Jonathan LeSuer (00:06) All right, guys, welcome back to another episode of the Fill Me In Podcast. I'm Injector Jon. And we are gonna be diving deeper into the world of aesthetics, but also wellness today, right, Nicole?
Nicole (00:11) and I'm aesthetic nurse Nicole. Yes, so we are very lucky we have our wellness clinician, Megan here with us. Megan, go ahead and introduce yourself.
Megan Piersanti (00:25) My name is Megan. I am the wellness provider at Exhibit Medical Aesthetics. I formed the exhibit wellness part of the office. So I have a DNP and a BSN. So I am technically a doctor of nursing practice. I'm an FNP. So I have a family nurse practitioner certification, but I don't go by Dr. Meg. I just go by Megan and yeah, that's why I'm here today.
Jonathan LeSuer (00:49) Yeah, and I love that.
Nicole (00:49) Love it. Megan's worked so hard building this incredible wellness, basically practice that we have now as part of our med spa. Megan kind of go into what we offer.
Megan Piersanti (01:03) Sure. So I've been with Exhibit for a little over a year now and I know I met with you guys probably a few months into helping form this practice, right? So a lot has changed in the last year. Yeah. This is the ultimate revenge, right? We get to say all the things that we wish we said the first time and so much has changed. But in the last year, really what we focused on or what I focused on in conjunction with our medical providers, the practice was—
Jonathan LeSuer (01:09) Yes. Yeah. Yep. This is part two.
Nicole (01:10) Yes, yep. Yes, part two, exactly. Yeah.
Jonathan LeSuer (01:21) Yes.
Megan Piersanti (01:30) understanding what our clients needs were, our patients needs were. Obviously our most common patient in aesthetics is our females, right? In their mid-life age, men too, of course, but part of what we do is we identify what the patients need, right? And we get feedback. And what we've really started to realize is women don't receive this type of care in insurance-based medicine. And they don't wanna be treated like they have to hand out a credit card every single time they come, especially with anything like hormones or weight management. So these are the two things that I focus on. We've developed some programs as a result and originally everything was, hey, when you come in, there's an appointment fee. We've really gotten away from that, right? So the way that we've changed is we funnel everyone in through a general consultation because you should never see a practitioner who's not willing to do a deep dive into what's bothering you.
And then we offer tailored programs now, right? So if I believe a program is better suited for you based off of weight management versus hormone management, maybe you're postpartum. Maybe we think you have a little bit of PCOS, right? Or you're a male looking for hormone optimization. You should not be treated the same way as my postpartum patient. And I think that's why in this type of care model, we can do that, right? Where in a traditional office, you go to your primary care office, all they know is your chief complaint.
Nicole (02:49) Mm-hmm. At the chart, yeah.
Megan Piersanti (02:49) And maybe not even that, if they don't have a chance to look after their 10, 20 minute appointments, they're basically walking in and saying, what can I do for you today? And you only get one complaint. As soon as you start listing more than one, they can't. Exactly. So that's, think we've changed that a lot in the last year. And even just building off my experience working at other practices, but also doing my clinicals, that was something I found was really important. And...
Nicole (02:58) Mm-hmm. Another appointment. Yep. Mm-hmm.
Megan Piersanti (03:17) It's really emerging right now as a really popular industry as we've started to notice the blend between aesthetics and wellness. But I think it's really important to differentiate between wellness as a marketing term, right? And understanding the difference between licensed clinicians and health influencers, right? And health coaches. And it doesn't mean there's not a time and a place for them. But there's a certain person who writes prescriptions and gives official medical advice.
Nicole (03:25) Mm-hmm.
Jonathan LeSuer (03:25) Mm-hmm. Mm-hmm. Mm-hmm. Ahem.
Megan Piersanti (03:44) And there's your influencers who can give you guidance, right, or information about a product, or review about a product, but under no circumstances should they be giving medical advice or writing prescriptions. So I that's really important.
Jonathan LeSuer (03:54) I feel like we're really
Nicole (03:54) Yes.
Jonathan LeSuer (03:55) like in this new wave of wellness and just because I think the biggest barrier for women and family medicine is sometimes they feel like they're overlooked, especially in their late 30s, 40s, 50s, early 60s, right? That pre, peri, post-menopausal symptoms. And I think over the past two years, there's been such a surge in people seeking hormone replacement therapy. And I do think that maybe the GLP-1s, the peptides that had came out, kind of pushed that a little bit, that more awareness. And I think, like you said, I think there's people like yourself that have started, maybe like focused a little bit more GLP-1s initially, but now are broadening into hormones because there's so much that goes into that as well, into making you feel good on the inside. So do you agree?
Megan Piersanti (04:45) So it's interesting you say that, and we haven't even talked directly about this in over a year now, but that's exactly what happened to me. So just a deep dive into like, started in cardiac telemetry as a nurse, then I went to emergency medicine, right? And yeah, you're just trying to put out fires there. When I started doing my clinicals as an FNP, I followed doctors and I followed nurse practitioners and PAs, right? And I was seeing the same theme over and over again, like I said.
Jonathan LeSuer (04:50) Mm-hmm. Mm-hmm.
Megan Piersanti (05:11) When I really started to notice the difference was when I went into the aesthetic space for the first time. I was in a practice where I was really the primary and mid-level. So there were no other PAs, no other NPs. And I noticed I started doing a lot of weight management with GLP1s. It was when they first blew up, for lack of better term, right? 2022 around that time. So every single patient was coming in. I was like, wow, this is great. I am really helping women. And I slowly gravitated away from aesthetics and into specific weight management because that's just what called me. It felt very familiar to me and I felt very comfortable with it. I needed to pick. I had the niche down.
Jonathan LeSuer (05:43) And
Nicole (05:46) Mm-hmm.
Jonathan LeSuer (05:47) what were you noticing with the GLP ones? What were they helping women with?
Megan Piersanti (05:51) So I notice a lot of women, they would immediately say within the first month, even if they didn't lose weight, 10 out of 10 times, I notice that I don't feel as puffy. And it sounds terrible, but the old, I don't feel like a sausage in casing anymore. And we would laugh because I never, you there's a huge, you have to be so mindful of how you speak about weight. But every time they would gesture to their midsection, but I never, I felt like I would hit a wall, right? You'd hit a plateau mentally, but also physically. And every time I'd say, just can't seem to get on top of some of these other symptoms like difficulty sleeping, mood swings, Mentoral changes. And I was like, I'm missing something here. And I don't feel that I can figure this out by quickly looking over the weekend. I started, definitely my algorithm worked for me. I started connecting with other practitioners who mostly were women, right? Female practitioners who were doing a lot of hormone management and doing a lot of menopause management. And if I didn't find those women on social media, those clinicians, I don't think I'd be where I am today. I mean, it goes hand in hand. Beyond what studies show us, we see studies of patients who use GLP-1s and hormone therapy, they do better, right? Not only with weight loss, but they just feel better. And I do think if you're solely out there just trying to offer weight management, but you're marketing yourself as more than an obesity medicine practitioner, you're letting people down, right? It is one of those things where,
Jonathan LeSuer (06:51) Mm-hmm. Mm-hmm. Mm-hmm.
Nicole (07:00) Mm-hmm.
Jonathan LeSuer (07:03) Mm-hmm.
Nicole (07:03) Mm-hmm.
Jonathan LeSuer (07:13) Mm-hmm.
Megan Piersanti (07:16) I think every clinician should have training in menopause management. Everyone's going to reach menopausal age if they're a female and they live past their 40s, right? So it should be included in education.
Jonathan LeSuer (07:20) Mm-hmm. Mm-hmm. Right. And they need to be
Nicole (07:25) right.
Jonathan LeSuer (07:28) more comfortable having that conversation because there's so many women and especially I know you Nicole, and I'm sure you Megan have seen this in your practice. Like my patients are like wanting to leave their current doctor to find maybe a young doctor that's up and coming because they're so well averse now in this new conversation that's happening in wellness that they want to make that switch over to someone who will take the time to talk to them.
Nicole (07:30) Mm-hmm.
Megan Piersanti (07:31) Yes.
Nicole (07:38) Right. Mm-hmm. Right. Mm-hmm.
Megan Piersanti (07:50) Yes, and I think it's so important to make the distinction, like even me, and I'm introducing myself as an FNP. I do not intend, and I sound like a broken record in the office, but I don't intend to replace your OBGYN, right? There's a need for them, right? I'm not doing, currently, not doing pap smears and pelvic exams, right? I'm not delivering babies. I'm also not necessarily, I am a little bit now, but I'm not doing Medicare wellness visits, right? Or doing a lot of that chronic disease management other than weight management and hormone management. There's a time and a place and I'm emerging as this person that is bridging the gap. So let's see, they see their OBGYN, they bring it up, maybe they get pushback, you know, they don't feel empowered like you said, and then they end up in my chair. Maybe they mentioned to Nicole or Melissa or Gab or Cami, one of our injectors, I'm just not feeling great about myself. Or they'll see one of our MAs who are working with me and they're like, you look fantastic, what are you doing?
Nicole (08:34) Mm-hmm. Mm-hmm.
Megan Piersanti (08:47) The beauty of women and men who have that community feel and are feeling comfortable in an environment is they're more willing to talk about it and be vulnerable. And I really don't think that would happen in a starchy, typical medical practice. You feel intimidated, right? And it's very uncomfortable to talk about dryness or I have no interest in intimacy. And that doesn't just affect women. It affects all relationships. And it's something that should be talked about.
Nicole (09:08) Right. Mm-hmm.
Jonathan LeSuer (09:09) Mm-hmm. Well,
Nicole (09:14) Right.
Jonathan LeSuer (09:16) and
Nicole (09:16) Right.
Jonathan LeSuer (09:16) I think people are willing to pay a premium, right, to have that conversation outside of a doctor-y feel office, like where they feel more comfortable having that one-on-one. You know what I'm saying?
Nicole (09:23) Mm-hmm.
Megan Piersanti (09:24) Yes.
Nicole (09:26) Right, well, and let's be real too, right? Like you're, if you are going to a doctor's office insurance space, they have about 15 minutes with you. So if, especially if it's a physical, right? If it's a physical, they're going to do, you know, go over the important things. And then when you bring something like that up, they're probably going to be like, unfortunately, you know, we're going to have to do another appointment or brush it off and be like, nah, you know.
Jonathan LeSuer (09:33) Sure. They're pressed for time. Mm-hmm. Right.
Megan Piersanti (09:47) And it's so important and that's where I try, I really try to choose my words. It's not anyone's fault. It is truly the system because I witnessed it myself. And yes, not, listen, not everybody thinks that stuff's important to talk about, but I do genuinely believe that as clinicians, most of us went to school and got a degree and a license to care for people, right? So I don't think it's in their best interest to say, you know, I don't care about this stuff. I don't want to do this stuff.
