Expensive Dr. Roach: My childhood pal simply emailed me that she has a 1.1-cm lesion on her lung. It was discovered on a CT scan. She’s having one other CT scan right now. She is a former smoker and has COPD. Is the lesion one thing that’s a part of COPD? What’s the distinction between a lesion and one thing else?
— J.B.
Expensive J.B.: A “lesion” is solely a time period meaning one thing doesn’t belong there, however on this case, the suspicion is that it means some sort of mass. The massive concern in a present or former smoker is lung most cancers. The looks of the lesion within the CT scan might help inform what it represents.
There are calculators that may assist give an thought of how doubtless a lung lesion (we regularly use the time period “nodule” for a stable lesion) is to be most cancers. Primarily based solely on the knowledge you gave me, there’s a couple of 15%-20% likelihood of most cancers, which is excessive sufficient that she could be really useful a biopsy. Relying on the place it’s within the lung, the biopsy could be finished by bronchoscopy, ultrasound, or a CT-guided biopsy via the pores and skin if the nodule isn’t shut sufficient to a big airway.
If it (hopefully) isn’t most cancers, it may very well be scar tissue, a present or previous an infection, a benign tumor, or many different potentialities, nearly all of that are higher than lung most cancers.
Expensive Dr. Roach: My husband has Sort 2 diabetes and has been on Trulicity for a number of years with nice outcomes. Currently, when it’s time for refills, the pharmacies are saying that it’s on again order and never obtainable for 3 to 4 weeks. I’m involved how this impacts his diabetes and well being. Why is there this discrepancy?
— Okay.F.
Dera Okay.F.: Dulaglutide (Trulicity) is within the class of GLP-1 agonists, like semaglutide (Ozempic and Wegovy). Not solely are they good remedies for diabetes, they have a tendency to advertise weight reduction and scale back the danger of coronary heart illness. Consequently, they’re in excessive demand.
Semaglutide and an analogous drug, tirzepatide, have been accredited for weight reduction by the Meals and Drug Administration, whereas Trulicity has not. Nevertheless, many insurance coverage firms are demanding that their prospects attempt a special drug when their physician has prescribed semaglutide, and dulaglutide is without doubt one of the most typical ones to attempt. They’re very related, though Trulicity isn’t examined as totally for weight reduction. The producer, Eli Lilly, has said that manufacturing shortages are more likely to prolong via December 2024.
It is rather irritating to have a medication that you’ve got been taking for years turn out to be unavailable, and the potential for hurt is important. It takes the physique weeks (or months) to get used to the upper doses, and if an individual is off of it for various weeks, they might should restart on the lowest dose and construct up once more to the upper dose to keep away from extreme uncomfortable side effects. On your husband, going with out his wanted medicine will make his diabetes much less well-controlled.
I’m afraid that I don’t have an excellent resolution. The drug firms are making actually huge income from these medicines and have each incentive to extend manufacturing (which they’re). However demand continues to outstrip provide.
Readers might electronic mail inquiries to ToYourGoodHealth@med.cornell.edu.
