Ian Lindsay & Associates: Ian Lindsay of Lindsay and Associates has played an active role in the local community since 1979. He has been with Re/MAX Vancouver Island's most advanced real estate business network since 1996, marketing and selling residential, rural strata recreational investment, and project development real estate. Ian has received several awards recognizing his exceptional community commitment locally. As well as awards for outstanding performance and achievement from both RE/MAX International and the Vancouver Island Real Estate Board. You'll find true real estate professionals@ianlindsay.ca. 

Rockin Rhonda & The Blues Band: Here comes Peter. Here comes Dave. Oh listen. Bringing stories, making waves. No missing. Spinning tales in the podcast cave. So much laughs and insights everywhere. Peter and Dave, they're on the mics. Alright, join the ride. It's gonna feel just right.

Peter McCully: Yes. This is the Pulse Community podcast. Another week has passed and we're back with more stories from mid Vancouver Island. Ladies and gentlemen, may I present my co-host and magazine model? Dave Graham 

Dave Graham: and thank you to my co-host Peter McCully. Thank you for the introduction, Peter. But you didn't have to mention that I'm now a magazine model.

Peter McCully: Well, you asked me to say that and no, you're not a magazine model. 

Dave Graham: Hey, there was a photographer I had to pose for a bunch of photos and one of them is going to make the cover of the Neighbors of Parksville and French Creek Magazine this summer. So I'm a magazine model. 

Peter McCully: Well then so am I because I was there too.

Dave Graham: Oh yeah. So two middle-aged guys who really aren't models on the cover of a magazine. That's not normally the key to success in publishing, but we wish them well. The issue in question will be coming out in July.

Peter McCully: on this edition of the Pulse Community Podcast will be chatting with pharmacist AKI Shaw.

Aki Shaw: About Semaglutide, the popular diabetes and weight loss drug sold under the brand names of Ozempic and Wegovy among others about how they work and more. When you combine it with lifestyle modification, that's when it gives results. Otherwise, if you just take semaglutide and make no lifestyle changes, it's not gonna do a lot for you. So the key is to combine it with what you were trying to do before, but now this time with a new tool. So someone tried to lose weight, but they were unsuccessful. This time they would be, because your metabolism is not gonna drop. Instead it's going to increase. But the thing is, you first had tried the reduced calorie intake, so you would have to try that again. You first tried exercise, so you would have to combine that again. So when you combine it with reduced calorie intake and exercise, that's when it's gonna give results. Otherwise it won’t.

Dave Graham:  Illana Hester updates us on what's happening at the old school house art center. 

Illana Hester: We have so many new things coming into fall education. Our winter education was quite booked, and so we extended a lot of those classes into May, June, and then coming in September, we'll have everything you can imagine from watercolor to acrylics to oil portraits, just a couple of drawing classes, color matching, and then a lot of textile work. So there's a little something for everyone. Also, there'll be photography. There's jewelry. It's quite an eclectic mix, but all taught by a very professional artists who are local. 

Peter McCully: Hey Dave, have you heard the latest dirt? 

Dave Graham: Well, Peter, I don't know. Are we talking gossip, hard factor, conjecture, 

Peter McCully: dirt. I'm talking about dirt. The Meadowood Store's Garden Center is jam packed with dirt. That is to say bagged soils, manure and fertilizers. And get this Chris Burger says he won't be under soiled. 

Dave Graham: Oh, ha ha. I remember you saying that from last week. It doesn't get old. Love. A good dirt joke. What else have you got for us, Peter? 

Peter McCully: Well, the Meadowood Stores Garden Center also has a great selection of starter plants and veggies.

Dave Graham: Well, this is excellent information because magazine models like myself are just too busy to grow things from seeds. Focus 

Peter McCully: Dave, we're talking about the Meadow Wood Store Garden Center. 

Dave Graham: Hey, you can post for pictures with Bigfoot while you're there and the kids can paint a rock, to add to Rocky the Rock Snake.

Peter McCully: Chris will match prices with just about anyone anywhere. And you know what they say at the Meadowood Store Garden Center. 

Dave Graham:Uh, thanks for shopping a Meadow Wood Garden Center. 

Peter McCully: They say they dig what you plant.

Dave Graham:  Do they literally say that? Hey, thanks for shopping at Meadow Wood Garden Center where we did what you planned. I, I don't see that happening. That would be weird.

Peter McCully: It's just a slogan, Dave. And we thank the Meadow Wood Garden Center for their support of the Pulse Community Podcast. I.

