When Your Quad Meets a 10-Gauge Needle

This week in Peptide Purgatory: my quadriceps met a 10-gauge vacuum needle in the name of science, my wrists revealed themselves as arthritic museums with a dash of chondrocalcinosis, the SOMMA study begrudgingly coughed up a CBC and an A1c (lawyers or the ADA to thank, take your pick), and “food noise” got the Bullshit Corner treatment it so richly deserves. All that, plus a purple leg, a limp, and a nagging question: will I ever actually see the rest of my results?

Lab Rat Culmination Visit

Today’s adventure in the SOMMA2 study involved something called a muscle biopsy, which sounds clinical enough until you’re the one on the table. The star of the show was a 10-gauge needle — basically a hollow stainless steel straw — jammed deep into my quadriceps. They didn’t just numb the skin; the lidocaine was injected at varying depths into the muscle itself, so the numbing went far deeper than cosmetic. That helped, but “numb” is still a relative term once the needle hits the meat you walk on.

The fun (or horror) part was how they harvest the tissue. The needle was connected by a plastic tube to a syringe-like piston contraption that acts like a vacuum pump. Once the tip was positioned, they pulled the plunger, sucking out plugs of muscle tissue. Imagine a Shop-Vac reengineered for human quads. Out came a couple of chunks of steak, destined for freezers and future assays.

Then came the asterisk of steri-strips, the waterproof cover, and the pressure bandage, cinched tight enough to choke off a river. Within minutes my lower leg had turned a bruise-purple, as if Jackson Pollock had decided to paint in hematoma. I was told to keep the wrap on for four hours and warned the pain would arrive later. Tylenol only, if I really needed it. Translation: brace yourself, old man — you’re not getting the good stuff.

As if coring me like a side of beef weren’t enough, they also drew 10–12 vials of blood (no exaggeration here) and sent me off for a urinalysis. At that point I felt more like a parts donor than a study subject, and my iron deficiency took a nosedive, no doubt.

Keystone Cops

The comedy act came when I mentioned that I take creatine monohydrate daily. Suddenly the staff scattered into full Keystone Cops mode — nurses, techs, and maybe even the janitor — fretting that my supplement habit would confound their deuterium-tagged creatine tracer dose. I had already cleared this with the research director at our orientation session, but that didn’t stop the chaos until a senior colleague materialized to calm the flock and confirm that Western science would not collapse.

Finally, the nutritional inquisition — same drill as last week. Everything I ate and drank in the previous 24 hours. I half expected them to subpoena my MyFitnessPal logs. If I’d admitted to a Pop-Tart, I’m pretty sure the sprinklers would have gone off.

Free to Go

Finally, the tiny, barely understandable Asian assistant told me, “You’re free to go.” Oh, wow, I didn’t know I had been formally incarcerated. But she added, “You were awesome!” I bet she says that to all the senior citizens on whom she gets to play out her sadistic fantasies.

The aftermath? I’m now favoring that leg. It hurts when I walk, it hurts when I bend it, and I hobbled out of there like an extra from The Walking Dead. Between the purple bandage, the limp, and the missing muscle, I look like the poster child for “volunteer for science.” But, hey, I was “favoring” the other leg due to my quad tendinopathy. So now, they’re even—evenly painful!

While I’m recovering from this torture, no showers for 24 hours, no strenuous exercise for 48 hours and no baths, swimming, or hot tubs for 72 hours. I’m on infection alert, watching for pus and redness, should some hospital-borne pathogen have found its way into the deep puncture wound. They tell me the steri-strips should fall off on their own but if they don’t, I can yank them off after Day 7.

So what did I get out of it aside from discharge instructions? A purple leg, a limp, missing tissue, lightheadedness from a vampire-scale blood draw, and the distinct impression that “clinical rigor” is just another phrase for “let’s see how much we can take out of you while keeping a straight face.”

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The Hand Bone’s Connected to the … Parathyroid?

Fresh off the quad-coring festivities, I limped into my imaging appointment for hand and wrist x-rays. The report came back fast — thank you, Advent/Epic/MyChart efficiency — and it’s a doozy.

