Where Care Becomes Quiet Understanding
I am William Conway M.D, a concierge physician in Nashville. To us, “concierge” means that I know you, I’m available to you, and I keep your story private and safe. When you speak, I hear what you say and what you do not say. I understand both the conscious and the unconscious, the quiet meaning that is the essence of you. Understanding this quiet essence allows us to share space which is meaningful to us both. Our professional relationship means that I am your doctor, with all that entails.
Our relationship will be both professional and spiritual. I’m a person- not a system- and so are you. My promise, as your physician, is to be your physician each and every time we meet. When you make an appointment with me in my clinic, I will be the person to shake your hand and look you in the eye, and together we will make decisions that will help you in your journey towards health.
In my practices- Nashville Suboxone+Primary Care™ and Nashville Concierge Medicines– I study constantly so that your care is well-informed. And I write constantly, so that your care is understandable. In this shared space, we will meet together and discuss whatever matters most to you, and we will share your future with joy.
Case Study
The weight gain had snuck up on Lynn, the slow progression of numbers inching higher and higher at every annual check-up. But the diabetes diagnosis at age 47 had come with the shock of a thunderbolt. She had felt real fear then, not just of the possible complications the doctor was reading off to – blindness, kidney failure… amputation!- but of the everyday management that seemed so utterly baffling. The chorus line of needles and calorie counts and the seemingly endless choices that had to be made: diets, medications, monitoring methods. It was overwhelming.
She started to do some research on her own, and while all the decisions she would have to make still seemed staggering, she figured out one important thing: She needed to find the right doctor. Her online support group shared a few options, and she chose one. He helped make sense of what felt like countless decisions she had to make. He discussed the pros and cons of several medical options.
After that- and for almost a decade- she had shied away from using semaglutide as a treatment because of her fear of needles. Then, almost miraculously, came the same medication in pill form! She could just take a pill every day before breakfast! And- wonder of wonders- this medication might not only lead to weight loss, but it could also help her heart. The initial nausea was off-putting, but her doctor walked her through that valley with calm optimism. In time, her risk of heart disease actually decreased… she no longer lived in fear of needles, or of dealing with amputation, or of dying of a heart attack.
Slowly, Lynn’s life seemed to start rolling in the right direction. Her glucose levels stabilized. Her weight stopped climbing, and then gradually began to drop. The signs her doctor had initially seen that hinted at heart disease began to reverse. She began to look towards her own future with both a sigh of relief and a sense of hope.
Maybe Lynn’s story resonates with you, and maybe it doesn’t. Every person I have treated, regardless of their diagnosis, has had their own unique set of issues and preferences, complications and needs. Wherever you are on your health journey, the thing that matters most is what you do next. But first things first. Let’s start with some information on a bright new medication option in the world of diabetes and weight control!
Semaglutide: The Basics
Semaglutide is highly studied and effective, but it can be expensive. Back in the day, it was only available as an injection, but now that it’s available as a pill, I’m taking the opportunity to offer this simpler option to my patients.
I know that many people are looking for treatment for blood sugar issues that doesn’t involve needles. But of course, with new treatments, there are always questions: Does it work? How expensive is it? Should I get started on it? I’ve written this article to let you know what I tell my own patients at Nashville Concierge Medicines when we talk about Rybelsus, the new oral form of semaglutide.
Why Rybelsus?
Rybelsus is the brand name of the drug semaglutide, which has been around since 2012. It’s been used to treat diabetes- as an injection- for about seven years. Since then, it’s been used to treat obesity as well, but the pill form didn’t come around until 2019.
Oral Semaglutide is Convenient
For years, semaglutide has been a really popular treatment for both diabetes and- more recently- weight loss. Up until the pill form came out, it was given as an injection, once a week. Now that the pill is available, you can take it daily (usually before breakfast) instead of having to deal with needles. This new pill form is called Rybelsus.
It’s no secret that convenience is important for everyone, and my patients are no exception. At Nashville Concierge Medicines, I have patients who hate the inconvenience of needles. And beyond that, I have a lot of patients who have avoided taking insulin because of their fear of needles. This fear of needles can extend to semaglutide. But now, having the option of taking a pill is available!
Convenience does matter. Fear does matter. Patients lead busy, complicated lives. Adding a daily medication routine into the mix of daily demands can be challenging. Rybelsus is a convenient addition to your daily medication regimen. I spend time every day coaching patients on how to take their pills. I explore their habits. You and I can talk about how to make this daily medication regimen as easy as possible. For example, do you use moisturizer on your skin in the mornings? Could you use that daily routine as a reminder to take your medication at the same time?