Dave Graham: If you would like a weekly email reminder of the latest pulse podcasts and contests, just head over to our homepage, the pulse community.ca, and sign up for the podcast newsletter. It'll keep you up to date with upcoming episodes, just like what we're going to do right now. 

Peter McCully: Future guests include Sean McCann, formerly of Great Big Sea, who will be playing in Parksville in the coming weeks.

Michelle Stillwell will chat about accessibility week, which is the last week of May. We'll also be featuring a visit with Theresa Cooper from the Parksville Downtown Business Association as they feature events and activities in the months to come, 

Dave Graham: In the interest of transparency, I have been hired by the Downtown Business Association to provide music for the street dances again this summer.

This is going to be the third year that I've worked with a dance instructor to teach some steps. We cover line dancing, salsa, and swing, and rest assured, actually, I have absolutely nothing to do with the instruction part. You know, I once took ballroom dance lessons and didn't even complete the course.

I'm just. That anyway, as a dancer, I make a good dj. These dancers are free. They're open to all. It's, you know, truly wonderful to see the really good dancers, but also it's wonderful to watch those who maybe aren't so good just learning the steps and they're out there dancing like nobody's watching and just having fun.

Be on the lookout for the Parksville Downtown Dance with me. Events coming in July and August.

Peter McCully: The evening of Saturday, July 12th is going to be a special one in the community park as Chilliwack arrives on their Farewell tour. It's part of the opening weekend of Beach Fest and there's still time to enter our drop.

If you would like to enter your name to win tickets for two to see Chilliwack, email us with your name and where you live and let us know which Chilliwack song is your favorite and her at contest@thepulsecommunity.ca. 

Windsor Plywood French Creek: The Pulse Community Podcast is brought to you in part by Windsor Plywood in French Creek, specializing in hard to source interior and exterior home finishing products. Including flooring, doors and moldings and exterior project materials such as yellow, cedar, Windsor, plywood, French Creek carries high quality, responsibly sourced products and are committed to providing outstanding value and personalized one-on-one service to all of our customers. Homeowners do-it-yourselfers, renovators, builders, designers, craftsmen, and contractors. Regardless of the type or size of your project, Windsor can help you bring your vision to life from start to finish. Let Windsor plywood and French Creek help you with your renovation, new build, or building project. Visit them online or call 752-3122. 

Thrifty Foods Parksville: At Thrifty Foods, we love to help nonprofits, charities, and schools. Our Thrifty Foods Smile Card bulk program allows organizations to immediately save up to 6% on the purchase of Smile Cards in bulk, allowing you to keep more money in your organization's pockets. Ask for details at Thrifty Foods in Parksville. 

Dave Graham: We thank Thrifty Foods and Windsor Plywood for supporting the Pulse Community Podcast. You know, we're the only ones offering this kind of coverage for the mid Vancouver Island region. We welcome inquiries from others interested in sponsorship opportunities. One way to reach us is with email. I suggest to email Peter is addresses peter@thepulsecommunity.ca. 

Peter McCully: Yes, you can email or text us or even leave us a voice message. Follow the links from our homepage, the pulse community.ca. It's time for our first guest, Marilyn, if you please.

Marilyn: Standing by in the green room is Alana Hester, the executive director of TOSH, the Old Schoolhouse Art Center in Qualicum Beach. 

Peter McCully: Thanks for joining us today, Alana. 

Illana Hester: Thank you for having me.

Peter McCully: Volunteers had been working very hard on an archives project that was recently completed. Perhaps you could tell folks about that, that aren't in the know. 

Illana Hester: Absolutely. We were the wonderful recipients of a grant from New Horizons for Seniors, which is a federal grant that enables seniors to participate more actively in their community.

And I proposed a project of a digital archive for the organization because we are 37 years old. This organization that's been around since 1988, which I know is very young for some, but for an arts organization is quite a feat. So we have a lot of ephemera. We have a lot of paper ephemera, we have a lot of photographs.

We have a lot of stories and narratives and memories that are stored in this 115 year old building. And so I was just running into this problem where I didn't wanna get rid of anything, but I also need a little bit more space because everything takes space. Well, of our senior volunteers enacted a massive archive project.

So they scanned and they tagged, and they. Edited and they basically took the entire history of Tosh and uploaded it to our website. So if you go to our website under the tab at the top that says Archives, we now have a searchable digital collection. So they all learned how to scan things. They all learned how to create a catalog of items, everything.