Nicole (09:51) Mm-hmm. Right, right.
Jonathan LeSuer (09:55) It is.
Nicole (09:57) Mm-hmm.
Jonathan LeSuer (10:08) Mm-hmm.
Nicole (10:14) Mm-hmm.
Megan Piersanti (10:14) they're seeing, like you said, by the time they get in there with the MA and the MA's out of the room, they're in there for 10 to 20 minutes. They have to literally put out fires and triage. What is the most important right now? And they're using their codes, right? Their billing codes. I explain this to patients. They're using CPT codes and ICD codes to basically dictate whether or not it's going to be a worthy visit to the practice. And that's so devastating because I do think a lot of practitioners wish that they could go deeper.
Nicole (10:18) Right. Yep. Mm-hmm.
Jonathan LeSuer (10:22) Mm-hmm.
Nicole (10:34) you
Jonathan LeSuer (10:35) Mm-hmm.
Megan Piersanti (10:41) And they can't, they're gonna get dinged one way or the other, right? And that's where we've all emerged. I think it's so important though to know where you're spending your money because we're not cheap, right? What I love about what I do, similar to you and John and other injectors is we provide quality care and we don't feel that we have to rush the patient in and out. Why are we able to do that? Because we're not using insurance as a middleman.
Nicole (10:42) Yep. Right. Mm-hmm. Right. Mm-hmm.
Nicole (11:10) Let me tell you, I remember being in FNP school and like, you you learn how to chart, you learn how to code and putting the codes in and my instructor was like, you can't put 60 minutes for a physical. And I'm like, but I was in there for 60 minutes. And she's like, it'll get denied. Like you cannot put a 60 minute visit. I'm like, but it was a 60 minute visit. Like, so that's why they physically, like they just, they don't do 60 minute visits because insurance won't cover it. Like it's crazy.
Jonathan LeSuer (11:24) Mm-hmm. Mm-hmm.
Megan Piersanti (11:29) Yes. Yes. It's actually scary.
Speaker 1 (11:39)
Hey everyone, it's Jonathan, also known as Injector John.
Speaker 2 (11:42)
Nicole or aesthetic nurse Nicole if you follow me online.
Speaker 1 (11:45)
so excited to let you know that we've launched our Patreon.
Speaker 2 (11:48)
Yes, it's on there. We'll be sharing exclusive content you won't find anywhere else. Our own injecting techniques, advanced education, and even some behind the scenes business advice.
Speaker 1 (11:57)
If you're an injector, aesthetic professional, or just curious about the industry, it's the perfect place to learn and grow with us.
Speaker 2 (12:03)
So head over to Patreon, search for us and make sure to subscribe to get access to all that extra content.
Speaker 1 (12:08)
And don't forget, you can find me at InjectorJohn.
Speaker 2 (12:11)
and me at Aesthetic Nurse Nicole. We can't wait to see you there.
Speaker 1 (12:13)
I love you guys.
Megan Piersanti (12:15)
And John, that's something that we kind of, I've built in the last few months leading up to 2026 is I kept running into the same patient. was a male or female in their twenties. They're coming to me. They're like, Hey, Megan, I heard about you on the podcast or I heard about you from one of the girls in the office or my friend came to see you and you did a deep dive into their blood work. I want to do that too. Can you send me to LabCorp? Can you use my insurance? And the first thing I say to them is,
Nicole (12:15)
Mm-hmm.
Jonathan LeSuer (12:19)
Mm-hmm.
Megan Piersanti (12:41)
Luckily for you in the state of New Jersey, they protect the consumer. I do not profit off the labs I order for you, but I can guarantee if I order it through lab core requests and use your insurance with the long panel that you're seeking, I cannot guarantee what that bill is going to look like. And I can almost promise you your insurance is going to deny it. And now it's going to be stuck on you. So trust me when I say pay the cash lab that we have preset. It's a very transparent. Every single lab is listed as an item on the invoice.
Jonathan LeSuer (12:59)
course.
Megan Piersanti (13:11)
and we don't have to stress out over whether or not you're going to get a thousand dollar bill later on, right? So if you want that deep dive, you have to be okay with shelling out, I don't know, my lab panel is a little over $200, not including the consultation fee. And I think that's pretty reasonable, right? Given we're risking going to lab core requests, I'll do it, there's no skin off my back, but now I can't promise you you're not going to get a large bill after the fact.
Jonathan LeSuer (13:14)
Mm-hmm.
Nicole (13:15)
Mm-hmm. Yes.
Jonathan LeSuer (13:27)
Mm-hmm.
Nicole (13:33)
Right. And I can attest to that. So Megan actually follows me and my husband and lab work and all of that. So Kevin wanted to draw a bunch of different labs. And she was like, I really think we should go with Rupa, a cash pay, because you have no idea what they're going to come back and cover. So we did Rupa for him. And then because mine is thyroid and things like that, and we have codes for it, we ran that through insurance. So my insurance covered everything but like $20. And we drew, I don't know, maybe like two tubes on me. And it came back as good.
Megan Piersanti (14:05)
Not much.
Nicole (14:06)
close to $1,000 what insurance covered. And then Kevin did, we drew eight tubes on him. We sent it to cash pay. He paid $250 and it was $250 cash pay, but had we sent it to LabCorp and they denied it, he probably would have been on the hook for at least $1,500. So it's just, if you're a patient listening, like $250 might sound like a lot, but compared to $1,000, it's not. And you don't want to rely on your insurance and then be stuck with a big bill.
Megan Piersanti (14:14)
Yeah. Kevin did more than I even do in my panel.
Jonathan LeSuer (14:32)
Well, and I hear from other places in my area, you know, that do wellness that, I mean, some people are spending like $800 a month or they're spending, you know, or six or eight, you know what I mean? On like, they pay them, they pay the office like an office fee and then they, you know, prescribe their medications or do whatever, you know what I'm saying? But people will do it. They will do it because they feel better and yeah, it's worth it.
Nicole (14:36)
Mm-hmm. Mm-hmm. Yes, yep. Yeah, right. Yeah, it's worth it. Well, Megan, do you want to, this would probably be a good time to talk about. So obviously Megan's been with us for a while now. And in the beginning we had the compounding that we lost the compounding. So there was a lot of changes that we had to make and Megan's put so much work into figuring out what people want and what works for people. So we recently just made like a big menu change and maybe she could touch on that because it's, it's, kind of steer away from even like, we don't want monthly payments. We want you to feel like that care is there and I guess Megan you can explain it better.
Jonathan LeSuer (15:12)
Mm-hmm.
Megan Piersanti (15:27)
Yeah, absolutely. So to touch on the compounding conversation, we went from using mostly compounds, right? Part of that was because they weren't available through the brand name pharmacies, right? There was no availability, right? So a lot of us were using compounds and I liked them. I loved the customization of the dosing. It had a little bit of B vitamin typically or other vitamins and most patients were deficient in them anyway, right? So we're preventing multiple injections a week for one purpose.
Nicole (15:30)
Hmm
Jonathan LeSuer (15:39)
Mm-hmm.
Megan Piersanti (15:54)
And then it became more commercially available. Even further, they started offering a similar item. So one of the companies, Eli Lilly offers is that bound in vials. So that has become my drug of choice. And it's not that I have a problem with novo-nordisc or semaglutide. In studies, we know that patients in the zet-bound arm or the tris-epatide arm did lose more weight than the patients in the semaglutide or Wigovia arm. So they do lose more weight. I tend to find patients have less side effects, right?
Nicole (16:06)
you
Megan Piersanti (16:22)
And the main thing I care about is, that dose appropriate for the patient? Because John, I'm sure you guys see this too. If that dose is too high, this is 1000 % where those negative side effects are coming from, along with the nutrition. And speaking with a clinician actually is giving you that feedback. So I like the vials because if someone can't tolerate that full dose, we don't have to anymore. Where the pens, patients are being told, you know, shoot it in there and pull it out halfway. It's like, what are we doing? It's gotten wild.
Jonathan LeSuer (16:32)
Right.
Nicole (16:34)
Mm-hmm. You
Jonathan LeSuer (16:49)
I've never heard of that.
Megan Piersanti (16:50)
It is like, patients were literally being told, dial it up, push the button, and then pull it out after one second. Yeah, to make it work. And so there's a time and a place. So I've steered away from compounds, not completely. I'm not gonna sit here and say I don't use them from time to time. If a patient is deficient in B12, maybe they have a gut issue like a Crohn's or an IBS, or we know they have an absorption issue, right? A lot of our Celiac patients, or they do really well with, I don't wanna bring up microdosing, that's a whole...
Nicole (16:51)
you
Jonathan LeSuer (16:53)
Really? Oh god. Ugh. Sure.
Megan Piersanti (17:18)
tangent we could go off of, if someone benefits from using this medication off label in terms of how often they're using it, whether it's twice a week, right, in smaller doses, there is a time and a place for using compounds. Just as there's always been, I think we kind of went off in a tangent because patients were being told this is better, this is safer, right? or it's only this 100 % of the time. And just as you guys know, you've got your menu of fillers, you've got your menu of toxins, you've got your menu of skincare.
Jonathan LeSuer (17:37)
Mm-hmm.
Nicole (17:41)
Mm-hmm.
Jonathan LeSuer (17:41)
Mm-hmm.
Megan Piersanti (17:48)
It should never be one size fits all. And I think we got, we got so tunnel vision with only compounds or only brand. It's like, take a step back, use your clinical judgment. If, if insurance covers the medication for a patient or if they need that extra B vitamin, use it, you know, it's, it's used as a tool. but the program, like what you were saying, Nicole, I got away from, I tried to get away from the monthly payments because I still think a lot of patients get confused about.
Nicole (17:50)
Yes. Mm-hmm.
Jonathan LeSuer (17:59)
Mm-hmm.
Nicole (18:07)
Yep. Mm-hmm.
Megan Piersanti (18:17)
the non-insurance model, right? And I don't want them to feel like every single month that they come in, they're being charged for something. And I've also noticed a trend, and John, I'm sure you can attest to this as well, nobody's sticking with this for three months. Everybody's in this for the long haul, which I love. Patients are really starting to understand this is not a quick fix. I don't care if your body fat percentage is just a smidge over what it should be.
Nicole (18:19)
Right.
Jonathan LeSuer (18:26)
Mm-hmm. Mm. Mm-hmm. Mm-hmm.
