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Key topics to address include: Your complete medical history , particularly: History of pancreatitis or gallbladder disease (relevant for Ozempic) Kidney disease or history of kidney stones (relevant for Topamax) Any thyroid disease (Ozempic has shown effects on thyroid C-cells in rodents, though human relevance is uncertain) History of depression, suicidal ideation, or other psychiatric conditions (relevant for Topamax) Glaucoma or other eye conditions (relevant for Topamax) Diabetic retinopathy (may worsen with rapid glucose improvement on Ozempic) All current medications and supplements , as both drugs may interact with other treatments

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Loss of the epithelial marker E-cadherin may impair cell-cell adhesion, cell-matrix adhesion, and cell polarity

I had a patient come from another clinic who was on almost the max dose after 2 months

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