It's hashtagged and searchable, so you can search up different artists that you think of or different mediums or different ears. The only thing I'll say is that the archive takes a minute to load because it's about 500 objects that are actively searchable. So when you do open that page, just give it a minute to load and then you can play around in our archives and see everything that Tots has done for the past 37 year.

Peter McCully: Well, I'm gonna do that. TOSH ran a donations program recently as well to raise funds for operating capital. How did that go? 

Illana Hester: It went really well. We did a membership matching campaign that started off in November, and then mid January we raised $14,000 for the organization, which is absolutely fantastic. We are in a really interesting financial position in that we don't receive operating fund from any governing body. So the maintenance of this building and our entire operations and being open all the time, basically it's visitor center to our community. Community Arts center isn't funded regularly by anyone, so we are under the auspice of funding and creating that capital.

So participation in our community that values the arts is really important. And I think that our members came out and said that in full by how much funds they raised. Donations are always accepted. We are in an active donation campaign mode, so if anyone has any interest in donating or being a monthly donor, that kind of donation goes a very long way to our programming, to keeping the doors open and to creating real community connection, which I think is so important here.

Everyone coming back post Covid. I think that that is so fundamental in a community like ours. There needs to be a place for people to meet each other, and I think that meeting each other over. Art is one of the softest place to have those hard conversations. Daily eyewitness, incredible bonding between many generations of folks and artists and non-artists and visitors who are here enjoying our beautiful place.

And then people who are here year round. So it's a real vibrant hub of community connection and, you know, we work really hard to keep it going. 

Peter McCully: Chatting about programming. Several partner organizations across Vancouver Island, including ts, are running a queer preneur project, which I understand offers pretty basic help to those starting out, including photography, which is so important in the state of the internet and networking.

Illana Hester: We received a fund from the Canadian Gay and Lesbian Chamber of Commerce that I applied for because as I've gone through, I've been on the island now for almost seven years. I've noticed that there's a real definitive lack of marketplace. So for a landman that has about 75,000 artists on it, which is, you know, 5% of the population, we look across Canada, the percentage of artists is about 1%.

So we have this huge amount of people employed in the creative arts and who are artists. There isn't really a marketplace, there's not like a very defined marketplace, and there's not a lot of places to show. There's not a lot of infrastructure that's created around that marketplace. One of the ways that we test out and see if we can create a stronger, more connected community across Vancouver Island is by hosting various programs.

This Queer Printer program is specifically designed to support L-G-B-T-Q community because we face, you know, unique challenges and systemic barriers and accessing resources and opportunities and support. This project is really to support queer creatives. In entrepreneurial skills. So what we've done is we've created a hub model across New Cooper Island.

So there's about eight hubs that will be enacted, and each of those have networking meetups, mentorship sessions, skill building opportunities, such as like photography, which is what we hosted here most recently, to be involved in that. Just look on our website, there's a tab for that one too. That is a program that runs until March of 2026.

It's been really exciting to work with folks all across the island from Victoria on supporting artists. 

Peter McCully: You mentioned the data about the number of artists in the Parksville Qualicum Beach area, and I recall looking at the census data. It's a while ago now, maybe 20 years ago, but I think the percentages are still the same, that the top three areas in British Columbia for penetration of artists was Parksville, Qualcom Beach, Haida Gwaii, and Salt Spring Island. I'm not sure a lot of folks are aware of that. 

Illana Hester: Absolutely. The Gulf Island's actually incredibly strong in artists. I wonder if it's changed a lot now. There is still a lot of artists on Salt Spring and up North and out here, but there's also a lot in Gulf Islands like Gabriola as well. So yeah, we have a huge percentage of artists on the island, especially compared to the nation's numbers, so I'm not surprised and beautiful here.

Peter McCully: Tell us about some of those upcoming artists and the shows that we should be marking on our calendars. 

Illana Hester: We'll be opening our latest exhibitions, which are two month exhibitions, so we're showing Heather Thomas, Steve Casey, and Brooke Emily. Three fantastic local artists who all at one point in time have been teachers and professors, and so they're all showing a wide range of media and really different legalities of painting.

Brooke has a show that's really about local and about people here. She's a new mom. And is really showcasing what is so beautiful about this place. Dave Casey does really interesting geometric and navigational work on top of his more abstracted but very canadiana images. And Heather Thomas is a multimedia artist who does a lot of printmaking and does a lot of commentary on environmental activism.

So it should be a really interesting mix show. We close it on June 28th, so there'll be lots of time to stop in and come and see all the work that's here. 

