Dr. Faust your measured, thoughtful & if I may underlying common sense approach is refreshing. The latter often anything but common.
Thoughts from my side of the counter, which I avoid along with the ever present plexiglass...I prefer to chat face to face & often sit with those that require a conversation & an explanation.
1st computer generated info sheets, rarely leave with the patient ...went to the shredder. Why...they lack context VIP, often read the same for many drugs & rarely inform yet give the reader reason(s) not to take the Rx
For those not aware, pkg info sheets & the Google search for side effects to every drug were those "observed" when submitting for drug approval. No investigation as to cause & effect e.g. constipation & diarrhea for same Rx 🤔
It not that they were not real for the patient.
But it is most likely the individual will not experience the listed side effects, regardless there are some who are convinced...I am very sensitive to medication 🤔 If there is a s/e I'll get it..nope. Yes the list continues.
If your Phm does not take the time (often a short chat) to put context to what you're paying for ...move to another. Please don't come ask me when I didn't dispense it...ok all too often I have explained. In my province the "fee" is for not only the cost of preparing the Rx it's comes with the knowledge of how to benefit from it.
When a patient has "buy in"... acceptance of their condition (ownership) and a trust relationship with their health care provider they can often navigate those s/e's, receive the benefits & most importantly have an improved QOL.
Dr. Faust- I love your patient forward approach. As is common in Latinx families, as I’m the matriarch and worked in healthcare I’m the person family members check their health concerns with, along with the two physicians we have in the family, and this kind of thoughtful, nuanced information is very helpful. Best to you and your family for Thanksgiving 🙏🏽
A family member has found ozempic to be a game changer for their diabetes: for this person, it has worked very well at the lowest dose--.5mg--when it was in short supply, they started to get the 1 mg pen and titrated to .5mg. As their cost is significant, the low dose (something I do quite frequently with statins, due to the flat dose response curve) and the use of the higher dose pen led to great efficacy and low side effects. I find I dial back on patients all the time: no need to titrate up as per manufacturer if the patient has responded well.
I know a person who desperately needs a GLP-1 but had pancreatitis on Monjauro...not benign.
My good friend went on Wegovy (and didn't tell us, because she is a private person and perhaps felt uncomfortable about taking the drug.) She has high blood pressure that is treated with some sort of medication. We didn't hear about her first fainting episode because she didn't suffer any injuries from it. Her second fainting episode within two months of starting the Wegovy injections caused her to break all her front teeth and badly sprain ligaments in fingers of her right hand. Her physician immediately discontinued her Wegovy. My friend was pleased to have lost 18 pounds so easily, but the concussion, the thousands of dollars of dental reconstruction, and the still injured hand were not worth it for her.
(Correlation is not causation but she has never previously fainted.)
Two acquaintances take zepbound and monjauro, they often say they wish it could be spaced out a bit more between doses. They take moderate not high doses for maintenance. I wonder if there will be more research in the future about spacing these medicines out more like instead of weekly injection like every week and a half, or even two weeks …I wonder if this research is being done or was done already, anyone know ?
I think people really want these drugs to be bad for you because they think "hard work" is necessary for people with obesity and that the drugs are cheating. Since by this point, there are typically accounts of serious side effects that are not all that rare with most "miracle" drugs, everyone is desperately seeking these. At this point, the "side effects" being reported with these drugs are actually benefits (ie, improves many conditions, might be a game changer for addictions), which makes everyone skeptical, and gives the Puritans hope.
In addition to the sort of problem you describe like risk-aversion, the opposite is also true with Rx's. There are many patients like myself that would LOVE an opportunity to try a drug but there are not meds available to us especially if Big Pharma doesn't think they can make $ on us. I was diagnosed with Progressive MS in 1985 and there were no disease-modifying drugs for us until 2016 (that insurance companies would cover as we're 15% of the MS population)! I was so excited like many PMS patients when Ocrevus (monoclonal anti-body) was approved for us and found to elongate our lives while actually reducing Relapsing/Remitting patients. 31 years of damage to my brain before this came out. Before I went on Ocrevus, my neuro said likely I had 2- 5 year life expectancy. I'm at the 6 year mark and they just took me off it as I'm over 60 and worried about people over 60 with the expected weakening of aging immune systems as Ocrevus lowers your B and T cells substantially. But shouldn't that be the CHOICE of the patient after she/he is given relevant info from their doctor??
