Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Shea, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My guest today is Sulagna Misra. She's an internal medicine integrated medicine and aesthetic medicine specialist in Encino, California. Welcome to the podcast.

Dr. Misra (00:42):
Thank you for having me. Nice to meet you, Eva.

Eva Sheie (00:45):
Nice to meet you too. So when you're on a plane and someone says, what do you do for a living? How do you usually answer them?

Dr. Misra (00:51):
Not a stewardess and not a doctor.

Eva Sheie (00:56):
You don't tell them you're a doctor?

Dr. Misra (00:57):
No, I don't. If I wanted to say that I was a doctor, I would write Sulagna, Misra, MD on the ticket. But generally I don't because I'm doctoring all the time. Sometimes it's nice to not. Plus that's a lot of pressure on the plane. Literally.

Eva Sheie (01:15):
It is. Right. Do you ever have to push when they push the gall button and look for a doctor, do you ever actually volunteer?

Dr. Misra (01:21):
I have in the past. It also depends on what's going on. I mean, and what other doctors are on the plane and if their specialty can take care of situation a little bit better.

Eva Sheie (01:31):
For sure. So I think most of us know what an internal medicine is, but maybe not so much what integrated medicine is. Do you want to tell us more about what that looks like?

Dr. Misra (01:41):
Of course. So integrative medicine is akin with functional medicine, lifestyle medicine, anti-aging medicine. They're all kind of under the similar umbrella. Longevity medicine, preventative medicine, so to speak. So a lot of these things not covered by insurance because they're not standard medical accepted practices of care. It's basically looking outside of the box, working on food as medicine, working on supplementation, lifestyle, behavior, psychology, so many different things. What we practice in western medicine is actually allopathic medicine and we are treating disease or dis disease, which means the body is not at ease. So the language also is a little different In eastern traditional Chinese medicine, Ayurvedic medicine, we speak of balance and bringing back to homeostasis and that's why they practice homeopathy. So the approach is different. I'm sure the means is the same. The goal is similar, wellness and improvement, longevity and health and vitality, which is quality of life, very important. And I think something that we all recognized through covid, we want an improved quality of life. If we're going to be here, we don't know how long we're going to be here. So multiple things in that conversation. Integrative medicine is just a way of treating something with outside of the box treatments.

Eva Sheie (03:09):
Was there something that attracted you to integrated medicine?

Dr. Misra (03:12):
Oh, burnout. I did not want to practice medicine anymore. I was done. I was tired. I didn't feel like I was helping anybody working in these big systems. Right now I practice something called Direct Primary Care. Direct primary care was what physicians started to get back to the premise of let's have the physician patient relationship at the center and get away from it administrative burdens and see if we can drive healthcare dollars down. A good example of this that I do all the time with my patients, I utilize a lab and so I get contracted negotiated prices with that lab. So a BMP or a CMP complete metabolic panel or a CBC might cost me or charge the patient four to $5.

Eva Sheie (04:02):
Did you say four or five or 45?

Dr. Misra (04:04):
Four to $5. $4 or $5.

Eva Sheie (04:08):
Like a cup of coffee.

Dr. Misra (04:09):
Like a cup of coffee. Yeah. That's the price that I get for some labs, not all. And then I take the same, I'll take a patient's blue shield, platinum PPO plan. It's very popular to have blue Shield here or Aetna Platinum PPO plan. And you will see a bill $2,300. You are responsible for $300. The rest is covered by insurance. What you think is the cost of these labs is exorbitant. And so that $2,000, you're like, well, I guess insurance is covering it. I guess if I have to pay that $300 copay, I'll it, that's not so bad compared to I could be charged $2,300, but what if I told you I could get those same labs for 100 to $150 without even involving insurance?