Peter McCully: Summer camp, everyone loves summer camp, even. I love summer camp. What do you have for summer camps at Tosh?

Illana Hester: This year we have five weeks of summer camp booked with three different artists, and so definitely check out our website.

Those are already live and people are signing up. We have a wide variety of summer camp availability, so we have artists that teach just printmaking. We have a few artists that are gonna be walking kids through. A painted canvas from start to finish Monday to Friday. And then we have a few other ones that are just mixed media.

So definitely check 'em out. There's both flavor for all the kids, all the different modalities of art. 

Peter McCully: I know it seems strange to be talking about the fall schedule in spring, but it's, very popular. You'll be releasing the fall education schedule in May. What's new there? 

Illana Hester: We have so many new things coming into fall education.

Our winter education was quite booked, and so we extended a lot of those classes into May, June, and then coming in September, we'll have everything you can imagine from watercolor to acrylics to oil portraits, just a couple of drawing classes, color matching, and then a lot of textile work. So there's a little something for everyone.

Also there'll be photography. There's jewelry. It's quite an eclectic mix, but all taught by a very professional artist who are local. 

Peter McCully: Sounds interesting. I know TOSH is a busy place, but I was still surprised to see that in May you'll be asking for exhibition applications for 2027, 

Illana Hester: Booking out two years in advance is a requisite for some of the grants that I am applying for, and so we always end up booking out a little bit early. Plus, as you know with the data, there's so many artists who want to apply. Our last exhibition call got over 65 applications and it's only for 18 spots, so it's a highly competitive application process, but it is also very Bible in that it gives access to local and regional artists to have an exhibition venue.

We walk artists through that exhibition process and split proceeds of any sales. And it's really an amazing opportunity to show to such a wide variety of folks, visitors and locals like, and we put on, I think, beautiful exhibitions. There's so many good artists that we here, so I encourage everyone to apply.

It is a few years away, but that gives people lots of time for planning and it brings us really great co-created exhibitions. 

Peter McCully: You talked about the volunteers working very hard on that archives project, and I hear they have their eye on a new project. 

Illana Hester: We will be soon announcing the next project that will happen for our senior volunteers.

But so I can just hint that it will involve a lot of accessible arts history lectures for folks in the community, and a lot more discussion on critical commentary of artwork, how to talk about artwork, how to look at artwork. And so definitely keep in touch on our newsletter. Can sign up on our website www.theoldschoolhouse.org and see what's in store, 'cause there's some new and exciting projects coming down the line. 

Peter McCully: Those volunteers are a very important part of TSH and they help make a go. Obviously, if folks are looking to help, they're looking to do some volunteering. What are you looking for and how do folks contact you? 

Illana Hester: Thank you so much. Volunteers are the heartbeat of this organization and I think also. The heartbeat of this community. You know, I think we have time to give and we have time to connect, and that makes for some really beautiful storytelling and some really interesting work that happens. People can sign up on our website.

We have a volunteer tab, or they can just give us a call here at the art center or stop by. We have lots of different volunteer positions, everything from installation committees, which hang the shows every two months. To helping us with various events, to sitting at our front desk and asking questions and signing folks up to participating in new projects like the Archive Project and like the other one that's going to be coming up.

Peter McCully: Well, thanks for your time today, Illana. We'll make sure to drop by and see what's happening. 

Illana Hester: It was lovely talk to you again, Peter. 

Dave Graham: How fortunate we are to have the old school house art center in our midst. The three main galleries all had new exhibits put in recently. They have loads of workshops exploring all kinds of disciplines over the coming months.

Plus they have some exciting opportunities for kids with their art camps this summer. 

Peter McCully: We here at the Pulse community also have something for the kids with our Skookum Kid’s stories. Listen in for the adventures of Captain Dave and his crew of creatures aboard the mellow submarine. Narrated by Dave Graham 

Dave Graham: Then there's Peter and Gracie, a boy and his dog. That's Gracie the Eskimo dog. Their recent stories involve some educational opportunities for both Peter and Gracie, including dealing with nervousness. Its soccer practice narrated by Peter McCully. Skookum Kids Stories are available through our homepage, the Pulse community.ca. Also ASkookum kids.com plus all our podcasts and stories are available through all the usual ways. Apple, iHeart, Amazon, YouTube, Spotify, and Buzzsprout. 

