MEDICAL NEWS BRIEFS #25

More Studies Confirm SEMAGLUTIDE’S Superiority: Additional scientific studies have once again shown semaglutide’s superiority to all other GLP-1 receptor agonists for weight loss. This especially true for obese, non-diabetic patients who over a year had a mean weight loss of 5.9% of body weight compared to diabetics who lost a mean of 3.2%. Semaglutide users were also more likely to use the drug for a full year, because it is a once-weekly injection rather than daily. One negative, however, is only partial- or non-coverage by insurers. 

Reference: Ault A. Semaglutide Bests Liraglutide in Long-Term Weight Loss Medscape Medical News 2024 September 20.

Muscle Relaxants Shown to Help Chronic Pain: Patients with chronic low back pain, fibromyalgia, or headaches do not respond to muscle relaxants, but those with cramps and spasms of the neck have been helped by long-term use. Baclofen (Lioresal), carisoprodol (Soma), methocarbamol (Robaxin), cyclobenzaprine (Flexeril), orphenadrine (Norflex/Norgesic), and tizanidine (Zanaflex) were studied compared to placebo. Results showed the following:

1. Baclofen, orphenadrine, carisoprodol, and methocarbamol improved cramp frequency.
2. Tizanidine improved pain severity in headaches. 
3. Quality of sleep was “enhanced.”
4. Intensity of pain from fibromyalgia and chronic back problems was reduced. 
5. Dry mouth and drowsiness caused a lot of patients to stop these medications.
6. Those who were able to use them for >4 weeks found they helped.

Muscle relaxants should be tried in patients with chronic muscle pain and spasms.

Reference: Talwadekar M. Muscle Rekaxants for Chronic Pain: Where is the Greatest Evidence? Medscape Medical News 2024 September 20. 

Weight loss drugs in the news again: As I’ve reported often, GLP-1 drugs, originally developed for lowering A1C levels in diabetics, have the additional benefit of causing significant weight loss. The three drugs marketed for diabetes and weight loss are semaglutide, liraglutide, and tirzepatide (Ozempic, Victoza, and Zepbound, respectively). After two years+ of use and numerous clinical studies, it is now known that tirzepatide leads to greater weight loss and a greater reduction in A1C. Unfortunately, tirzepatide, and all 3 GLP-1’s, compared to placebo, caused more side effects as well. GI problems of nausea, vomiting, constipation, and particularly, diarrhea are seen. Better outcomes in regard to weight loss and side effects came when behavioral support, dietary changes, and physical exercise were incorporated into the treatment regimen. Sufficient fiber in the form of vegetables, fruits, beans, and legumes (salads, spinach) can reduce GI effects. Supplemental calcium and vitamin and are recommended as well. This conclusion differs completely from the results of the first article is this blog post. 

References: Eppinger U. Tirzepatide wins on weight loss, but at a gastrointestinal cost. Medscape News UK 2024 October 1. 

Davis KW. How are doctors using terzepatide vs. semaglutide? Q&A. Medscape Medical News 2024 October 21. 

Was your child’s navel an “outie?” 2.7% of infants are born with an umbilical hernia. I saw quite a few. An umbilical hernia is a weakness and separation of the abdominal wall where the umbilical cord attached. At birth, an infant’s umbilical cord is tied off and cut. The remnants of the cord dry up and fall away, and the opening in the abdominal wall spontaneously closes. When closure does not occur (2.7% of births), the infant is left with an umbilical hernia, the term used for an “outie navel.” Contained in that bulge are various contents of the abdomen cavity. The dilemma then becomes “do you operate and repair it or not?” Surgery is curative, but is it necessary to subject an infant to an anesthetic and an abdominal operation? NO. What we all want is for the defect to close on its own. Now we have important information to guide us. Most umbilical hernias (88.6%) close on their own by 5 years of age. 86% close by age 4, 83% by age 3, and 77% by age two. So depending on the degree of concern expressed by the parents, waiting for spontaneous closure until at least age 2 years is acceptable, and until age 5 years, as well. In my experience, though, only the children who had parents that were seriously upset by the constant bulge from the child’s navel, had surgery. Waiting five years for this darn thing to close requires a lot of patience from parents and doctors, alike. But to spare a child from major surgery is worth the wait.

Reference: Barry HC. 89% of Umbilical Hernias Spontaneously Close by 5 Years of Age. Am Fam Phys 2024 October;110(4):433.

