By Dr. Ian Wallace

Happy June! While we still turn on the heater and wear jackets, summer is assuredly around the corner. With school wrapping up, families making summer plans, I wanted this article to be generalized, so that each of us can find something in it to hopefully improve our health this summer (and in the seasons beyond). I wanted to share a few poems with you this month. Probably not the type of poems you might be thinking about. We won’t be talking about Robert Frost, or E. E. Cummings or William Shakespeare. Instead we’ll be looking at some Patient-Oriented Evidence that Matters (P, O, E, M). These are research papers that discuss how to make your life better either by doing something (taking a medication, exercising more) or not doing something (stopping a medication or smoking, etc). Let’s take a look at the best POEM’s from 2021.
The first set of POEM’s are related to type 2 diabetes mellitus (DM II). Best estimates are that between 10-12% of people suffer from DM II, which equates to roughly 34 million Americans. We learned some interesting things in 202, which might help you to discuss options for treatment with your doctor. Anyone with diabetes will usually tell you there are a lot of medications involved with treating it. As we understand more about the disease, we understand which medications are more effective. For example, those 70 years and older trying to achieve an A1C level less than 7% is associated with landing in the hospital for low sugar levels (hypoglycemia). A better target may be A1C less than 8% instead. Using certain medications appears to be better for your heart and kidneys. Next time you see your doctor you should try and review your current medications to see if you are on the best regiment to control your sugars and protect the kidney and liver.
Another topic reviewed last year was musculoskeletal issues. Think chronic low back pain, chronic muscle spasms, and similar conditions. Painful conditions that many times will have people coming to the emergency room for help to try and control the pain, discomfort and impact on overall quality of life. Items that tended to help with chronic low back pain included exercise, nonsteroidal anti-inflammatory medications (such as Ibuprofen), duloxetine (Cymbalta) and in select cases opioids. Interestingly only exercise had sustained relief in the studies while most of the others lost their effect over time. Another intervention common with low back pain is treating muscular spasm. The studies found no clear benefit for muscle relaxants and again found that anti-inflammatory drugs worked best. In addition, study authors tried to tease out which medications help best for acute pain and surprisingly acetaminophen with ibuprofen is just as effective as opioids in controlling pain. Usually a dose of acetaminophen 500 mg to 1000 mg taken with ibuprofen 400 mg provided just as much relief as opiates. They did not find any benefit from taking a higher dose of ibuprofen such as 800 mg. You can save your stomach and still have good pain control. Don’t forget to walk and do some gentle stretching.
The final set of POEM’s reviewed some common questions around gastrointestinal conditions. Many probably know I perform colonoscopies and EGD’s here at our local hospital in an effort to prevent cancers. There is good news for anyone who is not interested in performing a colonoscopy for colon cancer screening. A stool based test called a FIT test, if done yearly, was at least as effective at finding advanced adenomas. This test can be performed safely in people who have no family history of colon cancer and don’t have concerning symptoms. If you have concerning symptoms which typically are bleeding, change in your bowel habits or problems with swallowing, then a more sophisticated study really is better for you.
Those are just a few of the numerous research studies in 2021 that provided patient-oriented evidence that matters. Evidence-based treatment plans that will make a difference in your health and wellbeing if you suffer from one of the conditions and need to decide on the best treatment option. If you are interested in more information, come talk with one of us in the clinic. And, happy summer! Let’s all see if we can make at least a small change so as to improve our overall health this season. Maybe sit under a tree, take deep breaths, take a walk, and read a poem or two?