Eva Sheie (04:56):
Most people I think would be shocked, but I was a freelance musician for a decade and so I was negotiating my own prices on everything during that stretch of time. And I lived in Houston where people were way more entrepreneurial. So you could actually find doctors here and there who were I think doing this DPC, but they were just really early to it. It wasn't called that yet. And I remember being just so thrilled that I knew what the price was and that I could afford it and I knew what I was going to be able to expect. And so for me, price transparency was something I was really passionate about really early and have fought to help in aesthetics at least to help practices understand the benefit to the patient of being truthful. It seems like should not be that complicated and it shouldn't.

Dr. Misra (05:45):
It should not. You should not be like, what's the deductible? What's the copay? Why am I paying 500 to a thousand dollars for a service that I don't even use? What are the actual prices that you are covering versus what should come out of my pocket? Why are you covering only this versus this insurance is covering this?

Eva Sheie (06:02):
Where is my money going?

Dr. Misra (06:04):
So that's the other thing. So if my price negotiated, which is done through you paying me and me, them having me off on the hook, so I'm on the hook, you pay me, and then that money stays and then they withdraw the money from that account and that's how we get those negotiated prices. So if you're doing those labs quarterly, it adds up. And then if you have to see the doctor each time and pay a copay to see the doctor, to review the labs, to do this, to do that, it adds up. Versus one monthly membership where you can just kind of see your doctor.

Eva Sheie (06:35):
And doesn't the high price of basic stuff become a disincentive for people to get proper healthcare and take care of themselves? Yes. Yeah.

Dr. Misra (06:42):
Yes, but I mean sometimes our copays beat the price that is contracted by insurance. I have a patient that's trying to get a sleep study. She works in a system and she works for the system and she's trying to get a sleep study in the system and there's a wait list for six to eight months. And so she came to me and I found her an at-home sleep study, two days of a sleep study, $180 out of pocket. I don't know how much that sleep study would be with her insurance. I haven't done all that stuff.

Eva Sheie (07:16):
Oh. Probably $16,000 or some crazy number.

Dr. Misra (07:18):
I don't know. But she doesn't have to wait six to eight months. She's getting her care or her treatment and evaluation and that's it.

Eva Sheie (07:27):
No. Do you feel a little bit like a superhero when you're able to do this stuff?

Dr. Misra (07:31):
No, I get angry, actually,

(07:35):
Anger out is always better than anger in This is why I want to make change. I'm a little bit of a disruptive doctor now. It's just direct primary care doctors. We don't fit in boxes because we're entrepreneurs and we think of bigger than what medicine should be. Medicine is not just popping pills. Medicine is not just treating disease, it's preventing disease. And we in a western system do not benefit or give benefits to disease prevention. So obesity, which is ballooning, I love puns by the way. I like to use double words. So obesity, which is ballooning and people are starved for these medications. We are not able to get them. But some of the things that I found literally in the last week to get zep bound or manjaro, forget about majaro because that needs to be for type two diabetics. So zep bound was now tirzepatide, which is manjaro in a different type of packaging, but still in an injectable pen and it is approved for obesity, chronic obesity, BMI of 30 or BMI of 27 plus a couple of comorbid conditions that are obesity related disease states Z bound, not the manufacturer, but some insurances are requiring that you fail.

(08:55):
We'll go via your ozempic first. They're not even on the shelves. Where are we going to get them? How are you going to fail that? But they're different medications too, so where are they supposed to get the semaglutide? The tirzepatide. If you're putting restrictions then, which there's some prior authorizations that say, we're not going to cover the wegovy unless you fail ozempic. It's the same medication.

(09:27):
It's just semaglutide. Ozempic goes up to two milligrams, wegovy goes up to 2.4. Where is the logic in this? Why is insurance literally putting barriers to care for something that is so preventative that causes such a huge burden in healthcare costs that we can treat now because they don't want to? Because there are too many hands in the pockets of healthcare that are benefiting and it's not the patient that's getting money back and it's not the doctor that's making money anymore. Maybe back in the day, the reason insurances were started was because there were some bad apples. There's always going to be bad apples, but insurance is getting worse. It's getting worse. They're dictating care. And I'm on the phone fighting with someone who's not my specialty, who does not have my level of education, who's saying no. So this is why direct primary care is moving away from insurance.

