James Ries, DO | Flight Surgeon

The @US_FDA's own scientists said no to peptides. The panel that actually votes was just built to overrule them. I prescribe these, so here's the part the headlines are skipping. Ahead of the July 23-24 advisory meeting, FDA career staff put it in writing: Keep all 7 peptides under review (BPC-157, TB-500, KPV, MOTS-c, Semax, Epitalon, DSIP) off the 503A list. Licensed pharmacies can't legally compound those peptides unless they are on that list. If it were just up FDA staff, those peptides' fates would be sealed. But staff don't get the final say. An advisory committee votes first. And @HHSGov just rebuilt that committee with 8 new members, most of whom run or profit from peptide businesses. Put plainly, it was stacked to vote yes. So this isn't "peptides are dead." It's career FDA staff against a hand-picked pro-peptide panel, and the agency writes the actual rule afterward. What I actually care about is what happens to patients. The gray-market peptide world deserves scrutiny. Purity is a genuine problem. But cutting off regulated compounding doesn't make peptides safer. It just sends people somewhere worse. Watch July 23 and 24. Two FDAs collide, and your access hangs on it. h/t @RxRegA, who surfaced the FDA briefing doc.

@iamlalaT @CNN If sulfa is out, the usual fallbacks are ciprofloxacin or nitazoxanide.

@JamesRiesDO @CNN What do you do if your allergic to Sulfa antibiotics?

An outbreak of diarrhea caused by the parasite cyclospora has risen to more than 3,000 cases in Michigan and Ohio, and the ongoing investigation suggests lettuce or salad greens may be the source. However, Michigan health officials said other foods can’t be ruled out and no specific type, grower or supplier has been identified as the source. cnn.it/4vqE4zC

Important note: This is a parasite, not 24-hour food poisoning. Untreated, it can run for weeks in relapsing waves, and it does not respond to the usual anti-diarrhea meds or most antibiotics. The one thing that reliably clears it is a specific sulfa antibiotic, TMP-SMX. Watery diarrhea more than a few days after fresh produce is worth getting checked → linkly.link/2mRcW

The outbreak of diarrhea from cyclosporiasis has been linked to more states while the CDC reports nearly 7,000 cases confirmed or under investigation in the US since May. cnn.it/4ymPQxQ

Good question! For symptomatic women within about 10 years of menopause and no contraindications, systemic estrogen (transdermal is a clean default for the lower clot risk) plus progesterone if she has a uterus. Add vaginal estrogen for genitourinary symptoms, which is safe even in many women who cannot take systemic. Testosterone is increasingly used for low libido that persists after estrogen is dialed in.

@JamesRiesDO This is really way out of my comfort zone. What is the treatment protocol for perimenopausal/postmenopausal women these days?

The most damaging myth in women's health: That menopause is something you're just supposed to endure. A generation of women got scared off hormone therapy by a study that has since been walked back. The result: Millions white-knuckling through hot flashes, sleepless nights, brain fog, joint pain, and a libido that vanished, all while being told it was "just aging." Here is what we actually know now. For most healthy women who start within about 10 years of menopause, hormone therapy is one of the most effective things in all of medicine. It brings back sleep, mood, energy, and desire, and it protects your bones and likely your heart. The risk was never the treatment. The risk is losing a decade of your life feeling like a stranger in your own body because someone told you to tough it out. You don't have to. This is fixable, and it is worth fixing.

@mamalovesjbiebs @ann_mcnitt Cipro is nobody's favorite. That is exactly why it is the backup, not the default. Bactrim is first-line for a reason.

@JamesRiesDO @ann_mcnitt Nobody in their right mind wants to take ciprofloxacin

My pharmacy today: "That antiparasitic med prescribed for you, that we promised you tomorrow? We can no longer get it " 🤦 Michigan is drowning in Cyclospora.

@Rocknsoul1319 @nbcsandiego Are you still experiencing symptoms? If so, please pay us a visit: linkly.link/2mRcW

@JamesRiesDO @nbcsandiego Pretty sure this is what felt like a colonoscopy prep in late June, not perfect the past few weeks but not like the first week—am I good just keeping on or should I get the antibiotic?

A San Diego infectious disease doctor says it’s probably best to stay away from fresh produce for the next week or so, even if you wash it. A fecal parasite illness, known as cyclosporiasis, has now reached California. NBC 7’s Shandel Menezes has details. on.nbc7.com/fJ8api2

Cyclospora, the foodborne parasite known to cause explosive diarrhea, has been found in: —Parsley —Cilantro —Snow peas —Mesclun lettuce —Spinach —Salad mixes —Berries Cases are on the rise nationwide.