Meadowood Store Garden Centre: The Meadowood Store's Garden Center is jam packed with starter plants and veggies, bag soils, manure, and fertilizers. Chris Burger says he won't be under soiled. The folks at the Meadowood Store Garden Center will match sales prices just about anywhere, kids coming at a painted rock to make rocky the rock snake grow longer. Enjoy the relaxing drive to Meadowood, where the bargains are tariff free and are big. Bigfoot Big. The Meadowood General Store in Dashwood is the home of Bigfoot. It's a convenient spot for beer, wine, and spirits, groceries, deli, propane, and lotto. Come in and have your picture taken with Bigfoot inside or outside the store at 1221 Meadowood Way in Dashwood.

Ian Lindsay & Associates: Ian Lindsay of Lindsay and Associates has played an active role in the local community since 1979. He has been with RE/MAX Vancouver Island's most advanced real estate business network since 1996, marketing and selling residential, rural strata recreational investment, and project development real estate. Ian has received several awards recognizing his exceptional community commitment locally. As well as awards for outstanding performance and achievement from both RE/MAX International and the Vancouver Island Real Estate Board. You'll find true real estate professionals@ianlindsay.ca. 

Dave Graham: By the way, we are always happy to hear from you. Perhaps there's a person or a story that you think we should be looking into, maybe some questions, the need answering. There are lots of ways to connect. Just look for the contact links on our homepage, the pulsecommunity.ca. There are plenty of questions when it comes to semaglutide. We'll let Marilyn take it from here.

Marilyn: Semaglutide is an anti-diabetic medication used for the treatment of type two diabetes and an anti-obesity medication used for long-term weight management from the green room. To talk more in depth about glides is pharmacist Aki Sha. 

Peter McCully: Welcome to the podcast Aki. 

Aki Shaw: Thank you, Peter for having me. Before we talk about Semaglutide, better known under some of the brand names like Ozempic and bogo, let's talk about you for a moment. You're a student of the world. You studied pharmacy in India. You got your MBA in Australia and Master's in Public health in Canada.

Aki Shaw: Yes. I never thought of immigrating or anything like that. I worked for Sun Pharma where I designed some molecules on the formulation aspect. They're actually now quite famous products by name of Qua and another anti acne cream.

I was working in the r and d and then I went to University of Adelaide to get my MBA with the hopes to progress in the r and d department. But then I got an opportunity with retail one pharmacies in Australia. I helped, uh, store grow from one location to like 21 locations before it was acquired by Chemist Warehouse.

It's like Shoppers of Australia after that. I worked a little bit in New Zealand where they opened seven more stores, but were again acquired by warehouse. Then I moved back to India. This time it was too late for me to join the r and d department. Plus I had a vision to join my father's business, but to diversify in pharmaceuticals, we used to manufacture paints.

However, international competition was such that when the paints would land in India, they would be so low in price that we weren't able to compete. So that was a big shock. So forget about diversifying. We weren't even having enough revenue to sustain ourselves. At that point, a random discussion from an old friend, university of Saskatchewan, a good friend of mine.

He said that, Hey, pharmacists here make six digit salary, and I didn't take it lightly. So I applied University of Saskatchewan. I didn't expect that I would get selected, but then I did get selected with a scholarship as well. That's how I came here. I studied University of Saskatchewan, then got married.

My wife was at UBC. She said, it's either me or Saskatchewan. So I moved to BC after working for a few years with Rexal. It was good, but then it was taken over by an American company and things changed, like the culture and stuff. So then we decided to have our own pharmacy. The growth story began by grace of God, like from one pharmacy to second, and now third. I thank God and I thank that things worked out. In the end, 

Peter McCully: I'd like to see your Air Miles account. I bet you there's a few points on there. 

Aki Shaw: You know, actually I lost my air miles account, otherwise there was, there's something that happened when I changed banks and then there was an expiration, but I lost all of the things.

Peter McCully: Aki, could you explain in simple terms how semaglutide work in the body to help weight loss and diabetes management? 

Aki Shaw: So basically what happens is there are certain receptors in the body that it binds to. So whenever you try to lose weight, for example, your body automatically has a mechanism, turns down the volume on the metabolism.

So in order to adjust for the reduced calorie intake. So what it's doing is it's preserving energy. So even if you're fasting because your metabolism rate has gone down, you are not expanding as much energy and you're not seeing the weight loss happen. Of course, if you push that process too far, then the weight loss starts to kick in, but it's a bit of a grind and not many people are able to get into that ketosis phase, as we say.