Megan Piersanti (18:41)
You're still not going to start and stop this aggressively. And it should feel like a journey, not this sprint of my wedding's next month. I need to lose 20 pounds. Don't even bother, right?
Nicole (18:49)
Mm-hmm.
Jonathan LeSuer (18:51)
Well, and plus they are on it, they feel how good, they notice how good they feel, you know, on it. You know what I mean? Okay, Nicole, that was an aggressive little... I'm just kidding!
Nicole (18:54)
Mm-hmm. Right. Mm-hmm. sorry. Sorry. You know what I'm used to? I'm used to having the mic, so I'm like, over here, and I'm probably right next to the computer microphone. Sorry, everyone.
Megan Piersanti (19:00)
Yeah. my...
Jonathan LeSuer (19:06)
I'm
Megan Piersanti (19:11)
No,
Jonathan LeSuer (19:11)
I'm
Megan Piersanti (19:11)
literally I was like, I'm gonna start laughing.
Jonathan LeSuer (19:13)
I'm like, you twirl that matcha girl. But people notice how good they feel on these once they start it and they don't want to get off of it. And I think, you know, for me personally, my personal journey, I've tried ZipBound. I had side effects to it, which—
Nicole (19:15)
I'm so sorry. my God, I'm so sorry. It all settled on the bottom.
Megan Piersanti (19:17)
Hahaha
Jonathan LeSuer (19:33)
for me it was just too much rapid weight loss which I don't need because I'm a string ball or string bean. I also had and I'm very transparent, I had the runs with it. Like literally it would happen for three straight days. I go, do I have norovirus or is this a mount? I really don't know. Because it would literally be like pissing out of my ass for three days like I was taking a go lightly prep. And then I kind of went through it and then I'm like, okay, I—
Nicole (19:37)
That scared me. He would call me every day and like, hey, I'm on the toilet.
Megan Piersanti (19:47)
Mm.
Nicole (19:53)
You
Jonathan LeSuer (20:03)
I need to be on this for my high cholesterol because it really helped to lower my cholesterol by 70 points. So I switched over, I talked to my husband and he's like, all right, let's just switch you over to Wegovi. And I went over to Wegovi. Previously, I had issues with constipation with Wegovi because obviously it acts more in the GLP-1 with slowing the gut. since switching, I'm actually doing good and I've increased my fiber intake and I'm doing much better. Like I'm like.
Nicole (20:24)
Mm-hmm.
Megan Piersanti (20:25)
Okay. See, but that's a perfect example of, it's a big red flag and I love the parallels right now. If you go to a provider who says, we only offer this brand of filler, no, diversity, right? Because it should, yes, it should never be, know, I only use ZetBound for every patient, right? How do you know it's going to work for all for that patient? And it's, I'm not trying to attack, right?
Nicole (20:29)
Yeah.
Jonathan LeSuer (20:34)
Mm-hmm.
Nicole (20:37)
Mm-hmm. Yeah. Yes, yep. Yes, yep.
Jonathan LeSuer (20:37)
Mm-hmm. Yeah, yes. No, diversity, that's a very good point.
Nicole (20:48)
Mm-hmm.
Jonathan LeSuer (20:48)
Mm-hmm.
Megan Piersanti (20:54)
But if you're only so confident in one modality, then you need to branch out and get comfortable with other modalities. And don't even get in like the whole drama with the insurance. That gets a little confusing. I will use insurance for your medication, right? So office-wise, you're paying me for an annual membership. That means when you come in the door, don't whip out your credit card.
Jonathan LeSuer (20:54)
No. Mm-hmm.
Nicole (21:00)
Right? With others.
Jonathan LeSuer (21:00)
Mm-hmm.
Nicole (21:06)
Mm-hmm.
Megan Piersanti (21:18)
You get perks, you get supplement credits, you get a percentage off our other services, which we find to be complimentary to what you're doing. But any office visit, we built in some sick visits, body scans, vitamin injections, put your card back in your bag, you're already in, right? You're in with us for the year. I cover two lab draws for them so they can come in and I can draw their blood or they can go to lab core requests and I will use that once they're established, right? I have the ICD-10 codes. If they wanna go really in depth, we'll go back to Rupa and we'll do the big.
Jonathan LeSuer (21:18)
Mm-hmm.
Nicole (21:34)
Mm-hmm.
Jonathan LeSuer (21:45)
Mm-hmm.
Megan Piersanti (21:46)
but for medication, I'm happy to use insurance for your drugs because medication insurance, which this is a learning curve for lot of patients, there's a drug insurance and there's a medical insurance and for many patients it's not on the same card. It's like, so I'm willing, sometimes John, you might be like, really want to try, like in your experience, what's the best medication? I might tell you personally, I'm a Zet-bound girly, but I'll be honest with you, if insurance,
Nicole (21:55)
I guess, yep.
Jonathan LeSuer (22:02)
Mm-hmm.
Nicole (22:03)
Yeah.
Jonathan LeSuer (22:13)
Mm-hmm.
Megan Piersanti (22:15)
tells me that they will not cover it until you've tried Wigovie for three months. I can try to fight it, but we might, if it's important to you that we try something now, I might have to put you on that and we'll give it our best bet. That's why you need the body compositions, right? Because I can go back and say, all right, John has come in every month, he's following his nutrition, he's following everything he's supposed to be doing, he's doing the lowest, most effective dose for him, and he's not seeing that percentage change in his weight.
Jonathan LeSuer (22:20)
Sure.
Nicole (22:30)
Mm-hmm.
Jonathan LeSuer (22:34)
Yeah. Well, and that's the thing for me is when I went, I was on the ZipBound previously a year ago and I tolerated it really well for four months and the hunger noise, I cannot get over how I had zero noise to eat. Like it was, and it was on the lowest dose every other week. I'm like, this is insane. And can I, helped my, actually helped my anxiety. I realized I actually had like hunger anxiety. Like I would, if I was stressed out and that was before I was on an SSRI.
Nicole (22:54)
That's crazy. Mm-hmm.
Jonathan LeSuer (23:09)
But like I was when I was more stressed out, I would want to eat. I'm a stress eater. Right. So like I noticed, wow, my anxiety was more controlled. So I was really bummed because I ended up going off setbound initially because I did lose a little bit too much weight went off of it. But then I was like, I need to go back on it because it helped my cholesterol so much. And when I went back on setbound, I don't know what happened. I just I was eating healthy. It just didn't tolerate really well for me the second time it can. OK, good. Well, I'm pissed because I really like.
Nicole (23:10)
Mm-hmm. Mm.
Megan Piersanti (23:14)
Yes.
Nicole (23:18)
Mm-hmm.
Megan Piersanti (23:30)
No, it, yeah. And it can change, yeah. I mean, your tolerance can definitely change and you're the perfect,
Nicole (23:31)
Yeah.
Jonathan LeSuer (23:39)
I it. I wanted it.
Megan Piersanti (23:40)
but you're the perfect example. It's not, and I love that you mentioned, like it's okay. And I remind my patients this all the time. You never wanna be like, know, willy nilly with anything. It's like, it's especially with SSRIs, think about that, or blood pressure medication. You're on it or you're not, right?
Jonathan LeSuer (23:46)
Mm-hmm.
Nicole (23:52)
Mm-hmm.
Jonathan LeSuer (23:52)
sure. Right.
Megan Piersanti (23:58)
thyroid medication, Nicole, I almost passed away when she told me that she was being willy-nilly with it over the summer. With this type of use, if you're working with a clinician who truly understands how it is used and you're not using it for diabetes purposes, it is okay to cycle on safely, cycle off safely, right? Titrate your dose down appropriately. It sounds like you were just really sensitive to it and that's why, like, why are we beating a dead horse? It's too much. It's too much.
Nicole (23:59)
Mm-hmm. you Mm-hmm.
Jonathan LeSuer (24:21)
I guess. Mm-hmm, that's too much.
Nicole (24:22)
Yeah. Right. Yeah.
Jonathan LeSuer (24:25)
So yeah, then I switched right over and I was completely fine. It was great and I'm just doing .25 every other week.
Nicole (24:26)
I think it. Yeah.
Megan Piersanti (24:33)
Yeah, so that's even still like, and that's so important to mention too, like you're not a short guy, right? I know you have a smaller frame, but a lot of patients will tell me, well, you know, I'm 350 pounds. I'm going to need a lot of medication. Absolutely. I have, I have patients who can't get off that starter dose and they feel great and it's working. So yes, yes.
Jonathan LeSuer (24:37)
Mm-mm.
Nicole (24:47)
Yeah, right. Mm-hmm.
Jonathan LeSuer (24:49)
and they feel great and it's working. So why go up? If you're actively losing weight, don't, yeah. That was the issue like in the beginning. People were so excited to get to that 15 milligrams of ZetBound. They wanted to get in the highest dose, but they were shitting themselves, puking, having God knows what happened to them, right? Having all these side effects, not eating at all, losing muscle mass. And then of course, it's been a huge learning curve the past few years on these GLP ones. And I think definitely it's, this is what I say.
Nicole (24:55)
Yeah. You
Megan Piersanti (25:07)
Yes.
Jonathan LeSuer (25:17)
This has been the year of the lips. We're going natural with the lips. This has been a year of people really getting more responsible and finding the right provider that's gonna manage you better on your GLP-1s and your weight loss journey.
Nicole (25:24)
Yes. Absolutely.
Megan Piersanti (25:28)
And I think what's important to what you mentioned about aggressively shooting your dose up, like you said, losing muscle mass, losing hair, I always threaten that. It's a good threat. It's a nice threat. But then they stop it. And then they stop. And they're like, well, it's too much, so I'm gonna stop. And then they'll find out. They'll say, well, I just gained it all right back. And I'm not making fun. think it's educational. For educational purposes, we need to educate these patients and explain.
Jonathan LeSuer (25:36)
the hair loss, yeah. Mm-hmm. Yeah.
Nicole (25:37)
Yep. People are like, God. Yes,
Jonathan LeSuer (25:51)
Yeah.
Nicole (25:54)
Mm-hmm.
Megan Piersanti (25:55)
If we're fixing a metabolic issue that you have, yes, it might have been done too aggressively, but if you have insulin resistance, if you look at all your family members and they have all similar metabolic issues, right? If you had gestational diabetes, if you've had issues with your weight, PCOS, most of your life, and you aggressively start and stop any way of dieting or managing weight, you're going to affect your metabolism and not in a good way. You're going to burn through muscle mass, but you also are potentially setting yourself for failure when you stop it, right? And it might not ever be a good idea for someone to stop. You shouldn't be that high. You shouldn't feel like crap. And I say to patients, you should not be able to tell that you're on this medication from a side effect standpoint. Yes, you should notice changes to food noise. Yes, you should notice that you just...