@betr_media @nbcsandiego The usual fallbacks are ciprofloxacin or nitazoxanide.

@JamesRiesDO @nbcsandiego Hi Doc. I am allergic to Sulfa antibiotics. Anything else work? Not experiencing symptoms just spooked

Good breakdown. Worth underlining for people: It does not reliably clear on its own, and it does not respond to the usual anti-diarrheals or most antibiotics. The fix is a specific sulfa drug, TMP-SMX, with ciprofloxacin or nitazoxanide as fallbacks for anyone who can't take sulfa. Symptoms dragging past a few days is the signal to get evaluated rather than wait it out.

A parasite called Cyclospora is spreading fast, triggering explosive diarrhea, severe stomach cramps and nausea that can last a whole month. ​Where does this bug hide in your food, and how can you avoid it? Let's break it down.

If you experience these symptoms, reach out to us at Twenty Mile Medical. We can get you help fast. linkly.link/2mRcW

The cyclospora outbreak is now past 4,000 cases across 31 states. Most of the coverage tells you how to avoid it, not what to do if you already have it. Here's the part that matters, from a doctor: This is a parasite, not 24-hour food poisoning. It will not clear in a day. Left alone it can run for weeks and come in relapsing waves. You feel better, then it crashes back. Two things people get wrong: 1. You cannot wash it off. Cyclospora clings to produce. Cooking kills it, rinsing does not. 2. It does not respond to the usual anti-diarrhea meds or most antibiotics. The one thing that reliably clears it is a specific sulfa antibiotic, TMP-SMX. So if you have had watery diarrhea more than a few days after eating fresh produce, especially leafy greens or berries, do not ride it out. Get evaluated and get the right prescription.

This sounds scarier than it is. What formed is a bezoar, a hardened clump of food that can happen when the stomach empties slowly, and cola dissolving it is actually a known medical trick. It is uncommon and very treatable. The real takeaway is not to fear GLP-1s, it is to run them with a clinician who dials your dose and watches for exactly this. Done right, they are one of the best tools we have.

NEW: Doctors prescribe 1.5 liters of Diet Coke to dissolve a stomach mass in a woman caused by weight-loss drug semaglutide.

@ann_mcnitt @ArtVand76385057 It’s generally a better experience

@JamesRiesDO @ArtVand76385057 I think I'll stick with the proven treatment. 🙄

Argh. Cyclospora positive. The symptoms are brutal, and I've lost 6 pounds in four days. DON'T EAT RAW VEGETABLES OR GREENS FROM GROCERY STORES OR RESTAURANTS!

This outbreak has been tied to thousands of cases across 30-plus states, which sounds alarming but fits the normal pattern. Cyclospora is seasonal here, clustering in late spring and summer, and in a typical year the US sees a few thousand reported cases. Practical caution: Skip raw produce right now, and if you get watery diarrhea that won't quit, get evaluated rather than ride it out. linkly.link/2mRcW

@JamesRiesDO @ann_mcnitt Do you have any info on the scale/prevalence of this? It’s hard to know how much caution to take/how to evaluate risk without knowing the scale of it and also how long it might linger

It can drag on for weeks and come back in waves, and it doesn't respond to the usual anti-diarrhea meds or even most antibiotics. The one thing that reliably clears it is a specific sulfa drug, TMP-SMX. So if you've had watery diarrhea more than a few days after eating fresh produce, don't ride it out, get evaluated. We handle this from home across 37 states → linkly.link/2mRcW

A fast-spreading stomach parasite has sickened thousands of people across more than 30 US states. Cyclosporiasis has been linked to various types of imported fresh produce, such as raspberries, basil and leafy vegetables.

Great question, and it's a real gap since Bactrim is the clear first choice here. For people who can't take sulfa, there's no perfect one-to-one swap, but the usual fallbacks are ciprofloxacin, and sometimes nitazoxanide. Both tend to be a little less reliable against this particular parasite, so it really comes down to a clinician weighing your history and how you're doing. If you're dealing with this right now, it's worth getting evaluated rather than riding it out, especially with an allergy in the mix → linkly.link/2mRcW

@JamesRiesDO @ann_mcnitt What do you do if you have a sulfa allergy that makes it impossible to take Bactrim?