WW presents “Distant Voices,” a daily video interview for the era of social distancing. Our reporters are asking Portlanders what they’re doing during quarantine.
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- PCOS Weight Loss Medication By Christine Traxler, MD Medically Reviewed by Kim Langdon, MD on 07.16.23 Polycystic ovary syndrome (PCOS) is a complex metabolic disorder seen in up to 12% of women of reproductive age. While the name suggests it results in cysts on your ovaries, you don’t have to actually have cysts to have this disorder. Some of the more common symptoms of PCOS include menstrual irregularities, insulin resistance, weight gain, excess facial and body hair, mood dysfunction, acne, and infertility. When you combine excess weight with high blood sugar, you risk complications like diabetes, heart disease, and certain hormone-sensitive cancers. Among women trying to manage the disorder, the biggest challenge is fighting weight gain with PCOS. Weight gain around the midsection—sometimes referred to as PCOS belly—is often due to the combination of male hormone dominance and insulin resistance. Weight loss is important to managing PCOS because even a small amount of weight loss (around 5% to 10% of your total weight) can have a significant impact on symptoms and outcome. You may be wondering if medications like those we have been hearing so much about lately could help someone with PCOS lose weight. The answer is yes. Medications used for weight loss in other situations may also benefit those with PCOS and obesity. Some options include Orlistat, metformin, and semaglutide (brands Ozempic and Wegovy). They act in different ways to improve weight loss. Many are specifically recommended for those who have type 2 diabetes. This guide goes over the medications you can consider if you want to lose weight with PCOS. Learn how the medications work and the side effects you may experience if your doctor prescribes them for you. Medications that can help with PCOS weight loss Some women with PCOS can lose weight using only diet and exercise. In many cases, weight loss can be achieved by eating food with fewer calories and burning them through increased activity. Others have metabolic issues like low thyroid function and insulin resistance that negatively impact their ability to lose weight. If you’re having difficulty losing weight with PCOS, you may want to talk to your doctor about taking medications to help you lose weight. Your doctor is the best resource for deciding which, if any, of these medications are appropriate for your unique condition. This list will hopefully help you collaborate with your doctor by explaining how they work. It is not intended to provide you with medical advice but, instead, to educate you regarding what’s out there and why they help some individuals with PCOS and obesity. Metformin Metformin is a commonly used drug for diabetes and prediabetes. When it was studied in the prevention of diabetes, researchers noted that those who took the drug steadily prevented diabetes by 31%. In addition, users of metformin lost about 3.5% of their body weight and kept it off. The fat loss was more often located around the midsection. Metformin acts to reduce the risk of diabetes by blocking the production of excess glucose in the liver. When it does this, less insulin is released by the pancreas. In addition, it reduces appetite and changes the gut microbiome to promote enhanced weight loss. The major side effects of metformin are nausea, diarrhea, and bloating, which may also transiently affect appetite. It may cause some foods to taste different, too. Researchers have noted that you would need to remain on the drug long-term to reap the maximum benefits. Weight gain after stopping metformin is entirely possible. Take Control of PCOS by Partnering With a Dietitian 90% of Zaya Care patients pay $0 for one-on-one counseling with a Registered Dietitan >> Find Your Match Acarbose (Precose) Acarbose is an antidiabetic drug that prevents glucose absorption by blocking the enzymes responsible for bringing glucose into the bloodstream from the gut. The drug itself doesn’t get absorbed into your system to a great degree. By blocking sugar uptake, acarbose lowers blood sugar and insulin levels. Acarbose has been found to reduce triglycerides and lower the risk of diabetic complications. Those who take it have reduced weight compared to those taking a placebo. In one study, the BMI was reduced from 30 (obesity) to an average of around 23 (normal). The main side effects of acarbose are flatulence and diarrhea. This occurs because there is excess food that doesn’t get absorbed by the gut, particularly carbohydrates. Like most of these medications, stopping the medicine may mean that you’ll gain the weight back. Orlistat (Alli or Xenical) Orlistat has been used for several years to reduce weight