Nicole (26:18)
Mm-hmm.
Jonathan LeSuer (26:26)
Mm-hmm.
Nicole (26:26)
Right.
Jonathan LeSuer (26:37)
Yeah, you're so right.
Nicole (26:37)
Mm-hmm.
Megan Piersanti (26:41)
feel a little bit better or that you feel more full. You might have the occasional side effect if you're going to a wedding or a cocktail hour or you're traveling and that's okay to skip it or to push it out a little bit or lower your dose. Like it should feel like that versus this hard and fast start stop, you know, and then they wonder why their hair is falling out or they felt so, so tired or so nauseous. It should not be. And that is where this medication or this class of drugs got a bad name and—
Nicole (26:47)
Mm-hmm Mm-hmm. Mm-hmm.
Megan Piersanti (27:10)
Too much of anything is never a good thing. It's just like every other trend. It had to happen for us to learn from it, I think.
Nicole (27:13)
Right. Right, absolutely.
Jonathan LeSuer (27:16)
One question I wanna ask, and I have one patient who very was like convinced that the, what'd she say? That the compounded triseptide was stronger than the ZepPound. And when we converted over to ZepPound, right, when the whole compounded thing happened, we converted over to norvodorosine, know, lily, all of that. We did that and she just said, I just noticed it's just not the same. But it's the same drug, it's still terzepotide that you're getting. But I wasn't sure if you noticed anything.
Megan Piersanti (27:52)
Yeah. So theoretically, it's the same, and I'm so careful about explaining. You know how you have acetaminophen and then you have Tylenol, right? There's generics. There's a generic for a lot of our medications that are FDA approved. There is no actual generic for those. There is one, it's Lyraglutide, and that's an actual generic form of a brand name gel. It's an old, like one of our OGs. I think it's a daily injectable. I don't use it. But—
Jonathan LeSuer (27:59)
huh. Yeah, yeah, Old one. Mm-hm. Yeah, yeah, yeah.
Megan Piersanti (28:20)
It's not exactly, it's not a generic, but let's be honest, compounding pharmacies have chemists, right? They know what they're doing. They're still sourcing those ingredients from similar places and they're able to make the product, right? So theoretically, it should be the same, but some of them are salt forms. Some of them are different forms, but they also sometimes have that other vitamin or amino acid or something else added to it, which for that patient may have been providing a synergistic effect. Some of it could be placebo.
Jonathan LeSuer (28:34)
Yeah.
Megan Piersanti (28:48)
Some of it could be that she was injecting in a different spot, right? Belly versus inner thigh versus back of the arm. But I never say never. And I'm sure you guys obviously believed her, but sometimes you're trying to wrap your head around, like, how is it possibly any different? I've heard it before too, and I don't ever tell the patient you're wrong.
Jonathan LeSuer (29:03)
In my head, brain of science, I'm like, you're getting, it's the same drug. So for me, it has to be either where, like you said, where it was injected or something like that. I had no idea. I have no idea.
Megan Piersanti (29:21)
But what's interesting that you say that is think about the patients and Nicole, you might be able to speak to this. Think about patients that take Synthroid versus Levothyroxine. There are patients that swear, they'll say to me, like my endocrinologist will not put me on Levothyroxine because I, so I think it's emerging. Yeah, and there's also, yes, and when I used to switch patients back when the compounding pharmacies were just starting to become a thing, a really popular for GLP ones, sometimes we would change pharmacies.
Nicole (29:26)
Mm-hmm.
Jonathan LeSuer (29:28)
Love about that, Roxanne. Yeah.
Nicole (29:36)
Mm-hmm.
Jonathan LeSuer (29:37)
I remember that in the hospital. People were so gung-ho.
Megan Piersanti (29:50)
And patients would say the same thing, like, swear I notice a difference. So that is the one blessing and curse with the compounds is they just don't have the same formula, right? They're not apples to apples across the board. They should be, but it's not necessarily where, if you're getting Novo Nordisk product or Eli Lilly products specific to them, you're going to get the same exact thing every single time. And so that's why I don't think that it's a hard or fast, good or bad. I think it's more what works for the patient, what makes the most sense for them, and I hear them out. And that's something I would document, right, if I were her.
Nicole (30:25)
Mm-hmm. Mm-hmm.
Jonathan LeSuer (30:27)
What would you say someone who comes in, and we get this all the time with Botox units, when they say like, my friend got 34 units, so I should get 34 units. What do you say, my friend, know, I know I've been on We Go Be, but my friend's on untraceptide, she's lost way more weight, I think I should switch over to this, I think that's the better one, or, and to add onto that, what—
Nicole (30:34)
Ha!
Jonathan LeSuer (30:51)
Can you explain to the audience the difference between Wegovi versus ZepBound or semaglutide versus terzepatide and how the GLP-1 and GIP, like all of that.
Megan Piersanti (31:01)
Yeah, so to back up, I think a lot of what I determine with the patient, unfortunately, but fortunately comes down to cost. It comes down to what their insurance will cover, but ultimately it comes down to what I think is best for the patient. If there's a family member connection, and I get a lot of mother-daughters, which I love, right? Not that they're coming in together, sometimes they do, and that's fine, but I get a lot of that, my mom is trying it, and the mom will start talking to me and say, hey, you know what, my daughter, look, reminds me of myself, she's struggling in the same way. I wanna help her more than how I was helped at her age. And it's very delicate, right? With younger women, of course. But nine times out of 10, that daughter is agreeable to it and wants to come in and learn about it. If the mom really did well on one versus the other, I tend to put that patient on the same one, just because I find sometimes they have similar effects or they feel similarly. But if it just comes down, if you just came in and you were like, tell me what you think is best.
Nicole (31:35)
Mm-hmm.
Jonathan LeSuer (31:53)
Mm-hmm.
Megan Piersanti (32:00)
I usually say, hey, if your insurance covers it, we'll go with whatever one is covered first. If insurance is not a concern and they're like, tell me what to take and I'll take it, I'm going towards the ZetBound. And like I mentioned before, it's solely just because patients, unlike you, tend to do better on lower doses and it activates the GLP and GIP. Now that just has to do with what receptors are being activated and where they're located in the body.
Jonathan LeSuer (32:09)
Mm-hmm. Sir.
Megan Piersanti (32:25)
And the new ones that are coming out are actually activating three receptors. So there's more coming out down the pipeline. There's Retatrutide. There is an oral version of Zephound that's coming out from Eli Lilly, actually. There's oral Wigovie that just dropped. I have, I don't want to call them guinea pigs because we've had, we've had Rhebelsis, right? We've had oral semiglutide at 14 milligrams. It's not new, please. It is not new. Ugh, but.
Jonathan LeSuer (32:28)
Mm-hmm. Wee gobee. Wee gobee pill just came out. Yep. It's a daily pill.
Nicole (32:40)
Mmm. Yeah
Jonathan LeSuer (32:52)
Mm-hmm.
Megan Piersanti (32:52)
using Oral Wigovia up to 25 milligrams is new and we have to be so so direct with that, right? We're not, this is not brand new information or brand new medication, but the application is different and the reason why we have higher doses is because they're trying to make sure that the dose that's reached is tolerated, but it's also comparable to what's available in the injectable form. All right, and I could draw a little diagram which I feel that I should, but you could branch off in a million different directions here, right? So now you've got injectable Wigovie, injectable Ozempic, same company, Novo Nordisk, oral Wigovie, right? All the same company, same active ingredient, different absorption, different FDA approval, different application. Mostly similar dosing pattern, but not necessarily for diabetes versus obesity. Then on the other end, you have my besties, Eli, Lily, and I'm not getting paid by them to say this, but I just tend to just vibe with them more.
Nicole (33:48)
lol
Megan Piersanti (33:50)
We've got right now just Monjaro and ZepBound. And a lot of my appointments half the time go into just starting there. Like, hey, what are all these names? What do they all mean? Monjaro's diabetes, ZepBound is obesity. Then you have this new oral version that's coming out. I was told end of quarter one, but we'll see. And then you have these other medications like Reta-Trutide that are still in trials. I just heard from another endocrinologist about another one that's an antibody and it's a once a month injection. So it's a different science, like a different technology, but same similar activation of these other receptors. So again, it's just a lot. And then you have, like I said, the old school Lyric Glutide. It's just, it's more, more options, like more fillers, more, more, you know, toxins. Daxi came out and everybody was like, my God, six months. You start to walk that back when you actually start using it you realize some patients do, are a good candidate for that. Yes. Yes.
Nicole (34:34)
Mm-hmm. Right.
Jonathan LeSuer (34:45)
Some people are unicorns and that does last six to nine months and some for—
Nicole (34:47)
Yep. And the rest are like me and it doesn't.
Jonathan LeSuer (34:50)
the most... my God, stop it. Yeah. But she's also looking at people like that, like...
Megan Piersanti (34:52)
Yeah. But you know those patients who you, A, you're willing. You're willing to try it with certain patients, right? Because A, they're agreeable. B, they need a try of something different. I have a patient who no matter what we do, she tries a ZetBound, sick as a dog. We had her on compounded semiglutide. She was barely barely, she was at like half of the starter dose and was still so, so sensitive. I said, you know what? You're my perfect, perfect patient to try, try oral Wigovie, but just hopping on over into hormones, guess what? She had a hysterectomy. I said, please.
Nicole (35:00)
Right, Mm-hmm.
Jonathan LeSuer (35:01)
Yeah.
Nicole (35:09)
Mm-hmm.
Megan Piersanti (35:27)
let's just talk about it. It is not, I never, never, never tout hormone therapy as the main driver of weight loss, but if you're still willing to try those GLP-1s, please let's try to touch some of your other symptoms with something else, knowing you had that partial hysterectomy. She has one ovary. I'm like, it's not cutting it anymore. You're in your early 40s, let's do both together and just try it. Nothing has to be this, you know,
Nicole (35:48)
Mm-hmm.
Megan Piersanti (35:52)
you're on this for a year guaranteed. If it doesn't work, we'll switch you to something else. And that's what I love about these products coming out. What I don't love is we're sourcing it from places that are not appropriate or we're diving in and just saying, I need that. But they're not changing their nutrition. They're not even understanding if they have insulin resistance to begin with. They don't have any direction as to why they're even using it. John, your reasoning was perfect. You had high cholesterol, right? So yeah, you're not morbidly obese. You never were.
Nicole (36:06)
So, mm-hmm. Right.
Megan Piersanti (36:21)
but it was okay to use it in the way that you did, knowing as an indirect benefit, it would help with your cholesterol. And that's what I think should be the takeaway, instead of advertising this as, don't need to diet or exercise, just pay us for four doses a month and here you get the medication. Don't pay us for medication. Go to your GP if that's all you want, right?
