GLP-1 agents for weight loss tied to pancreatitis:
The medical “rage” these days is the use of once weekly injections of Glucagon-Like Peptide-1 agonists (GLP-1) for weight loss. One of those drugs is Tirzepatide, known clinically as Mounjaro or Zepbound. There have been several alarming reports of this drug causing acute pancreatitis, and one such case resulted in death. A 64 year old patient went to the ER with sudden severe upper abdominal (epigastric) pain. She had recently started tirzepatide, and her last dose was 4 days prior. A CT showed acute pancreatitis. Over the ensuing three days she progressively worsened, had a stroke, cardiac arrest, and died. Her entire situation was blamed on the GLP-1. That has led doctors to heighten awareness of this serious, potentially fatal, consequence of the use of GLP-1 agonists. They warn doctors, and patients, to carefully watch for signs and symptoms of pancreatitis—abdominal pain radiating to the back, nausea, vomiting—and stop GLP-1 injections at the first sign of trouble. Those at highest risk are patients with a history of pancreatitis, gallstones, high triglycerides in the blood, and overuse of alcohol as well as using terzeparide for longer than 26 weeks. There needs to be a “lower threshold for stopping terzepatide” if pancreatitis is suspected.
Reference: Remaly J. Terzepatide Woes: Pancreatitis Strikes, Raising Alarm Among Some Doctors Medscape Medical News 2024 June 10. (medscape.com/viewarticle/tirzepatide-woes)
Are beta blockers harmful?
Of course not, if used properly. These drugs block beta adrenergic receptors which are the cellular elements that when stimulated by the sympathetic nervous system affect heart rate, the force of pumping of the heart (contractility), and dilation of the bronchial tubes. Beta blockers, then, block those functions—they slow the heart rate, blunt the pumping effect of the heart, and cause spasm of the bronchial tubes leading to wheezing. They have numerous uses, are extremely effective, are safe, and inexpensive. Examples are propranolol, metoprolol, atenolol, and carvedilol. They’re used to treat high blood pressure, coronary artery disease, benign non-Parkinsonian tremors, heart attacks, heart failure, and are used for the prevention of migraine headaches. The biggest “knock” on beta blockers is their effect on exercise tolerance. Slowing the heart rate and reducing the pumping force of the heart directly leads to chronotropic incompetence, or the inability of the heart to respond appropriately to exercise leading to activity intolerance. Thus, since response is variable, personalized treatment and close monitoring of a patient’s exercise capacity are very important.
Reference: Holley AB. The Tyranny of Beta Blockers. Medscape Medical News 2024 June 12; (medsacape.com/viewarticle/the-tyranny-of-beta-blockers).
Walking helps guard against recurrent low back pain:
Once a person has had an episode of low back pain (LBP), there is a strong likelihood it will happen again. It is stated that “about 7 out of 10 people who recover from an episode of LBP will have a recurrence within the following year.” Exercise has long been recommended to prevent recurrent bouts. Thus, Australian researchers set out to find if walking helped. Half of a group of 701 LBP patients were to walk, under the supervision of a physical therapist, for 30 minutes 5 times a week for 6 months. The other half, the control group, did not walk. This group of patients had a median of 33 previous episodes of LBP. The results of the study showed that “walking intervention was effective in preventing an episode of activity-limiting LBP. And the number of days until LBP recurred was longer among the walking group participants than in control participants (208 days vs. 112 days—almost twice as long). The reason for improvement was not determined, but it was thought “the benefits of walking could have been from the gentle movements, loading and strengthening of the spinal structures and muscles, the relaxation and stress relief it provides, and the release of feel-good endorphins.” Therefore, patients with recurrent LBP are encouraged to walk regularly to prevent LBP from reoccurring. Further research is planned with diverse populations of patients and in people with other contributing problems.
Reference: Brooks M. Walking Helps Guard Against Recurrent Low Back Pain. Medscape Medical News 2024 June 20.(https://www.medscaoe.com/viewarticle/walking-helps-guardian-against-low-back-pain)
Tirzepatide Reduces Sleep Disruptions:
Zepbound and Mounjaro, two GLP-1 receptor agonists known generically as tirzepatide, have been found to be so effective against the sleep disruptions caused by OSA, Obstructive Sleep Apnea, that 40% to 50% of patients were able to discontinue using CPAP. Obesity is a major accompaniment of OSA, so a once-weekly injection for a year caused enough weight loss that OSA patients saw a reduction in sleep disruptions from an average of 51.5 per hour to between 21 to 24 per hour. Doctors are uncertain if tirzepatide has a direct effect on OSA or if the improvement was from weight loss.
Reference: Ault A. Tirzepatide Significantly Reduces Sleep Disruptions Medscape Medical News 2024 June 22 (medscape.com/viewarticle/tirzepatide-significantly-reduces-sleep-disturbances)
Doctors Sued Most for Laser Hair Removal of Face, Head, Neck:
Plastic Surgeons who perform “energy-based device procedures” such as facial hair removal were the health professionals sued the most. It is alleged that many practitioners are inadequately trained for the procedure and thus have many complications. Burns, scarring, and pigmentation changes were the problems encountered most often, and many non-physician ancillary personnel (52% of cases) under the doctors were given responsibility for this procedure. Physicians should better supervise these situations, and assure those practitioners are adequately trained.
Reference: Brunk D. Laser Hair Removal Most Litigated Energy-Based Procedure. Medscape Medical News 2024 June 25:(medscape.com/viewarticle/Laser-hair-removal-most-litigated-procedure).
Study Shows Surgeons Most Likely to Behave Unprofessionally:
To no one’s surprise, the Center for Patient and Professional Advocacy’s Coworker Observation Reporting System (CORS) program reported surgeons most likely to be observed behaving unprofessionally. Examples of unprofessional behavior are berating coworker or calling them unflattering names, rudeness to staff, impatience with assistants, or improper procedure coding (upcoding to increase reimbursement). Unprofessional behavior is unpleasant and may lead to patient complications and malpractice claims. Surgeons work in a stressful, high-pressure environment and must not make costly or fatal mistakes.
Reference: Hurt A. Surgeons Most Likely to behave Unprofessionally: Study. Medscape Medical News 2024 June 17: (medscape.com/viewarticle/surgeons-most-likely-to-behave-unprofessionally).
