Doctor wants to prescribe me Bontril and Vitamin B12 shots?!
Okay, so I went to my primary health care doctor today for my yearly pap and check-up. I have PCOS, and I am not currently on Metformin though I have been in the past. I have shown signs of insulin resistance in the past, but embarrassingly I did not keep up with my treatment well through college. Note, the no longer taking Metformin. Well, my weight loss has been very slow, even though I genuinely feel like I have been kicking my own butt, and I have taken my fasting blood sugar a few times and have noticed that it has been somewhat elevated. So, I asked my doctor if she felt that going on Metformin would help with my weight loss if I am indeed having high blood sugars. She looked at my last labs (which I did not even have a fasting blood sugar on) and said that my thyroid and sugar looked fine and that she did not feel that I needed to be placed on Metformin. Okay, that's okay and good, though I was under the impression that Metformin is fairly common in the treatment of PCOS. :S
She then talks to me about how she and another woman at the doctor's office are doing medically supervised weight loss programs with their patients who appear to be "working hard" towards weight loss goals but are struggling. She asked me about my exercise and calories. I told her I do 3 days of cardio, two of lifting, and I eat between 1700-1800 calories a day. She tells me she would advice me to go 1500 calories, because really, I'm actually just at maintenance with 1700-1800. This goes against all literature I have read about my maintenance calories. Perhaps I am incorrect? Any of you super smart people know?
She then goes on to tell me that there is a drug, Bontril, which is a stimulant that supposedly has less side-effects and is much safer than other phen drugs. She also talked about taking vitamin b-12 shots. I told her that I would think about it, so she went ahead and gave me a prescription for a low dose of Bontril and the shots (self-administered) and made me an appointment three months from now. It is not until that appointment that she actually plans to check my blood sugar levels with an A1c.
I will admit that one part of me was and is piqued, though I think it is the frustrated part. Mostly, I am full of shock. I have looked into Bontril, and it does not appear to be any safer, less habit forming, or geared towards weight loss maintenance than any other weight loss drug I have seen. I also have a very slight murmur and have experienced heart palpitations, though they appear to be more stress related than any heart trouble. From what I've read, these conditions are not suitable for taking the drug. Plus, I just recently began getting migraines with auras (milder pain but wild visual stuff for me), and it appears that this drug can cause even more trouble with headaches. My doctor has treated me concerning all of these problems, so it seems odd she would prescribe such a drug.
And vitamin b-12 shots? Well, from what I have read, there is very little scientific evidence to go on that they actually work. Is this true?
My doctor talked like these things would be just a little "boost," but there's experience of some people losing up to 7 pounds in a week on this stuff. That's not a boost. That's a freakin' rocket launcher! This may be experiences from some individuals who have much higher doses (she says weight loss clinics give some pretty dangerous doses), but still.
I don't know what I'm looking for here. I'm a little confused. Currently, I am not feeling okay with the idea of medicating like this, though my doctor made it seem like it was all so safe. Is it safe? Is the weight loss even maintainable? What happens when I go off this medication and I have not adjusted my calorie intake and exercise level down to the weight I would be at? I don't know. It just goes against most of the way I have come to view my own weight loss, and I just think my doctor is wrong about this one.
Any opinions from you weight loss gurus would be much appreciated. I'm swimming.
Last edited by Song of Surly; 02-12-2013 at 07:55 PM.
I know nothing of Bontril or Vitamin B12 shots but several years ago my Doctor suggested a Diet Pill called Redux, I took it and lost weight BUT it was found to have serious heart related side effects possibly even fatal. It was taken off the market. I am not comparing the two since I do not know about side effects of Bontril ,I guess what I an saying even if a Doctor recommends something it might not be safe. Proceed with caution.
Your doctor wants to put you on speed. Man ... how come my doctors are never this cool?
B12 shots are great if you're deficient. Are you?
Personally I wouldn't fill either script.