in individuals with or without diabetes. It is not an antidiabetic agent but instead inhibits a pancreatic enzyme called lipase. It prevents the absorption of dietary fat. Other nutrients are easily absorbed without change. Years of use of the drug from the time it was placed on the market in 1999 indicate that it does promote a modest weight loss among those who use it regularly. Only about four to six pounds of excess weight are lost in most individuals but, for some, it can improve the risk of obesity complications. The main side effects are greasy stools and diarrhea, but they tend to pass within a few weeks in most users. Rarely, the drug can cause kidney stones or an inflamed pancreas. Tizepatide (Mounjaro) Tizepatide (Mounjaro) is a drug acting in two ways to combat diabetes. It mimics the GIP hormone (glucose-dependent insulinotropic peptide) and also acts on the GLP-1 (glucagon-like peptide-1) receptors. The result is a reduced amount of glucose sugar entering the body from the GI tract. By lowering blood sugar, insulin levels are reduced. For those with obesity, Tizepatide lowers body weight by up to 20% of your original weight. Lipid metabolism is also improved. Appetite can be suppressed and, for those with diabetes, blood sugar is reduced. Mounjaro must be injected into the soft tissue of your body (often under the skin of the abdomen or thigh) every week. Side effects can include nausea or abdominal pain. Diarrhea or constipation may occur as well. It is also extremely expensive if your insurance won’t cover it. >> Read more: Mounjaro diet plan: Best foods to eat & which to avoid Liraglutide (Victoza or Saxenda) Liraglutide is an injectable drug that acts as a GLP-1 agonist. When you take it, it can promote insulin secretion, slow gastric emptying, and suppress your appetite. It is believed that this is how weight loss is achieved. It also improves diabetic control in those who have diabetes or prediabetes. Liraglutide must be injected regularly to be effective. Most doctors begin prescribing a low dose injected daily to see how well you tolerate it. Side effects are mostly gastrointestinal in nature (nausea, stomach pains, constipation, or diarrhea). Individuals using this drug lose about 10 to 11 pounds on average, mostly because they aren’t hungry. Low blood sugar does not happen as long as other diabetic drugs aren’t taken at the same time; however, those with high blood sugar have improved blood sugar numbers. >> Read more: Saxenda diet plan: Best foods to eat & which to avoid Semaglutide (Ozempic or Wegovy) There are two drugs marketed under the generic name of semaglutide. They are the same drug; however, Ozempic is prescribed for diabetes, while Wegovy has been approved for weight loss. Other than the semantics, these GLP-1 receptor agonists are the same drug. Both are injected; however, some take the drug daily and others take it once per week. Like all of these GLP-1 receptor agonists, the side effects include nausea, abdominal pain, bloating, and diarrhea or constipation. They act to reduce your appetite and slow the emptying of your GI tract. On average, it takes around 6 months to lose 11% of your weight on Ozempic, but it varies from person to person. Note that Ozempic typically isn’t covered by insurance unless it’s prescribed for diabetes. Wegovy, on the other hand, can be prescribed for weight loss and is covered by many insurance plans. You can learn more about what the research says about using Ozempic for PCOS here. >> Read more: Ozempic diet plan: Best foods to eat & which to avoidWhy am I not losing weight on Ozempic?Cost of Wegovy with & without insurance Phentermine-Topiramate Phentermine-topiramate is a combination drug used for short-term weight loss. It is an oral pill that combines phentermine (a stimulant) and topiramate (often used as an anticonvulsant). The drug has the potential for abuse because the phentermine is similar to amphetamine, so few doctors prescribe it. It is an oral pill that suppresses your appetite. This results in weight loss that varies by person. It is only recommended for 12 weeks or less and may increase heart rate or cause nervousness in some individuals. In women of reproductive age, it can cause birth defects if a pregnancy occurs. >> Find a PCOS nutritionist who accepts your insurance How insulin resistance from PCOS causes weight gain Why would drugs used for diabetes help weight loss? Much of this question is answered by understanding the impact of insulin resistance on weight. Insulin resistance is the underlying problem among most with type 2 diabetes. When sugar enters the body, insulin is produced to put it into the cells. If you are resistant to the effects of insulin, the sugar remains in the bloodstream, unable to enter and nourish the cells of your body. This excess, unused energy is put into the fat cells as fatty acids. PCOS and