Community-Acquired Pneumonia: Most Oral Treatments are Similarly Effective. Community-acquired pneumonia is that contracted outside of a hospital and usually not severe enough to require hospitalization or intravenous antibiotics. One example of this would be “walking pneumonia,” the nebulous name given to a viral or atypical type of bacterial lung infection acquired during daily, routine activities. Mild or moderate cases can be treated as an outpatient with oral antibiotics. This reference article cites information identified from 24 studies on the subject. The best drug for oral treatment was Biaxin (clarithromycin). Zithromax (Z-pack), Levaquin (levofloxacin), and Augmentin (amoxicillin/clavulanic acid) could all be used but were all slightly less effective. Hopefully this information helps patients in this situation.

Reference: Shaughnessy AF. Community-Acquired Pneumonia: Most Oral Treatments are Similarly Effective Am Fam Phys 2024 October;110(4):432.

Rapid heart rate and chronic kidney disease make for a worrisome combination: Adults age 65 and older with non-dialysis-dependent chronic kidney disease (stages I,II,III) observed for a period of five years, whose resting heart rate was 80 beats/minute or above had a greater risk for cardiovascular events than patients whose HR was 70 beats/minute or less. Controlling one’s HR at 70 o less lowers one’s risk of CV mortality.

Reference: Battacharya S. A Racing Heart Signals Trouble in Chronic Kidney Disease Medscape Medical News 2024 August 9.

GLP-1 RA’s: Lose weight and avoid alcohol and opioid abuse. The “drugs of the century” are at it again. Glucagon-Like Peptide 1 Receptor Agonists (GLP-1RA’s) not only lower one’s body weight and A1C, they also lower the rate of opioid overdose by 40% and acute alcohol intoxication by 50%. A study of 503,747 patients showed semaglutide prescribed to opioid and alcohol abusers lowered the risk of overdose and intoxication by 40% and 50% respectively. Is there no end to what these drugs can do?.

Reference: Brooks M. Can Weight loss Drugs also treat addiction? Medscape Medical News 2024 October 18.

Treating a miscarriage is not a criminal offense: I have seen numerous political ads on TV, recently, alleging that doctors who treat women after a spontaneous miscarriage are at risk of criminal prosecution if they surgically remove the remaining products of conception. I have even seen an ad where people who are allegedly physicians corroborate that assertion. Well, they are either confused, not physicians, or lying for political gain. Let me set things straight.

First, I will address the terminology: The fetus, placenta, and amniotic fluid within a pregnant uterus are known as “products of conception.” A miscarriage is the spontaneous, unprovoked expelling of the products of conception that is called a “spontaneous abortion.” When part of the products of conception are not expelled, it is called “retained products of conception,” or an “incomplete abortion.” This non-viable tissue needs to be removed ASAP to prevent bleeding or uterine infection. 

When the pregnant woman in her first trimester begins cramping and/or bleeding, the term for this is a “Threatened Abortion.” The pregnancy is not viable and is threatening to abort.

In this context (a miscarriage), abortion is not defined the way lay people usually think of. Here, it means the loss of a pregnancy as a result of a physical complication or abnormality of the pregnancy. The fetus is not viable. Something has caused it to expire and now the body is naturally expelling it. This is a medical complication of pregnancy.

In the political context (Roe vs. Wade), abortion takes on a new definition. This situation is called a “Therapeutic abortion.” Here, there is no known abnormality of the pregnancy, and there may or may not be a fetal heart beat. The patient, for reasons only she knows, has chosen to end her pregnancy. The products of conception are therapeutically removed from the uterus. This is the abortion most people know of and have argued about for the last 51 years. 

The ads mentioned above imply spontaneous abortion and therapeutic abortion are the same. They are not! They also imply doctors could face criminal charges if they treat incomplete abortions just as they could for therapeutic abortions. There is no ethical similarity. The removal of retained products of conception from an incomplete spontaneous abortion is a well-established, legal, uncontroversial, and necessary medical procedure. There is no criminality about it, and to imply there is is deceptive and disingenuous. Treating an incomplete abortion does not have the same relevance as a therapeutic abortion. In this scenario, it is a legitimate, necessary medical procedure free of controversy or political stigma. 

I wish these ads would go away or at least be honest about what they say. Fortunately, we won’t have any of this baloney after November 5th.