Eva Sheie (10:28):
I'll, in full disclosure, admit that I have been on a DPC. I have had a DPC doctor for about a year and a half is the best decision I've ever made. I can text her anytime I want. I don't bother her at night with silly things, but I can if I need to, and I don't have to go stand in a big line and check in and wait in a waiting room with people hacking and coughing thing. And I was just like, I can't tolerate this anymore. I don't have the kind of time it takes to call and make an appointment and then bicker with somebody about what kind of appointment and then tell the person who has no idea who I am, why I need an appointment. That was the thing I actually hated the most, was explaining what I needed an appointment for to someone who doesn't need to know.

Dr. Misra (11:17):
And then you go there and maybe you have three complaints and maybe they're all related, but the doctor's like, I can only do one complaint at a time.

Eva Sheie (11:25):
I can only talk to you about one of these.

Dr. Misra (11:25):
Because they only get billed one at a time and paid one at a time. I mean, it's ridiculous. So each time you go in three copays could easily wipe out or you for the month for eating groceries.

Eva Sheie (11:39):
Especially now.

Dr. Misra (11:40):
Yeah. Yeah. Some HMO plans, I've seen their copays are like $75 and I'm like, you need the doctor twice a month. That's it. You pay even more than my membership is ridiculous.

Eva Sheie (11:53):
Yeah. Well, I love that DPC is spreading mostly because I think there's a lot of really independent thinking doctors out there who just need to take the leap. And so now that I'm seeing it more and more, I think that's really positive trend for the rest of us, for those of us that need you.

Dr. Misra (12:11):
I was nervous about making the jump myself. I didn't understand it. I didn't know how to explain it, and I said, let me try going to my own doctor. If it sucks, I will withdraw my membership. I did not withdraw my membership and I've saved tons of money and I have now lowered my insurance plan, so I'm not paying these exorbitant fees. And my health has changed dramatically too because I get access to better care.

Eva Sheie (12:39):
In the past, we called it concierge and because I've been on the retail side of medical marketing for so long, I've seen all these little things pop up and people try them and concierge was always the wrong word, and in the beginning it was just for really, really rich people. But it's not the case anymore because the math has flipped.

Dr. Misra (12:56):
Yes. This is what we call affordable concierge like care, which means you get access to your doctor, you get benefits with your membership. We cap our membership at a certain number of patients so that we can give you the care that you need. And we don't take on more patients once we are capped unless people leave. So we have a wait list. So it's rare for people to leave when they leave. They often are being mised information or not really, or maybe they're given free insurance or something like that from a job, but direct primary care is addictive.

Eva Sheie (13:33):
I'll never not have it again. Are you selective about who you choose to be in your group of patients?

Dr. Misra (13:40):
No. Although right now weight loss is huge and I have been treating weight loss for a very long time. Before there was an obesity medicine board, the weight loss space has changed so much and a lot of physicians don't want to do the prior authorization and the calls and the insurance paperwork and stuff like that. Direct primary care allows for me to read more, keep up to date with the latest technology, put boundaries on what I can and cannot do and what I feel comfortable doing and not doing. But it also allows me to do more, which is why I can specialize in these things. Men's health and obesity, there are doctors that are straight up saying, I understand obesity is a chronic disease state. I understand hypogonadism symptomatic hypogonadism slash symptomatic. T is a chronic disease state. I will not treat those things. Sorry, they're not part of my primary care program. That's fine. You can do that with direct primary care with places, systems, they will tell you, you doctors cannot do this, so don't even bring it up. Don't even test. Don't treat it and ignore it. Pretend it doesn't exist. It's horrible. These medications are groundbreaking. You should be able to straight up be like, how have you not heard of semaglutide and liraglutide and tirzepatide and where are you living?

