The Risk of Taking Compound GLP-1s

Posted on August 20, 2026 by Patrick Hercules

Over the past few years, GLP-1 medications, such as semaglutide and tirzepatide, have become a popular way to help people lose weight.

However, some patients and healthcare providers have turned to compounded versions of semaglutide and tirzepatide called compounded GLP-1 antagonists.

Glucagon-like peptide-1 or GLP-1 antagonists are a class of medications that mainly manage blood sugar levels in people with Type 2 diabetes. In 2024, nearly one in three Americans taking a GLP-1 drug said they were getting it from a compounding pharmacy.

Compounded GLP-1 antagonists are custom-mixed weight loss medications made by certain pharmacies, not drug companies, and use the same active ingredients as the brand names, but they don’t have approval from the U.S. Food and Drug Administration (FDA) for safety or effectiveness, and some compounded GLP-1 drugs have additional ingredients or alternate chemical forms of the active drugs.

This is why the FDA has warned against taking compounded versions of semaglutide and tirzepatide, as they don’t undergo regulatory testing for safety, quality, or effectiveness. They also issued a warning about a spike in overdoses and adverse side effects largely attributed to dosing errors with these drugs, due to them coming with syringes for people to draw the medications themselves, unlike brand-name GLP-1 injections that come in prefilled pens.

In 2024, the FDA raised concerns about the increased risk of dosing errors, improper storage, and fraudulently labeled GLP-1s from compounding pharmacies. Consequently, hundreds of people reported serious problems, including dangerous dosing mistakes, where patients got five to twenty times more than the proper dose.

By April of 2025, the FDA had logged over 520 reports linked to compounded semaglutide and 480 for compounded tirzepatide.

Additionally, U.S. poison centers have seen a nearly 1,500% increase in calls related to overdose or side effects of injectable weight-loss drugs since 2019. What’s more, as of April 30th, 2025, poison centers have managed 3,633 GLP-1 agonist-related exposure cases and 22,966 cases from 2019-2025.

The common side effects of GLP-1 antagonist poisoning include:

Nausea and vomiting
Constipation and diarrhea
Abdominal pain

Other symptoms and side effects to watch out for include:

Signs of severe dehydration such as fainting and confusion or not urinating for eight hours.
Pancreatitis, which usually feels like sharp pain in your upper abdomen and back.
Gastrointestinal symptoms that don’t improve when you eat smaller meals or take anti-nausea medications.
Gastrointestinal symptoms that grow worse rather than easing the longer you’re on the drug.

However, there are instances when it might be appropriate for a person to take a compounded drug, such as when a patient’s medical need can’t be met by an FDA-approved drug, or the FDA-approved drug is not commercially available.

If taking a compounded GLP-1 is your only option, it is important to confirm if it is coming from a 503B-registered outsourcing facility, rather than an unregistered seller, and that you remain under close medical supervision while using it.

Other clues that your compounded prescription may not be legitimate:

It does not require a prescription.
The pharmacy is not located within the U.S.
The medication arrives in packaging that is damaged, open, labeled in a foreign language, or has no expiration date.
Unusual delivery methods. Delivery methods other than injections and oral pills, such as sublingual drops and dissolving tablets, have not been tested in clinical trials.
Vague or proprietary ingredient lists. Products marketed as “personalized” blends with added vitamins or other ingredients, without a clear clinical rationale, are often designed to promote those additions to sidestep regulations rather than to benefit the patient.

If you need help locating a licensed online pharmacy, you can use the FDA’s BeSafeRx program. For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Updated Vaccine for Returning Students

Posted on August 7, 2026 by Patrick Hercules

The new school year is right around the corner. That means parents will be taking their children shopping for new school supplies and clothes. In addition to updating their child’s wardrobe and supplies, parents should remember to schedule vaccinations before the school year begins.

