My Blog

You can see it in the fishing picture. I failed. It's the genes, it's the food, it's the exercise, it's not my fault. Bull. I went to my new Florida doctor today. Greek tragedy. "What do you think happened, he said?" Um, felt like a 6 year old, "I'm not sure."

It's May second and I'm over 50 and I give a second grade answer. I ate the wrong foods, drank 2 glasses of wine a night, didn't exercise enough and bought larger clothes when things started to bulge. Damn. I did it. Might be some genetic creep from my diabetic parents and certainly with that risk, I need to be close to ideal weight. I failed. Have you failed? Why not join in with me? I am asking myself for one pound this week. Can you do the same?

For the next 10 weeks, let's see what I can do. One drink a night. Spritzer with wine. Downsize the portions and nutrient dense foods. Increase the exercise to 50 minutes a day. Increase the water to 4 glasses (not going to lie about 8 as I don't think I would make that), increase the vegetables to double portions. OK then. Let's get real. 5' 11" 225. There. Damn. Time for change... 

By Dr Jim Rybacki
August 17, 2018
Category: Uncategorized
Tags: Untagged

I've been getting a lot of questions about Narcan (naloxone), Percocet, and opioids since the news was released that opioid-type medicine was found on Prince's body. It is crucial to realize that there is rampant speculation and nothing is proven or certain unless medical records are released and toxicology reports are known. We all react to medicines in our own individual way and medicines themselves interact with pills that have similar effects, ones that block removal and ones that potentiate effects (such as alcohol and pain killers).

What is certain is that ANYONE can suffer an accidental overdose and people feel such a loss in the death of Prince, rumors are rampant.

Opioids are used most often to treat pain. Examples include opiates, an older word used to describe medicines derived/extracted from or similar to morphine or other compounds that come from opium. Having said that, yes, morphine is an opioid and an opiate. Heroin is an opiate and is actually diacetylmorphine. Technically, opiates are natural alkaloids found in the opium poppy. Further examples of opioids include fentanyl, hydrocodone, oxycodone (Percocet is oxycodone plus acetaminophen). For added clarity, there are also extended release forms of many opioids. MS-Contin is a brand of sustained or extended release morphine.

Confusion emerged when CNN mentioned Narcan being used to reverse excessive levels of opioids. Narcan (naloxone) is a medicine usually given intravenously to reverse excessive efffects of morphine or morphine-like medicines. This medicine is usually titrated (dosed in smaller doses and then increased) to effect if someone has suffered an over dose of an opioid and is unconscious or has extremely slow breathing. There is actually a self-injected (autoinjector) form of naloxone (Evzio). It is important to note that naloxone lasts a shorter time than morphine, so patients may be given this drug, recover from their overdose, then when the naloxone is removed by the body (usually in 30-90 minutes), the original morphine may lead to loss of consiousness again. In these cases, the naloxone is then given again.

Hopefully, this information will clear up some of the questions surrounding opioids, reversal agents for opioids and facts about medicines for pain. Clarity in the tragic death of Prince will come from official answers, not rumors. Every condolence to his family and friends. The world has lost another genius. It will be extremely sad if this death was the result of drug interactions or an accidental overdose of medicine that has helped so much pain.

The biosimilar adventure continues-Somewhat like generic medicines, A new biosimilar for infliximab or (Remicade) got the approval not from the FDA. What this means is that the medicine works to combat rheumatoid arthritis and Chrohn's disease, but costs much much less that the well-known brand.

Interestingly, the medicine was developed by Celltrion and will be co-marketed by Pfizer. The name you will see is Inflectra and it IS a kind of infliximab, but will carry the suffix "-dyyb" to differentiate itself. This is only the second biosimilar to be approved by the FDA. More to follow as always, but we appear to have a new FDA approval that will give similar results while saving literally billions of dollars.

By Dr Jim Rybacki
August 17, 2018
Category: Uncategorized
Tags: Untagged

Late breaking clinical trials (LBCT) at ACC are always very very interesting, but today we apparently learned two new ways how NOT to make a light bulb and HOW we might design trials (adaptive study design) to quickly find out if a new medicine works or not.

I just attended an LBCT which had two negative trials. LATITUDE-TIMI 60 and the CARIN trial were interesting approaches to promising medicines in Acute Coronary Syndrome (ACS) and sudden kidney injury. The two medicines didn't work, yet there is hope for the new adaptive study design that was used.

Some colleagues frown at a negative trial, but let's make lemonade from those lemmons. LATITUDE should be given some lattitude because the patients who did have a STEMI trended toward benefit AND the dose used in the study may not be the best dose. Contrast Induced Kidney Injury is a prevalent challenge which may be modified if not prevented by a 12 hour hydration. The study was designed to show the benefits of CMX-2043, but is also showed that hydration as a preventative approach was only used in half of the patients.

WHY ??? It takes 12 hours of IV and the realities of our healthcare system according to Dr. Bhatt (the presenter) are that the increased length of stay and the flow of admission and pressures to discharge may have precluded that approach. From my perspective, there is clearly something wrong with this picture. Why not protocoiize the requirement for hydration prior to high osmolality contrast AND vet that increased length of stay through the insurance carriers. 

The clear star of this morning is the adaptive study design that was used in the two studies I mentioned. If you visit www.clinicaltrials.gov and look at the design, you will see a new, efficient, effective an economically sound approach that is something I think you will see in many many upcoming studies. 

By Dr Jim Rybacki
August 17, 2018
Category: Uncategorized
Tags: Untagged

After a stellar day of GAUSS-3 and mhealth yesterday, the start fo the week brings FIRE AND ICE and LATITUDE-TIMI 60. #CNN Time to head out to #ACC16. Should be another great day of science and FIRE AND ICE with LATTITUDE. More to follow and prevention too! Or should it be great information on PREVENTION and more to follow. Let's try to prevent heart disease and stroke anywhere we can !!





This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.