Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: My childhood friend just emailed me that she has a 1.1-cm lesion on her lung. It was found on a CT scan. She’s having another CT scan today. She is a former smoker and has COPD. Is the lesion something that’s part of COPD? What’s the difference between a lesion and something else? — J.B.
ANSWER: A “lesion” is simply a term that means something doesn’t belong there, but in this case, the suspicion is that it means some kind of mass. The big concern in a current or former smoker is lung cancer. The appearance of the lesion in the CT scan can help tell what it represents.
There are calculators that can help give an idea of how likely a lung lesion (we often use the term “nodule” for a solid lesion) is to be cancer. Based only on the information you gave me, there’s about a 15%-20% chance of cancer, which is high enough that she would be recommended a biopsy. Depending on where it is in the lung, the biopsy can be done by bronchoscopy, ultrasound, or a CT-guided biopsy through the skin if the nodule isn’t close enough to a large airway.
If it (hopefully) isn’t cancer, it could be scar tissue, a current or past infection, a benign tumor, or many other possibilities, almost all of which are better than lung cancer.
DEAR DR. ROACH: My husband has Type 2 diabetes and has been on Trulicity for a few years with great results. Lately, when it’s time for refills, the pharmacies are saying that it’s on back order and not available for three to four weeks. I am concerned how this affects his diabetes and health. Why is there this discrepancy? — K.F.
ANSWER: Dulaglutide (Trulicity) is in the class of GLP-1 agonists, like semaglutide (Ozempic and Wegovy). Not only are they good treatments for diabetes, they tend to promote weight loss and reduce the risk of heart disease. Consequently, they are in high demand.
Semaglutide and a similar drug, tirzepatide, have been approved for weight loss by the Food and Drug Administration, while Trulicity has not. However, many insurance companies are demanding that their customers try a different drug when their doctor has prescribed semaglutide, and dulaglutide is one of the most common ones to try. They are very similar, although Trulicity isn’t tested as thoroughly for weight loss. The manufacturer, Eli Lilly, has stated that manufacturing shortages are likely to extend through December 2024.
It is very frustrating to have a medicine that you have been taking for years become unavailable, and the potential for harm is significant. It takes the body weeks (or months) to get used to the higher doses, and if a person is off of it for more than a few weeks, they may have to restart at the lowest dose and build up again to the higher dose to avoid severe side effects. For your husband, going without his needed medication will make his diabetes less well-controlled.
I’m afraid that I don’t have a good solution. The drug companies are making truly enormous profits from these medicines and have every incentive to increase manufacturing (which they are). But demand continues to outstrip supply.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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