Off the Cuff: Set It and Forget It

Last year I was diagnosed with insulin resistance. I was told because of the way insulin resistance affects the body, it makes it impossible to lose weight. So what’s the treatment? Lose weight. It was an incredibly disheartening and sick catch 22. I needed a way for my body to process insulin differently. With my family history of diabetes, I agreed to start the injectable semaglutide. Next month I will have been on this medication for a year, and it has helped me achieve a 24% weight loss.

Throughout this year I have had random symptoms pop up. Many symptoms have been reported with the use of semaglutide, so I thought it may have been the medication itself. I won’t bore you with the details, but it wasn’t the semaglutide at all. After a battery of cardiovascular tests, which were all fine, we were ultimately barking up the wrong tree. It was my thyroid medication. With the weight loss, my dose of thyroid medications wasn’t being titrated with the weight loss. It seems obvious after the fact, but at the time my thyroid levels weren’t being monitored as my weight was dropping. The dose now is nearly half of what I was taking at my heaviest, and all the symptoms have stopped.

This week I saw three different patients, who weren’t feeling very well and all had incredibly low blood pressure readings. When I reviewed their systemic medications, all three had been on the same multiple blood pressure medications for years. No changes in doses or medication classes even though the patients were older and had new health issues. It reminded me of that infomercial for the rotisserie oven, where Ron Popeil would say, “Set it, and forget it.” Common maintenance medications for blood pressure, cholesterol, and thyroid are seen as rather innocuous, and with follow-up appointments every six to twelve months, it’s easy to see how symptoms of overmedication can be overlooked by primary care and patients alike. By pointing out the concern of possible overmedication to these patients, they can have a discussion with their primary care physician that helps our patients make informed decisions and get a better handle on their own healthcare. This goes to show how optometry’s role in our patients’ healthcare is not singularly about their eyes but is truly part of overall primary care.

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Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.