Nicole (36:30)
Mm-hmm. Right. now.
Jonathan LeSuer (36:41)
No.
Nicole (36:43)
Right. Yep.
Jonathan LeSuer (36:44)
And the one thing, and I mean, I was just talking about this at dinner with a friend last night who was also an injector and she noticed she just had to go off of her GLP-1 for two months because she had just had a breast lift augmentation and she's gonna go back on it in a few weeks once she's like more progressing and healing more, just so that way she gets her adequate protein intake. That's why they're telling her to remain off of it. So she heals right, but.
Nicole (37:06)
Mm.
Jonathan LeSuer (37:08)
She's noticed she's like, my God, I feel bloated again. I feel like when I was on it, I felt like my body was more like an hourglass. My face was less puffy. And that's something that I feel like over the past year, people tell me all the time, like, Johnny, you just look so good. Like your face looks so good. Like you're you don't look. It's just like you're more like like contoured and like less inflamed. I'm like, yeah, like and like my pants feel better. Like I'm less bloated. I used to have to after I ate on my fucking pants on the way home just so I could—
Nicole (37:23)
Mm-hmm. Yep.
Megan Piersanti (37:37)
Mm-hmm.
Jonathan LeSuer (37:38)
of like, just so can breathe. I eat a meal now and I don't have to do that. Like it's helped with food sensitivity. You know, there's just so much that it does. And I just, just fricking love the medication so much. I think I feel like my, my rings fit better in my hands cause I'm less inflamed.
Megan Piersanti (37:56)
Well, it's important you say that, and you guys are injectors, this is all you have, right? I've heard, I don't, none of this, like, asterisk this, this is not proven medical, right? We don't have this in studies, but anecdotal observational data, in my opinion, still matters, and as clinicians, this is what guides our clinical practice. You ask anybody, right? You know what works and what doesn't based on your experience. I've heard of improvements in joint pain, improvements with sleep, improvements with energy, improvements with...
Jonathan LeSuer (38:00)
Mm-hmm. yeah yeah yeah. No. Anecdotal.
Nicole (38:15)
Mm-hmm.
Jonathan LeSuer (38:17)
Right.
Megan Piersanti (38:25)
Some patient was like, Megan, have you had anyone say that they have OCD clinically diagnosed and their thoughts have improved? And I said, you know what, no, but it makes sense to me. It does it because it all is connected to that thought process, right? And we know that it impacts that. So the bloating, the GI symptoms, patients sometimes they have chronic idiopathic constipation. They're like, I'm terrified to do this because I'm afraid it's going to make me worse. I have had patients say that it's made them more regular.
Jonathan LeSuer (38:29)
Mm-hmm.
Nicole (38:34)
Hmm.
Jonathan LeSuer (38:39)
Mm-hmm. Mm-hmm.
Nicole (38:50)
Mm-hmm.
Megan Piersanti (38:53)
coming from both sides of the spectrum. Anyone with Crohn's, IBS, thyroid, Nicole Hashimoto's, like it can do all of those things. And again, if it's used correctly.
Nicole (38:58)
Mm-hmm.
Jonathan LeSuer (39:04)
Have you heard of the GLP bonds or GIPs causing anxiety?
Megan Piersanti (39:09)
So there are some warnings if you look at the labeling about suicidal ideation and, you know, thoughts of harm to others and yourself. You have to be mindful of that because if we think about when you take away something like food noise, and I'm just being very general about this, patients have noticed and they're definitely, there's starting to be conversations about it being used for alcohol use, right? Gambling, any addictive behaviors. When you take that away,
Jonathan LeSuer (39:33)
Yes, yes.
Megan Piersanti (39:37)
you're calming what that person probably used as like a dopamine hit for a lot of their life. So I do see patients, especially with libido, I warn them, I say, if you're already coming into me with low libido and it's impacting your marriage or your partnership or your relationship, and now we're giving you something that might calm down some of that drive, we have to be so careful, right? Especially if we're toning down energy too, because we're not eating enough or we're not.
Jonathan LeSuer (39:43)
coping mechanism.
Nicole (40:00)
Mm-hmm.
Megan Piersanti (40:05)
you know, moving our bodies. I, a thousand percent, I do see that. Imagine someone that has a lot of side effects, a lot of vomiting, a lot of diarrhea, malabsorption. They're not getting enough nutrients, right? Not enough vitamin D, not enough ferritin, not enough iron stores, really. Those are all affecting your mood, right? So indirectly, you have to know that going into this.
Nicole (40:22)
Mm-hmm.
Jonathan LeSuer (40:25)
So maybe more depression in like low libido potentially, but not as much maybe anxiety that you've been seeing.
Megan Piersanti (40:31)
Anxiety, I've had a couple patients tell me they've had tachycardia, like they've felt palpitations when they first started it. And that is actually a side effect that we know can happen. So I think it's really important again to educate about the time of the day, yeah.
Nicole (40:37)
Mm.
Jonathan LeSuer (40:37)
Okay. Sure. I actually had that when I switched
Nicole (40:44)
Mm-hmm. Do you think that do you think that has anything to do with like dehydration?
Megan Piersanti (40:50)
I don't, listen, yes, right? If John started taking it and he's vomiting, having diarrhea, or just not drinking or eating enough because he's not thinking about it, duh, right? Like, yes. But if he's doing all the things and he's still getting that tachycardia, that is a known side effect. It's usually during initiation of therapy. But the worst thing you can do is tell someone, it's not from that, there's no way. I'm like.
Nicole (40:57)
Great.
Jonathan LeSuer (40:59)
Ciao.
Nicole (41:02)
Right and still having that.
Jonathan LeSuer (41:02)
Mm-hmm. Mm-hmm. Yes. I feel so much better.
Nicole (41:12)
Right, right. You feel like, like...
Jonathan LeSuer (41:14)
Cause when I switched over to Wegovi three and a months ago, I started having a little bit of like heart palpitations or whatever. And I gave it a few days and ended up resolving and I haven't had it since and my heart rate's always 60, 70s, you know, pretty low. I...
Nicole (41:22)
Mmm. Yeah, I do remember you telling me that.
Megan Piersanti (41:31)
And a lot of women and men with the aura ring, notice it. They'll tell me like my HRV has changed. My average heart rate has changed and they don't even notice it. So as much as I love...
Nicole (41:34)
Yes.
Jonathan LeSuer (41:38)
Mm-hmm. I literally went upstairs to check my blood pressure and Corey's like, what are you doing? And I'm like, check my blood pressure. My heart is racing. I don't, think I'm dying. Like, do I have a PE? Like we had just traveled. I'm like, oh my God, feeling, do I have calf pain? Do have calf? And then he's like, you are crazy. And I checked and I'm like, my heart rate's 94. This is not normal for me. Like, but.
Nicole (41:44)
I think I'm dying. This is not me. Yep.
Megan Piersanti (41:57)
But it's good to be aware of that. And I think the best way, yeah, and like all kidding aside, not to sit here and sell ourselves even further, guess what? A patient who's checking in every month with their provider can get those validating, that feedback, right? Versus someone who's like, I don't know, I just, I take patients all the time who are seeing a regular clinic, like a regular insurance-based model doctor or practitioner, PANP, it doesn't matter. And...
Nicole (41:59)
Mm-hmm. Right, yep.
Jonathan LeSuer (42:00)
That's good to know.
Nicole (42:09)
Yes. Yep.
Jonathan LeSuer (42:12)
Yeah. Right.
Megan Piersanti (42:24)
they're not given what I'm giving them. Or I'll get a lot of women who'll come in and say, you know, my husband's using this and they don't hear or tell me about any of this. Can he see you? I'm like, absolutely. So a lot of them are already using the medication, but guess what? It's not just about the drug. It's about everything else that you can use to your benefit if you're informed. And that is what you're not, that's what you're paying me for. You're not paying me for a prescription.
Nicole (42:33)
Mm-hmm. Right. Yeah.
Jonathan LeSuer (42:38)
Mm-hmm.
Nicole (42:42)
Right?
Jonathan LeSuer (42:43)
but What I love, and that's what I love about you, is that you're well informed and you're so educated. Other people might be offering the services and someone might ask that question and they don't know, or they say, no, it doesn't cause that. And then they're like, they're still anxious. like, God, is something wrong with me? And then they'll go and they'll get all these tests. But really, like you said, initiation of therapy can sometimes cause a little heart palpitations, but usually resolves over the next couple of months or whatever.
Nicole (42:50)
Yes. Mm-hmm. Mm-hmm.
Megan Piersanti (43:14)
And it's okay if you don't know, right? As a clinician, like we don't know everything. And guess what? The only way I've learned this, yes, is 100%. The only way I've learned this stuff is A, because it's all I do. I eat, sleep, drink, breathe, podcasts, you name it, all the time. But I had to find that community. I, and Nicole Mel, hear me talk about this, everyone who works at Exhibit, I don't have, you know, a peer with me in the office. Obviously, someday I would love to grow to have that.
Nicole (43:16)
Right. Mm-hmm. Yes. Yes, yep.
Jonathan LeSuer (43:17)
But ask. have a community. Yes.
Nicole (43:27)
Mm-hmm.
Jonathan LeSuer (43:29)
Mm-hmm.
Nicole (43:38)
Right. Mm-hmm.
Megan Piersanti (43:42)
but it's hard to find people that are doing what I'm doing. It's almost like you guys when you first started injecting, it's hard to find that community if you don't look for them. Had I not found them online and got my way into some of these mentorship courses and joined this community, I would feel very lost and the only way to find these communities is looking for it and not just acting like you know it all and saying, well, there's no way, right? I had to look for these answers and also learn from my experience with patients if they reported symptoms back.
Nicole (43:56)
Mm-hmm. Right. Right. Yep.
Megan Piersanti (44:10)
jotting them down and making connections and saying, hey, I'm seeing this in a lot of patients, like there's gotta be a connection.
Nicole (44:11)
Mm-hmm. Right, yeah. Meg, I have two questions. Kind of going back to, True Tide you had brought up. I, and I'm sure a couple of people listening might know who I'm talking about, but there's someone like a creator on TikTok who said that she was taking that and it was from, you know, she's up and down. was from a reputable physician.
Megan Piersanti (44:18)
sure.
Nicole (44:37)
And she had really bad side effects on it and whatever it may be. And I think it's important to just talk about, right? Like even though she's seeing a reputable physician, again, it's not FDA approved. So we don't know where it's coming from. It's still in trials and kind of like touching on that and other peptides, you know, their safety and efficacy and all of that.