It is a problem and for many of the reasons you've noted. Which is why having a managing doctor who is accessible if you run into trouble with a drug is so important. But so often for patients now it's so hard to get any communication from docs' offices outside of non-medical staff. Doc feel over-booked and stressed. (Wish they were all like you, but they're not.) Or you have to wait months even when you're an established patient. And yes, we all could use some ed in ratios and proportions as many times drug companies list even the most minute %'s of side effects to protect themselves.
Jan..if your "dial back" is altering the dose by counting clicks to equal a lower dosage from a 1mg pen, not harmful, possibly more cost effective yet the practicality is a challenge, given the count extends to counting 30-40 clicks.
From a professional context I have always found such "side steps" counter intuitive, not necessarily dangerous yet unsubstantiated should the "puritans" challenge the approach...aka my licencing body. The list of similar e.g. is lengthy 1) opthalmologist telling pt's put your eye drops in the refrigerator...feel them when instilled 🤔 pkg states store at room temp.
2) certain formulations of nitroglycerin patches can be cut (matrix) to deliver half-dosages 🤔 yeah keep that straight, which mft or Mary/Bob angina is poorly controlled 3) I have seen the same with fentanyl patches for palliative cancer pt's
Never comfortable with acquiescing to what has been put forward by a colleague or a physician.
The use of the 1 mg pen to deliver.5 mg was necessary during the shortage— the prescribing physician concurred. As the lowest dose pen delivers either.25 or .5 mg it was simple to determine that 36 clicks is half. After the shortage resolved, the patient was doing so well that they agreed to continue— and the practice pharmacist is on board. A family member had also had to use the higher dose pen for the lower dose due to the shortage and on physician advice.
Dr. Faust your measured, thoughtful & if I may underlying common sense approach is refreshing. The latter often anything but common.
Thoughts from my side of the counter, which I avoid along with the ever present plexiglass...I prefer to chat face to face & often sit with those that require a conversation & an explanation.
1st computer generated info sheets, rarely leave with the patient ...went to the shredder. Why...they lack context VIP, often read the same for many drugs & rarely inform yet give the reader reason(s) not to take the Rx
For those not aware, pkg info sheets & the Google search for side effects to every drug were those "observed" when submitting for drug approval. No investigation as to cause & effect e.g. constipation & diarrhea for same Rx 🤔
It not that they were not real for the patient.
But it is most likely the individual will not experience the listed side effects, regardless there are some who are convinced...I am very sensitive to medication 🤔 If there is a s/e I'll get it..nope. Yes the list continues.
If your Phm does not take the time (often a short chat) to put context to what you're paying for ...move to another. Please don't come ask me when I didn't dispense it...ok all too often I have explained. In my province the "fee" is for not only the cost of preparing the Rx it's comes with the knowledge of how to benefit from it.
When a patient has "buy in"... acceptance of their condition (ownership) and a trust relationship with their health care provider they can often navigate those s/e's, receive the benefits & most importantly have an improved QOL.
Dr. Faust- I love your patient forward approach. As is common in Latinx families, as I’m the matriarch and worked in healthcare I’m the person family members check their health concerns with, along with the two physicians we have in the family, and this kind of thoughtful, nuanced information is very helpful. Best to you and your family for Thanksgiving 🙏🏽
A family member has found ozempic to be a game changer for their diabetes: for this person, it has worked very well at the lowest dose--.5mg--when it was in short supply, they started to get the 1 mg pen and titrated to .5mg. As their cost is significant, the low dose (something I do quite frequently with statins, due to the flat dose response curve) and the use of the higher dose pen led to great efficacy and low side effects. I find I dial back on patients all the time: no need to titrate up as per manufacturer if the patient has responded well.
