Peptide Purgatory: Back to Work

Labor Day Edition: Science Projects & Doctor Swaps

After a few thousand highway miles I’m back with a double-feature update: my first foray into the SOMMA study and my ongoing shuffle of primary care physicians. Yes, I’ve been poked, prodded, measured, and interrogated more thoroughly than a Labor Day ribeye.

My schizophrenic, full self-driving 2023 Tesla Model Y named “R U Reddy?” performed well throughout the vacation although at times it acted like a teenage driver with ‘roid rage. Alas, Jenny picked up a case of the current strain of COVID (which I’ll label as the North Kilpatrick Variant) somewhere in Dallas, Guthrie, and Chicago, or at various stops in-between. She was miserable during the three-day return trip—I knew she was in bad shape because her complaining was minimal.

But all told, we survived yet another calamity-laced summer road trip with only minor scars and some warm memories, including participating in the ham radio confab (replete with donuts) and hiking some interesting terrain in Dallas, of all places!

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SOMMA: The Six-Hour Shakedown

The SOMMA study (Study of Muscle, Mobility, and Aging) is a three-year NIH project designed to figure out why some of us keep moving into our eighties while others end up stranded in a recliner. As I’ve mentioned in prior updates, I am deeply interested in the subject of sarcopenia and finding effective ways to minimize its impact. So, having met their qualifications, I signed on as a guinea pig. They want data, and they got plenty of it out of me in my first six-hour session:

• In-depth health interview (translation: every ache and pain since 1947).
• Eye chart and retinal imaging (checking whether I can still spot the exit door).
• Vitals — blood pressure done the right way: sitting quietly for five minutes in a darkened room before two careful readings. (Take note, rushed PCP offices!)
• Mobility and strength gauntlet:
  • 400m walk
  • Grip strength
  • Agility drills
  • Sit-to-stand repetitions
  • Balance testing
  • Leg strength push
  • Stair climb torture test
• Arterial blood flow — thigh cuffed for five minutes, then watching blood return to the lower leg.
• Pain tolerance — lower leg probed until I said uncle.
• Cognitive assessment — designed to prove whether I still have all my marbles.
• ActiGraph watch + GPS tracker — because they don’t trust me to tell the truth about my activity.
• Homework: a week-long sleep log and a one-day food diary before the next session.

Give Me Data

I am hoping the researchers will share my data with me. Casually and off the record, the research assistant in charge of my strength assessment noted that I was the strongest of the participants thus far in grip and leg strength. He asked me what made me want to devote so much energy to staying strong. I told him it was my desire to stave off sarcopenia. “You’re not a candidate for sarcopenia,” he retorted. My response: “With all due respect, we all get old.” He’ll learn.

They also gave me my marching orders: no exercise for 24 hours before the next round, MRI prep instructions, and a promise that I’ll get my deuterium-tagged creatine pill (which sounds like something from a Marvel movie) at the second session. The MRI, VO? max test, and muscle biopsy are slated for Sessions Two and Three (September 9 and 17).

So yes, the fun has only just begun.

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Sidebar: Creatine, Deuterium, and the Bicep Test

Because I’m already a gym rat, I’ve been supplementing with creatine for months. It helps me keep up with my six-day lifting schedule and (at least in my head) puts some extra gas in the tank against sarcopenia.

So naturally, when the SOMMA team told me I’d be swallowing a deuterium-tagged creatine pill as part of their metabolism tracking, I asked the PI whether my existing creatine use would distort their carefully plotted data curves. He shrugged and said, “Slightly, but we’ll still get useful data.” Then he hit me with the question: “Is it working?”

I gave him the only scientifically valid answer: I flexed a bicep.

The real magic of their pill is that the deuterium label lets researchers follow creatine’s journey in the body — uptake into muscle, recycling, and turnover — without me having to spend the next three years in a metabolic chamber. It’s tracer science, not bodybuilder voodoo. Still, it was nice to see a leading researcher reduce the whole thing to the same basic question I ask myself: does it work?

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Doctor DeLorean Out, Dr. Macallan In

Eight years of “concierge care” with Dr. DeLorean cost me a lot of money, currently $3,500 annually. At first, it seemed worth it: quick access, direct contact, and the illusion of special treatment. Back in the early days, I can recall imaging providers coming to his office with portable equipment as a convenience to give patients services like carotid ultrasound studies. Back then, his staff made my appointments for visits to other providers. Somewhere along the way, these benefits eroded while the fees climbed. Thus, the service began to feel less like a concierge and more like a hotel clerk shrugging behind the desk.

I heard a rumor from another patient that the fee will be increasing to $5,000 per year. Typically, I see the doc four times a year, so the value is lacking. Should I pay $1,250 per appointment just so I can brag about having a fancy concierge doc with a fancy address? Hell, even at the current fee, I felt like the value proposition is sheer fantasy. Concierge? Like the guy at the hotel who arranges your dinner reservations and theater tickets? At least the medical equivalent should make appointments for their clients for imaging or specialist visits. This one doesn’t. Hell, this guy once told me it was hard keeping up with all my chronic conditions! Imagine that brand of cheekiness! So, just why the hell am I paying concierge fees?