Eva Sheie (14:59):
Right?

Dr. Misra (15:00):
That's your relationship with your doctor. Maybe the doctor needs some education too. That's okay. We're not perfect. We're human.

Eva Sheie (15:07):
Here's another one that I hear all the time. Well, they're just going to gain it back.

Dr. Misra (15:11):
Oh yeah, they'll gain it back if you don't give them the tools. Obesity is a chronic disease state, so for some patients it has taken them a lifetime to get here. It may take a lifetime to treat it. Let's treat it and give it the respect that it deserves. Let's not confuse that, but not also forget weight gain. And the fact that we just had a global traumatic event for three years where we sequestered, humans are supposed to connect and communicate. That is a part of what creates humanity. That is humanity. Humans are meant to connect, collaborate, communicate. Good things came out of covid, digital, what we can do right now, podcasts, deliveries, things like that. But we are now facing a new normal. So if you say, here's a pandemic, everyone stay home. Nobody communicate. We're limited in what we can do. Running out of food, running out of alcohol, running out of this toilet paper.

Eva Sheie (16:11):
It's okay to go to the liquor store, but not the gym.

Dr. Misra (16:13):
Yeah, exactly. The parks are closed, all of this stuff. I'm not saying that there's a proper way to do this or if I would've done it better, I am not saying that at all. But this is just a situation. And then we couldn't travel. We couldn't do anything. You're going to gain weight. I tried ordering fitness stuff. They were out. They were out for months. Toilet paper was out for months. We almost all blocked that a lot. You don't want to think, yeah, you don't want to think about the fact that you might have to mask again for months and worry about this. And we moved past it very quickly. But our bodies and the trauma of those three years still live with us. So I hate pathologizing something that is normal. This is an adjustment situation. We have a new society. We have two wars going on in the world, potentially more that may occur. We're battling all these different changes and just trying to keep up. So if you feel a little weird and a little off and not normal and having dis-ease, there could be a reason. Sometimes I just tell my patients that and they feel better. That conversation is curative healing.

Eva Sheie (17:29):
Well, you also see a lot of people and we're more isolated than we've ever been, even though we're more connected than we've ever been. And so you have a unique seat in that you see a lot of people and talk to them about their health and that holds more weight coming from you.

Dr. Misra (17:46):
Something else. I had a lot of change in my doctoring during Covid too because before Covid I was against telemedicine. I was like, how can you possibly properly treat a patient without physically examining them? And some things you cannot. You absolutely cannot. It's just the limitations of telemedicine and the way the medicine is. But after we had no choice, so many of us except for to do some virtual care, it changed my entire practice because my access that the patients wanted changed and I have to meet them in their journey where they are. So sometimes I see them in office. Sometimes we'll have a virtual.

Eva Sheie (18:29):
Were you in New York or were you in California?

Dr. Misra (18:32):
So I moved from New York to LA right before Covid and I moved here because my parents died and I wanted a fresh start. I didn't feel like I could get proper footing in New York still. I was born in California. I was born in la, but I don't remember anything because my mother got residency in New York, so that's why we lived there. She also is a doctor. I come from a family of doctors, which is why I fought it so hard.

Eva Sheie (18:56):
To not be one.

Dr. Misra (18:58):
Yes, I think remember I told you about the mic. I wanted to be a singer songwriter back then too. So this is over 20 years ago. That was what I wanted to do or join the FBI or I even applied. I tried to get to the Navy and my mom was like, you're not doing that. You're my only child and you're a woman. I don't think so.

Eva Sheie (19:16):
You could have still been a doctor in the Navy and they would've paid for the whole thing.

Dr. Misra (19:20):
Yep, we talked about that. She did not want me going, but it ended up being a blessing in disguise because she ended up getting cancer. And when you are a caretaker and a patient yourself as a doctor, it also changes your doctoring.

