GLP1 meds and fasting

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PpfSuxTube said:
My point is more of a retort to the earlier statement about obesity having some sort of medical explanation that makes it ok to eat a bag of Oreos in one sitting.

It's not ok to eat yourself to 400lbs.

Popping a pill to lose weight doesnt undo whatever self destructive behaviour you have that made you eat like that. That's self hate or something else that manifest in other ways that also shorten your life...

Its a very serious disorder that I just don't think will go away by simply losing weight. There must be more in it. Eating to 400lbs is a massive problem

Thats my point...
Click to expand...
All fair points, although obesity is much more complex than many of us are aware of.

That being said, if we have a medication that makes people lose weight despite their bad habits it is still 100% worth it given how bad obesity is for people and how expensive it is to treat the complications of obesity.

We have medications to help opioid addiction and alcohol addiction. Why should this be any different?
 
VA Hopeful Dr said:
All fair points, although obesity is much more complex than many of us are aware of.

That being said, if we have a medication that makes people lose weight despite their bad habits it is still 100% worth it given how bad obesity is for people and how expensive it is to treat the complications of obesity.

We have medications to help opioid addiction and alcohol addiction. Why should this be any different?
Click to expand...

i wonder how long patients will be able to tolerate it before some untoward side effect makes them stop. will this be another 6 month fad and then regain all the weight on the rebound? that is my suspicion. no one really loses weight and the drug company makes out great. i truly hope not but it has been a struggle with similarly intended medicines in the past
 
Hoya11 said:
i wonder how long patients will be able to tolerate it before some untoward side effect makes them stop. will this be another 6 month fad and then regain all the weight on the rebound? that is my suspicion. no one really loses weight and the drug company makes out great. i truly hope not but it has been a struggle with similarly intended medicines in the past
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I was talking to a urologist who treats obesity - and he says these drugs cause too much pancreatitis to be used at the rate that they are being used.

He uses b-HCG...says it works very well for weight loss. I had never heard of that.
 
Speaking of new drugs -

Any concerns with anesthesia and the new Orexin Receptor antagonists (ie..Daridorexant) for insomnia?

​

 
epidural man said:
I was talking to a urologist who treats obesity - and he says these drugs cause too much pancreatitis to be used at the rate that they are being used.

He uses b-HCG...says it works very well for weight loss. I had never heard of that.
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Your friend prescribes the b-HCG diet to his patients? Does he also have a flip phone and drive a car without power windows? I haven't heard of anyone actually recommending it in years.

The b-HCG diet doesn't work because of the HCG injections. It works because it stipulates that the patient follow a 500 calorie a day diet for several weeks.
 
VA Hopeful Dr said:
All fair points, although obesity is much more complex than many of us are aware of.

That being said, if we have a medication that makes people lose weight despite their bad habits it is still 100% worth it given how bad obesity is for people and how expensive it is to treat the complications of obesity.

We have medications to help opioid addiction and alcohol addiction. Why should this be any different?
Click to expand...
Good point. Never thought of it this way.
 
epidural man said:
I was talking to a urologist who treats obesity - and he says these drugs cause too much pancreatitis to be used at the rate that they are being used.

He uses b-HCG...says it works very well for weight loss. I had never heard of that.
Click to expand...
Why is a urologist treating pancreatitis (<1% on the phase 3 studies of wegovy)? You'd think he be more worried about aki, another rare complication that shouldn't deter people from using them...
 
epidural man said:
I was talking to a urologist who treats obesity - and he says these drugs cause too much pancreatitis to be used at the rate that they are being used.

He uses b-HCG...says it works very well for weight loss. I had never heard of that.
Click to expand...
He's a shyster if he claims HCG does **** all
 
Pfizer has an ORAL version with similar weight-loss efficacy. It is in phase three clinical trial. For SDN investors who missed Novo Nordisk bandwagon, it may not be a bad idea to look into pfizer.

The stock price low, dividend good. Has a lot cash from covid vaccine to buy other companies, get RSV vaccine going, and now the weight loss drug.
 
narcotics999 said:
Pfizer has an ORAL version with similar weight-loss efficacy. It is in phase three clinical trial. For SDN investors who missed Novo Nordisk bandwagon, it may not be a bad idea to look into pfizer.

The stock price low, dividend good. Has a lot cash from covid vaccine to buy other companies, get RSV vaccine going, and now the weight loss drug.
Click to expand...
Meh, I've not been impressed with Rybelsus so far - for diabetes or weight loss.
 
After reading this thread, start to all these people on ozempic.

Just did one EGD this morning…. Young girl BMI 56, with 3 different meds for DM, one being ozempic 2mg two days ago.

Was like, nah, not gonna play. RSI…. Surgeon went in, can’t see shlt…. Came out.
 
IMGASMD said:
www.apsf.org

Are Serious Anesthesia Risks of Semaglutide and Other GLP-1 Agonists Under-Recognized? Case Reports of Retained Solid Gastric Contents in Patients Undergoing Anesthesia

Glucagon-like peptide (GLP-1) receptor agonists are an emerging and increasingly popular class of medications used for the treatment of type 2 diabetes mellitus and, more recently, obesity. Since the expansion of approved uses to include...
www.apsf.org www.apsf.org

Hot off the press

Though doesn’t say what to do.
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Not even remotely helpful.
 
