Confused by doctor options to choose, including Keith McCormick

Posted by stacibw @stacibw, Apr 2 11:51am

I’m still learning and navigating my Osteoporosis diagnosis and trying to get my healthcare providers lined up. I’m 51.

I have a PCP who I will only be using as a “sick doctor” going forward. She is aware of my diagnosis and is not up to date on care or treatment.

I have a neuro-kinetic therapist who I work with (recovering from a back injury) who is extremely knowledgeable in osteoporosis exercise. So I will continue to work with her for strength building.

I have a gyn who is not knowledgeable about osteoporosis and referred me to a local endocrinologist.

Those are all of my current health care providers.

Here’s where I’m getting confused….

I really am drawn to Keith McCormick. I prefer functional medicine but like that he also is incredibly knowledgeable about meds and doesn’t hesitate to use them when needed. I have no problems with video appointments.

I have a consultation with the Mayo Clinic in July - the endocrinology team.
They will review my case and decide if they will provide a treatment plan for my local docs or if they will accept me as a patient. So that’s up in the air.

There is a local functional doctor, who specializes in healthy aging and osteoporosis that I am considering.

The endocrinologist that my gyn referred me to doesn’t have an opening until August.

My questions….

Do people use Keith McCormick to completely manage osteo? Or do you also have a local endocrinologist and they work together? Furthermore, when McCormick orders labs, is that done at a local lab or through my regular doc? Thinking costs…..and insurance (I have Cigna - too young for Medicare) for all of those lab tests.

Does anyone have a functional doctor that manages osteoporosis in collaboration with Keith McCormick?

Does anyone see a dietician? I eat a whole foods plant based diet, so am realizing that I am deficient in quite a bit of protein and calcium according to “Strong Bones” teachings. Both of the functional med doctors have nutritionists on board that could help with that.

I’m so overwhelmed just choosing providers! What do you suggest?

Cost does matter - it isn’t the driving factor at this point (understanding and knowledge is the highest priority now).

As of now - I’m flying solo until the end of July, when I meet with Mayo. Wish I had some solid medical guidance before then, but so far have not been able to get earlier new patient appts.

What are most people doing - especially those who have seen or talked to Keith McCormick for a consult or care?

The more I read, the more confused I get. I have time to make decisions, but half a year will have passed before I actually see someone, let alone make any decisions about care. Need to get my ducks in a row.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

I don’t know if this post will help you, I hope so. My endocrinologist handles my healthcare when it comes to bone loss. She orders the required lab work and Dexa scans. It’s important you have faith in your endocrinologist. Mine initially started me on Evenity and after three treatments and a conversation with the drug manufacturer she switched me off of Evenity and over to Reclast because of some of the side effects, it was determined that Evenity was not a good match for me. The Reclast seems to be going well and I like the convenience of once a year. I agree with some of the other folks comments; the most important thing while you wait for your appointment is to take care that you don’t fracture any bones. Plus if you do see an endocrinologist make sure they know your complete health history so the best course of treatment can be recommended.

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@windyshores

McCormick did Forteo himself and has done well. He broke cortical bone. I did Tymlos first and my hip (including cortical) gained quite a bit. I think it is reasonable to do Tymlos first and then Evenity. McCormick is a big fan of Evenity right now, it seems, but the other meds are good too. You can do Tymlos, covered by insurance, and if gains are not enough, iinsurance should then cover Evenity. That is what I am doing. Just my two cents!

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I have an aortic heart valve leak that is being watch, (along with a mitral valve leak that most 77 year old people have that is not concerning). I have read that Evenity is not good for patients with heart problems, but I do not know if this is true. I am still trying to decide between Fosomax or Reclast treatment which I will have in July when my Forteo stops.
I hope your Reclast infusion goes well in June. Will you have it at Ma Gen?

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@janflute

I have an aortic heart valve leak that is being watch, (along with a mitral valve leak that most 77 year old people have that is not concerning). I have read that Evenity is not good for patients with heart problems, but I do not know if this is true. I am still trying to decide between Fosomax or Reclast treatment which I will have in July when my Forteo stops.
I hope your Reclast infusion goes well in June. Will you have it at Ma Gen?

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Read about the conflicting reports on cardiovascular risk with Evenity. one trial found no difference between Evenity and placebo, and one found a slight difference with alendronate being slightly better. Read the begining but especially the section on clinical trials- scroll down.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9511529/

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@tsd1366

Hello dna41 and thisoldewe -
How long have you been taking Prolia? And has your doctor been open to help you wean off Prolia? Are you going to take another osteoporosis medication or going to manage it without medications?

