Peptide Purgatory: An Untarnished Hour with DOCTOR Macallan

Welcome to another week of Peptide Purgatory, my egocentric on-line vehicle for exposing all you readers to the sordid secrets of my geriatric degeneracy and what I am doing about it. In this week’s issue, I describe my first real appointment with my new primary care doctor. I’ll also introduce a new feature of this weekly column, which I have dubbed “Bullshit Corner.”

Macallan: The Real Intake

This wasn’t the handshake “meet and greet” from June. This was the real deal — a full hour with Dr. Macallan (not his real name), the physician I’ve tapped as successor to DeLorean (not his real name, either), the man whose claim to fame was: “I can’t keep track of all your chronic conditions!” (Great line, Doc. You should’ve engraved it on my invoices right next to the $3,500 concierge fee. Oh, yeah — you also famously said I was the only patient who ever complained about your practice — medical gaslighting carried to a pre-emptive meta-extreme!)

So what did we accomplish in an hour? Quite a lot, too much from all over my medical map to get a firm handle on how this relationship will pan out. Most of the interaction was encouragingly optimistic as we worked through “all my chronic conditions” and set a follow-up for October 1.

At that meeting, I want to ensure we’re on the same page with respect to my expectations, which is a collaborative approach to organizing and managing my health care. In other words, I’m seeking a medical partner, not a daddy. In exchange for my retainer fee, I get Macallan’s expertise to fill in the gaps in my medical knowledge, add fresh ideas, and allow access to a healthcare system that demands licensed practitioners. Meanwhile, I make the final decisions.

That’s the way healthcare should work, but the old “I’m your doctor and I know what’s best for you” paradigm is still pervasive. Although I saw some signs that Macallan might wish to revert to that, let me jostle him and see if I can show him a better way. If I can, then this is a promising relationship.

Ironing Out the Kinks and Lumps

Getting down to my aging carcass, Macallan wanted to talk iron, kidneys, Mounjaro, muscles, inguinal hernias, and my torn quadriceps tendon. He even dropped the word hepcidin, which put him a notch above DeLorean, whose idea of managing iron deficiency was to wave his hands and tell me not to donate blood.

Never mind that my ferritin has now sunk to 27. I’ve been chewing Feosol Complete like candy for six months and still can’t keep iron in the bank. Macallan’s plan: schedule the hernia surgery, then pump me up with IV iron during the eight-week recovery. Practical? Sure. Conservative? Maybe. Consistent with peri-op guidelines? Not exactly — but at least it’s a plan.

(Later, the surgeon who will fight the battle of the bulge, Dr. Kileh — also not his real name — nodded his assent. I’ll be scheduling the operation later today, so you can be sure you’ll get all the gruesome details here real soon!)

CKD and SGLT-2 Inhibitors

On kidneys, Macallan pointed out the slow drift downward — eGFR now at 46. He mentioned Farxiga, one of several ‘gliflozins, the SGLT-2 inhibitors that nephrologists are giddy about these days. To me, Farxiga sounds like the name of a Klingon warship, and its side-effect list is equally fearsome: UTIs, yeast infections, and the rare but memorable necrotizing fasciitis of the perineum (i.e., your crotch rots off).

Having endured a painful urinary tract infection at the beginning of 2025, I expressed my discomfort with his idea. I told him about my friend who spent half a year battling UTIs on Jardiance (one of the SGLT-2 inhibitors), which was prescribed for his congestive heart failure, and another on Jardiance for diabetes who lost a toe to gangrene. Macallan’s counterpoint: evidence says SGLT-2s save kidneys. My counterpoint: I’d like to keep my penis attached. Call me old-fashioned.

Since then, I’ve been trudging through the literature: nephrons, afferent and efferent arterioles, sodium transport, the works. The data look promising, if you ignore the Fournier’s gangrene horror stories. Although the nasty side-effects are described as “rare”, I would prefer that they be “nonexistent.” I’ll make this call sometime after the hernia surgery, when my displaced weight-lifting time will provide opportunities for further study.

“I don’t want you to lose any more weight.”

We also talked Mounjaro. I’m currently on 7.5 mg weekly, with my body weight holding steady at 80 kg (down from 84 earlier this year). Wary of further weight loss and concomitant sarcopenia, Macallan mentioned that we might want to reduce the dose to 5 mg. As you might recall from my prior columns here, I set an end-of-year target for deprescribing the incretin drug. So, this proposed dosage reduction might work toward that end.

With my muscles in mind, he asked about my protein intake. When I told him I get ~120 grams of protein daily, he said I need more. More? At 1.5 g/kg? Maybe he thinks I’m training for the Senior Mr. Olympia. Still, it’s refreshing to have a doc who worries about preserving muscle instead of worshipping the BMI chart. He didn’t give me a target, so I’ll pin him down next time: How much protein, why that much, and what about the kidneys?

What Macallan didn’t glean in his cursory overview is that my weight has stabilized over the past three months. Last spring, due to concerns about further muscle mass declines, I had already decided to stop losing weight. I increased protein, carbs, and total caloric intake at that point. However, my fasting blood sugar also increased around that time, so I want to be careful about reducing Mounjaro dose. I’ll work on the muscles; I need help with the glucose. We’ll continue to review the medical evidence to make an informed decision.