Megan Piersanti (44:55)
Absolutely. Yeah, so I actually attended an A4M conference in September 2023 and what was beautiful about it was this is when peptides were still available via compounding pharmacies. So it was, I was learning about all these peptides for gut, for injectable, intranasal, oral peptides, right? Those are usually the three main ways. We were learning about PRF and hair restoration and under eye and skin rejuvenation and gut health and—
Jonathan LeSuer (45:19)
Mm-hmm.
Megan Piersanti (45:23)
all these applications, right? And it was amazing. I was overwhelmed with information. I bought all the books, which I gave to Kevin. I'm like, this is just, wow, this is a lot. And how did we not learn about this in school? This is crazy. That weekend they pulled, they made an announcement the FDA was pulling peptides from, you know, approval. And it was mostly because they were noticing there were enough reported side effects and they realized there were not enough studies.
Nicole (45:29)
Yeah. Mm-hmm.
Megan Piersanti (45:47)
What's happening now is you're noticing that it's exploded again. I think part of it, and we're not getting political here, but the new administration did mention that they were going to list that as a priority, right? So obviously that brings things to the surface. What you're seeing now is some clinicians are still choosing to prescribe it, even if it's coming, as you said, from research-based sources, compounding pharmacies who are willing to take the risk and still create them, or they're just using it from, you know, they're, going into that gray area and they're willing to provide it. And I don't really have a comment on whether or not that's the best thing for them. I think you have to look at your state guidelines, right? Your Board of Pharmacy and all your different state guidelines for nursing practice as well and make sure you see what's going on in your state for trials and what's happening legally. But I also think it's important to understand, are you actually optimizing the opportunity for that peptide to do what it's supposed to do, right?
Nicole (46:19)
Mm-hmm. Mm-hmm. Mm-hmm.
Megan Piersanti (46:44)
GLP ones are peptides, Reta-Trutide is one of them. But there's other peptides out there like BPC, CJC, ipimoralin. I personally used to prescribe them because they were available and I saw that they worked for tissue healing, tendon repair, gut repair. But the problem now is they're not technically allowed to prescribe and that's something that you have to console. We're so lucky to have Langea with us, but you have to be willing to talk to legal.
Nicole (46:53)
Mm-hmm. Mm-hmm.
Megan Piersanti (47:12)
a mentor, all the clinicians you're working with, and not only understand what they're doing, but really be confident that they're going to provide the benefits that you're touting, right? Having your consents in order and counseling the patient. Most of my patients, yes, malpractice. And it's your responsibility as provider to not advertise it as this magic juice. You're seeing it advertised as it's gonna change your life and then you talk to the patient like, well, I still like to go out and drink five to six times a month.
Nicole (47:12)
Right. Right. and checking with your insurance company. Malpractice, yep. Mm-hmm.
Megan Piersanti (47:40)
Even once a week at this point, they're not going to the gym, they're not eating whole foods. It's okay, there's no judgment, but do not waste your money. These peptides can be very expensive, very unstable. Everyone's combining into these stacks. You'll see stacks of like three to five peptides. Do you even know if those are now stable in that one vial? That's where, and these health coaches, again, nothing against them, but non-licensed providers right now, they're exploding because they don't have anything to lose and they can make...
Nicole (47:45)
Mm-hmm. Right, yep. Right, right. Mm-hmm.
Megan Piersanti (48:10)
claims and they don't get the same backlash that we would get as a clinician if we were to make certain claims, right? Because that's the license we signed. We have these agreements that we sign when we become providers and we provide prescriptions. It's tough.
Nicole (48:22)
Right. Yep.
Jonathan LeSuer (48:23)
Have you had to deal with, I know in the injectables world, we've had to deal with a lot of patients, I hate saying deal, but we've had to address a lot of issues with people being scared of filler, that filler fear, they're scared that they're gonna look fake or not like themselves. Have you had anybody coming in fear mongering over these GLP ones or hormone replacement therapy that you've had to talk them off a ledge or maybe just, you know.
Nicole (48:37)
Mm-hmm.
Jonathan LeSuer (48:52)
go over certain myths versus facts with them. Yeah.
Megan Piersanti (48:56)
Absolutely, and just similar to you guys, remember, no one's coming in. We're not pulling these people off the street, okay? They are willingly coming in, but it is okay to have your qualms and things that are holding you back. And I think the fact that patients are willing to be honest with you guys in the chair means that they trust you and they're just looking for that support. So instead of us attacking them and saying, how could you say that? They're looking for education and I think that's, right? It's a safe place, so.
Nicole (49:01)
Right. Mm-hmm.
Jonathan LeSuer (49:01)
Mm-hmm. Yep.
Nicole (49:10)
Mm-hmm.
Jonathan LeSuer (49:17)
yeah, of course. They are.
Nicole (49:21)
Right.
Megan Piersanti (49:21)
I don't find, to be honest with you, I don't find it's happening as much with GLP-1s anymore because the media, in a good way, has really done a mostly decent job lately about the benefits. Yeah, for a while there, like my parents were like, you know, you're hearing more about those GLP-1s and it's causing bowel perforations and pancreatitis and all the, and it's ruining fertility and crazy, right?
Nicole (49:26)
Mm-hmm.
Jonathan LeSuer (49:32)
It shed a really good light on it. Yeah. It was.
Nicole (49:34)
Yes. Yeah. yeah. Uh-huh. Well, I remember Kevin went on it for his, he's pre-diabetic and we just cannot get his A1C down and he went on it for that. And I remember my mom finding out he was on it she's like, why is he on that? He doesn't need to lose weight. Like that's crazy. And I'm like, that's, it's not right, right. Right. It's not for weight, right. Right.
Jonathan LeSuer (49:57)
and you're like, it's not for weight loss, yeah. And that's what I tell people about my cholesterol. They think, I'm like, guys, it's not, I'm not losing weight. I've stayed at 176, it's—
Megan Piersanti (49:58)
Right. Right. But, but now... It's
Jonathan LeSuer (50:07)
great.
Megan Piersanti (50:07)
shifted now, I don't wanna call it fear, but the counseling I've noticed is now with my women, very, very heavy on hormone therapy. And we could go on for 10 hours, which we're not going to do. But the moral of the story is there's a lot of lack of education from your providers who are more experienced, myself included, when I came out. The education we received in our schooling did not match what's happening now.
Nicole (50:11)
Mm-hmm.
Jonathan LeSuer (50:18)
Are people scared to go on hormone therapy?
Nicole (50:23)
Mm-hmm.
Jonathan LeSuer (50:23)
Sure.
Nicole (50:33)
Mm-hmm.
Megan Piersanti (50:34)
due to the WHI. It's the study that ended early, came out in 2001. If you actually read through the study, it was really to see if initiating hormone therapy would help prevent cardiac, poor cardiac outcomes. So the intentions were great. They ended it early because when they pulled out some data prematurely and there's a difference between absolute and relative risk, all you need to know is...
Nicole (50:51)
Mm-hmm.
Megan Piersanti (50:59)
They hosted a press conference. were like, we ended the study. was causing breast cancer. It caused mass chaos. If you look at the study now and you actually understand how to interpret the statistics and the data, and they've rerun through this multiple times now, there were a lot of good outcomes that came from it with colon cancer and other cancers that it helped actually prevent. But you also have to look at the hormones that were used. They were using hormones that we really don't use anymore. They were not really using bioidenticals like we do now, right? And bioidenticals could be a whole other conversation, but all that matters is they're synthetic.
and there's ones that your body recognizes as identical, that the main difference. They were using mostly synthetic hormones in that study. And they also didn't pick the correct study groups. So they picked women who were already in their 70s and 60s and maybe already had other things that could increase their risk for breast cancer. Some had been on hormonal birth control for years, others hadn't. They didn't really control the groups well enough, which is still now to this day causing a lot of fear and lack of...
Jonathan LeSuer (51:49)
Mm-hmm.
Megan Piersanti (51:55)
you know, what's the word, the courage in providers to prescribe it. And as soon as they hear family history of blood clots, family history of liver disease, family history of breast cancer, it's like they get a hard stop. And they're telling them you're gonna get breast cancer if you do that. I've had patients call me and say, Megan, my primary care doctor found out I was using a estrogen patch, which is bioidentical, transdermal, not going through the liver, not going through first pass metabolism, not changing risk for clot at all above baseline.
Nicole (52:02)
Mm-hmm. Yep. Mm-hmm.
Megan Piersanti (52:24)
She literally told her, you are going to get blood clots from that. Rip that off your leg now. Not even bothering to try to talk to me. Yes, and so I do get those patients who have factor five light in, like have clotting risk, right? Or they have a family history of breast cancer, or they had a personal history of breast cancer. Hormones, again, just like everything else that we do, they're not black and white. There's so many tears.
Jonathan LeSuer (52:29)
Mm-hmm.
Nicole (52:30)
Yeah, it's great. Like the miseducation,
Megan Piersanti (52:50)
to what you can offer. There's vaginal estrogen that's localized. There's systemic hormones. There's synthetic hormones. There's pills, patches, sprays. Pellets don't get me started. But there's so many ways of delivering this medication or this hormone that can change your risk profile but also your benefits. And you need to speak with someone who's aware of all this.
Jonathan LeSuer (52:51)
Right. Let's talk about nicotine because nicotine has been in the media, I feel like a lot. Well, because I've had a few patients that have come in with nicotine patches and they are reading that it's actually helping to increase their cognitive function. There might be, I don't know if anecdotal studies or data that's showing that it's decreasing risk for dementia or Alzheimer's is helping with focus.
Nicole (53:15)
Why do you wanna talk about nicotine, John? yes.
Jonathan LeSuer (53:39)
So what do you have to say about that, Meg?
Megan Piersanti (53:44)
Not much. I only because personally it hasn't hit me yet. Like it, I don't want to speak on it if I don't, I haven't experienced it yet, but I also have seen that in some of the communities. But what I will say is remember decades ago, doctors were recommending smoking nicotine, smoking cigarettes to their patients. Right? So I'm not about to be out there yet recommending nicotine patches, but what I can say is the delivery route matters, right? A transdermal delivery versus you smoking something completely different. So if they're
Jonathan LeSuer (53:45)
Hahahaha
Nicole (53:49)
you
Jonathan LeSuer (53:50)
Heh.
Nicole (53:57)
Mm-hmm.
Jonathan LeSuer (54:00)
Mm-hmm.
Nicole (54:03)
Mm-hmm.
Jonathan LeSuer (54:08)
Mm-hmm.
Nicole (54:13)
Mm-hmm.
Jonathan LeSuer (54:13)
Mm-hmm.
