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[BodybuildingMD]

Hey all:

Fallen from former glory here's someone I'm helping to train. He's a very very busy man. Works close to 80 hours a week in a high stress job. Once upon a time was 30lbs lighter and a lot more cut...with a larger bench press and deadlift. Squatting and deadlifts are now an issue for him b/c overall his legs and back are just too TIGHT and become painful with the movements.
He still tries to work around it. Recently became familiar with this site and access to stuff.
Knowing these stats what would you have him do (Personally I think he needs a major cutting cycle)
By calipers about 13-14% body fat. Realistically probably 16% all of which is central. E.g. his thigh measurement is under 10, chest around 4-5 and abdominal is 25 to 30 (down from 40 in january).
Umbilicus measures 43-44inches...huge. Probably close to 40 where pants are actually worn. Used to be about 10 inches smaller.
He got his first ship of new supplements about 2.5 weeks ago.

Arms are just shy of 18. Bench press: 315 for 3 reps. Deadlift I don't know anymore...a few of 315. Used to do 460. Cardio is atrocious at this point (dude used to run 8 miles in 55 minutes). He's down from 270 earlier this year. Currently weights 245lbs.....

Fire away with suggestions; criticisms, etc...Will try and get better photos later. Dude is 31 y/o.

 

[CensoredBoardsSuck]

Dude needs diet and cardio, not drugs. He's nowhere near 16% BF. From that picture he looks closer to mid 20s. Diet and cardio.

 

[BodybuildingMD]

That could explain his string of bad dates lately

 

[hotdog23]

Thigh measurement under 10"? At which point?

 

[biglumber69]

The dude your are talking about sounds a lot like one of your doctor friends. I use to way 280lbs I did not even think about cycling until 215. Diet is key. I believe you said you are a real doctor on another thread. Can't you help him out with diet pills or real Watson cyp

 

[BodybuildingMD]

The thigh 10 measurment: I was referring to calipers. It's in millimeters. Using JP 3 site method with calipers. I've found that system to be about 3-4 points under dunk tank measurements in the past. While the actual equated number doesn't matter the trend does. Guy was 230 when he started his second year of residency. Then was up to 270 by January. Down to 230 by April. Leveled off at 235-240....new "supplements," at 245. By calipers he's gone from 20% body fat to about 13% but not that well evidenced by the photos nor his waistline shrinking.
Overall going by calipers his chest about 12-14mm. Now about 4mm. Abdomen was about 40mm now about 26. Thigh was 10-14 now 8-10. Waist size isn't budging.
Even if he's 20% body fat if he can drop about 20 he'd be down almost to single digit level if he could preserve his LBM. A lot it is likely cortisol related and poor sleep....28 hour long shifts don't help. He cooks his own food for work daily...currently he has 4 chicken breasts and a bunch of veggies ready for his workday tomorrow.

As far as me being a doc I am. I'm still resident level and I'm in a field far removed from primary care. I did some primary care intern year but very very little clinic work. I was mostly hospital based (99 percent of the time) and felt comfortable being a hospitalist at the end of the year. I wouldn't feel comfortable doing urgent care or really being outside an OR at the moment. I'm on Surgical ICU at the moment and it's the first time I've had to take care of patients outside the OR in ten months other than writing narcotics and such when I was on the pain service; but that was in a consulting role.

Since I don't discharge patients I don't have a DEA license (they're expensive) and don't have a need to write patients narcotics outside the hospital. For wt loss pharmaceutically outside the standard T3/T4 stuff or albuterol (neither of those I'll write for people b/c I'm not their PC doc and with thyroid stuff as a doc you need to be checking labs at some fixed frequency not treating empirically) there aren't a ton of options. Adderall of course works for many. An unknown gem IMO is wellbutrin. Strattera works well too but is pricey. Metformin can help as well.

The problem we run into with these weight loss drugs is it's risky. Thyroid hormones work in part by sensitizing your body to catecholamines (Norepi and epi). This makes your more prone to arrhythmias. Undiagnosed weird arrhytmia --> torsades --> V fib --> sudden death etc. Or unknown underlying Coronary artery disease and you can precipitate acute myocardial ischemia etc or valvular disorders....or a patient goes and snorts cocaine afterwards etc.

Trust me....I still use this stuff everyday. I have ampules of pure ephedrine in my pocket daily and use it like it's water. It's a great drug...but I also am using it in a very, very controlled NASA-LIke environment. So you need to have respect and fear for these drugs.

Like MJ with propofol....propofol is a wonder drug. No more counting back from 100 to fall asleep. You say night night and the patient's out 20 seconds later. Or it has other utilities like for refractory nausea. But a year in and I'm still not a master of using it and titrating it. Sure I could manage myself in the endoscopy suite for the most part..but it's still a powerful drug.

