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Slide 8

Patient Care

Treatment advances in patients with vitiligo

My approach begins with a thorough discussion of the chronic and unpredictable nature of vitiligo, emphasizing realistic expectations and the importance of adhering to treatment. I educate patients on available options, including topical corticosteroids, calcineurin inhibitors, phototherapy, and now JAK inhibitors. The emergence of topical JAK inhibitors has significantly expanded our treatment arsenal. Compliance remains a common barrier, so quarterly follow-ups help maintain motivation and improve long-term outcomes.

Slide 3

Patient Care

Exploring Novel Therapeutic Approaches for Major Depressive Disorder: The Role of Digital Therapeutics

I have had patients use digital therapeutics, including apps that help track mood, sleep, energy, stress, etc. It seems that using something like a cell phone is an easy way to track this as these devices have already become integrated in our lives. The biggest drawback is older patients who have limited experience with technology.

Slide 4

Prescribing Decisions

Advancing T2D Management: Key Insights from the Latest ADA Guidelines

CGMs and AID systems into routine care, along with the use of SGLT2 inhibitors, can significantly enhance outcomes for patients with T2D by improving glycemic control, reducing complications, and providing cardiovascular and renal benefits. This is both by improving awareness of glucose responses to foods and beverages as well as improved weight loss and A1c from SGLT2.

Slide 5

Patient Care

Optimizing Dyslipidemia Management: Strategies for Effective Multidisciplinary Collaboration and ASCVD Risk Reduction

As a Physician Assistant in Internal Medicine, collaboration is key. I often will refer to both cardiology and nutrition counseling. Most patients can get to goal with medication, diet and exercise but compliance is important. Cardiology workup is even more necessary for patients with family history of heart disease and/or comorbidities that increase their overall risk.

Slide 6

Prescribing Decisions

Reassess. Intensify. Protect: Timely LDL-C control post-MI can prevent what comes next

Coordinating with cardiology post-MI for lipid management is imperative. I'd say working in family practice, it's probably 50/50 whether we handle the lipids or cardiology does. We check every 3 months until at goal, then yearly thereafter. Intensifying treatment takes place if patient isn't at goal with current statin and are either unwilling or unable to make further lifestyle adjustments. At that point we look at adding ezetimibe, bempedoic acid or a PCSK9-inhibitor.

Slide 7

Patient Care

Redefining Patient Identification for Obesity Management

Expanding obesity care requires moving beyond BMI to a more holistic, patient-centered approach. The Edmonton Obesity Staging System (EOSS) helps assess health risks beyond weight alone. Key strategies include: (1) Obesity-Focused Histories: Assess weight-related complications and past treatment attempts. (2) Motivational Interviewing: Focus on health improvements rather than just weight loss. (3) Broader Identification Criteria: Consider metabolic risk and weight regain, not just BMI. (4) Technology & Digital Tools: Use body composition analysis and EHR decision support. (5) Interdisciplinary Collaboration: Involve dietitians, psychologists, and specialists early. These strategies help ensure respectful, effective, and early obesity care.

Slide 1

Prescribing Decisions

Tackling obesity and weight loss

Obesity management is a very normal part of my practice. Half the time the patient will bring up losing weight and will volunteer a medication name that they are interested in, the other half I bring up weight loss at the lab review visit after the physical. I re evaluate their labs to know if metabolic, diabetes or cardiovascular health is a comorbidity and that guides me with what direction to go to regarding medication. then the next barrier is the insurance coverage of the medications. I usually have a back up plan or two back ups with the expectation that the SGLT-1, 2 medications will be denied.

Slide 2

Patient Care

Cardiovascular-kidney-metabolic syndrome is associated with increased cardiovascular disease risk

I tend to be blunt rather than beating around the bush when it comes to CKM because the stakes are high. I let patients know that as their kidney function decreases, their chance of MI, stroke, heart failure and arrhythmias goes through the roof. I discuss how it is imperative that we stop further progression of the kidney function loss in order to minimize this risk. One of the biggest barriers is cost of medications. If a patient is non-diabetic, it is very difficult to get a prescription for an SGLT-2 or GLP-1 covered. Both of these classes have good data on their renal protective properties, but cost and insurance coverage is often prohibitive. This is especially true for the age group who is most affected: the elderly on Medicare.

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