Megan Piersanti (54:14)
making that connection between the benefits of nicotine and the fact that it's being delivered through a patch and they're not inhaling it. Okay, even the Nicorette gum, right?
Jonathan LeSuer (54:19)
Mm-hmm. Well, who is that doctor? Is it Dr. Peta Atea? Is that his name, Dr. Atea? Yeah, because I think my husband watches a lot of his podcasts and a lot of his videos, and he just talked about nicotine. He was saying, I don't recommend it all the time, but it's definitely not bad for you to go on a nicotine patch if you're looking for more focus. If you don't have anxiety, because it...
Megan Piersanti (54:25)
Yeah, Tia, yes.
Nicole (54:39)
Mm-hmm.
Jonathan LeSuer (54:46)
Nicotine is a stimulant, so it can increase your anxiety symptoms or tremors or whatever you have. But if you don't have anxiety but you're looking for more focus or more cognition clearing aspects, then consider going on it. And honestly, he said that there are potential studies in the works that could show that it could help decrease Alzheimer's and dementia.
Megan Piersanti (54:48)
Yes.
Nicole (55:05)
Interesting. Wow.
Megan Piersanti (55:08)
I think, and this is an example of, if someone came in to me and we did their full consultation, because that's the way I start everyone, they come in, they do their blood work, it's a full panel. If they're not on birth control and they're not in menopause, I say, come in at a certain time of the month, let's do your hormones along with everything else and we'll do a deep dive, right? They come back, we review their labs. Now, if someone's complaining of what you just said, like the lack of focus, the brain fog, they're concerned about their Alzheimer's dementia risk and maybe they're concerned about their bones and their sleep and their anxiety and their mood.
Jonathan LeSuer (55:23)
Yeah. Mm-hmm.
Megan Piersanti (55:37)
I'm going to make sure their hormones are optimized first. I'm going to ask, are you willing to talk about hormones? Because guess what? You're a great candidate. Maybe you're perimenopausal or maybe they're already menopausal. I'm gonna go that way first, right? But I'm also going to talk about nutrition and supplements, not going crazy, but making sure they understand like, we've identified in your labs, which are a snapshot of time, but we've still identified there are other things you can work on. I think you should try hormones too. Hey, maybe have a little bit of insulin resistance. Do you wanna try metformin? Do you wanna try a GLP-1?
Jonathan LeSuer (55:40)
Sure.
Megan Piersanti (56:06)
Do you wanna try low dose naltrexone because you're feeling like you have inflammation and maybe a chronic autoimmune condition like a fibromyalgia, chronic pain. But if we do all of that and they're like, hey, I'm still finding I have difficulty focusing and a lot of those other things and they want to try it, probably gonna tell them, go ahead and give it a shot, give it some time and if it makes you feel better, great. And if it doesn't, take it off.
Nicole (56:29)
Mm-hmm.
Megan Piersanti (56:29)
but that's
Jonathan LeSuer (56:30)
Great.
Megan Piersanti (56:30)
why it's so important to work with someone who's following you along that journey. If you went to your GP and asked them that in one appointment and then you don't see them again for like a sick visit or a year later or a cholesterol medication management, are you really going to be able to follow up with all these things? And is the provider honestly going to remember all that unless they have the time to write it all down? That's why the journey, I would be confident doing that because I'm going to see them every month for six months and then I see them quarterly. So we do have the time to talk about those.
Jonathan LeSuer (56:40)
Mm-hmm. Right.
Megan Piersanti (56:59)
little things that are nice adjuncts. There's C-LINK and C-MAX that are intranasal peptides that used to be really good for those. Same thing, was I gonna throw C-LINK or C-MAX at someone without discussing anything else? No, because if they're ferritins of six, they're iron deficient, right? Like they need that first, and then we're gonna build on with those other things. that's why, and patients do come in to me with that all the time, they're like, Megan, you're gonna hate me for asking this, but what do you think about...
Nicole (57:01)
Mm-hmm. Mm-hmm. Mm-hmm.
Jonathan LeSuer (57:19)
Mm-hmm.
Megan Piersanti (57:26)
this or that or NAD, I'm like, listen, if you're still out drinking or if you're not getting enough sleep and you're sleeping five hours a night or you're still smoking cigarettes, if you're doing other things we need to fix, do not ask me to put you on that. It's not, you know, I wanna get your cancer screening under control. If you're 60 and you haven't had a colonoscopy, turn your butt right around and we're going there first before we dive into shooting NAD in your arm. You know, it's all, and that's our job to do that.
Nicole (57:28)
Well, yeah.
Jonathan LeSuer (57:41)
Mm-hmm.
Nicole (57:44)
Before anything. Yeah. But,
Jonathan LeSuer (57:46)
Yeah.
Nicole (57:52)
and I think it's important to like, again, seeing a clinician like you instead of a, you know, your normal physical or things like that, because I think if you were to bring up that question about like a nicotine patch, they probably would just kind of laugh it off, you know? Whereas someone like Megan would take the time to really be like, you know what, let me look into this. There's some research behind it. Like, let's just see, let's optimize other things first and then maybe we can go that route. But.
Jonathan LeSuer (58:03)
They would.
Jonathan LeSuer (58:16)
That's really good point though you made about NAD and like you said, you have to look at their age and make sure that they've gotten all their screenings done to make sure that their cancer risk is lower, they're cancer free, or make sure their lab work is all good before starting them on NAD because as we know, NAD can, it fuels your mitochondrial cells, so it can stimulate new good cells. Growth, it's growth, growth of anything, good cells and bad cells.
Nicole (58:17)
Mm-hmm
Megan Piersanti (58:36)
Growth, growth.
Nicole (58:37)
Mm-hmm. Right. Right.
Megan Piersanti (58:41)
Same with peptides, they literally stimulate growth. that's again, patients are like, I wanna try CJC, I wanna try Samoralin. It's like, okay, but are your screenings under lock? Like are you engaging in other activities that do increase your baseline cancer risk? That's really important. And I think the other thing to capitalize on, what we talked about optimizing everything else is building a referral network. I don't do everything. I am not a one size fits all. If someone's mental health is in the toilet, I have a mental health, you know, a therapist that I tend to refer out to. I have a network that I joined.
Nicole (58:43)
Mm-hmm. Right.
Jonathan LeSuer (58:50)
Right.
Nicole (58:54)
Face your Mm-hmm.
Megan Piersanti (59:11)
in the fall, which was super exciting. I worked with the physical therapist personally for my daughter and they formed a collaborative network. So now I can refer out and say, work on this at the same time. I cannot provide therapy for you, right? Like mental health therapy. I might not be able to provide pelvic floor therapy, but I know someone who does and we can work together to achieve that common goal. Instead of you getting sent out with a list of referrals, you know, at the end of your appointment and there's no conversation about what they can do for you.
Jonathan LeSuer (59:24)
Mm-hmm.
Nicole (59:25)
Mm-hmm.
Jonathan LeSuer (59:29)
Mm-hmm.
Nicole (59:35)
Right. Or where to go. Yep.
Megan Piersanti (59:40)
So everything should be built upon, I know you guys do the whole cake analogy, right? It's not just filler, it's not just Botox, it's not just skincare. There's a reason why you guys refer to your estheticians for certain things, right? Because everybody plays a part in making you who you are and it should be the same internally. I refer patients back to GI sometimes. Yeah, there might not be functional medicine GIs that I'm referring to or oncologists or hematologists, but they still play a part. I say you need to get these things addressed first.
Nicole (59:44)
Mm-hmm.
Megan Piersanti (1:00:09)
I can still work with you. I hope they're on board with what I'm offering. If they're not, it's still your decision, right? It's informed consent and it should be shared decision making. So I hate to feel like with hormones especially, there's this like, I'm against the surgeons, I'm against the OBGYNs, I'm not. I'm just willing to really go into it and they might not be. And if they do get pushback, I say to the patient, hey, here's some guidelines. Bring it with you to your next appointment. And it's not in a nasty way. I give them my card, call me. It should be shared decision making.
Jonathan LeSuer (1:00:17)
Mm-hmm.
Nicole (1:00:17)
Mm-hmm.
Jonathan LeSuer (1:00:23)
Mm-hmm. Mm-hmm.
Nicole (1:00:32)
Right. Yep. Collaborative. Yes. Mm-hmm. Right.
Megan Piersanti (1:00:38)
but trust the person, yeah, trust the person that this is all I do. So I go to the conferences, I'm in the mentorship groups, you I follow the practitioners that are doing this all day every day. Instead of, you know, hitting up an influencer that has an MLM affiliate to a peptide company, that's, it's scary.
Nicole (1:00:52)
Right.
Jonathan LeSuer (1:00:54)
Oh, it—
Nicole (1:00:55)
Yes, yes, it's so true.
Jonathan LeSuer (1:00:56)
is scary. Especially some of these influencers or I don't know, I don't want to name names, but there's just one recently that just literally shared that she's doing that. Like she owns her own med spa, but then she's partnering with like a company that has doctors and you could purchase peptides through this doctor. And I'm like, oh, I'm like.
Nicole (1:01:09)
Mmm.
Megan Piersanti (1:01:11)
Yes. Yes. But
Nicole (1:01:13)
Yeah. Yeah.
Megan Piersanti (1:01:14)
what's scary is that company, and they've reached out to all of us, they're trying to tell these non-clinicians that there's zero risk associated because they're not the ones directly supplying it. They're even trying to pull in clinicians to say, hey, we're connecting the patient with a doctor. There's zero risk associated with what you're doing. I'm still referring that patient to someone, right? So it's a trust thing.
Jonathan LeSuer (1:01:29)
That's really scary.
Nicole (1:01:36)
Right. Mm-hmm. Yep.
Jonathan LeSuer (1:01:37)
Mm-hmm. Mm-hmm. Right.
Megan Piersanti (1:01:39)
Again, as clinicians, just seems like we have a lot more to lose. I think I'll be just fine doing what I'm doing, consulting with legal as needed, consulting with my medical director and my peers. know, what's great about Mel and Nicole is they're not in this field, but they have the experience in being solo providers and they have a network too. So the more that we work with each other as opposed to against each other, I try to reach out and network with my local OBGYNs and like I said, my pelvic floor PT that I referred to and my therapist.
Nicole (1:01:43)
Right.
Jonathan LeSuer (1:01:45)
I agree. Yeah.
Nicole (1:01:47)
Mm-hmm. Yep. Mm-hmm.
Megan Piersanti (1:02:10)
Moms are a great network. I go on these mom groups on Facebook sometimes, and I do look and see who they're talking up and who they're not talking up, because you have to work with reputable people, not people that just see dollar signs. And for us, sometimes charging cash, we appear to be greedy. We're really not. We're just trying to provide better care than if you did try to go through some of the older models of care. And I really...
