Dr. Sobrevilla Follow Up

Medical Consultation on Blood Pressure and Cholesterol

  • Overview of Consultation

    • Patient inquires about results from previous consultation regarding high blood pressure and cholesterol levels.

  • Cholesterol and Triglycerides Results

    • A1C level: 6.6
    • Definition: A1C is a measure of average blood glucose over the past 2 to 3 months.
    • Significance: A reading of 6.5% or higher indicates diabetes.
    • Triglycerides level: 320
    • Normal value: Should be less than 150
    • Implications: Higher triglycerides levels typically result from dietary choices and can indicate a risk for cardiovascular issues.

  • Dietary Recommendations

    • Importance of Diet: Elevated triglycerides often necessitate dietary adjustments.
    • Recommended Diet:
    • Mediterranean diet is suggested.
    • Fish such as salmon and mackerel are encouraged due to their heart-healthy fatty acids.
    • Lean proteins are acceptable, such as chicken and turkey, while red meat (beef) should be limited.

  • Medications Prescribed

    • Fenofibrate: 160 mg (for lowering triglycerides)
    • Hydrochlorothiazide: Water pill for blood pressure management
    • Mounjaro: Medication intended for weight loss and diabetes management.
    • Status: Patient has faced challenges with pharmacy approvals.
    • Vitamin D: Supplement prescribed to support overall health.

  • Medication Management

    • Discussion about medication compliance and follow-ups for Mounjaro approval.
    • Insurance Approval: Noted that to proceed with Mounjaro, the patient needs to be on metformin and Farxiga (two specific diabetes medications) for approval.
    • Potential side effects of medications discussed: including tinnitus, UTIs with Farxiga, and diarrhea with metformin.

  • Follow-up Procedures

    • Suggested to return in a month for documentation concerning weight loss and diabetes medications to facilitate the authorization for Mounjaro.
    • Referral for Colonoscopy:
    • Patient is proactive due to a history of lymphoma.
    • Insurance necessitates a referral, and colonoscopy screening is recommended before age 45 for those with a history of certain health issues like lymphoma.
    • Options for specialists: Patient considers DHR or South Texas Health Systems for this procedure, with DHR chosen for its proximity.

  • Insurance Discussion

    • Patient's insurance: Works for Sherryland district, where insurance coverage tends to vary greatly.
    • Comparisons made with other insurance plans (like PSJ), highlighting disparities in coverage for weight loss surgery requiring less out-of-pocket expense.

  • Conclusion and Next Steps

    • Patient plans to begin medications and return for follow-up.
    • Emphasis on lifestyle changes for managing diabetes.
    • Proposed loss of weight through medication Mounjaro (expected to result in a loss of 40 to 50 pounds).
    • Importance of regular check-ins and documentation to manage health effectively.
    • Patient and healthcare provider conclude on positive communication about upcoming health goals.