IMGASMD said:
www.apsf.org

Are Serious Anesthesia Risks of Semaglutide and Other GLP-1 Agonists Under-Recognized? Case Reports of Retained Solid Gastric Contents in Patients Undergoing Anesthesia

Glucagon-like peptide (GLP-1) receptor agonists are an emerging and increasingly popular class of medications used for the treatment of type 2 diabetes mellitus and, more recently, obesity. Since the expansion of approved uses to include...
www.apsf.org www.apsf.org

Hot off the press

Though doesn’t say what to do.
Click to expand...

Basically what we already know..
 
narcotics999 said:
Pfizer has an ORAL version with similar weight-loss efficacy. It is in phase three clinical trial. For SDN investors who missed Novo Nordisk bandwagon, it may not be a bad idea to look into pfizer.

The stock price low, dividend good. Has a lot cash from covid vaccine to buy other companies, get RSV vaccine going, and now the weight loss drug.
Click to expand...
Thought multiple are working on oral forms?
 
1686679335757.png
 
Unfortunately, without hard evidence, what are they supposed to say? It sucks, but we need more data.
 
VA Hopeful Dr said:
None of them got approval for obesity until 2015 and it wasn't until the last 1-2 years that insurance would cover for that indication.
Click to expand...


More indications.


www.reuters.com

Novo's Wegovy shows heart benefit alongside weight loss in trial

Wegovy maker Novo Nordisk said on Tuesday a large study had shown the highly effective obesity treatment also had a clear cardiovascular benefit, boosting the Danish company's hopes of moving beyond its image as a lifestyle drug.
www.reuters.com www.reuters.com
 
nimbus said:
More indications.


www.reuters.com

Novo's Wegovy shows heart benefit alongside weight loss in trial

Wegovy maker Novo Nordisk said on Tuesday a large study had shown the highly effective obesity treatment also had a clear cardiovascular benefit, boosting the Danish company's hopes of moving beyond its image as a lifestyle drug.
www.reuters.com www.reuters.com
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We've known it has that benefit for diabetics for several years now. Not a shock it does it in non-diabetic obese people as well.
 
FWIW I’ll tell another anecdote.

My brother in law has been on ozempic for a year now. He never ate very much and eats even less now. He’s 5’9” and has dropped from 230 to 180.
 
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I did 5 gastric ultrasounds for Mac cases today. Not as annoying as I thought it would be, but not everyone has a curvilinear probe and a sonosite lx

Tried it with a butterfly and a sonosite SiCU us machine not nearly as nice inages
 
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Our private practice group has made it a policy that patient has to be off the drugs for at least 2 weeks for weekly dosing and clear liquid diet for at least 24 hours.

The gastric ultrasound I think would give me a false sense of security. Maybe others can comment. How reliable is it?

Unfortunately we have a few older Gi docs who still insist on colonoscopy first and then egds on doubles. Would like them to switch so we can abort if there’s food during egd
 
Simba1711 said:
Our private practice group has made it a policy that patient has to be off the drugs for at least 2 weeks for weekly dosing and clear liquid diet for at least 24 hours.

The gastric ultrasound I think would give me a false sense of security. Maybe others can comment. How reliable is it?

Unfortunately we have a few older Gi docs who still insist on colonoscopy first and then egds on doubles. Would like them to switch so we can abort if there’s food during egd
Click to expand...




The experts seem to think (now) that it's highly validated and reliable imo. When I finished fellowship 10 years ago it was quasi experimental.

Above video posted because I liked it.
 

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Simba1711 said:
Our private practice group has made it a policy that patient has to be off the drugs for at least 2 weeks for weekly dosing and clear liquid diet for at least 24 hours.

The gastric ultrasound I think would give me a false sense of security. Maybe others can comment. How reliable is it?

Unfortunately we have a few older Gi docs who still insist on colonoscopy first and then egds on doubles. Would like them to switch so we can abort if there’s food during egd
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That is problematic--these drugs are titrated to effect over a period of 3-4 months and the manufacturer states you have to start over if you are that far behind doses. They would have to have a PCP appointment to just figure out how to restart the med and a new Rx after surgery.
 
Simba1711 said:
Unfortunately we have a few older Gi docs who still insist on colonoscopy first and then egds on doubles. Would like them to switch so we can abort if there’s food during egd
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Wtf, I’ve never seen anyone do the colon first on a double. Is this done anywhere else? Can you tell them to do the upper first for safety purposes? I don’t see how it would matter to them.
 
circleK said:
Wtf, I’ve never seen anyone do the colon first on a double. Is this done anywhere else? Can you tell them to do the upper first for safety purposes? I don’t see how it would matter to them.
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Maybe they do it that way to avoid cancellations when they find a full stomach...
 
Simba1711 said:
Our private practice group has made it a policy that patient has to be off the drugs for at least 2 weeks for weekly dosing and clear liquid diet for at least 24 hours.

The gastric ultrasound I think would give me a false sense of security. Maybe others can comment. How reliable is it?
Click to expand...

According to the experts, a negative gastric ultrasound has a 99% specificity.

Unfortunately we have a few older Gi docs who still insist on colonoscopy first and then egds on doubles. Would like them to switch so we can abort if there’s food during egd
Click to expand...

It's stupid yes. But the rationale I've heard is that the colonoscopy is less stimulating.
 
Simba1711 said:
Unfortunately we have a few older Gi docs who still insist on colonoscopy first and then egds on doubles. Would like them to switch so we can abort if there’s food during egd
Click to expand...

I worked with one GI who did it this way. Frankly, I didn’t mind it. I was able to get the patient in a good plane of anesthesia and probably had less periods of apnea and/or gagging compared to doing the EGD first. I never thought about possible full stomach issues unless there were risk factors.
 
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