Peptide Purgatory: Eyes Right!

Do Your Eyes Feel Left Out? Feed Them GLP-1s, Too!

Welcome to Peptide Purgatory, which began as a chronicle of my experience dealing with Mounjaro and has expanded to encompass news and opinions about GLP-1 receptor agonist drugs. These drugs, such as Mounjaro, Ozempic, Victoza, Wegovy, and Zepbound, originally used for treatment of Type 2 diabetes, exploded wildly when researchers confirmed their weight loss effects. Since then, they have become the vogue treatment, replacing diet, exercise, bariatric surgery, and common sense.

You’ll get no sugar-coating here. If you’re fat, change your lifestyle and make a serious commitment to exercise before you turn to last resort medications whose downsides are not yet well understood. Insufficient time has transpired for meaningful longitudinal studies to reveal potential dangers. People blindly accept the largely unknown risks to hop on the “easy weight loss” bandwagon. However, one very serious evidence-based side-effect is loss of muscle mass, along with the rapid weight loss. So, we stress the necessity of strength-building exercise here for anyone taking GLP-1s.

How many will pay heed? Precious few, as these drugs are being pushed at people purporting to be a magical cure for obesity. Big Pharma wants to put more drugs in more people and keep them on their expensive pharmacotherapy for life. So, why emphasize that hard work will be involved? We don’t condone that attitude here. Those who take GLP-1s for weight loss need to work even harder than those who don’t to preserve their musculature.

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That having been said, we transition into this week’s latest mishigoss. Seems like each week, a new specialty gets to benefit from GLP-1s. Big Pharma’s research engines are chugging like the Chattanooga Choo-Choo finding new and exciting uses for the incretin drugs. Every time I open up Healio or Epocrates, I expect to see some novel and unexpected use for GLP-1s. Big Pharma will have us all on these things sooner or later!

Ocular Claims and Ocular Oopses — Or Why GLP-1s Need a Second Opinion From an Ophthalmologist, Not a Dermatologist

If dermatology and rheumatology were jostling to join the GLP-1 party last issue, ophthalmology just waltzed in with a champagne bottle and no idea what it’s doing. A JAMA Ophthalmology cohort study this week claims that GLP-1 receptor agonists like semaglutide and liraglutide are associated with a dramatically reduced incidence of early (non-exudative) age-related macular degeneration compared with older weight-loss drugs — relative risks plummeting to the high-single-digit range over 10 years. Sounds like GLP-1s are about to take up golf and macular health on the side.

Before we start handing out ophthalmoscopes at endocrinology conferences, however, let’s be clear about the other ocular headlines piling up in the wake of this incretin stampede.

Not All Good News

First, not all the eye news is glow-up stories. There’s a growing body of pharmacovigilance and observational data linking GLP-1 RAs to rare but serious optic nerve events, most notably non-arteritic anterior ischemic optic neuropathy (NAION) — the “eye stroke” that can cause sudden, irreversible vision loss. Multiple cohort analyses and case reports suggest semaglutide and similar agents may be associated with increased NAION risk, albeit at low absolute incidence.

Regulatory bodies aren’t ignoring this; the European Medicines Agency’s safety committee has flagged NAION as a very rare but plausible side effect of semaglutide-containing drugs based on post-marketing surveillance. Ophthalmic associations caution clinicians to monitor vision changes specifically because NAION can manifest without pain and lead to permanent loss.

Other reported ocular signals include visual impairment, blurred vision, and retinal adverse event reports in pharmacovigilance databases, though causality isn’t established and risks vary across studies.

Inflammatory Eye Disease Benefits

What about inflammatory eye disease? Interestingly, large cohort data suggest GLP-1 users may have a lower risk of developing non-infectious uveitis compared with controls, perhaps reflecting anti-inflammatory effects — but this protective association isn’t uniform versus all comparators (e.g., SGLT2 inhibitors).

In other words: the eye story isn’t a one-way upward slope of benefit claims. There are plausible anti-inflammatory signals in uveitis risk, strong associations for reduced early AMD incidence, and contrary signals for serious optic nerve events like NAION — all in the same broad therapeutic class. It’s the kind of conflicting pattern that screams “we need randomized trials here,” rather than more retrospective spa-day anecdotes.

Get Your GLP-1s!