Anyway that was a long rant on the problems of medical weight loss. Wellbutrin's as far as I'll go to help people in that regard.

 

[Ozzy619]

The thigh 10 measurment: I was referring to calipers. It's in millimeters. Using JP 3 site method with calipers. I've found that system to be about 3-4 points under dunk tank measurements in the past. While the actual equated number doesn't matter the trend does. Guy was 230 when he started his second year of residency. Then was up to 270 by January. Down to 230 by April. Leveled off at 235-240....new "supplements," at 245. By calipers he's gone from 20% body fat to about 13% but not that well evidenced by the photos nor his waistline shrinking.
Overall going by calipers his chest about 12-14mm. Now about 4mm. Abdomen was about 40mm now about 26. Thigh was 10-14 now 8-10. Waist size isn't budging.
Even if he's 20% body fat if he can drop about 20 he'd be down almost to single digit level if he could preserve his LBM. A lot it is likely cortisol related and poor sleep....28 hour long shifts don't help. He cooks his own food for work daily...currently he has 4 chicken breasts and a bunch of veggies ready for his workday tomorrow.

As far as me being a doc I am. I'm still resident level and I'm in a field far removed from primary care. I did some primary care intern year but very very little clinic work. I was mostly hospital based (99 percent of the time) and felt comfortable being a hospitalist at the end of the year. I wouldn't feel comfortable doing urgent care or really being outside an OR at the moment. I'm on Surgical ICU at the moment and it's the first time I've had to take care of patients outside the OR in ten months other than writing narcotics and such when I was on the pain service; but that was in a consulting role.

Since I don't discharge patients I don't have a DEA license (they're expensive) and don't have a need to write patients narcotics outside the hospital. For wt loss pharmaceutically outside the standard T3/T4 stuff or albuterol (neither of those I'll write for people b/c I'm not their PC doc and with thyroid stuff as a doc you need to be checking labs at some fixed frequency not treating empirically) there aren't a ton of options. Adderall of course works for many. An unknown gem IMO is wellbutrin. Strattera works well too but is pricey. Metformin can help as well.

The problem we run into with these weight loss drugs is it's risky. Thyroid hormones work in part by sensitizing your body to catecholamines (Norepi and epi). This makes your more prone to arrhythmias. Undiagnosed weird arrhytmia --> torsades --> V fib --> sudden death etc. Or unknown underlying Coronary artery disease and you can precipitate acute myocardial ischemia etc or valvular disorders....or a patient goes and snorts cocaine afterwards etc.

Trust me....I still use this stuff everyday. I have ampules of pure ephedrine in my pocket daily and use it like it's water. It's a great drug...but I also am using it in a very, very controlled NASA-LIke environment. So you need to have respect and fear for these drugs.

Like MJ with propofol....propofol is a wonder drug. No more counting back from 100 to fall asleep. You say night night and the patient's out 20 seconds later. Or it has other utilities like for refractory nausea. But a year in and I'm still not a master of using it and titrating it. Sure I could manage myself in the endoscopy suite for the most part..but it's still a powerful drug.

Anyway that was a long rant on the problems of medical weight loss. Wellbutrin's as far as I'll go to help people in that regard.

Its funny you mentioned wellbutrin, its the only thing a doc has given me that helped depression while aided with boosting my libido. Its the only medication Ive ever liked from a doc.

 

[BodybuildingMD]

It's a good choice for a lot of younger people with depression with some caveats. Some people love it. Some people don't respond as well. It can decrease appetite. It can increase anxiety....helps with ADD as well. Theoretically it increases dopamine levels which inhibits prolactin --> increased GNRH release --> Increased LH/FSH --> increased libido. At least theoretically. I don't remember data quantifying if it actually increases testosterone or not.

Anyway I'll advice the trainee to just keep cutting here.... He will do dunk tank measurements next month when the thing comes to his area and get a better idea of what histrue body fat percentage is...I'll keep you posted on the progress....he has the muscle. He just needs to lose the blubber.

 

[BodybuildingMD]

So here's something interesting. Found a few articles on using ultrasound for body fat testing to compare it to calipers and DEXA. Was looking into buying one for home use but was like that's silly. I have them at work and can just borrow it. Plus I need to practice using it anyway. So ultrasound the three sites I do calipers on. Chest and thigh were the same. Abdomen i was getting about 30mm on. Was only about 20mm with calipers. Using ultrasound body fat equations I'm only like 11 percent bodyfat which I don't believe.
Actually tracking calories now and trying to keep a 1k deficit per day. Will see how it goes.

 

[biglumber69]

That is a big deficit. I usually only do 500 deficit and u am down to 215 from 280. I started dieting in January this year. Good luck either way you decide to go