What Semaglutide do is they not only not let the body turn down the volume on the metabolism, it actually increases the volume even though you are taking in less calories. The way it works for less calorie intake is first, is it reduces your gastric transit time, which means the time it takes for your food to move through the bowel system.

Your food is moving slowly so you get satie faster. It improves the leptin response. So there are two hormones, leptin and ghrelin. Leptin improves satiety. Ghrelin increases hunger and craving, so improves your satiety, reduces ghrelin response, so reduces cravings. It makes you feel full longer because your food is moving slower in your system.

I. Because your insulin sensitivity has increased. Your cells feel nourished in terms of the amount of glucose they have and energy they have, so you don't feel hunger in that sense either. So overall reduced calorie intake. And then on the other hand, not only it's maintaining the volume, it's increasing the volume in terms of metabolism rate.

First, you're reducing the calorie intake because of its effect, and on the other hand, your body has improved its metabolism. It's a double effect. Reduce calorie while not only maintaining but increased metabolism combined, you get weight loss. Semaglutide are just getting started like there is now from Ozempic.

There is Manjaro. Ozempic had seven to 12% weight loss manjaro, like 13 to 18% weight loss. And that's because it also acts on another molecule, like another receptor that's solely involved in fat metabolism. So what. Hepatitis is doing is, which is Manjaro. It's doing everything that Ozempic is plus. It's also increasing your fat specific metabolism, and that's why you see even more fat loss and weight loss with manjaro.

And then there are other molecules in the pipeline. It's gonna pass 25% because then your body's emergency functions kick in. The golden goal of that 25%, which is like a weight. Lost pill that everyone was thinking about. You take it and you lose weight and, and that's it. And that's not too far away. 

Peter McCully: So when a healthcare provider looks at the factors on a patient and decides whether or not they're a good candidate for semaglutide treatment, what are some of the factors they're looking at?

Aki Shaw: We do look at a lot of factors. That being said, patients sometimes being adamant on, uh, going on semaglutide is also a factor. Technically. Theoretically, the factors you look at is are they diabetic because they're number one users for diabetes, not weight loss. Second is, let's say they're not diabetic, but would weight loss help them?

So a lot of people are not diabetic, but they're the borderline diabetic. They can benefit a lot from their weight loss because of their lifestyle. And even after several trials, they're not able to lose weight. Some people have problem with their knees or their cardiac function, like, you know, the prognosis won't be as good if the weight continues at the place it is.

So these kind of patients benefit. The other thing, which is very important factor is their susceptibility to hypoglycemia. If they're not borderline diabetic or in general, there's sugar. Is in the lower ranges, then mostly the doctor won't prescribe you the ozempic because it's gonna take your sugar levels down.

If in general your nature is that your sugar is not just well controlled, but a little bit on the lower side already, then it's a good reason for you to not start ozempic because it'll take you into hypoglycemia, which could admit you to hospital. 

Peter McCully: Aki, could you walk us through the typical dosing strategy for somebody who's starting on Semaglutide?

Aki Shaw: Semaglutidem, because they're so new to the realm, the minimum effective dose is not clearly established, and plus, it's one of the drugs where there is not a clear dose to effect correlation. Everybody is different in terms of their metabolism, gastric transit time, and so on. The strategy is to start low and go slow.

So 0.25 milligrams to start the ozempic once a week, and you might see that, oh wow, at 0.25 and just once a week because it's actually a hormone. It's not a drug just like testosterone. You just need a little bit to have profound effects. A lot of people I have seen stabilize at 0.5. That being said, now there are pens that go as high as 2.4 milligrams per week.

Now these are outlier cases. Not many people need as much dose, and it has a stabilizing effect like the curve. It then stays flat. So let's say you are getting optimum results at 0.5%, which is seven to 12% weight loss in six to 18 months time. If you increase it to one milligram, it's not gonna take you any further because it has a ceiling effect.

So the key is which dose works best for you. Once you have hit that target, you can't expect more by increasing the dose. Whereas for people who haven't seen any weight loss in six months, even at say one milligram, yeah, they are candidates to go higher to say 1.5 or two or 2.4 milligrams. It's a time dependent process, I would say.

Peter McCully: What are some of the most common side effects that patients might report with Semaglutide, and what practical advice would you offer to help manage them? 

Aki Shaw: Three things. First is the very immediate side effects because your food is moving slower in your belly. The side effect to that is you feel a constipated.

Increased sensitivity to acid reflux. So if you're a candidate who already has acid reflux issues, expect that to be exaggerated a little bit because now your food is a little longer in your stomach, so that much more acid exposure. If you have constipation issues, that's because the food is moving slower.

