Peptide Purgatory: Poop Photos, PBM Paradoxes, and Peeing Out Pastries

Welcome to another week of my life on Mounjaro, which now covers anything else that comes to mind, generally in a related medical vein. This week, our feature story dives into the smartened toilet bowl, where AI can now analyze your, um, output — and I’m not making that up! Big Pharma and pharmacy benefit managers (PBMs), frequent targets here in Peptide Purgatory, take a sound thrashing for their incompetence, including a featured presence in Bullshit Corner.

So, sit back, grab a donut, and enjoy this episode of As the Mounjaro Turns.

The Loo That Knew: Smart Toilets, Dumb Hype, and Peeing Out My Donuts

We’ve entered the era when your toilet knows more about your health than your doctor — and possibly, your priest.

Nicole Nguyen of The Wall Street Journal recently subjected herself (and her plumbing) to Kohler’s $599 Dekoda, a Wi-Fi-enabled commode camera that analyzes urine and stool for “health insights.” It’s the first mass-market smart toilet attachment in the U.S. and, by God, someone’s going to buy it.

Dekoda clamps to your toilet bowl, flashes floodlights into the abyss, and beams images of your deposits to Kohler’s cloud for AI analysis. A fingerprint scanner identifies each household participant, so your spouse’s output doesn’t get confused with yours. For $7 a month, the app returns pearls of wisdom like “You may be under-hydrated” or “Listen to your gut.”

Nguyen’s verdict? It worked—sort of. It reminded her to drink water and eat fiber, then falsely flagged “blood in bowl” often enough to send her down a medical panic spiral. But hey, progress always begins with a mess.

The quantified crapper

Kohler isn’t alone. Withings’ new U-Scan ($380) hangs inside the bowl and analyzes urine chemistry—hydration, acidity, vitamin C, ketones, even calcium—via replaceable cartridges. And in Japan, Toto’s luxury Neorest models now integrate stool scanners right into the porcelain.

Each promises effortless self-knowledge. Just sit, do your thing, and wait for your phone to tell you what your body already knows.

It’s health gamification for people who think their Apple Watch isn’t intrusive enough.

Peeing out my donuts

All this makes me appreciate old-school metabolic engineering — like my newly prescribed Farxiga.

Unlike Kohler’s data drain, Farxiga actually does something: it convinces my kidneys to excrete excess glucose into the urine. In plain English, I’m peeing out my donuts — a kind of low-tech biohack that predates AI toilets by about a decade. It’s also a proven kidney-protective agent for Type 2 diabetics.

So while the Dekoda takes high-resolution photos of the aftermath, Farxiga modifies the content. One creates data; the other creates progress.

If Kohler’s algorithm ever gains access to my bathroom, it’ll probably light up like a Christmas tree: “Warning: glucose detected!” That’s not a privacy breach — that’s just pharmacology at work.

Why it might matter anyway

Still, I’ll grant the smart-toilet crowd one point: hydration and bowel-habit tracking can be surprisingly useful, especially for those of us on GLP-1s.

Mounjaro users know the swing between cement and soft-serve all too well. A Bristol-chart-scoring device that passively logs the pattern might actually help identify dietary triggers — too little fiber, too much fat, not enough water. Combine that with Farxiga’s diuretic effect, and you can see why keeping tabs on hydration is worth more than a joke.

But for now, these gadgets are data silos with vague coaching. “Listen to your gut” is not actionable medical advice; it’s something your yoga instructor says before you sign a waiver.

The privacy splash zone

Dekoda’s makers swear the photos are encrypted and fingerprint data stays local. Fine. But let’s be honest: if “my poop pics are in the cloud” doesn’t make you clench, nothing will.

Also, beware of alert fatigue. The WSJ tester’s early unit flagged blood in nearly every bowl, which is a great way to send the chronically online straight to WebMD hell.

The verdict

Buy one if: you’re a quantified-self enthusiast who already graphs your bowel movements and wants your toilet to join the fun.

Skip it if: you’d rather not authenticate with a fingerprint before you drop a deuce, or if you already own a working pair of eyeballs.

As for me, I’ll stick with the tools that have actual clinical validation: Dexcom on the arm, Mounjaro in the gut, and now Farxiga turning my urine into pastry runoff.

The toilet doesn’t need AI to tell me what’s happening — I can already hear the bubbles.

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Sidebar: Smart Toilets vs. Smart Habits — Who Wins?

Hydration

Dekoda’s “Drink more water” nudge is hardly revolutionary. If you’re on Farxiga, you already know dehydration risk is real. The drug works by promoting glycosuria — your kidneys filter out glucose and, in the process, water follows. Translation: you’re literally peeing out dessert. A toilet sensor telling you you’re dry is just confirming the obvious.

Stool Consistency (The Bristol Watch)

For Mounjaro users, the pendulum swing between “cement mixer” and “soft-serve” is a known side effect of slowed gastric emptying. A device that logs texture trends might help correlate symptoms with fiber intake or dose timing — assuming you don’t mind paying $599 up front and $7 a month for something you could jot in Notes.

Hemoglobin Detection

Now we’re getting warmer. Occult blood in stool or urine can be an early sign of GI or urinary pathology, but the problem is accuracy. The WSJ tester’s early Dekoda unit cried “blood!” on nearly everything short of spring water. Until FDA-grade validation exists, treat it as a “maybe” detector, not a diagnostic tool.

