On Tuesday evening, November 18, Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, presented an informative virtual lecture hosted by Congregation Etz Chaim. Dr. Breite shared new developments in medicine along with recommendations to help the community stay healthy, emphasizing that good medicine is still “old-fashioned”: primary care should be one-on-one.
He began with the popular GLP-1 drugs, such as Ozempic, now widely used for weight loss. Roughly nine percent of Americans are taking or have taken these medications, originally developed for diabetes in Denmark. Dr. Breite listed positive effects, including reduced fatty liver disease and improvement for patients with arterial insufficiency in their legs.
The downsides, however, are concerning. Retinal problems have developed in some patients after long-term use, though it is not yet known whether these drugs cause permanent damage. There may also be increased risk of certain cancers, particularly obesity-related cancers such as endometrial cancer.
Dr. Breite advised that if someone is taking these medications, they must begin slowly and increase slowly; taking too much too soon leads to significant side effects. People who discontinue them tend to regain the weight. He strongly suggested not taking them unless truly necessary.
He next discussed blood thinners. If a patient on blood thinners develops bleeding, they must undergo evaluation to determine the cause.
He cautioned that the asthma medication Singulair can cause sleep disorders and neurological issues. If sleep problems develop, patients should discontinue it.
Dr. Breite then addressed treatment for Carpal Tunnel Syndrome, caused by a pinched nerve at the wrist. It is the second most common surgery in the United States, after cataract surgery. Treatments include splints, cortisone injections, and surgery, but surgery is the only permanent fix. Anyone pursuing surgery should insist on a certified orthopedic hand surgeon specifically trained in this area.
He noted that if a woman receives a diagnosis of dense breast tissue on a mammogram, the best follow-up test is an MRI, which is more definitive than a sonogram.
Regarding vaccines, he recommended Shingrix, the shingles vaccine, for people over 50. Shingles is a painful and preventable disease. A recent study suggests this vaccine may even lower the incidence of dementia.
Urinary tract infections are common, and Dr. Breite advised waiting for a positive culture before beginning antibiotics. Urgent care centers often prescribe immediately, but premature treatment can lead to resistant bacteria.
Aspirin, once commonly used as a blood thinner, is losing favor due to bleeding risks. Gabapentin, used for seizures and pain management, can cause drowsiness and falls.
He referenced a recent paper stating that acupuncture may help with irritable bowel syndrome and lower back pain. His advice: if it doesn’t help, don’t continue.
For patients with atrial fibrillation, caffeine was long discouraged. A new study shows that one cup of coffee in the morning actually improved comfort for many. Caffeine remains the most studied drug, and recommended intake depends on how each person metabolizes it.
Blood pressure should be taken in the morning for consistency. Studies show that taking readings too often can lead to misleading highs. If a blood pressure medication stops working, adding a second medication is better than doubling the current dose. Medications ending in “-sartan” tend to have fewer side effects.
A new combination pill containing three blood pressure medications has been FDA-approved but is not yet on the market. Dr. Breite advised against starting all three components at once.
Cyclobenzaprine, a muscle relaxer, can help those suffering from fibromyalgia.
A recent study found that Hydralazine, an older blood pressure medication, may slow the progression of certain cancers at a dosage of 100 mg. This is not yet approved for that purpose.
CT scans emit significant radiation and are used to monitor conditions such as lymphoma in younger patients. Dr. Breite warned against unnecessary CT scans.
He recommended not waiting until pain becomes unbearable before undergoing hip replacement, calling it an excellent operation with strong outcomes.
A recent study found that Vitamin D does not prevent respiratory infections, though it remains recommended for menopausal women, children, and pregnant women.
For restless leg syndrome and leg cramps, he suggested stretching as the first step.
He concluded by emphasizing the importance of keeping immunizations up to date, including TDP, pneumonia, and flu shots. He does not recommend the Covid or RSV vaccines in general.
Regarding health insurance, he warned that non-routine lab tests may not be covered and that various insurance changes will take effect January 1. UnitedHealthcare Medicare Advantage is no longer accepted at NewYork-Presbyterian Hospital. Patients should confirm whether their doctors and local hospitals are covered. He added that EMS and Hatzalah will now take patients only to the nearest hospital.
Artificial intelligence is increasingly being used in medicine, he noted.
The community is grateful for Dr. Breite’s program and his willingness to share his many years of experience and expertise. May Hashem bless everyone, including Dr. Breite and his family, with good health.
By Susie Garber