As to your calories - for what it is worth - I personally eat about 2,000 calories a day when I want to lose fat. So if you're not losing as fast as you want you should consider eating less.
It's sad to say but most doctors know very little to none about nutrition. That's why we have nutritionist... Lol
I trust the doctors but I always check with another doctor as well, I also go around and ask other nurses.
I know your weight loss is hard and slow, but you are losing! You are not starving, you are being active and you are losing...
Get a second opinion, talk to a nutritionist... Sometimes doctors just see us as another file on their desk...
I think why it shocked me so much is that I am not that frustrated with my weight loss to have ever even considered such methods. I AM losing, and I feel like I am doing it in a way that works for me. I only asked about the metformin due to my past with IR trouble. I wasn't looking for some extreme quick fix, but I figured I needed to talk to my doctor about it to see how she felt. Obviously she felt like, as John put it, putting me on speed.
JohnP - I have never had my B12 tested. I take a multi-vitamin every day that has plenty of B12, however.
I think I kinda answered myself already, but thanks for the feedback you guys. Either way, it's reaffirming to have people tell you that they agree. It's just not the right fit for me in my current lifestyle change.
Last edited by Song of Surly; 02-12-2013 at 07:57 PM.
My PCOS held me back from losing weight for so long. I tried the Metformin, but didn't stay on it regularly because I hated the side effects. I tried watching my carbs and "eating well". I basically gave myself a pass to not try very hard to lose weight, because everything I heard basically said that "PCOS=fat".
I lost all of my weight on a low-cal, high-protein diet through calorie counting. Exercise ramped up as I became more able. Now I have been at goal for over a year and my periods are mostly regular (every 1-2 months, instead for once per year).
I am not saying that YOU are using PCOS as an excuse, as you are obviously already working out and eating at a reasonable rate. But if you aren't losing, and your labs are fine....you need a bigger deficit. You probably don't need OTC medicine or herbs, or event prescription remedies!!
I don't eat any animal products (normal source of B12) and I get my B12 tested. I've been in the mid to high range every time. Older adults, vegans and those that have a genetic disposition for malabsorption of B12 are generally the ones that should get tested. There is no reason to get B12 shots if you haven't been tested. I'd be a bit wary about your doctor.
From reading your post it definitely sounds as if the Bontril would be contraindicated in your case... Did you bring up your concerns about this with her? And what exactly was her rationale for prescribing the B12 shots? But since it sounds like you aren't going to do either one, I would make another appointment to let her know and get your other concerns addressed now and not in 3 months e.g. your HbA1c... I just don't see the rationale for waiting 3 months for that unless you're had one recently, especially if it is going to impact a treatment decision e.g. going back on metformin...
She looked at my last labs (which I did not even have a fasting blood sugar on) and said that my thyroid and sugar looked fine and that she did not feel that I needed to be placed on Metformin. Okay, that's okay and good, though I was under the impression that Metformin is fairly common in the treatment of PCOS. :S
Clarification (I also have PCOS) -- Metformin helps if you have IR and if you have problems with managing your blood glucose levels.
However, it's not always prescribed if your doctor thinks you're handling your blood sugar issues on your own (through diet/exercise) and how off the mark you are in terms of IR (it's a range, not a black or white thing).
In my case, my endo wanted me on Metformin, I turned him down, lost weight and I went back to ask for it, because I thought it might help me lose weight.
He said no, I just needed to lower my calories.
Quote:
Originally Posted by Song of Surly
She then talks to me about how she and another woman at the doctor's office are doing medically supervised weight loss programs with their patients who appear to be "working hard" towards weight loss goals but are struggling. She asked me about my exercise and calories. I told her I do 3 days of cardio, two of lifting, and I eat between 1700-1800 calories a day. She tells me she would advice me to go 1500 calories, because really, I'm actually just at maintenance with 1700-1800. This goes against all literature I have read about my maintenance calories. Perhaps I am incorrect? Any of you super smart people know?
I'm your height and 1700 - 1800 calories is maintenance for me.