So gastric walls has more time because the longer the food stays, the more water gets absorbed from it. Your stools are becoming harder, and the harder it gets, of course, the slower it passes. So the advice is to have reduced quantity of meals and have enough water. Now, what that would do is reduced quantity because your time to digest is increased.

So now for reduced quantity. It won't be as bad, and that way it counters your acid reflux. Also, avoiding spicy foods, especially at the start of the process till your body adjusts to that new gastric transit time. Secondly, water fiber won't help as much because that may even exacerbate the problem because the problems, not the fiber, the problems, the water, so have really good water intake so that your stool stays soft and moist.

Otherwise, your stool becomes hard and that much harder to pass. In terms of the second side effect, which is hypoglycemia, that means that you need to reduce your dose or stop the medication. The third side effect, which is a long-term side effect because again, these are new candidates. The long-term side effects we would know later on.

Several researches have pointed that it has potential to cause thyroid cancer. Of course, that study has not been fully validated, and the amount of subjects getting thyroid cancer were less than 0.2%. Thus is still deemed safe, but let's say we don't want to take our chances. In that case, once you achieve your weight loss goal, also have a strategy to wean down your dose or wean off completely.

Peter McCully: Aki, we're talking about patients and how they react to the semaglutide, how they can maximize their effectiveness. What lifestyle modifications should they consider as well? 

Aki Shaw: When you combine it with lifestyle modification, that's when it gives results. Otherwise, let's say if you just take semaglutide and make no lifestyle changes, it's not gonna do a lot for you.

So the key is to combine it with what you were trying to do before, but now this time with a new tool. So someone tried to lose weight, but they were unsuccessful. This time they would be, because your metabolism is not gonna drop. Instead it's going to increase. But the thing is, you first had. Tried the reduced calorie intake, so you would have to try that again.

You first tried exercise, so you would have to combine that again. So when you combine it with reduced calorie intake and exercise, that's when it's gonna give results. Otherwise it won't. That being said, don't jump on it right away. Don't make any severe lifestyle modifications right away. And that's because of hypoglycemia.

We wanna see that it's not producing your blood sugar too much, because when you reduce calorie burn calories, your glucose levels would of course drop. And then ozempic is also doing the same. Or manjaro, it might drop even further and put you into hypoglycemia. So we just wanna, for the first month, not be too hard on yourself, and then slowly and steadily increase your level of activity and calorie reduction.

Peter McCully: What options exist for patients who don't have insurance coverage for semaglutide? 

Aki Shaw: Not many. Actually. To be speaking practically as someone who works in a community pharmacy, there are some limited options, which can get you one or two pens, majaro, for example. The drug reps sometimes give the doctors a card, which you bring into the pharmacy and you get one pin, but that's just one pin which would last you a month.

Maybe he gives you two cards in two months, and then they have this patient assistance program, which is good. That would knock off half the price. You'd have to register for it, and it's open to everyone. So you would have to Google like on one Jar website for Canada, and it will give you like a patient assistance card.

They have also dropped their costs from $800 to $400, and then that card again knocks off another a hundred to one 50, depending on the pharmacy you choose. So it would end up around costing the same as Ozempic is, which is like around 200, 250, but that remains the baseline, 200 to two 50. 

Peter McCully: Could you explain the difference between the branded versions like Ozempic or Wegovy?

And perhaps compounded or generic alternatives that might be available. 

Aki Shaw: There are no generic alternatives because it's such a new drug. The patents last at least 10 years, and then after that, they get a chance to appeal and make it strike for another 10 years. And in this case, it's likely because thereby big pharma and they mostly succeed in extending their patent rights.

So for 10 to 20 years, we can see that there might not be a lot of generic options. With Ozempic, it would be like around five years because the patent would end sooner. Compounded versions and they can help with cost. If the pharmacy that's compounding it, it's not charging as much, so you would have to do your price comparison analysis.

There are few risks with that, which is of course the dose. If the pharmacy is not careful, they might overdose or underdose you when there is shortage. That's when the pharmacies are allowed to compound, not otherwise. At least that's what it is in Canada. That being said, there is a catch. If the dose does not exist, even then, they're allowed to compound.

So the workaround is the compounding pharmacy might have to give you a nearby dose, like say instead of 0.25 milligram, a 0.3 milligram or something. But again, it should make sense economically. Otherwise it's a riskier approach. Because it's not as standard, especially when it comes to injectables and sterile compounding in terms of dose consistency and quality consistency because it doesn't have a spectrophotometer or anything like that locally, which, uh, pharma lab would have.