Eva Sheie (19:37):
How did that change your doctoring?

Dr. Misra (19:40):
I am the summary of my experiences and I want to be the doctor that I want to see. I have seen a lot of doctors. I've been shamed by doctors. One of the things that led to my own personal weight loss journey, I lost 70 to 80 pounds on my own plan is because I went in for a symptom that was not weight related. And instead of getting evaluated and having those issues brought up, I instead was fat shamed. And I left the office crying and I was like, I have been doing obesity medicine forever and I'm fat, and this is all like I didn't get any symptomatic treatment. Fine. If you're going to say the weight is causing my symptoms and for me to be miserable, then I'm going to treat the weight. And so I treated the weight. Guess what? The symptoms are still there.

Eva Sheie (20:31):
A lot of times we get blamed. We can control the weight somehow. It's just easy. You just have to count your calories and go to the gym. But I can tell you after, I don't know, three plus decades of counting, tracking, weighing and measuring every single thing and going to the gym, it still wasn't really working.

Dr. Misra (20:51):
Most of my patients barely eat right part of the problem, but barely eat. Most of my patients have tried everything. There's this horrible statement. Obesity doesn't run in the family. Nobody runs in the family. That's absolutely not true. These new medications are groundbreaking because they target and treat several different things within obesity that that's why they're so groundbreaking. So we're not just treating one thing, the hunger or the sleep or this or the anxiety, the metabolism, the estrogen, the low testosterone, all the metabolic, the age. We're treating everything. Everything. We are going to see incidences of anxiety and depression go up for sure, because think about what the weight may represent. For some people it's armor. For some people, it's coping for some people. So if we take away the coping mechanism without providing and nourishing something back and feeding some good coping back and pointing out and learning and observing and not judging, but just being an observer of your own body and seeing how the weight comes off and how that makes you feel and just constantly communicating with your doctor along the way. This is what I feel. This is what I'm experiencing. Because you don't want to sit in your head and go like this. That's the problem with some med spas and with some doctors that are just like, here's the injection. Go goodbye. You are not given the tools.

Eva Sheie (22:27):
Or even worse, the online sources where there's nobody on the other side.

Dr. Misra (22:31):
Yes, or I mean I've worked with some telemedicine platforms. I've been disgusted by what they do. They don't even have the patients follow up. And some of the patients have been hospitalized and they're just giving medication and it's like the patient was hospitalized probably because of this medication. We have to stop and visit this. Lots of stuff in this conversation.

Eva Sheie (22:54):
In your current role in the world that you've built for yourself, which is really pretty exciting, you're looking at root causes of things and trying to address what's causing stuff. And I think that's sort of a huge distinction between the way you were trained, right? You were trained as an allopath and you said, this is not what I want to be.

Dr. Misra (23:18):
I believe there is a place for allopathic medicine 100%, which is why I treat these things with these medications. But there's also complimentary ways of treating patients too. And patients are not textbooks. We are art and science. We are a combination. You have to meet the patient where they are on that journey. I have a tagline, Mr. Wellness, feel, heal, reveal, and basically it's a journey that you're on to be your most authentic and self. And I will meet you on that journey, wherever it is. That was kind of the premise. And plus I have a rhyming pathology. I already told you I like my puns and stuff like that, but it is what I want the patient to feel because life is a journey. Wellness is a journey, and your wellness and my wellness are not the same. Wellness even has been watered down. It's just med spa wellness. And what is that for you? It's different than what it is for me and what maybe my wellness was a year ago versus my wellness this year.

Eva Sheie (24:18):
Well, as we lose weight, it completely changes too.

Dr. Misra (24:21):
Yeah. I mean not just weight, but weight is a front runner right now because there's so much good and so much bad going on. It is almost the perfect example of what's going on in the healthcare system, which is why I keep bringing it up. Plus most of my phone calls are for these weight loss and for medications for weight gain.