Long-Term Data Trends

The holy grail here isn’t any single flush — it’s trend correlation. Imagine hydration and bowel data overlaid with Dexcom glucose curves, MyFitnessPal macros, and BP readings. That’s when you could see patterns: dehydration days coinciding with elevated fasting glucose or constipation tracking with reduced dietary fat. Sadly, every gadget wants to be an island, so we’re drowning in dashboards.

Gut Microbiome Fantasyland

Marketers love to imply that these devices “support gut health.” What they really measure is color and consistency, not microbial diversity. Until someone builds a toilet that cultures your stool for Bacteroides fragilis versus Akkermansia muciniphila, we’re just playing Guess That Turd.

Verdict

Smart toilets are novel feedback loops — not replacements for common sense. The best hydration monitor is still your mouth; the best stool gauge is your own eyeball. Until the porcelain gets smarter and the software interoperates, call it what it is: quantified potty training for grown-ups.

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My Week on Mounjaro (and Farting Around with Farxiga)

Not much to report along the way of health progress, although I did lose a pound or two. Everything else is under control. So, I’ll take this opportunity to take a couple of jabs at my favorite PBM, Evernorth, a subsidiary of CIGNA that operates Express Scripts and EnGuide, and where the left hand never knows what the right hand is doing.

Expressly Confused: The Great GLP-1 Shell Game

Somewhere deep within the marble-floored catacombs of Evernorth Health Services, a vast subterranean machine hums, whirs, and spits out contradictory letters to diabetics. The machine bears a proud name: Express Scripts, a title that once implied speed, efficiency, and the possibility of actually receiving your medication before your next birthday. Those were the days.

My own recent adventure began innocently enough. My new doctor — a man still bright-eyed and unjaded by the Kafkaesque realm of PBM bureaucracy — tried to send my Mounjaro prescription to Express Scripts. They informed him, with the smug assurance of a DMV clerk wielding absolute power, that they don’t dispense that drug anymore.

Of course, that’s not exactly true. See, Express Scripts doesn’t fill Mounjaro these days because its alter ego, EnGuide Pharmacy, does. And who, you might ask, owns EnGuide? Why, the very same Cigna/Evernorth/Express Scripts conglomerate! It’s a corporate nesting doll where each layer is dumber and more bureaucratic than the last.

We Don’t Fill That, Depending on What Your Definition of “We” Is

So, Express Scripts “doesn’t fill Mounjaro,” but it does manage it, bill for it, track it, and display it in the same app and website where all my other “non-dispensed” prescriptions reside. EnGuide, meanwhile, operates in a sort of pharmaceutical witness protection program — the same organization, just wearing a mustache and fake glasses.

My doctor, bless his heart, gamely transmitted the prescription to EnGuide, and voilà — it popped up on my Express Scripts dashboard like it had never left home. The family resemblance is uncanny.

Then came the pièce de résistance: a letter from Express Scripts / Evernorth Health Services (apparently, they share stationery) informing me that, starting January 1, 2026, Express Scripts Pharmacy home delivery will no longer fill prescriptions for a 1-month supply or less. The notice even singled out my MOUNJARO prescription — yes, the very one they claim they don’t dispense.

The letter politely advised me to “ask your doctor if a longer supply is right for you.” (Ah, that gentle Big Pharma phrasing — I half-expected it to close with “Ask your doctor if Corporate Gaslighting™ is right for you.”)

The Bottom Line

So let’s get this straight:

• Express Scripts says they don’t dispense Mounjaro.
• EnGuide, which is Express Scripts in drag, does dispense it.
• But Express Scripts just wrote me a letter about the Mounjaro they don’t dispense, warning that they won’t dispense less of what they already don’t dispense after January 1.

It’s the hot potato of healthcare — each corporate entity tossing the spud before it burns through their quarterly profit margin. By the time your prescription reaches the actual pharmacist, it’s passed through so many hands that it’s probably developed travel fatigue.

I imagine the next step will be a new spinoff: EnGuide Express, a “fully independent” subsidiary of Evernorth Express Scripts Cigna Health Services, LLC (Delaware). Their logo will be the same, of course — just tilted five degrees and recolored to indicate “innovation.”

Meanwhile, I’ll just keep refilling my prescription the old-fashioned way: by clicking “Refill” in the Express Scripts app that insists it has nothing to do with Express Scripts.

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Flush, Inject, Repeat

So there you have it — a week in modern medicine.
The toilet wants my data, my kidneys want my donuts, and my PBM wants plausible deniability. Kohler photographs my output, Farxiga re-plumbs it, and Express Scripts re-brands it. Somewhere in this glorious feedback loop, someone’s collecting copays and calling it innovation.

If this is the future of healthcare, I can hardly wait for the next step: a smart toilet that auto-bills my smart PBM for every glucose molecule I flush, forwarding the analytics directly to Philo T. Evernorth, CEO of Everything and Nothing.

Until then, I’ll keep doing my part for science and satire — one jab, one flush, and one contradictory letter at a time.

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Peptide Purgatory: Because even your toilet has a login now —
and somewhere in the shimmering ether of the Cloud,
my immortalized poop photos will float forever,
a monument to modern medicine’s undying need for data.