When you have diabetes, taking your daily medication when you feel well is everything. I, Dr. Conway, can help you find a system that works for you. We can have detailed discussions on how to make taking your medication every day a habit.
Oral Semaglutide Improves Blood Sugar Control
Rybelsus- oral semaglutide- helps control blood sugar. You can see from the graph above that it does at least as good a job as other oral options. Insulin is the standard of care once your blood sugar levels reach a certain point, but as long as you can keep levels below that threshold, you can see how Rybelsus might work for you.
Treating diabetes has become very complicated, with lots of choices. Each choice has its pros and its cons. Each choice involves a cost in terms of effort, time, and money. Diabetes symptoms and severity vary widely from one person to another. Some people with diabetes can go their entire lifetime without complications. Others will progress rapidly to blindness, neuropathy pain, or amputations. But most importantly, every person has a story. Every person has their preferences. Every person has a unique set of needs. I will spend significant time with you at Nashville Concierge Medicines, providing you with reasonable options and helping you make safe choices that work for you. The reality is that Tennessee and Nashville in particular have a higher incidence of diabetes than the nation as a whole; if you live in or near Nashville, please contact me for private diabetes care.
Oral Semaglutide and Weight Loss
An article was written recently confirming that Rybelsus does in fact help with weight loss. The extent of this weight loss varies widely, of course, but the average weight loss is almost 14 percent of body weight, which is significant by any standards. (I have discussed weight loss with GLP-1 agonists in prior blog posts, in case you’re interested in looking those up.)
Patients who start taking Rybelsus for their diabetes usually experience reduced appetite fairly soon. Their cravings are reduced. They feel better. I, Dr. Conway, have personally witnessed my own patients lose weight while taking semaglutide.
Great News: Oral Semaglutide Protects the Heart!
Semaglutide is the pharmacological substitute for one of your body’s own hormones. Given that this hormone helps manage appetite and insulin secretion, it’s not surprising that semaglutide helps control blood sugar. It’s not surprising that it reduces appetite.
What is surprising is the reduction in the risk of heart attacks.
What is surprising is the slowing of the progression of kidney disease.
The research is supporting this. Semaglutide- both the injection and pill forms- is causing a decrease in major cardiovascular events in adults with type 2 diabetes. This wonderful benefit isn’t found in all medications used for blood sugar control, and it makes semaglutide a very valuable medicine for my patients!
Something a lot of my patients don’t realize is that diabetes is basically heart disease. Diabetes is a disease of the blood vessels. Problems with large vessels include strokes and heart attacks. Problems with smaller vessels include issues with the eyes (including blindness), the kidneys (such as kidney failure), and the nerves of the feet (which can cause severe pain).
When it comes to treating diabetes at Nashville Concierge Medicines, the protection of the heart is important. In the past, patients with diabetes often died of heart attacks. Even when it doesn’t lead to death, a heart attack can really decrease your quality of life. Rybelsus might be a good fit for you when it comes to reducing your risk of heart attack.
Rybelsus and Nausea
Gastrointestinal distress is a common side effect of Rybelsus. This can include nausea, vomiting, and diarrhea. This is information that people need to know before they start a medication, and I like to nip this problem in the bud.
Nausea is a side effect that tends to occur early on in treatment. The good news is that over time, it usually goes away. To avoid the problem as much as possible, I like to start my patients out at the lowest dose and increase it very slowly. Remember, this is a marathon, not a sprint. We aren’t in a “Biggest Loser” contest! Our first objective is to treat the main problem, and go from there, toward gradual weight loss. There are other uncommon but serious side effects with semaglutide such as pancreatitis and gallbladder disease. We can discuss the risks and benefits face-to-face.
Conclusion
It’s always exciting to have another choice when it comes to treating an illness. And it’s especially nice when that treatment comes in the form of a convenient pill. In my concierge medicine practice at Nashville Concierge Medicines, I will offer Rybelsus to patients with diabetes.
If what you’ve read here resonates with you- if you’re ready for care that feels personal, private, and encouraging- I, Dr. Conway, would be honored to be your physician.
At Nashville Concierge Medicines, every visit is unhurried, and every patient is remembered. I listen carefully and respond thoughtfully. I stay available between visits, whether in the office or by secure telemedicine.
The bottom line is that you deserve care that is intelligent, kind, and consistent. Let’s get started!
Call for an appointment with Dr. Conway at Nashville Concierge Medicines.
👉 Call 615-708-0390 | Office & Telemedicine Appointments in our Nashville Clinic.
Telemedicine is available to Tennessee residents when clinically appropriate.
Nashville Suboxone+Primary Care™ Blog Series