Vaccines are the best way to prevent your child from getting many illnesses and spreading them to others. Each age group has recommended vaccines they need to receive before starting their new grade:

Vaccines for children aged four to six before they start kindergarten:

Flu – needed every year
COVID-19
Measles, mumps, and rubella (MMR)
Diphtheria, tetanus, and pertussis (DTaP)
Chickenpox
Polio

Vaccines for children aged seven to 10 before they start elementary school:

Flu
COVID-19

Vaccines for children aged 11 to 12 before they begin middle school:

Flu
COVID-19
Tetanus, diphtheria, and pertussis (Tdap)
Meningococcal conjugate (MenACWY)
HPV

Vaccines for children aged 13-18 before they enter junior and high school:

Flu
COVID-19
Meningococcal conjugate (MenACWY)
HPV

Vaccines for college-aged teenagers:

Flu
COVID-19
Meningococcal conjugate (MenACWY)
HPV

You can find the complete schedule of recommended vaccines for your child by age on the Centers for Disease Control and Prevention’s website. To schedule an appointment for your child to receive the required vaccines at Flushing Hospital Medical Center’s  Ambulatory Care Center, please call (718) 670-5486.

Emotional Fatigue

Posted on August 4, 2026 by Patrick Hercules

When stress from negative or challenging life events occurs repeatedly without adequate recovery, you may find yourself feeling emotionally worn out and drained. This is known as emotional fatigue or exhaustion. Although emotional fatigue is most associated with workplace burnout, it can happen outside occupational contexts in:

Anyone whose emotional labor consistently exceeds their capacity to restore

Caregivers supporting ill or dependent family members

Individuals processing prolonged grief, trauma, or stress

People in chronic, conflict-heavy relationships

Parents of young children or children with complex needs

Emotional fatigue falls between ordinary stress, which most people can bounce back from quickly, and clinical disorders such as major depression or anxiety disorders. If it is left unaddressed, it frequently progresses toward both.

Emotional fatigue can present itself as emotional, physical, and performance signs and symptoms.

Emotional symptoms include:

Depression

Anxiety

Apathy

Irritability

Difficulty making decisions

Feeling hopeless

Feeling powerless or trapped

Lack of focus or forgetfulness

Lack of motivation

Negative thinking

Tearfulness

Nervousness

Physical symptoms include:

Persistent headaches or migraines

Heart palpitations or chest tightness

Fatigue

Poor sleep

An elevated susceptibility to illness

Nausea or upset stomach

Lack of appetite

Sore muscles or muscle tension

Performance symptoms include:

Performing work duties more slowly

Difficulty completing daily tasks for responsibilities

Failing to meet deadlines

Isolation or avoidance

Increased absences

Lower workplace commitment

You can address emotional fatigue by identifying the stressors you can reduce or prevent. When you are unable to change a stressor because it is out of your control, it is important to focus on the here and now. Try to focus on the various neutral and positive events that are happening. Focusing on these types of events can give you a better perspective about what is happening around you, allowing you to shift your focus away from the stressors.

Your body can often interpret stress as a threat to your survival. When this occurs, your brain releases stress hormones throughout your body, which can contribute to your emotional fatigue. As you focus on neutral or positive events in your life, your brain learns that the threat is not as bleak as it may seem. The amount of stress hormones released decreases, causing you to feel more emotionally balanced.

Some other strategies that can help reduce emotional fatigue include:

Practicing mindfulness to engage in the present moment

Eliminating or minimizing the stressor when possible

Identifying and challenging unhelpful thoughts and replacing them with balanced thoughts

Eating a healthy, balanced diet

Exercising

Getting adequate sleep

When emotional fatigue is addressed early, it often clears considerably with the proper rest and load reduction.

If you are experiencing emotional fatigue, you can discuss your signs and symptoms with a mental health professional. They can help you sort through the causes and symptoms you’re experiencing to determine a plan that will help you regain a sense of well-being.

To learn more about our mental health services or to schedule a virtual appointment, call (718) 670-5316 to speak with our intake coordinator or call (718) 670-5562 to reach the clinic.

BBQ Food Safety Tips

Posted on July 17, 2026 by Patrick Hercules

Summer is a time when we have and/or attend several barbecues or cookouts. However, whether you are hosting or attending, eating outdoors in warm weather can present food safety challenges.