So if dermatologists look at GLP-1s and think “inflammation? treat it,” and rheumatologists nod along, and now ophthalmologists start touting lower early AMD risk, let’s not forget that some of their patients may wake up to find that semaglutide didn’t just shrink their adipose — it also squeezed blood flow to the optic nerve. That’s the kind of outcome no amount of metabolic nirvana can justify without solid prospective evidence.

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Back to My Personal Week Off Mounjaro

Returning to my own decidedly non-observational medical adventure, while GLP-1s are being debated for their effects on retinas, optic nerves, skin, joints, and possibly begonias, I am living with something far more concrete: three fresh abdominal ports and a surgeon who has declared, with all the authority of Mount Sinai, that I am limited to ten pounds of lifting for eight weeks.

Ten. Pounds.

To comply, I have acquired what can only be described as pussy dumbbells — five pounds each, tastefully blue (not pink; I retain some dignity). With these, I may perform seated, high-rep Arnold presses, curls, and wrist curls, provided I do so without engaging my core, my ego, or my sense of purpose. Squats, deadlifts, and bench presses — the holy trinity — are forbidden. The core, apparently, is to be treated like a high-value optic nerve: observe only, no stress, no heroics.

Here I Sit, Broken Hearted

So here I sit on Saturday — traditionally a big lifting day — marooned with my little blue fucking dumbbells and a grip strengthener. No barbell. The bench is folded up by the chimney with care. No plates clanking. Normal breathing, no Valsalva. Just me, my ports, and a faint existential hum as I do 25-rep sets like a retiree in cardiac rehab.

This, it turns out, is the dark side of modern medicine. Drugs get marketed as lifestyle upgrades, robots punch precise holes in your abdomen, and when it’s all over you’re told that discipline now means restraint, not effort. I’m not injured enough to quit. I’m not healthy enough to train. I am, in lifting terms, a lost puppy — housebroken, well-intentioned, and deeply confused about why the leash is so short.

If GLP-1s really are good for whatever ails you, perhaps someone should study their effect on postoperative lifter despair. Until then, I’ll be over here curling five pounds and pretending it counts. So, I thought I would sum up the situation with a sarcastically contrived exercise program my surgeon can live with, even if I can’t.

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Approved Exercises Under the DaVinci Xi Post-Op Protocol™

(As interpreted by a confused patient with three abdominal ports, a surgeon with a stopwatch, and a lifelong barbell habit)

Tier 1: Explicitly Allowed (Because They Cannot Possibly Hurt Anything Important)

• Seated Arnold Presses (5 lb, Blue Edition)
  Performed while sitting upright like a Victorian schoolboy. Core engagement strictly prohibited. Facial expressions of effort discouraged.
• Seated Dumbbell Curls
  High reps encouraged, preferably to the point of philosophical reflection. Supination allowed; straining forbidden.
• Seated Wrist Curls / Reverse Wrist Curls
  Acceptable because no surgeon has ever cared about forearms. Bonus points for developing a Popeye-like imbalance no one asked for.
• Grip Strengthener
  Approved under the legal fiction that squeezing rubber does not transmit force to the abdomen. Also doubles as a stress toy.

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Tier 2: Implicitly Allowed (But Don’t Make It Weird)

• Walking
  Yes, walking. Preferably at a pace suggesting “active recovery,” not “mall stroller.” Hills allowed only if approached emotionally flat.
• Breathing
  Encouraged. Deep diaphragmatic breathing permitted provided it does not look suspiciously like bracing.
• Standing Up From a Chair
  Allowed once per attempt. Repeated reps risk reclassification as squats and will be met with surgical disapproval.

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Tier 3: Strictly Forbidden (The Surgeon’s “Absolutely Not” List)

• Squats
  Even imagining squats may activate the core. Do not visualize barbells.
• Deadlifts
  Known to awaken dormant abdominal demons. Banned outright.
• Bench Press
  “But I’m lying down” is not a defense.
• Planks, Crunches, Sit-Ups, Pallof Presses, or ‘Just a Little Bracing’
  Core engagement of any kind is considered a hostile act.
• Anything Described as ‘Functional’
  If it sounds useful, it’s probably illegal.

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Tier 4: Grey-Area Activities (Proceed Only If You Enjoy Living Dangerously)

• Putting Groceries on the Counter
  Light items only. Milk jugs are contraband.
• Opening a Stubborn Jar
  Allowed if you pretend it opened easily.
• Laughing Hard, Sneezing, or Coughing
  Not technically exercises, but they absolutely feel like them right now.