insulin resistance go hand-in-hand. If you have PCOS, you almost certainly have insulin resistance. The drugs most often effective in weight loss are those that also lower blood sugar and improve your sensitivity to insulin. Once you lose some weight, you will naturally improve insulin resistance because less fat means your insulin will work better—even if you stop taking weight loss medication. >> Read more: Supplements that may help with PCOS weight loss How a nutritionist can help with PCOS weight gain Losing weight is never a matter of just taking a pill or injecting yourself with a drug. It often takes increased physical activity and better eating habits to lose weight and keep it off. Unless you need the drugs for type 2 diabetes, you may decide to stop taking them after losing enough weight. A PCOS nutritionist can help in so many ways. PCOS nutritionists are trained in nutrition and the intricacies of managing PCOS through nutrition. Your PCOS nutritionist can evaluate your goals and current situation. They can make food recommendations and help you create a PCOS diet plan that will work at any stage in the weight loss process. While they cannot prescribe medications, a PCOS nutritionist can help you determine how diet and exercise can work with weight loss medication to influence your weight. They can also help you cope with the side effects of medications like nausea and constipation through changes to your meal plan. A nutritionist specializing in women’s health issues like PCOS can follow your progress, helping you succeed through individual attention and personalized recommendations so you can achieve your health-related goals. Take Control of PCOS by Partnering With a Dietitian 90% of Zaya Care patients pay $0 for one-on-one counseling with a Registered Dietitan >> Find Your Match By Christine Traxler, MD Christine Traxler MD is a family physician, lifelong writer, and author with a special interest in mental health, women’s healthcare, and the physical after-effects of psychological trauma. As a contributing writer and editor for numerous organizations, she brings a holistic focus to her work that emphasizes healing and wellness through daily self-care, connecting with others, and setting stepwise goals toward achieving more balanced and authentic lives.
You say you want a revolution? Andrew Tolman says the Deaf community better be involved.
“When we talk about Black Lives Matter, that means Black Disabled Lives Matter and Black Deaf Lives Matter,” says Tolman, an American Sign Language interpreter and founder of Portland’s Fingers Crossed Interpreting. “When meetings and workshops and know-your-rights trainings are being held without engaging those communities, we’re just doing the same thing and building a new system excluding a lot of intersections.”
After participating in the Occupy ICE protests in 2018, Tolman, a self-professed “linguistics nerd” who taught themselves sign language at a young age before majoring in it at Pima Community College in their hometown of Tucson, Ariz., started Fingers Crossed primarily as a means of connecting ASL interpreters with social justice movements—the organization’s tagline is “Revolutionize the Revolution.”
And with a revolution currently unfolding on the streets across America, Tolman has been busy.
In between interpreting for speakers at more formal actions organized by groups such as Care Not Cops, Tolman, who uses they/them pronouns, has spent many of their nights the last three weeks on the front lines of the protest, helping Deaf and Hard-of-Hearing demonstrators navigate a situation that can turn chaotic at any moment. That means not just relaying the Portland Police Bureau’s warnings, but conveying the intent behind them.
“As an interpreter, I’m listening for that escalation. I’m listening for the way the crowd sounds as things are happening. I’m listening for how people are responding,” they say. “We’re not only interpreting the words but also the feel of the things going on around us.”
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It’s a good deal of pressure, Tolman admits. But as they told WW, increasingly, they’re not having to take it on entirely by themselves.
WW: Give me the mission statement for Fingers Crossed Interpreting.
Andrew Tolman: The official mission statement of Fingers Crossed has yet to be determined. It’s kind of a shifting as the community needs thing. Our mission itself was born out of Occupy ICE PDX, out of Philip Wolfe’s City Council campaigns and a number of other actions around town that needed ASL interpreters but weren’t sure where to get them. Our goal is to provide accessibility as a means of inclusion regardless of budget restrictions or any other systematic restrictions.
The group’s tag line is “Revolutionize the Revolution.” Do you feel the Deaf community has been overlooked in the activist community?