Eva Sheie (24:40):
You've mentioned the brand names quite a bit. Are you only prescribing the brand names and getting them, or are you also utilizing compounded medication?

Dr. Misra (24:48):
So I utilize both. We have a major shortage of brand name medication. It is very hard for patients to get access to these medications. So I use an FDA approved pharmacy for the beds for compounding. I have seen their studies. I have seen their clinical efficacy. They do a very good job. I have also called compounding pharmacies to see what they're doing and vomited in my own mouth. I mean, some of their practices are just absolutely atrocious.

Eva Sheie (25:18):
There is a piece I think in the Washington Post yesterday about a lab that got shot down and the person behind the scam, they had gone from a million a month to a million dollars a day in one year, and then the person running the lab committed suicide. This was in the Washington Post yesterday, and all they were doing was making compounded. So yeah, there's definitely horror stories out there. And I think if you're considering this, you have to make sure you know what the doctor's source is too.

Dr. Misra (25:47):
Yes,

Eva Sheie (25:48):
Yes. And on your website it says you're a CLIA certified lab director.

Dr. Misra (25:53):
So I used to run a lab when I was working for someone else. It is not something that I would do again, unless they paid me a million dollars a day. No, running a lab is not easy. It is not easy.

Eva Sheie (26:05):
No, it's not. But I bet you learned a lot.

Dr. Misra (26:09):
Oh yeah. Oh yeah. I learned that I will send the patient to the lab. I'd rather the patient go direct to the place where I'm getting the contracted prices anyway and have very little issues with spinning the blood, having it sit there, someone not picking it up, temperature control. Maybe it spun wrong, maybe it, he blew up. I have no idea what happens. Got lost, got mislabeled, and then it ends up God knows where. I just would rather they go to the lab.

Eva Sheie (26:37):
You have a special interest in men's health and men are sort of well-known for not going to the doctor.

Dr. Misra (26:44):
Oh yeah.

Eva Sheie (26:45):
Are you doing anything to make it easier for them or more accessible for them to feel like this is no big deal and this is part of what I need to do to be a functioning adult?

Dr. Misra (26:54):
Yes. Actually, men themselves are doing a lot of the work. They are looking up their own symptoms. And generally it is podcasts, certain podcasts that are probably lifting this up a little bit. There's like I said, vitality, longevity medicine, these integrated functional, we have been checking hormones not in the standard endocrinologist way because some of those you have to push back against insurance and coverage and justify why you are ordering a lab versus just ordering the lab because it's part of something that you're looking for. A lot of men understand that treatment is generally not covered by insurance unless you have some fantastic fabulous insurance and it is coming out of pocket. But it is something that's quality of life improvement. And so I'm actually surprised sometimes at the reasons that they come in. And generally, that's also fascinating because for men it can be a place of shame to talk about I have ED or I am not building muscle the way I used to.

(27:56):
I cannot function at work the way I used to. I cannot take care of my family the way I used to. I can't keep up with my children. I'm not sleeping. I can't support my spouse. I can't meet the needs of my job, which are physically demanding. I have to wake up very early. I have shift work. I just want to be, and of course there is. I want to look better. I want to be belt, I want a bodybuilder, blah, blah, blah. There are people that are authentic about that too. But there are some things that I'm surprised that men show up for and it's more of a nurturing, caring, quality of life or preventative aspect than it is I want to testosterone. Sometimes what they need is actually just reassurance. And testosterone is not the best medication. It is not given and not treated by a lot of doctors for multiple reasons. We've seen death and disease states occur from direct testosterone relationships when it is treated by a physician who knows what they're doing. The incidence of these side effects and problems are lower. But of course they still exist.

Eva Sheie (29:00):
Do you remember that show where the personal trainer and the fat person would get together and then the personal trainer would gain a whole bunch of weight?