Bacteria in food multiply faster at temperatures between 40°F and 140°F, so the summer heat can create problems. Here are some tips to follow to help keep you and others safe from foodborne illnesses:

Washing your hands is very important. Wash your hands if you are preparing food, serving food, or after using the bathroom. Wash your hands and forearms with soap and warm water for at least 20 seconds. If you are in an outdoor setting without access to a bathroom, use a bottle of water, some soap, and paper towels, or use hand sanitizer.

Keep raw food separate from cooked food to avoid cross-contamination.

Don’t use any plates or utensils that have potentially touched or have been contaminated by raw meat, poultry, or seafood. It is recommended to wash utensils that have touched raw meats if they must also be used to handle cooked meats

Marinate food in the refrigerator, instead of out on the counter. If you want to use some of the marinade as a sauce on your food after it is cooked, keep a separate portion of it to use later. Do not reuse the marinade that contained raw meat

Cook food thoroughly to kill any harmful germs and bacteria that may be present. E. coli and Salmonella can still be present in undercooked meats such as hamburger and chicken, and can cause severe illness, even death. Each food should be at a certain temperature for it to be fully cooked:

- Chicken 165o F

- Hamburgers 160o F

- Pork 150o F

- Hot dogs 140o F

- Leftovers 165o F

- Eggs 145o F

Use a food thermometer to check the temperature of the food. Insert the thermometer into the center of the meat, which is the least cooked part. To check the temperature of hot dogs, go from the end of the hot dog to the center. Be careful not to pass through the meat and touch the cooking surface because you will get a false high temperature reading.

Refrigerate or freeze food immediately, as you shouldn’t leave food out of the refrigerator, cooler, or off the grill for more than two hours. Never leave food out for more than one hour when the outside temperature is above 90°F

Keep hot food hot and cold food cold. Hot food should be kept at or above 140°F, wrapped well, and placed in an insulated container. Cold food should be held at or below 40°F. Foods such as chicken salads and desserts that are in individual serving dishes should be placed directly on ice or in a shallow container set in a deep pan filled with ice. Drain off any water that pools as the ice melts, and replace the ice frequently

Wipe surfaces often, especially after using them for food preparation, as germs from undercooked meat can grow on vegetables cut or washed on the same surface as meat. Mix and use a sanitizing solution of one capful of chlorine bleach per gallon of water for cleaning work area surfaces. If possible, use separate cutting boards or surfaces for foods that will not be cooked, such as salad

Keep flies away by covering trash containers, and not storing meat wrappers and other trash in open cardboard boxes or uncovered containers, even for a short period of time

Don’t use fly spray or “No-Pest” chemical strips, as they can contaminate your food

Don’t keep food containers out in the open. Instead, place them in a shaded area

Keep plates, cups, utensils, and food covered until they are ready to be used

Handle plates, cups, and utensils where they won’t come in contact with any food

Don’t prepare and serve food if you have been sick with vomiting or diarrhea within the past 24 hours

Don’t wear loose finger or wrist jewelry or fake nails while working with food

Keep plenty of paper towels handy for cleaning your hands and surfaces

If you or a loved one is experiencing symptoms of a foodborne illness, you can receive treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Fourth of July Recipe

Posted on July 3, 2026 by Patrick Hercules

The Fourth of July is this weekend, and many of us expect to spend time with our family, friends, and loved ones, while eating some delicious food, and watching the fireworks. If you are bringing food to your get-together and need some ideas, here is a recipe for tasty, mouthwatering teriyaki wings to enjoy while celebrating Independence Day.

Teriyaki Chicken Wings Recipe | Tyler Florence | Food Network

Summer Health Concerns and How to Prevent them

Posted on July 2, 2026 by Patrick Hercules

Summer is in full swing, so most of our time will be spent outside doing various activities. However, there are many health concerns to consider.

Here are some summer health concerns and how to prevent them:

The human body is made of up to 78% of water, and when it doesn’t get enough, it can’t function properly. In high heat, dehydration can become severe and fatal. To prevent dehydration, it is important to stay hydrated. You can do this by drinking water and eating water-rich foods. Staying properly hydrated can also prevent kidney stones.