I know a person who desperately needs a GLP-1 but had pancreatitis on Monjauro...not benign.
My good friend went on Wegovy (and didn't tell us, because she is a private person and perhaps felt uncomfortable about taking the drug.) She has high blood pressure that is treated with some sort of medication. We didn't hear about her first fainting episode because she didn't suffer any injuries from it. Her second fainting episode within two months of starting the Wegovy injections caused her to break all her front teeth and badly sprain ligaments in fingers of her right hand. Her physician immediately discontinued her Wegovy. My friend was pleased to have lost 18 pounds so easily, but the concussion, the thousands of dollars of dental reconstruction, and the still injured hand were not worth it for her.
(Correlation is not causation but she has never previously fainted.)
Two acquaintances take zepbound and monjauro, they often say they wish it could be spaced out a bit more between doses. They take moderate not high doses for maintenance. I wonder if there will be more research in the future about spacing these medicines out more like instead of weekly injection like every week and a half, or even two weeks …I wonder if this research is being done or was done already, anyone know ?
I think people really want these drugs to be bad for you because they think "hard work" is necessary for people with obesity and that the drugs are cheating. Since by this point, there are typically accounts of serious side effects that are not all that rare with most "miracle" drugs, everyone is desperately seeking these. At this point, the "side effects" being reported with these drugs are actually benefits (ie, improves many conditions, might be a game changer for addictions), which makes everyone skeptical, and gives the Puritans hope.
In addition to the sort of problem you describe like risk-aversion, the opposite is also true with Rx's. There are many patients like myself that would LOVE an opportunity to try a drug but there are not meds available to us especially if Big Pharma doesn't think they can make $ on us. I was diagnosed with Progressive MS in 1985 and there were no disease-modifying drugs for us until 2016 (that insurance companies would cover as we're 15% of the MS population)! I was so excited like many PMS patients when Ocrevus (monoclonal anti-body) was approved for us and found to elongate our lives while actually reducing Relapsing/Remitting patients. 31 years of damage to my brain before this came out. Before I went on Ocrevus, my neuro said likely I had 2- 5 year life expectancy. I'm at the 6 year mark and they just took me off it as I'm over 60 and worried about people over 60 with the expected weakening of aging immune systems as Ocrevus lowers your B and T cells substantially. But shouldn't that be the CHOICE of the patient after she/he is given relevant info from their doctor??
It is a problem and for many of the reasons you've noted. Which is why having a managing doctor who is accessible if you run into trouble with a drug is so important. But so often for patients now it's so hard to get any communication from docs' offices outside of non-medical staff. Doc feel over-booked and stressed. (Wish they were all like you, but they're not.) Or you have to wait months even when you're an established patient. And yes, we all could use some ed in ratios and proportions as many times drug companies list even the most minute %'s of side effects to protect themselves.
Jan..if your "dial back" is altering the dose by counting clicks to equal a lower dosage from a 1mg pen, not harmful, possibly more cost effective yet the practicality is a challenge, given the count extends to counting 30-40 clicks.
From a professional context I have always found such "side steps" counter intuitive, not necessarily dangerous yet unsubstantiated should the "puritans" challenge the approach...aka my licencing body. The list of similar e.g. is lengthy 1) opthalmologist telling pt's put your eye drops in the refrigerator...feel them when instilled 🤔 pkg states store at room temp.
2) certain formulations of nitroglycerin patches can be cut (matrix) to deliver half-dosages 🤔 yeah keep that straight, which mft or Mary/Bob angina is poorly controlled 3) I have seen the same with fentanyl patches for palliative cancer pt's
Never comfortable with acquiescing to what has been put forward by a colleague or a physician.
The use of the 1 mg pen to deliver.5 mg was necessary during the shortage— the prescribing physician concurred. As the lowest dose pen delivers either.25 or .5 mg it was simple to determine that 36 clicks is half. After the shortage resolved, the patient was doing so well that they agreed to continue— and the practice pharmacist is on board. A family member had also had to use the higher dose pen for the lower dose due to the shortage and on physician advice.