I lose slowly at 1500 calories and no exercise. I lose about 0.5 lbs if I exercise per week if I eat 1500 calories and exercise every day.
This is the thing, women with PCOS have been found in some studies to actually have a lower metabolism/RMR than other people. We are just more efficient at using the calories that we have!
So, yes, you may be finding out that you have to eat less than a "normal" person.
Quote:
Originally Posted by Song of Surly
She then goes on to tell me that there is a drug, Bontril, which is a stimulant that supposedly has less side-effects and is much safer than other phen drugs. She also talked about taking vitamin b-12 shots. I told her that I would think about it, so she went ahead and gave me a prescription for a low dose of Bontril and the shots (self-administered) and made me an appointment three months from now. It is not until that appointment that she actually plans to check my blood sugar levels with an A1c.
Your A1C test after three months will tell her if you're really working on your diet/exercise and whether or not you will need something else.
A lot of endocrinologists (if she is one) will recommend weight-loss drugs if you tell them that you are doing ABSOLUTELY everything to lose weight and nothing is happening.
If you are pre-diabetic and they are trying to save you from becoming diabetic, losing weight is critical -- if you are IR/pre-diabetic, then your pancreas is slowly losing it's ability to create insulin and to regulate it correctly in your blood. If you don't lose weight, you will basically exhaust your pancreas until you become diabetic and then you will have to inject insulin to balance the glucose levels in your blood.
These doctors have usually seen the worst case scenarios so they are trying to prevent you from reaching those worst cases where you're losing fingers or going blind because your diabetes is unchecked.
If you don't want to go to those extremes, you just have to tell them and then actually go and lose the weight, so that the doctors can see that you can do it the "natural" way rather than the drug-induced way.
As for the B-12 shots, women with PCOS/IR are usually low in their B vitamins. IF she is getting ready to prescribe Metformin for you, you will need those B-12 levels to be high because Metformin will deplete all your stores and you will have to supplement to keep them at optimal levels. Low B-12 can make you feel lethargic, have a low immune response, etc. until it eventually leads to anemia. She may have heard you tell her that you bleed heavily (a symptom found in PCOS women)? Or she may have seen in your labwork that your levels were low.
Quote:
Originally Posted by Song of Surly
My doctor talked like these things would be just a little "boost," but there's experience of some people losing up to 7 pounds in a week on this stuff. That's not a boost. That's a freakin' rocket launcher! This may be experiences from some individuals who have much higher doses (she says weight loss clinics give some pretty dangerous doses), but still.
IR people usually aren't absorbing their vitamins and minerals as well as other normal people. I've been taking supplements for a long time now and I did feel a difference between the time when I wasn't taking supplements to after a few weeks of taking the ones that I do.
Quote:
Originally Posted by Song of Surly
I don't know what I'm looking for here. I'm a little confused. Currently, I am not feeling okay with the idea of medicating like this, though my doctor made it seem like it was all so safe. Is it safe? Is the weight loss even maintainable? What happens when I go off this medication and I have not adjusted my calorie intake and exercise level down to the weight I would be at? I don't know. It just goes against most of the way I have come to view my own weight loss, and I just think my doctor is wrong about this one.
Any opinions from you weight loss gurus would be much appreciated. I'm swimming.
I had one endo that prescribed Meridia a weight loss drug and I tried it. It did help curb the insane hunger that I was feeling back then -- which was due to the high carb diet I was on -- and I learned that I didn't have to be ruled by those carb highs/crashes. I knew something was wrong with me then, but I still didn't know enough about PCOS or dieting or nutrition to pin-point it. I also worried, but my endo seemed to be fine. Eventually, I learned as much as I could on nutrition, PCOS, and my own body to decide that while the Meridia was okay for me, I wasn't happy with taking a weight loss drug for the same reasons you cited. I stopped after a month and after having lost about 5 - 7 lbs (with less work than every before).