Ableism is very prevalent in general in our society. I don’t think it’s specifically against one side or another. Most groups and most movements right now have inaccessibility and inherent ableism. I’ve also seen a push over the last few years in a lot of these movements to undue that and actively find ways to engage the community that I don’t necessarily see on the right wing side or any other side, frankly. People forget disability and deafness, which are two separate things, can intersect with any other identity. When we talk about Black Lives Matter, that means Black Disabled Lives Matter and Black Deaf Lives Matter. When meetings and workshops and know-your-rights trainings are being held without engaging those communities, we’re just doing the same thing and building a new system excluding a lot of intersections and forgetting a lot of intersections. It’s intent versus impact as well. So I want to call people out for saying things they’re involved in are revolutionary when they’re very inherently ableistic. And if they’re not prioritizing that, that’s a dialogue we need to be having for sure.
Does interpreting for protests or social justice actions require a specific skill set for an interpreter?
One thing, a lot of concepts we’re talking about, like capitalism, imperialism, big jargon words like that in activist circles, don’t have established sign language vocabulary. A lot of the time we’re having to sign around the concept or finger spell it, or work with members of the Deaf community to come up with a sign that might be appropriate. For example, the other night we had Deaf people who were hit physically by crowd control munitions, and the sign we were using was this [signs a gun shape], which usually denotes a gun or actual firearm. We didn’t want that concept to be confused when sharing information later. So the group of us came up with a thicker gun sign that’s not established and no one else uses it, but in that moment and now in these circles we’re using it to explain a phenomenon that doesn’t really have a word. So interpreters have to be able to understand conceptually what they’re talking about and have that be as culturally competent in Deaf ASL as we can. As second language users, that’s very hard.
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Another level of it is vicarious trauma, and probably direct trauma as well, depending on their involvement. We interpret for families of people who have been murdered by the police here, we interpret for people who themselves are survivors of police brutality. I myself interpreting have experienced police brutality firsthand. So the movement of a story, and the trauma to make it dynamically equivalent as an interpreter requires a level of empathy we can’t avoid. When we are in the middle of a very tense escalation or situation, we’re sort of an empathy sponge, and pulling in all of that. Interpreters need to be aware of that before they enter any space like this. It’s going to be heavy, and regardless of how you feel about one issue or another, who you agree with or not, it’s moving through your body and moving through your psyche. I wouldn’t say all interpreters are called to do that in the same way I wouldn’t say all people belong on the frontline.
What are the challenges of interpreting while on the frontlines of a protest, in a chaotic situation?
I want to make sure whatever’s important for me and my safety auditorily, that I’m giving that information. I can hear when certain crowd control munitions are being shot, even if it’s not in our direction. I can hear the air cannon rebounding off the fence. I can hear how far away the bang is. I can hear the helicopter has circled back over us and is no longer on the other side of town. I can hear the police giving instructions in general, saying, “This is a peaceful protest,” into “please don’t touch the fence” into “this is unlawful,” all the things they say within 30 minutes. None of that is inaccessible, there is clearly no consideration for accessibility at all. Frankly, it doesn’t feel like they care if someone can hear it or not, it’s more for them to say they can do it, so they can say, “Well, we tried, now we’re going to beat the fuck out of people.”
As an interpreter, I’m listening for that escalation. I’m listening for the way the crowd sounds as things are happening. i’m listening for how people are responding. If the cops say, for example, “This is an unlawful gathering, remove yourself from the area or you will be subject to arrest or use of force including crowd control munitions”—that’s tethered into my brain now because I’ve interpreted it so many times—I can hear the way the crowd responds to that, whether they’re going to listen, whether it’s going to be an escalation and when that’s going to happen. We’re not only interpreting the words but also the feel of the things going on around us.
It sounds like that puts a lot of responsibility on your back. Is there a lot of pressure on you in those situations?
It’s pressure I feel like I chose. Anytime I’m in an action that way, I have eyes at every hour—my 6, 3 and 9—and I’m watching comrades and protesters, especially because we have so many new people. There are so many people who are experiencing this for the first time. And because the Deaf community is experiencing it with them together, there’s a bond that happens as well. The pressure is not so much completely on me, because the [National Lawyers Guild] is now knowledgeable that there are Deaf people in the crowd, medics know Deaf people are over here, people are signing the chants with us in solidarity. There’s this whole community response that happens too, so I feel while I have pressure, it’s more a responsibility I’m willing to take on, and as we show up more and more, the community is taking that on together.
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This post was last modified on Tháng mười một 18, 2024 3:27 chiều