Highlights from the radiologist’s greatest hits:

• Madelung deformity of the left wrist. Translation: the radius bows the wrong way, the carpal bones form a “V,” and the lunate wedges itself like an uninvited guest between radius and ulna.
• Advanced radiocarpal arthritis at the radiolunate articulation. That’s medical code for “bone-on-bone, with added crunchy sound effects.”
• Bilateral thumb base arthritis (CMC joints), plus wear-and-tear at the STT joints. In other words, gripping, twisting, and opening jars will all be Olympic events.
• Chondrocalcinosis — subtle calcium deposits around the wrist joint spaces, which can hint at crystal arthropathy or metabolic mischief.
• And just for fun: mild diffuse soft tissue swelling and a few stray bone fragments.

Back at our last session while I was bitching about hand pain and wrist stiffness, Macallan mentioned wanting to look into parathyroid function. Well, wouldn’t you know — calcifications plus arthritis might make him look downright prescient. Elevated parathyroid hormone can leach calcium from bones and drop it where it doesn’t belong, like joint spaces.

Where to from here?

In what direction will he be going with this? I don’t know yet — he hasn’t commented on the x-ray report as of this writing. I’ll certainly get his take October 1, if not sooner. Until then, I’m left with radiology jargon, sore thumbs, and the creeping suspicion that my wrists are auditioning for the role of “arthritic exhibit” in a med school museum.

A funny thing happened on the way to Macallan getting these results. Advent, in all their efficient glory, still listed DeLorean as my primary care physician, so he’ll get the x-ray reports, too. That’s hilarious because he’s the doc who wouldn’t get off his ass to order x-rays when I first complained of the hand pain back in April and again in June, which was the final straw that broke this old fart of a camel’s back. His half-assed “solution” to the problem was for me to apply a topical analgesic (Voltaren gel) and wear wrist braces while lifting weights. Now, two weeks after I dumped him into the Nittany Turkey’s Discarded Doctor Landfill, he has received gratuitous notification that someone else, namely Macallan, is a diagnostician instead of a damn medical gaslighter.

I’ve already told Macallan he deserves a fee increase from me for all the work he has put into organizing my aging carcass — all with just a single, one-hour appointment and some back-and-forth emails. Even if I paid him 50% more than his current fee, I’d spend only half as much as I paid DeLorean, while getting ten times the service and engagement. Winning!

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SOMMA Results: Lawyers Made Them Do It

Miracle of miracles, I received a few results from the SOMMA2 study. No, not the muscle biopsy data — I’ll probably see those when hell freezes over — but a CBC. My cynical guess is that Advent’s lawyers insisted any abnormal findings get released to the subject and their physician, lest somebody sue over a missed diagnosis.

And sure enough, the numbers tripped a few alarms:

• Hemoglobin: 12.9 (barely above the cutoff)
• Hematocrit: 40.4 (ditto, just skating along)
• MCH: 27.4 (low)
• Monocytes: 12.3% / 0.97 absolute (elevated)

Not a train wreck, but not pretty either. Enough red-flag material to keep me in the “marginal iron” club and make the lab lawyers happy.

Action Prompted

I passed the report along to Macallan, along with the news that I had scheduled my hernia surgery for December 9. That gave him a window to agree — sensibly — to set up an iron infusion beforehand. Finally, an actual plan: fix the hernia, refill the iron tank, and hope I don’t leave the operating room looking like a used parts sale.

And, in fairness, the SOMMA crew did slip me one more data crumb: HbA1c at 5.5%, identical to my September 3 labs. No drama, no change, just steady control. I doubt the lawyers forced that one out of them — more likely the staff figured it was harmless enough to share. Unless, of course, the ADA has a royalty clause where they get paid every time an A1c result gets disclosed.

So while the muscle biopsy data remain under lock and key, at least a couple scraps of SOMMA output escaped the vault — enough to confirm what we already knew: my iron stores are circling the drain, but my glucose control is boringly solid.

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See You Next Week

So there you have it: a quad vacuumed for science, wrists auditioning for museum exhibits, blood counts screaming for iron, an A1c steady as a rock, and a new buzzword in the crosshairs. As for whether I’ll ever see the rest of my SOMMA results? Your guess is as good as mine. I’ll keep hitting refresh on the portal, but I’m not holding my breath.

See you next week for the next installment of medical comedy disguised as clinical progress.

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For an annotated catalog of all my Peptide Purgatory and Mounjaro updates, visit my Mounjaro Update Catalog page.