I would like to get off Prolia and plan to talk to my endo in June. I've taken Prolia 3 times and would like to not take it come the 4th time. Any suggestions on best way to approach this subject with the endo?

All the best to you both.

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Hi tsd1366,
The main question is, Why do you want to get off of this? Side effects? Expense?
How are your test results? Your bone density?
I have had 3 Prolia shots, and have been I'll with chest infections, which complicates my other conditions very adversely.
My G.P. and 2 of my specialists are in agreement to stop the Prolia due to the complications of lowering the immune system. Not a usual problem.
Perhaps you could look up comments by formisc and gently. There are thorough discussions on the How of getting off of Prolia.
All the best to you.

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Would you please tell me how you got a consult appointment with the mayo clinic?

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@yogagirl57

Excellent! I'm presuming the appointment is via Zoom or are you close and go in person?

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I’m driving seven hours.

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@senoravicki

Would you please tell me how you got a consult appointment with the mayo clinic?

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I googled “how to get an appt with mayo” and completed a screening questionnaire.

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@windyshores

@stacibw I haven't told my doctors that I talk with McCormick!

I wonder if you can get on the cancellation list (and call at 10 am to see if there are any!).

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New patient appts are not the same as established ones. So, no.

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@baguette

Could you make an appointment with McCormick that comes after your Mayo consult? Then if your consult goes well, you could cancel the McCormick appointment. If you think you want a second opinion, you could keep the appointment.

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Thank you. I am hoping to do both, even if I think one or the other bombs or goes beautifully. What I do with that, I have no idea!

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@roisin11

Hi stacibw, it's great that you found this platform. Given how young you are, it's also great that you're trying to get a handle on what is best to do. First of all, nothing is urgent. Your condition is not going anywhere and any deterioration is slow. The most important thing other than fact finding and making appointments is to avoid situations where you could experience a fracture. So waiting for months for an initial consult is fine. Osteoporosis (OP) treatment is usually managed by endocrinology and rheumatology, though PCPs will and do manage care also. In my opinion, it's best to go to a specialist with training and experience in treating OP.

My PCP referred me to the care of my rheumatologist who simply prescribed Evenity based on my DEXA scan results and did no lab work whatsoever. I then scheduled with an endocrinologist who is a leading researcher in OP and waited a year to see her. My insurance denied Evenity, my rheumatologist then prescribed Tymlos and I declined that. They are both similarly priced and it didn't sit well with me that my insurance was dictating treatment, so I waited. While waiting, I had a consultation with Dr. McCormick, who recommended the lab work and also recommended Evenity. He shared an interesting tidbit, that he had seen a few clients whose distal radius scores got worse after Tymlos, and given that my worst score is there (at the wrists), he was glad that I had declined to take it. A year later I saw the endocrinologist who ordered all the labs but one and also prescribed Evenity to be followed by Reclast as I had had one infusion back in 2018 with no adverse side effects.
So, I knew what I needed and when my insurance declined again, this time dictating that I do Tymlos and Forteo beforehand (another story about the stupidity of that), I looked into paying out of pocket. I got one quote of $13K per month (uh huh!) and another at the retail cost of $2,650 or so per month. I agreed to pay that, and then the pharmacist worked with the Amgen rep and appealed the decision and won! Somehow they were able to get the medical part of my insurance to cover some of the cost (vs the medication part of my insurance run by Caremark), which qualified me to apply for Amgen's support program. I now pay $25.00 per month and have had eight treatments thus far. I mention this because you will probably run into this issue as well.
So my OP is being managed by an endocrinologist (who does all the testing and DEXA scans), rheumatology (through which I get the treatment), and I continue to consult with Dr. McCormick and use his supplements. I also work with functional integrative MD and their nutritionist for IBS. From diagnosis to treatment start took about 2.5 years for me, but only because I refused treatments that were covered in favor of getting the treatment that was prescribed. There is a lot . . . a lot of information to gather and learn, so take your time, take a deep breath and know that Mayo endocrinology and Dr. McCormick will most likely give you the best advice for your needs. Good luck!

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Thank you for this well written and thorough response. It is really helpful. I feel like every day is crucial and that is adding a lot of unnecessary stress. Finding providers has been incredibly difficult. I really want to find someone in my area (Atlanta or Athens ga) who is an “expert” but thus far am coming up with no one. I want functional medicine, but am shocked at the rates ($660 for initial consultation and $350 thereafter) which insurance doesn’t even acknowledge.

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