Fix Mah Knee!

And then there was the torn quad tendon. His advice: leg day once a week, lighter loads, ice it at night. No arguments there. Dr. Kileh will soon sentence me to eight weeks of lifting nothing heavier than a cat, so rehab mode is coming whether I like it or not. Hiking yesterday, though — albeit only four miles — didn’t cause significant pain. Walking seems to help, and Kileh placed no restrictions there.

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The Naming Game

The one awkward moment: I asked whether to call him by his first name or Dr. Macallan. His answer: “In here, Dr. Macallan. Outside, my first name.”

By his own admission, that’s the old guard whispering in his ear: create the barrier, preserve the authority, remind the patient who’s boss. But let’s be clear — this is a partnership, and I’m the senior partner. Nothing happens without my imprimatur.

This Got Me Wound Up!

So, what’s the deal with the stilted formality? Proven performance and sincerity generate respect; titles do not. Having worked in a university for many years, I can tell you that the large number of societal misfits running around flaunting their PhDs demanding to be called “doctor” to indelibly reinforce the academic pecking order is laughable. The glass ceiling must persevere at the cost of clouding true merit. Consequently, while academe is not the real world, the academic hangover tends to persist in certain circles — like medicine.

None of my other professional relationships require this title-spouting ego-trip. Their performance and competence is what garners my respect. For example, my lawyer is Randy, my CPA is Marty, my dentist is Jennifer. They all do good work, or they wouldn’t be on my team. Only physicians cling to titles like barnacles to a rotting hull, as if “Dr.” were the last defense against patient empowerment. Yea, verily, it wouldn’t be so bad if the professional courtesy were reciprocal, but many doctors address patients by their given names to reinforce the asymmetry.

Don’t Stop Me — I’m on a Roll!

I told Macallan, “That’s fine. We’ll keep it professional.” And we will. I’m too old to play control games, so the proof won’t be in titles — it’ll be in how we tackle the collaboration: iron, kidneys, tendon, and the whole chronic-condition circus. And in the end, it’s my money, my way.

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Editorial Commentary

Medicine still suffers from its authoritarian hangover: patients as sheep, doctors as shepherds, Big Pharma as butcher. The paternalism is alive and well, but some of us refuse to play along. I’ll keep showing up with my lab spreadsheets, timelines, and sarcastic commentary, because I’d rather be the pain-in-the-ass senior partner than the compliant sheep nodding to “doctor’s orders.”

I’ve been around long enough to spot the duds. I’ve sent more than a few packing — and vice versa. Hell, in one case back in 2006, an insecure doc who claimed to run a patient-oriented practice fired me because I demanded explanations and accountability along with courtesy from his staff. But with Macallan, I’m optimistic. He’s young, thoughtful, and willing to engage. Here’s hoping he doesn’t wind up in the Nittany Turkey reject pile alongside DeLorean and some of the others who didn’t make the grade!

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Bullshit Corner: Diabetes Tarnishes Silver

I decided to add a new feature to the weekly posts where I debunk healthcare folk wisdom and urban medical mythology. In an inspirational moment of journalistic brilliance, I named it “Bullshit Corner.”

I have egg on my face. I told my wife, known here as Artificially Sweetened, that I was “pretty sure” diabetics accelerate silver tarnish by their mere presence in proximity to the shiny precious metal (current spot price: $42.48/oz.). She told me that was a myth. And she was right — of course. Her joint degrees were in microbiology and chemistry, so she might know a thing or two. Meanwhile, I’m a big bullshitter, so she sometimes reels me in. What I am writing here will serve at once as my confession and my penance.

So, sue me for long believing this bullshit page from the People Will Believe Anything file: the notion that diabetics are walking, talking silver-polish nightmares. Supposedly, simply being near a Type 2 would turn Grandma’s heirloom flatware into pirate loot. I turned to ChatGPT for corroboration of my wife’s opposing stance on the subject.

Here’s reality: silver tarnishes when it reacts with sulfur compounds in the air, mainly hydrogen sulfide. The real villains are rotten eggs, onions, polluted air, and time — not insulin resistance.

Yes, diabetics can have funky sweat chemistry, sometimes more acidic or ketone-tinged if sugars run high. But unless you’re excreting enough sulfur to open your own volcano, your sweat is not going to etch jewelry. And no, metformin doesn’t make you a human Brimstone Fog Machine.

If your silver is tarnishing fast, it’s not Cousin Ed’s A1c — it’s just silver doing what silver always does. Polish your ring, stop blaming diabetics, and save the conspiracy theories for chemtrail forums.

Myth debunked, silver intact, bullshit flushed. Wife was right — again.

I’ll shovel some more at you in next week’s Bullshit Corner.

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See You Next Week

This week brought a real intake with Dr. Macallan — iron infusions on the horizon, kidney debates over Klingon-sounding drugs, protein wars in the name of muscle, and tendon troubles destined for rehab. We groused about the medical profession’s intransigence with paternalism, and we debunked the myth that diabetics double as jewelry tarnisher. Lotta ground covered this week.

So here we go: hernia surgery about to be scheduled, iron infusion pending, kidney questions simmering, and leg day on probation. Peptide Purgatory marches on.

Stay tuned for the next exciting installment, where I’ll do some more kvetching, in the storied tradition of my forebears.