So you are kind of, and the mercy of the perfection process of the pharmacy. So it's important that you trust that pharmacy. Not many pharmacies do that because Health Canada had a big crackdown on those. But if you find one and if it makes economical sense and if you trust the pharmacy enough and you want to take your chances, that's okay.

But unless it's be giving you significant economic benefits, there is no reason to choose a compounded version. 

Peter McCully: Lucky as a pharmacist, what has surprised you most about the Semaglutide phenomenon and its impact on healthcare? I. 

Aki Shaw: It may be new to the world, but in the pharmacy world, the news about semaglutide and developing such molecules had been around for long, especially me being in r and d.

These molecules take anywhere from 10 to 15 years before they are actually finally a product available on the shelf. So you could imagine that, uh, the researchers. Would've began quite early on, and at that time I was already in the r and d domain quite actively. So I did have some idea, though I didn't have the idea of its success because at that time it was just a concept and it's a very hush, hush process.

It's not like an open book because of competition, of course. So when it actually made it, that's when it surprised me that, wow, that disguise did figure out. Because the key challenge is receptor selectivity. It has to bind to the receptors you wanted to bind, and they succeeded in that. And that's all it takes to get the ball rolling once you know that, that's why manjaro came quite quickly after ozempic.

It didn't take 10, 15 years longer, and the subsequent molecules would be even quicker. So. Now we have opened this new domain of health and it's going to help humanity tremendously. I would say, over time, especially when generics start to kick in, because it's gonna reduce a lot of chronic diseases, which unfortunately our system is built such a way that we can't escape like the fools around us.

Bar cabinets around us because of the society. Everyone is stressed, everyone is working. They don't have much time. So you don't get time to have quality food, prepare food, exercise. It won't work as a shortcut, but it would cover up your lapses when you are not able to stay at a hundred percent. So I think it's gonna be a good future with Semaglutide and this class of medication.

Peter McCully: One final question before we let you go, AKI. I. What misconceptions about semaglutide do you commonly encounter? And what facts would you like the public to better understand 

Aki Shaw: that once you're on it, you cannot be off it? So the thing is that it's hard to get off of it. But not impossible, and I strongly advise patients when you achieve your weight loss goal, pharma companies won't likely for that because they would want you to be on it forever.

But as a healthcare professional, it's my duty to let people know that it is possible. The thing is the strategy you use to win off. So let's say you are at one milligram, you go down to 0.75, you would see a little bit of weight increase, which is fine. That's because your metabolism rate has reduced and all those mechanisms have now started to reverse.

What you do is you use your diet and exercise to counter it. It's a very manageable situation, two to four kilograms or five to 10 pounds, you have to bring it back once you're back again at your baseline, then go back down at 0.25 again and that way slowly and. Steadily you increase, decrease, increase, decrease, you won't be able to decrease a lot.

But when you are at the very last stage at 0.25 and off altogether and at your normal weight, you have trained your body with that new weight and equilibrium and then that's how you get off and that would reduce that chance of that thyroid or cancer happening. 

Peter McCully: Lots of great information today, AKI. Thanks for your time. 

Aki Shaw: Yes, have a nice day, Peter. 

Dave Graham: Some answers about Semaglutide on the Pulse podcast. That's some basic information about the product, not intended to be medical advice. See your medical provider for more information. Well look at the time. We've just about reached the end of another  episode. You know what comes next. 

Peter McCully: We get to check out what Mabel has on special in the cafeteria today.

Dave Graham:  As a magazine model. I need to watch my figure.

Peter McCully: Dave, for the last time. You're not a. Okay. Mr. Magazine model. So what will it be? A salad? 

Dave Graham: Yes. As long as you order something with fries. So I can have some.

Dave Graham: Well, I wasn't planning on getting any fries, but, okay. Oh, and gravy. Get some gravy too. 

Peter McCully: Okay. I could get a thing of gravy. 

Dave Graham: I shouldn't order any, dessert, or we can split yours now. Let's talk about options. I'm really in the mood for chocolate. 

Rockin Rhonda & The Blues Band: Here comes Peter. Here comes Dave. Oh listen. Bringing stories, making waves. No missing. Spinning tales in the podcast cave. So much laughs and insights everywhere. Peter and Dave, they're on the mics. Alright, join the ride. It's gonna feel just right.