. Research has shown that going on any of the major available commercial diets (e.g. Atkins, Ornish, South Beach, Zone,...) for the short term can result in weight loss. However, the majority of the patients gain the weight back. The main reason behind this is that short term dietary changes by themselves have been shown to be insufficient to cause a rather for permanent weight loss. The behaviors that, throughout one's life have caused overweighti and obesityi need to be recognized and changed.
I am planning to have a gastric bypass. would I be able to benefit from your program before I undergo the surgery?
At least 10% weight loss pre-operatively has shown to significantly improve the outcome of gastric bypass. This will aid the surgeon by decreasing the size of the liver and the abdominal fat pad, so it will help their approach. Moreover, by changing the dietary and exercise behaviors that have caused overweighti, we will be able to help you maintain the outcome of your surgery post-operatively. Gastric Bypass, gastric sleeve, and Lap Band are great choices to help with weight loss and its comorbidities for qualified clients. However, patients who have not joined a long term weight loss program post-operatively gain back some of their lost weight.
I have already had a gastric bypass/lap band. Would your program help me maintain my results and lose more weight?
Absolutely! We will provide you with the vitamins and nutrients that you need post-operatively, as well as provide you with the ultimate post-operative dietary and exercise program. These measures will ensure that you maintain the weight you have lost, lose additional weight and reach your ultimate level of fitness and vitality. Studies have shown that individuals that are in a maintenance weight loss program after weight loss surgery maintain their results much longer than those who do not.
How is your weight loss program different than other programs?
In our program you will get a comprehensive evaluation by Dr. Shafipour, a medical weight lossi specialist, who will review the results of your tests. Based on these results, he will recommend the best weight loss program for you. This program will result in significant fat loss and maintenance of your vitality and fitness over a long period of time.
What does your weight loss program involve?
Every client will receive a comprehensive history and physical examination, as well as blood work, resting metabolic testing, electrocardiogram (EKG), and body composition analysis. We see the client in one week after their initial visit and go over the results with them. Then we plan an individualized program that meets our mutual goals and results in weight loss and increased vitality. Our focus is to become your partner in health and provide you with the best care and the latest health information.
What Cancers are directly related to Obesityi?
Obesityi statistics are interwoven with cancer statistics in some complex and confusing ways. We know that people who are fit and trim and eat healthful foods appear less likely to contract diseases, but we also know of many exceptions. Medical research has determined with reasonable certainty that obesityi is a risk factor for cancers of the colon, breast, endometrium (lining of the uterus), kidney, and esophagus. Because some studies show a decreased risk for cancers of the cervix, gall bladder, prostate, and thyroid in people with healthier, low carb/low saturated fat diets and/or a higher level of physical activity, an obesityi link to these forms of the disease is also suspected.
How is obesityi related to infertility?
Many studies have reported an association between increased Body Mass Index above 27 kg/m2 and subfertility. In addition, multiple observational studies have found that weight reduction in obese, infertile women was associated with an increase in the frequency of ovulation and the likelihood of pregnancy. Subfertility in obese women is most commonly related to ovulatory dysfunction, and, in some obese women, the ovulatory dysfunction is related to polycystic ovary syndrome (PCOS). It is also important to note that even among subfertile ovulatory women, increasing obesityi is associated with decreasing spontaneous pregnancy rates.
Obesityi may also have a negative impact on the outcome of treatment of infertility. The effect of obesityi on outcome of in vitro fertilization is not clear. Several series reported higher cycle cancellation rates in obese compared to normal weight patients, and a few described lower live birth rates.
Weight loss in obese subfertile women appears to lead to favorable hormonal changes and improvement in fertility.
Research has demonstrated that women with BMI ≥30 kg/m2 were at increased risk of miscarriage when compared with women with normal BMI.
The increased risk of miscarriage in obese women may be because such women often have PCOS or isolated insulin resistance, which have been associated with a higher frequency of early pregnancy loss.