I then changed my endo to a reproductive one (there are differences!) and the reproductive endo basically told me I needed to eat low-carb, eat less, and exercise more. I trust him. He knows what he's talking about and he's 100% right.
All the studies on PCOS show that's the answer.
Sadly, the issue is that we do have to eat less calories than a "normal" person, so it means that we have to be very strategic about the food that we consume. Or the exercise that we do in exchange. While someone might be able to lose at 1800 calories a day, we simply can't. So what works for others just doesn't work for us -- we can't compare ourselves to them because we will get frustrated and annoyed that we aren't losing weight (or gaining at the same levels).
I've currently gained weight (5-7 lbs) because it is hard to eat less and be strategic because I'm super busy with work. But I know that if I eat less calories, then I can lose weight again.
I wish you luck! There is a PCOS board if you want to join here at 3FC.
Honestly, I think you should trust your instinct. It's usually right. I might be biased though because I'm not a fan of medication in general. You went in to check into helping with your PCOS, not the other prescriptions. So unless she had very good points and proof that your body needs them, you should look into it more. You could read up on it, and if you're still not comfortable, maybe look into a second opinion first. Home shots sounds like such a painful hassle if it's not really what you need.
I also lose weight really slow. But at least you know it's most likely all fat and not muscle, and sustainable.
Last edited by Samantha18; 02-12-2013 at 11:36 PM.
Both myself and my teenage daughter have used B12 Injections in the past,but first levels were drawn even though we were symptomatic.
Once it was confirmed are levels were low we were started on a series and then switched over to oral for maintenance.
I also had other labs and Vitamin levels drawn and was treated for that again once it was confirmed that I was low.
This was done before I ever thought about dieting.
I am aware B12 injections now are being used in weight loss programs so maybe they do not follow the same protocol as my PCP does. Without levels how do you know if you are at a therapeutic level?
My hubby also has Diabetes and he usually has appts every 3 months and sometimes Dr just monitors to see how things are going before making changes in treatment plan.
Good Luck,Roo2
That seems kind of crazy! I've ready about JFK and Jackie getting B12 shots from a whack doctor in the 60s to keep up their energy...? Not to say that B12 shots should always be avoided. If you have a deficiency, then maybe. Otherwise, your doctor's advice seems a little off? I would get a second opinion from another doctor to be sure.
Advice for all medical questions: you feel uneasy about it, a second opinion can't hurt.
I believe the B12 shots were given under the premise that they supposedly help with weight loss. It's this "vitamin mix" that these crazy weight loss clinics give to patients. It is given to all of her patients that are going through this program at the doctor's office. There was no indication that I, myself, am low on B12. At least she did not inform me of that. I have no idea of my B vitamins are low, but I have no indication that they were prescribed for any perceived deficit.
I think I will try to find ways to lower my daily caloric intake. Thank you every one for advice on that. I was under the impression that maintenance calories are much higher for some one my size and activity level.
I have not been to an endo in several years. I was diagnosed with PCOS at 14 and prescribed metformin. I do not want to be on a drug I don't have to be on. I was concerned I was hurting my efforts by stopping taking the drug unsupervised by a doctor. My mother and sister are both type II diabetics due to PCOS, and so it's a very serious concern for me. I was really concerned because my most recent labs did not contain a test of my fasting blood sugar. I just came in after work. I have not had a fasting blood sugar test in years, so I was hoping to get it checked. Can they seriously test your sugar if you are not fasting and there is no indication of time of your last meal? Or, rather, with a random blood sugar test? My last labs were not focused on my sugar levels, but any issues related to my heart. I trust my doctor, but I am confused, as this is not my former experience with testing my blood sugar levels. Though, probably, I should have asked my doctor instead of asking you all. I was a little floored by the other recommendations, so I didn't think about this question until after I got home.
Thanks for all the info and advice everyone!
Last edited by Song of Surly; 02-13-2013 at 09:04 AM.
Doctor wants to prescribe me Bontril and Vitamin B12 shots?!