Dr. Misra (29:10):
This is a long time ago.

Eva Sheie (29:12):
Abominable, the trainer would gain weight and then prove to the fat person that they could lose it, but then they couldn't lose it.

Dr. Misra (29:19):
Yes. And there's questions we were talking about, couldn't lose it. Plateauing on these meds, not having the meds work for you because they don't work for everybody. People think this is a magic bullet for everybody. It's not. Unfortunately, there are groups of patients that we're still trying to identify. Maybe it's genetics or certain syndromes or something that have them not lose weight, but there's all sorts of behavioral and psychological stuff. Even to bring up a conversation with your doctor is very hard because, and even for a doctor to bring it up, I lost 70 to 80 pounds on my plan. I could not bring up obesity and weight. I was the obesity weight doctor. I didn't feel comfortable, but I would bring it up in passing kind of like, it's hard because you don't want to push the patient to tears the way I was.

(30:15):
I left that place crying. I was fat shamed. I will never forget it. I'm not a different person. But she did not help me. And in fact, well, she may have helped me because I'm passionate about what I do and I've gone through my own. I have gone through some stuff, but that wasn't helpful to me. And I am not one to force other people. I offer myself, I love doing meet and greets with DPC because we were talking about how you're just given a physician and sometimes you might hate them and they might just dismiss you each time you come in and you have to go back to them over and over again and you're begging for a higher quality of care, but you're used to this standard, let's break this standard. That's what DPC is doing. We are breaking the expectations of medical care because they suck.

Eva Sheie (31:06):
Yeah, they do. Even if you do a bunch of research and you go meet one and you put all the time in and do all the homework, when you get to them, they're still in the old system and they're monetized in a way that after the first time you see them, you will probably not ever see them again. On your website, you have really beautiful photos of you and your dog, but you don't even look like that anymore.

Dr. Misra (31:29):
I know. And I'm redoing my website because I am a new person. I am physically so much different. I don't look like that at all.

Eva Sheie (31:41):
So your weight loss is recent

Dr. Misra (31:43):
Within the last six, no a year. So I actually started on semaglutide and I plateaued on semaglutide. I lost 30 to 50 pounds, something like that. I was very, very overweight. I changed my diet and then I just, without working out and everything with covid, I plateaued. I gained 40 pounds back and then I switched to Tirzepatide and I realized I have to change my behavior and listened to the cues that my body is now giving me because there are cues that these medications help you learn or relearn, but you have to listen and you have to be with someone who knows how to flag those cues and identify those cues. Otherwise you'll just ignore them and eat over them old coping mechanisms. So I plateaued and then I went on Tirzepatide and I was like, okay, this is not happening again because there's nothing after tirzepatide.

(32:36):
There is in the works, but there's nothing after tirzepitide.

Eva Sheie (32:39):
But there's something coming?

Dr. Misra (32:39):
Um retitutide which is a hormone three, three incretin, three peptide targeting medication now by Lilly is, I think they're doing some investigation. I don't know where they are in the process, but when you tell someone something like, and because there is a psychological component, well, we have semaglutide that targets one peptide and then we have tirzepatide, which targets two, and then there may be coming out with something that targets three. It removes that weight gain. Oh my god, I'm going to regain and I'm going to be stuck and I'm not going to be able to get anything ever again. It removes that a little bit. It's an internal narrative game that you have to unfortunately participate in to help prevent the anxiety of weight regain because that is very real for all of us.

Eva Sheie (33:28):
Yeah, why do we have to stop taking the medication?

Dr. Misra (33:32):
Well, some people, it doesn't work. Some people have adverse events right now they're doing studies to even see how to get off of the medication. So what does maintenance look like? I keep saying you're not a textbook. Maintenance looks like something different for everybody. My maintenance is not the same as your maintenance is not the same as X, Y, Z patient's maintenance. So I don't like to pathologize that either. Like I said, this is a chronic disease state for some people that has taken a lifetime. So let's give it the respect that it deserves.