Jonathan LeSuer (1:02:12)
Yeah, they are.
Nicole (1:02:18)
Mm-hmm.
Jonathan LeSuer (1:02:21)
Yeah.
Nicole (1:02:27)
Mm-hmm. Right. Absolutely.
Megan Piersanti (1:02:35)
I try to hit that home. Sometimes it's hard before I meet a person, but once I do, they're like, she's just, you know, she wants to be thorough and wants to chit chat for an hour instead of 20 minutes, right?
Nicole (1:02:42)
Right? Right.
Jonathan LeSuer (1:02:44)
Mm-hmm.
Nicole (1:02:45)
Yeah, which is so important. Well, this was great, Meg. Yes, very informative. And I just wanted to hit, like, before we close out, like, you also, there's so much you can do just looking at a panel of labs and even myself, right? I don't take hormones. I have not done a GLP one, but I've worked with Meg so closely and she's taken care of my thyroid and she's optimized my vitamin D levels and...
Jonathan LeSuer (1:02:48)
This was amazing. What a great episode. Yeah.
Nicole (1:03:11)
and all these things that could play a role in making you feel foggy and tired. there's a lot of other, I guess, I don't know, more holistic or just vitamin-based things you could be doing. Mm-hmm.
Megan Piersanti (1:03:21)
Yeah, it's things that you can do at home. And that's where I also remind patients, don't have to work with me for a prescription. And that's where I kind of built out this primary care. John, I have like a three tiered primary care program now where my healthy men and women who maybe don't need medication or prescriptions, but they want the occasional sick visit. They want to do their labs quarterly or every, you know, twice a year and see how their vitamins are. Yes. So that's, yeah, I still think there's a need for that too. And that's kind of why I built that out.
Nicole (1:03:54)
and actually understand the labs, right? Actually understand them, yeah. Mm-hmm.
Jonathan LeSuer (1:03:58)
I love that.
Nicole (1:04:00)
Yeah.
Megan Piersanti (1:04:00)
where they don't have to feel like, well, Megan, if I don't need a prescription, how do I work with you again? That was a big question I kept getting. Can you be my primary care? I mean, technically, yes, but I don't have the infrastructure right now. I didn't build it. So what do we do? We built it, right? And the other exciting thing's coming is, and you guys are big proponents of this, is I would love to educate further and just provide mentorship to other clinicians because I think that's important. Yes, I'm licensed in New York. Yes, I'm licensed. Yes, yes.
Nicole (1:04:13)
Right. Mm-hmm. Yep. Mm-hmm.
Jonathan LeSuer (1:04:20)
Can I do a virtual? Can I do a virtual consultation because... you are? my God, that's so cool.
Nicole (1:04:23)
Yeah, absolutely. She is. She's licensed in New York. Yeah.
Megan Piersanti (1:04:30)
Yup. Yup.
Jonathan LeSuer (1:04:30)
my God, I would love to do that Rupa thing and the Rupa thing. I'm sounding so... I would love... So clinical I'm sounding, but I would love to do my Rupa lab work and...
Nicole (1:04:33)
Mm-hmm. Yeah. So clinical. Yeah.
Megan Piersanti (1:04:33)
Yeah. You Yeah.
Jonathan LeSuer (1:04:44)
learn more and talk more with you. Because
Nicole (1:04:44)
That's what we did with mine. Yep.
Jonathan LeSuer (1:04:46)
I'm not gonna lie to you, I take those vitamins from that company, what's it called? Pure Encapsulations, and I'm doing the men's formula, but I'll be honest with you, it would be nice to kind of just get a whole list of anything that I'm low on, and maybe I don't need to be on some of these things. You know what I'm saying? What if I have iron overload? And what is it called? Hemochromatosis? What if I have something like that, and I'm taking iron and I don't need it?
Nicole (1:04:50)
Yeah. The peer encapsulations, yes.
Megan Piersanti (1:04:51)
Pure encapsulations.
Nicole (1:04:57)
Mm-hmm. Right, right. No, and it's a possibility, yep,
Megan Piersanti (1:05:05)
Right, right, yeah. And
Nicole (1:05:12)
you
Megan Piersanti (1:05:13)
even my out of state patients, I've had a lot of patients reach out to me from listening to you guys and just from meeting me through social media and they're like, can you work with me even though I'm out of your states that you're licensed in? I can provide educational calls, which I also now offer that, right? So there's no prescribing, no official medical, anything, right? No labs, nothing, but giving them that direction. I have a referral network now because of some of the programs I've been a part of, that's important.
Jonathan LeSuer (1:05:23)
You're perfect, yes.
Nicole (1:05:24)
Mm-hmm.
Jonathan LeSuer (1:05:28)
That's great. Right.
Megan Piersanti (1:05:35)
But I do think just doing what you just said sometimes is so beneficial to patients. And then they know what they're working with and they don't need to feel, that's why telehealth is great.
Nicole (1:05:38)
Mm-hmm.
Jonathan LeSuer (1:05:40)
Sure.
Nicole (1:05:42)
Right?
Jonathan LeSuer (1:05:43)
Well, I get anxious
Nicole (1:05:45)
Yep.
Jonathan LeSuer (1:05:45)
because I see some of these people that look so amazing and they're on these supplements and I'm like, fuck, I need to go on CMOS. Fuck, I need to go on this. And then I like start it and I'm like, wait, is this, do I do, should I be on this or is this, the Armra? The Armra, that gave me diarrhea. Like I could not deal with it. I clearly, have like a, honey, it's not well. I clearly have some,
Nicole (1:05:51)
I need some sublets. Do I need this? Yeah.
Megan Piersanti (1:05:58)
Well, the colostrum has just taken the colostrum, the collagen. It's like they're, yes.
Nicole (1:06:01)
I get with you. Yeah, it really has.
Megan Piersanti (1:06:08)
Your poor stomach has been through a lot. For beauty.
Nicole (1:06:13)
Ted. my god. Well, do our gut test. That's another thing. Sensitivity, yes,
Jonathan LeSuer (1:06:13)
I have some gut food stuff and Cory says that all the time. He's like you have food No, I want the gut and I want the rupa
Nicole (1:06:21)
yep. And I'm telling you guys, we really, if you're looking for something like that, like, you know, getting supplements that are tailored to you, knowing what's going on with your body, also looking at the gut. even for me, and we're gonna close in a second here, but like migraine prevention, like I've been dealing with these migraines postpartum and Megan's been able to look at my hormones and kind of work.
Megan Piersanti (1:06:22)
Do it.
Jonathan LeSuer (1:06:27)
Mm-hmm.
Nicole (1:06:41)
We're kind of trying to figure out what might be triggering them. And there's so much you can do that's not just GLP and weight loss and things like that. So it's a really exciting time. Mm-hmm, yep. Right. Right. Right. Mm-hmm.
Jonathan LeSuer (1:06:44)
Yes.
Megan Piersanti (1:06:48)
And there's no age. Yeah, it's not like, okay, Nicole, well, I'll see you in 20 years when your periods are gone to 40 years. There is no hard and fast. If they can hand you a birth
Jonathan LeSuer (1:06:48)
It's amazing. Yeah.
Megan Piersanti (1:06:58)
control pill, then we have the right to talk about hormones and what they're doing. So especially postpartum.
Jonathan LeSuer (1:06:59)
Yes.
Nicole (1:07:01)
Absolutely, absolutely.
Jonathan LeSuer (1:07:02)
So Meg, where can people find you?
Nicole (1:07:03)
Yes.
Megan Piersanti (1:07:06)
So I changed with my rebrand. I am no longer Meg Aesthetic because your girl is not doing personally anything aesthetic to my own face, because God forbid I have time to do that. But also I just don't offer laser and Botox anymore. So I'm Megan Persanti underscore NP on Instagram. I am hopefully coming out with a Patreon soon. I would love to provide mentorship that way, just with like things that I think are.
Jonathan LeSuer (1:07:09)
Mm-hmm. Yeah that's really exciting.
Nicole (1:07:31)
Mm-hmm
Megan Piersanti (1:07:33)
you know, day to day, are really beneficial, right? But I also wanna start offering, you know, in-person shadowing. So really it's all through my Instagram. But I thank you guys so much for, yeah.
Jonathan LeSuer (1:07:40)
That's huge and please let us know when you have your Patreon and we'll—
Nicole (1:07:40)
Mm-hmm. I told her she's she's making it before Tuesday. So when this goes up, she'll have a Patreon right Megan?
Jonathan LeSuer (1:07:44)
promote the shit out of that. That's amazing!
Megan Piersanti (1:07:49)
Thank God for this snow. mean, the amount of people that ask me, and you guys know it has to be a passion, right? I'm not a millionaire. We're not making millionaires out of us, but we wanna help people and we wanna do it correctly and niche down. I can tell you how to do that because it happened. Here I am.
Jonathan LeSuer (1:07:52)
I know.
Nicole (1:07:54)
Yeah. Mm-hmm. Right. Nope. Yep. Yeah.
Jonathan LeSuer (1:07:56)
It has to be a passion.
Nicole (1:08:04)
Mm-hmm. Yep.
Jonathan LeSuer (1:08:05)
Yep.
Nicole (1:08:07)
Yep. With a beautiful program. Well, thank you so much, Megan. Of course.
Jonathan LeSuer (1:08:07)
Yep. Thank you guys, and thank you guys for tuning.
Megan Piersanti (1:08:11)
Thanks for having me guys.
Jonathan LeSuer (1:08:13)
Yes.
Megan Piersanti (1:08:14)
John, you don't do the fit test this time, I'm not gonna forget. We are gonna get, we're gonna, your battles will thank you.
Jonathan LeSuer (1:08:17)
Okay, I will do it.
Nicole (1:08:19)
Wait, we should do, let's do it and we'll do an episode going over your lab work. Right? We should do that. Yeah. no. Where's it going? Yep. All right, we'll send it to you Tuesday.
Jonathan LeSuer (1:08:22)
I promise. No, that would actually be really great because I think it's gonna be eye-opening. I just watched my husband leave. Where is he going? In the snowstorm?
Megan Piersanti (1:08:25)
Yeah. You could do it, we can have him do it right from home. We can mail it to his house, he can do the little finger stick. Yeah.
Jonathan LeSuer (1:08:33)
Okay, great. I will do it all. Yep, great. I will send you my address. Guys, thank you so much for tuning into this week's episode of the Film Mian podcast with Mag the Wellness NP. We're so happy that you came on. Till next time.
Megan Piersanti (1:08:37)
All right. Bye.