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Tier 5: Psychological Conditioning (Unavoidable)

• Staring at the Barbell Rack
  Permitted for up to 30 seconds. Longer durations risk acute melancholy leading to schizophrenic dissociation.
• Reorganizing Plates You Are Not Allowed to Lift
  A recognized coping mechanism, but only if done mentally — otherwise, verboten!
• Explaining to Other Lifters Why You’re Using Five-Pound Dumbbells
  Optional. Often exhausting. But at least they’re not pink.

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Tier 6: Explicitly Not Counted as Exercise (But Will Still Happen)

• Googling “How Long Until I Can Deadlift After Hernia Repair”
  Repeated hourly.
• Mentally Redesigning Your Training Program for Week 9
  Futile but therapeutic.

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Clinical Summary

Under the DaVinci Xi Protocol, strength training has been temporarily redefined as patience with light resistance, and discipline now means not doing the thing you’re best at. Compliance is measured not in PRs, but in not ending up back on the operating table.

Eight weeks feels long. It isn’t. But today?

Today you lift blue dumbbells and your own irritation.

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ADVENTHEALTH POST-OPERATIVE DISCHARGE INSTRUCTIONS

DaVinci Xi–Assisted Abdominal Port Placement (a.k.a. “We Drilled Three Holes in You”)

Patient: [Redacted for HIPAA and Dignity]Procedure Date: Recent enough to still sting
Discharging Service: General Surgery (Robotics Division)
Condition on Discharge: Stable, ambulatory, emotionally inconvenienced

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ACTIVITY RESTRICTIONS

For the next 8 weeks, the patient is advised to adhere to the following:

• Do not lift more than 10 pounds.
  This includes but is not limited to:
  • Barbells
  • Dumbbells larger than “embarrassing”
  • Egos
  • Hope
• No squats, deadlifts, bench presses, or movements that could be described as “real training.”
  Yes, we know what these are. No, we are not negotiating.
• Avoid core engagement.
  If you feel your abdomen doing anything at all, stop immediately and reconsider your life choices.

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APPROVED EXERCISES

The following activities are permitted and medically sanctioned:

• Seated upper-extremity resistance training using 5-lb dumbbells
  (Color irrelevant. Emotional response expected.)
• High-repetition curls, Arnold presses, wrist curls
  Sets may extend into the “why am I even here” range.
• Grip strengthening devices
  Squeezing rubber is not considered a threat to surgical repair integrity.
• Walking
  Pace should suggest “responsible adult,” not “mall walker” or “Olympic hopeful.”

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PROHIBITED ACTIVITIES

The patient should NOT engage in:

• Squatting “just to see how it feels”
• Deadlifting “light”
• Bench pressing “carefully”
• Planks, crunches, sit-ups, Pallof presses, or “accidental bracing”
• Any exercise described as:
  • Functional
  • Athletic
  • Compound
  • Satisfying

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PAIN MANAGEMENT

• Mild discomfort, pulling, and the sensation of having been professionally punctured is expected.
• Laughing, coughing, and sneezing may briefly feel like a personal betrayal.
• Pain that worsens with lifting things you were explicitly told not to lift is not considered a complication.

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WOUND CARE

• Keep incisions clean and dry.
• Do not poke, prod, or “check the integrity” with your fingers.
• Staring at them in the mirror is allowed but discouraged after the third time.
• Showing them off to uninterested visitors may enhance desired solitude.

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PSYCHOLOGICAL CONSIDERATIONS

During recovery, patients may experience:

• Irritability
• Existential dread
• Sudden interest in grip strength metrics
• Repeated Googling of “when can I lift again”
• Acute jealousy of strangers deadlifting in public

These symptoms are normal and typically resolve when barbells are reintroduced.

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FOLLOW-UP

• Resume normal training only when cleared by the surgeon, not when “it feels fine.”
• Eight weeks is temporary. Re-injury is forever.

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FINAL NOTE FROM YOUR SURGICAL TEAM

You were fixed, not fragile.
Patience is the prescription.
Stupidity is the contraindication.

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Peptide Purgatory chronicles one man’s ongoing experiment with GLP-1s, metabolism, and medical modernity. Side effects may include sarcasm, elevated skepticism, and mild tachycardia while reading policy papers. So, ask your doctor whether Peptide Purgatory is right for you!

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