Sunburns occur when ultraviolet (UV) rays from the sun cause a radiation burn on the skin. Sunburns can contribute to premature aging of the skin and skin cancer, and can also lead to dehydration, sun poisoning, and infection from severe burns. To prevent sunburn, wear sunscreen containing titanium oxide or zinc oxide every day, even on overcast days. Make sure to cover your entire body, including your ears, eyelids, lips, scalp, and, if exposed, the top of your feet.

Spending time in the sun doesn’t only bring the risks of sunburn and dehydration. It also brings the risk of heat illnesses, including:

Heat rash- a red stinging rash that develops when sweat gets trapped in your glands.
Heat cramps are painful muscle cramps that occur when you sweat so much that your body loses salts and fluids.
Heat exhaustion occurs when the body can’t cool itself through sweating. If it’s not treated, it can quickly turn into heatstroke.
Heatstroke, or sunstroke, occurs when a person’s body temperature climbs to dangerous levels. It’s the most severe heat-related illness and can be fatal.

To prevent heat illnesses, limit the time you spend outdoors. Also, take any symptoms you observe in yourself and others seriously.

Insects are more active during the summer, which means there’s a higher risk of encountering them. Especially for:

Bee stings
Mosquito bites
Tick bites
Ant bites

To prevent bugs from stinging or biting you, wear an insect repellent with the active ingredients DEET or picaridin. Other ways to prevent stings and bites include:

Avoid using scented products.
Drain any standing water.
Put on protective clothing.
Don’t leave any food uncovered outside.

We want to spend more time near water to cool off as temperatures rise. However, it is important to follow proper safety precautions to avoid drowning risks. Here are some ways to prevent drowning risks:

Learn CPR
Use drain covers on pool drains.
Wear life jackets
Sign up for swimming lessons.

Everybody loves a good summer barbecue or cookout, but sometimes the food we eat doesn’t always love us back. The smoking process that gives smoked meats their flavor also creates harmful substances called polycyclic aromatic hydrocarbons or PAHs and heterocyclic amines or HCAs. The National Cancer Institute warns that PAHs and HCAs are mutagenic, meaning they can cause changes to your DNA that put you at risk for certain types of cancer. You can prevent ingesting these harmful substances by using liquid smoke as an alternative marinade for your meats. Foodborne illness can be a concern for cookout food as well. This is the case for food left out or leftover sitting in the “temperature danger zone” of 40 to 140 degrees Fahrenheit. These temperatures allow bacteria to grow that can make you sick. You can prevent foodborne illness by cooking meats to a safe temperature and throwing any food that has sat out too long in the trash.

Seasonal allergies caused by pollen is a huge problem in the summer as the weather gets warmer and trees, grass, and flowers pollinate. To prevent seasonal allergies, try taking allergy medications before the season starts so your body can build its defense.

These preventative measures can help you enjoy your summer and keep you safe.

If you or a loved one is experiencing symptoms of heat-related illness, you can receive treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486. If you or someone you are with is experiencing an emergency, call 911 immediately.

Why Are Autoimmune Diseases More Common in Women?

Posted on June 24, 2026 by Patrick Hercules

The immune system helps defend our body against illnesses and infections. However, when a person has an autoimmune disease, the immune system mistakenly attacks the body, destroying healthy cells and tissues.

There are several autoimmune disorders and diseases. Here are a few of the main areas of the body that they affect:

Type 1 diabetes affects the pancreas, which leads to reduced insulin production

Multiple sclerosis (MS) affects the nervous system

Rheumatoid arthritis affects the joints

Juvenile idiopathic arthritis affects the joints

Lupus affects many organs and systems

Hashimoto’s thyroiditis affects the thyroid

Autoimmune hepatitis affects the liver

Celiac disease affects the small intestine as a reaction to eating gluten

Myositis affects the muscles

Sjogren’s syndrome affects the glands that produce tears and saliva

Vasculitis affects the blood vessels

Myasthenia gravis affects the nerves and muscles

An autoimmune disease can target any part of the body, and if a vital organ is attacked, the disease can be life-threatening.