Empire Building

Through the years, DeLorean’s approach to medicine seemed to shift from patient care to empire building: he replaced his rental quarters with a shiny new edifice on pricey real estate, complete with a garage where he could tinker with his car collection, a nurse practitioner as an extender, and a small army of front-office types about whom he once bragged, “…and they CAN ALL DRAW BLOOD!!” At that point, I wasn’t sure whether I was in a doctor’s office or auditioning for a phlebotomy circus.

DeLorean doesn’t take insurance of any kind, so what are all those women doing up there? If he increased his patient load to such an extent that he needs that much clerical help, it’s no wonder that he can’t stay abreast of patients’ chronic conditions. Harrumph!

Meanwhile, as the staff grew, the service declined. Prescriptions and communications between the office and specialists got screwed up. The doc would gaslight my complaints, handwaving through why nothing needed treatment. When I asserted that I could get better service from a storefront clinic, DeLorean took it as an insult, gaslighting me once again by telling me I was his only patient who had any complaints. What? Does he not understand that patients talk with each other? That conversation at the beginning of this year impelled me to get off my ass and look for a new primary care physician. After a couple of false starts, eliminating other “concierge practices” that would take me out of the frying pan and into the fire, I am finally pulling the trigger.

A Shot of Scotch

Enter Dr. Macallan — younger, much more communicative, and refreshingly unjaded. He’s open-minded, not yet weighed down by the medical-industrial complex, and unlikely to roll his eyes when I mention using AI to prep for appointments. He and his wife, also a physician, run an austere, no-nonsense direct-pay primary care practice. My interview with him last spring revealed a forthright, engaged young physician who will be a pleasure to work with.

His innovative pricing scheme will be much easier on my wallet, even though my age puts me in his highest fee tier. Included in the fee are typical generic maintenance drugs that might cause me to rethink my Part D plan. (No, unfortunately for me, Mounjaro, which is not on the generic maintenance drug formulary, will still be subject to the vagaries of Poona & Co).

So, as of today, September 1, I’ve engaged Dr. Macallan as my primary care physician. Even before our first intake appointment, I’ve had an ongoing direct email dialogue with him — a refreshing change from the “patient portal” charade with DeLorean, where hourly staffers wrote back with, “He says…” before relaying the actual doctor’s words like some medieval court scribe. Macallan answers himself, promptly, and without the pomp.

I’ve bowed out politely with DeLorean — a cordial thank-you note, a request for my records, and no dramatic exit interview. Giving him thirty days notice is a gift of about $275 in unearned fees, which I told him he can use to copy my records and transmit them to his successor. But I’m ready for a physician who actually believes in being an advocate rather than a toll collector.

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Meanwhile, in the Land of Mounjaro…

So, how did I do on vacation? At the ham radio conclave, we had doughnuts every day, and I must admit they were good ones—not the typical Dunkin’ Crapnuts you get at many catered meetings. In fact, the food was excellent throughout the three-day affair in Oklahoma. And, of course, Jenny and I ate dinner out every night while on the road for two weeks. So, did I gain any weight?

I was at 177 lbs when we left on August 10; upon my return on August 23, I weighed 177.4. Flat, within a margin of error. So the Mounjaro did its job weightwise, even though my portable insulin cooler did only a half-assed job of protecting the precious peptide to preserve potency and prevent peril by providing proper refrigeration. (I alliterate well, don’t I?)

Now, as to the dreaded blood glucose effect of so many donuts, I cannot comment intelligently, because I wisely removed my Stelo glucose monitor before the trip. However, for the past week, average fasting blood glucose read by the Contour Next glucometer has been 100 mg/dL and average overall serum glucose has been 115, according to the Stelo. Back in July, I was running 105 and 101, respectively.

As I’ve often said in these pages, I hope to get off Mounjaro at some point. My initial target for deprescribing it was the end of this year. I’ll be discussing this with Dr. Macallan to get his take. I mentioned it at our initial interview last June, to which he responded, “You can do it without weaning off it, but you really need to watch your diet when you do.”

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Closing Thoughts

Between SOMMA and the doctor switch, this fall feels like a reboot. One project is scrutinizing every joint, vessel, and brain cell I have left; the other is about finding a doctor who won’t scoff at modern tools or nickel-and-dime me over HSA cards.

Fall brings all kinds of crap: hurricanes, time changes, and I fervently hope, cooler temperatures! When you can consider a jaunt to the Dust Bowl an escape from the heat, you know it’s been hot as hell in Florida!

Next week, we’ll return to the usual Dexcom graphs, Mounjaro musings, and assorted snark including what in the hell is going on with my knees. For now, enjoy your Labor Day barbecue. I already had mine — in the form of six hours on the NIH grill.

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For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.