GLP1 meds and fasting

[VA Hopeful Dr]

Seems like it's been working real well to help the obesity epidemic

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.

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[VA Hopeful Dr]

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...

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?

 

[Hoya11]

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?

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

 

[epidural man]

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

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.

 

[BLADEMDA]

I Took Ozempic, Then I Got Pancreatitis

After taking Ozempic for three years, Dawn Gentle was diagnosed with pancreatitis, a rare but possible side effect of the medication.

www.healthline.com

https://journals.lww.com/ajg/Fulltext/2022/10002/S1849_Watch_out_for_Semaglutide__Potential_Cause.1849.aspx

 

[epidural man]

Speaking of new drugs -

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

​

 

[smq123]

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.

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.

 

[abolt18]

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?

Good point. Never thought of it this way.

 

[chessknt]

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.

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...

 

[VA Hopeful Dr]

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.

He's a shyster if he claims HCG does **** all

 

[narcotics999]

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.

 

[VA Hopeful Dr]

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.

Meh, I've not been impressed with Rybelsus so far - for diabetes or weight loss.

 

[Maz777]

Had an add-on EGD for a patient on semaglutide yesterday (for DM). Ate dinner the night before. NPO for about 18 hours. Stomach full of solid food (massive chunks). Aborted.

 

[IMGASMD]

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.

 

[okayplayer]

This is a problem. We need some practice guidelines or something definitive to guide practice in regards to holding these medications.

 

[Shimmy8]

So we’re asking everyone to be off of them for a week. Strict NPO 8 hours, including clear liquids.

May need to be even more aggressive, sounds like.

 

[Simba1711]

I heard the asa is working on guidelines. Not sure when it’s coming out.

 

[jwk]

I heard the asa is working on guidelines. Not sure when it’s coming out.

It's been a hot topic on the ASA Community forum.

 

[Shimmy8]

Also…what’s everyone doing about the ERAS/ESR pre-op carb drink? Hold it as well?

 

[IMGASMD]

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

Hot off the press

Though doesn’t say what to do.

 

[okayplayer]

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

Hot off the press

Though doesn’t say what to do.

Not even remotely helpful.

 

[coffeebythelake]

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

Hot off the press

Though doesn’t say what to do.

Basically what we already know..

 

[anbuitachi]

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.

Thought multiple are working on oral forms?

 

[anbuitachi]

 

[okayplayer]

Also totally unhelpful.

 

[coffeebythelake]

View attachment 373013

Wtf is this? A whole lot of nothingl-burger. And they published this? What a joke!

Would have thought one of these guidances would suggest gastric ultrasound!!

 

[linkin06]

Ozempic Might Help You Drink and Smoke Less

Animal studies suggest GLP-1 drugs alter behaviors associated with reward and pleasure.

www.wsj.com

oh boy...everybody gonna be on it. pharmaceutical panacea

 

[NumTacos]

Unfortunately, without hard evidence, what are they supposed to say? It sucks, but we need more data.

 

[nimbus]

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.

More indications.

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

 

[VA Hopeful Dr]

More indications.

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

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.

 

[Beeftenderloin]

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.

It’s almost as if diabetes, heart disease and obesity are in some way related.

 

[Robotic Wis-Hipple]

How nasty, slimy, unethical, and frankly criminal.

You spelled gastroenterology wrong four whole times there.

 

[nimbus]

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.

 

[Airway]

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

 

[Simba1711]

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

 

[Arch Guillotti]

Unfortunately we have a few older Gi docs who still insist on colonoscopy first and then egds on doubles.

This is idiotic.

 

[Airway]

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

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.

 

[IMGASMD]

POCUS Spotlight: Gastric Ultrasound

I

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.

Video says unavailable.

 

[chessknt]

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

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.

 

[circleK]

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

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.

 

[nimbus]

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.

Both ends are gross but do the slightly less gross end first.

 

[abolt18]

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.

Maybe they do it that way to avoid cancellations when they find a full stomach...

 

[coffeebythelake]

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?

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

It's stupid yes. But the rationale I've heard is that the colonoscopy is less stimulating.

 

[anaesthetic]

Both ends are gross but do the slightly less gross end first.

I think it just depends. Are they using one scope or two?

 

[nimbus]

I think it just depends. Are they using one scope or two?

Is one scope really a thing?

 

[Dr. Rude]

Is one scope really a thing?

It absolutely used to be.

 

[nimbus]

It absolutely used to be.

Then definitively upper first.

 

[coffeebythelake]

Then definitively upper first.

I mean.. if the colono prep was excellent does it really matter?

 

[Airway]

Video says unavailable.

Fixed link. No conflict of interest

 

[GravelRider]

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

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.