Autoimmune disorders are significantly more common in women than in men. According to a recent study published in The Journal of Clinical Investigation, 67 percent of autoimmune diagnoses are in women, and 18 out of the 20 most common autoimmune diseases, such as rheumatoid arthritis, psoriasis, multiple sclerosis, and lupus, are more prevalent in women than men. What’s more, as many as 70 to 80 percent of people with autoimmune diseases are female, with the percentages for some specific conditions being higher, for example, 95 percent of those with Sjogren’s syndrome are women.

Genetics plays a large role in the risk of developing autoimmune diseases in both men and women. Environmental factors, such as exposure to ultraviolet rays, pesticides, and organic mercury, can also contribute to men and women developing an autoimmune disease. However, other major factors increase women’s proneness for these diseases, including:

High Estrogen Levels- Estrogen boosts the function of T and B immune system cells, which can be an advantage in fighting infections. However, it can be problematic for people with other factors that make them more likely to have autoimmune diseases. Estrogen levels are highest during pregnancy, and some autoimmune diseases are more common in women during their childbearing years in general, particularly during pregnancy

DNA- Chromosomes contain our DNA and genetic information. Males have one X chromosome and a much smaller Y chromosome, while females have two copies of the X chromosome. One of the two X chromosomes in females is usually dormant, which leads to males and females expressing one X chromosome gene. However, the intricate system that causes this to occur has many protein components that tend to become targets of the immune system, which can lead to autoimmune disease. In some rare instances, some males and females can have more copies of the X chromosome than normal, which makes them more likely to have certain autoimmune diseases, such as lupus and/or Sjogren’s syndrome

Immune Response- Women can generate a stronger immune response to infection than men. This gives them a better chance to fight infection, but produces an autoimmune disease in a person who is genetically predisposed to developing one

Hormones- When females are going through puberty or are pregnant, they experience hormone surges, which may cause the immune system to overreact and increase the risk of developing autoimmune diseases, such as lupus. Their risk of developing an autoimmune disease or experiencing a worsening of symptoms decreases after menopause

Birth Control- Some women with severe autoimmune disease, such as lupus, may need to avoid hormonal birth control that contains estrogen due to the increased risk of estrogen exposure. However, most women can use some form of birth control safely if they consult with their rheumatologist and Ob/Gyn

It is important to see your healthcare provider if you have any lasting symptoms, such as fatigue, weakness, joint pain, weight loss, or rashes that could be related to morning stiffness, as these symptoms should be taken seriously.

Treatment for autoimmune diseases is specialized for the individual and the amount of organ involvement. If a person has mild symptoms without major organ participation, the use of medications that regulate immune response without immunosuppression, along with treating symptoms, may be adequate. However, if major organs are affected, immunosuppressive and biologic medications that target certain parts of the immune system are used.

If you or a loved one is experiencing symptoms of an autoimmune disease, you can receive treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Summer Recipe: Rigatoni with Summer Bolognese

Posted on June 3, 2026 by Patrick Hercules

Summer is approaching, and many fruits and vegetables are coming into season. Here is a recipe for rigatoni with summer bolognese made with seasonal vegetables, a flavorful way to enjoy a relaxing summer evening.

GLP-1 Microdosing

Posted on May 27, 2026 by Patrick Hercules

Glucagon-like peptide-1 or GLP-1 antagonists are, however, a class of medications that mainly manage blood sugar levels in people with Type 2 diabetes. Medications, such as semaglutide and tirzepatide, have become popular over the past few years to help people lose weight.

Recently, however, some people have been microdosing GLP-1 medications as their preferred way to take these medications. Microdosing means taking much smaller doses than those approved by the Food and Drug Administration (FDA).

People may microdose GLP-1 medications for many reasons, including:

They have hit their target weight goal

They have concerns about the cost of the medications

They are sensitive to the side effects of the medications

They want to just suppress their appetite

They are worried about the supply of the medications

Microdosing GLP-1 medications can come with real risks, including:

Inaccurate doses

Reduced effectiveness

Unpredictable outcomes

Possibility of regaining weight

No data on the long-term effects of microdosing

Minimal oversight

Large clinical trials have confirmed that the standard GLP-1 doses work well when helping people lose weight and manage Type 2 diabetes. What’s more, precise doses have proven benefits for heart, liver, and kidney health. Taking very low doses may not provide the same results.