Eva Sheie (34:02):
Well said.

Dr. Misra (34:04):
So compounding. Compounding is not a nasty word. No. Compounding is something we've been doing for eons. It compounding is when your child cannot swallow a tablet and so you make it into a liquid so that child can take that medication. Compounding is when you're going for your Botox or your Dysport or your filler and microneedling or whatever, and they're numbing your face with BLT or LT cream. That's compounded medication. Compounding is not a bad word, but like I said, we can't have nice things sometimes some of us ruin it, so some people bad apples ruin it for the larger population. But ask questions with your doctor. That's the whole premise of DPC, to have a relationship where you can ask questions. And if I don't know, I don't know. I'll try to look it up. I'm me, but I don't know. And I'll tell you.

Eva Sheie (34:52):
Well, you have the time to look it up because you're a DPC. Tell me before we go, what do you like to do outside of work?

Dr. Misra (35:02):
So one of my favorite things about losing the weight, and this is something that patients tell me, I don't tell them. I tell them a little bit. You're going to have a little more time on your hands. And some of the things I'm working on are some studies from some patients. I want to know what their credit card bills, not the actual bill, but the percentage of bill spent on food and beverage and what that has. Maybe during your podcast you can even ask your friend, can you track your first three before you start credit card bills and the percent that you've spent on food and then track it each month after you've started this treatment. These meds pay for themselves, in some ways.

Eva Sheie (35:49):
You can have mine.

Dr. Misra (35:51):
I mean I'm going to have to look into my own, but it's also skewed because of covid. So we have to remember some of these studies and things are going to be skewed, but it's kind of fascinating. I am very interested to know what is your credit card bill? I know for me, I went from blasting the AC all the time and I'm in California, so electric bills are ha to now. I have a electric heating blanket. I'm cold all the time. So my consumption of energy is less. My consumption of utilities is less. Using less grocery shopping. DoorDash is seamless. That stuff kind of falls to the wayside. Oh, by the way, what did I pick up with that extra time? I think that was that whole gardening.

Eva Sheie (36:34):
Gardening.

Dr. Misra (36:35):
I ended up gardening so much that I now kind of sell kind of the extra plants. And it's also part of my exercise regimen too. My house is exploding with growth and I think that that's a metaphor.

Eva Sheie (36:50):
I want to see pictures. Are they on your Instagram?

Dr. Misra (36:53):
I actually have a separate Instagram for that because I'm just, I'm messing around with Instagram because doctors are not really always social media savvy. We're shy. We're kind of behind the scenes. So I did this because I wanted to get comfortable in front of the camera. So I said, let me talk about something that I'm now newly passionate about, which is plants. So my Instagram handle is me and my plants 2023, that's when I started. It's just me and my plants and I'm a little bit ridiculous. And yeah, another side of the doctor at home.

Eva Sheie (37:27):
Well, I can't wait to talk to you again. This is going to be great. Your website is Misra Wellness, M-I-S-R-A, wellness.com. And you're in Encino, California. And where should we follow you on social?

Dr. Misra (37:39):
So Misra dot Wellness is that Misra Wellness was taken by someone else. I also don't just work in Encino. I have something called the Wellness Wheels. It is a mobile medical unit. It's basically an office on wheels. Like I said, I like to be the doctor that I want to see. So there are patients that have shame about their homes and how they live. And so I offer a way for me to see the patient. This is concierge for me to see the patient without actually going in their homes and being able to do aesthetic medical examinations and treatments right outside their door.

Eva Sheie (38:13):
It's brilliant.

Dr. Misra (38:15):
It's fun.

Eva Sheie (38:17):
Thank you so much for joining us today. I can't wait to talk to you again.

Dr. Misra (38:21):
Thank you for having me.

Eva Sheie (38:26):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, THE AXIS.io.