Additionally, smaller GLP-1 doses may help reduce symptoms such as nausea or an upset stomach. However, microdosing may prevent you from reaching the effective dose needed to make significant changes in your body weight or blood sugar levels. In many cases, the side effects of GLP-1 treatment are temporary. GLP-1 dosage schedules are intended to increase doses gradually to help balance their benefits and potential side effects.

GLP-1 medications affect people differently. Some people may see substantial benefits even at lower doses. However, other people may not see their benefits at full doses.

Before you consider microdosing GLP-1 medications, it is important to speak with a healthcare provider who is knowledgeable about these treatments. Here are some things to consider:

If the GLP-1 medication is off-label, it is an unproven treatment

The health benefits for those who don’t have Type 2 diabetes or a high body mass index (BMI) are unproven

Taking smaller doses doesn’t make them risk-free

As an alternative to taking GLP-1 medications, here are some proven ways to support metabolic and overall health naturally:

Exercising regularly

Eating a healthy, balanced diet

Managing stress

Getting enough restful sleep

Eating certain foods and taking supplements

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

Centering Pregnancy at Flushing Hospital

Posted on May 12, 2026 by Patrick Hercules

Flushing Hospital Medical Center is committed to providing the best possible prenatal care to our patients. That is why we are offering Centering Pregnancy to our expectant parents.

Centering Pregnancy is an innovative prenatal model designed to promote the overall health and well-being of the mother and baby. Unlike traditional one-on-one prenatal visits, this approach incorporates small-group sessions for medical care, education, and emotional support, fostering meaningful relationships between participants and clinicians.

After an initial private visit with a provider, participants in the centering pregnancy program, all of whom are in similar stages of their pregnancy, meet in a small group setting for their prenatal appointments. Here, participants share with and learn from each other during the course of their pregnancy. Each of the ten-centering prenatal care group sessions is approximately 90 minutes long. This group dynamic gives each of the participants the advantage of having more time with their provider.

At the beginning of the session, our facilitator will guide each patient to get weighed, have their blood pressure checked, and record their values for the provider to review. The provider will listen to the baby’s heartbeat and review the pertinent patient-specific information. After this information is collected, the 8-12 participants will form a circle and begin the fun and interactive educational session.

Some of the topics covered in these sessions, designed to promote health and well-being during the pregnancy and postpartum period, include:

The progression of their pregnancy

Relaxation techniques

Common discomforts and how to resolve them

Nutrition during pregnancy

What to expect during labor and delivery

Newborn feeding, including breastfeeding

Newborn care

Games are played to help the learning process and to assist in building friendships between the participants. After the educational session, there is a question-and-answer period.

Expectant mothers are actively involved in their care as they share similar experiences with women during the same stage of pregnancy. Moms and providers can relax and get to know each other. Many long-lasting friendships are formed from being involved in Centering Pregnancy.

Studies show that women who participate in Centering Pregnancy programs tend to experience:

Fewer preterm births (33 percent fewer, according to some research)

Lower rates of emergency C-sections

Higher rates of breastfeeding

Better engagement in their own health

Improved spacing between pregnancies

Better well-child visit attendance and immunization rates

Lower rates of postpartum depression

Dramatically reduced racial disparities in preterm birth, especially among African American women

“The Centering Pregnancy has proven to be overwhelmingly positive, with participants expressing satisfaction with the group setting and the support they receive. Expectant women learn together, feel less isolated, and share their questions and experiences. Empowering women and allaying fears throughout pregnancy and after birth has been a benefit of Centering Pregnancy,” said Maria DeMarinis Smilios, MSN, CNS, RNC, IBCLC, Director of Nursing-Maternal & Child Services and Ambulatory Care

These are the many benefits of Centering Pregnancy compared to traditional care. There is no extra charge for this type of prenatal care when compared to traditional prenatal care.

For more information and to schedule for Centering Pregnancy, call 718 670-8992.