I’m back with another update about my experience with the Type 2 diabetes drug Mounjaro. This week, I continue last week’s discussion of the tools I use to track my progress, and I’ll add some comments about weight loss drugs for children. As usual, I close with the current status of all my old fart conditions.

How I Track My Exercise

Last week, I provided an incomplete list of equipment and software apps I use to monitor my progress. What I left out were the two tools with which I track exercise: a Fitbit smart watch and the Jefit exercise tracking app.

Fitbit Versa 4

I’ve used Fitbit Versas since 2020. I bought a second Versa 2 after an unfortunate accident with the first one, and more recenly, I bought a Versa 4 (available from Amazon.com for $149.99). It does everything you would expect from a fitness tracker: heart rate, sleep quality, respiration, pulse oxygen, steps taken, etc., at a much cheaper price than competing products from Apple, Garmin, and Samsung. And it can tell time, too.

Although I have a couple of nice, traditional (dumb) wristwatches, I find myself wearing the Fitbit all the time. I like that it will automatically log exercise if it detects fifteen minutes of activity. It even tries to guess the type of activity. If I am taking a hike, its internal GPS receiver creates a map showing the path I took, giving me heart rate and pace for each segment. If I am at the gym, I start it up before my warm-up and wear it throughout the workout. When I’m done, it gives me my stats.

The associated app is wonderful for analyzing workout exertion with its heart rate graph. The Versa 4 has loads of features. With the basic package, I have found that I get everything I need without spending additional money on the premium membership subscription fee.

Jefit App

How do I keep tack of which exercises I do, how much I lift, how many reps? The Jefit app does all that and much more. You can download it free from the Apple App Store or Google Play. If you want the full features, you’ll need to pay an annual subscription costing $69.99. Paying the big bucks ties you in to their huge exercise database, where you can search for exercises targeting specific muscle groups. You can filter results by equipment, like dumbbells, barbells, machines, body weight, etc. Each exercise has a video showing how to perform it, as well as detailed, written instructions.

You’ll find that a bit of a learning curve is necessary to master how to set up workouts and do the tracking. For me, the time invested in learning how to use Jefit was well worth the effort. Aside from the ability to track progress from workout to workout, at the end of each workout Jefit reports which muscle groups you have worked and which have been neglected. It uploads the data to the cloud so I can access it on multiple devices. I set up Jefit to track my workouts both at the gym and at home.

That wraps up what I wanted to share with you about how i track my health and fitness. Next, I move on to vent my opinion on some current research. As those who know me well can attest, I have an opinion or two, and when I get torqued up about something, I vent.

Big Pharma Takes Aim on Our Chilllldren

Being a career hypochondriac, I receive daily digests from the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM). A study published recently in the latter journal caught my eye: Liraglutide for Children 6 to <12 Years of Age with Obesity — A Randomized Trial. This annoyed me, so I dug into the abstract, wading through the medicalese and statisticalese describing the trial until I arrived at the final, parenthetical sentence: “(Funded by Novo Nordisk; SCALE Kids ClinicalTrials.gov number, NCT04775082.)”

Novo Nordisk is the Danish manufacturer of Victoza, their brand name for liraglutide, as well as Ozempic and Wegovy, similar GLP-1 RA drugs whose generic name is semaglutide. Of course, the practice of studies funded by Big Pharma is nothing new — we live in a money-driven world where self-interest is no longer a conflict. Their marketing effort is a full-scale assault on society from all directions. Direct-to-consumer advertising targets Joe Citizen, who they command to: “Ask your doctor if Victoza is right for you!” Funded studies published in prestigious medical journals like NEJM aim at not just the endpoint prescribers, but also at the broad medical community. It is an all-out blitz.

How Can I Bilk Thee? Let Me Count the Ways.

The aim is to establish prescribers as an extension of the marketing arm of Big Pharma, and from the reported sales numbers of GLP-1 RA drugs, they’re succeeding big time! Treating obese patients, many doctors now just skip the counseling about lifestyle interventions like diet and exercise and go straight to prescribing the vogue weight-loss drugs from Big Pharma, notably Novo Nordisk and Eli Lilly & Company.

To make that pill easier to swallow (pun intended), the medical community is removing the personal responsibility aspect of being fat. If we can be convinced that we are fat through no fault of our own, we can take lifestyle improvements off the table and go straight to the high-cost alternatives. I encountered some suggested practice guidelines from the UK, published in JAMA, which counseled physicians to avoid the subjects of diet and exercise and never, ever mention the word “obese” within earshot of a patient. Be gentle, Doc. Wouldn’t want to hurt anyone’s sensitive feelings.

It’s Not My Fault That I’m Fat

WTF! We know we’re fat and we know what we must do about it. Now, they want to facilitate creation of a class of victims. The article went on to say that the practitioner should introduce the subject kindly, referring to earlier conversations, like, “Didn’t you tell me last year that you would like to lose some weight?” Oy, gevalt! What will follow, once the subject is on the table, is easy to imagine. “Have I got a drug for you! Now that it is your idea to lose weight, we’ll get you started!” However, if the patient shows signs of wanting to avoid a conversation about avoirdupois, the doctor must immediately clam up or change the subject. So goes the learned author team’s advice.

The current mantra promoted by Big Pharma and their dutiful servants in the medical community is that obesity is “a complex, chronic, relapsing condition”. Some go as far as to call it a disease. Leveraging this characterization, Big Pharma has reoriented the doctor-patient relationship to find angles that strike paydirt by conning patients into making it their idea to ask the complicit physician, “Is Wegovy right for me?!” Now that patients have been absolved of responsibility for being fat, having been told it’s not their fault that they caught a treatable disease, we can jump right into the pharmacotherapy for same with no shame, no stigma, and best of all, no nasty diets or exercise. (Or so patients may be led to think).

No Easy Way

If physicians must avoid suggesting that we fatsos get up off our asses, go to the gym, shitcan the donuts and start eating broccoli, then the alternatives are drugs and bariatric surgery. These are both worth more money to the medical services and pharmaceutical industries than kickbacks from dietitian referrals and gyms. (Unfair accusation, I know. I don’t know whether such graft exists, but that’s beside the point. What I am saying here is that surgery and drugs are big money-makers whereas recommending traditional lifestyle adjustments does not significantly pump-up medical revenue).

Back to my original point. The prepubescent market is out there and it is ripe for exploitation, uncharted territory for the profiteers. Thus, now, we want to target six- to twelve-year-olds: “Tell your mommy to ask the pediatrician if Victoza is right for you!” Never mind that you’ll be subjecting your kids to a once-daily subcutaneous injection of a foreign substance. It’s all about parents seeking society’s approval. We don’ wan’ no freakin’ fat keeds! Parents take heed! Drug your kids and make them addicts for life, but they’ll look maaahvelous!

Let Kids Be Kids

How long will they need to stay on the drug, and at what cost to their family and to society? No one knows. In this one-sided so-called war on obesity, getting the foot in the door is 90% of the battle. The street-corner drug pusher knows that once their clients start, many will be customers for life (suitably shortened by malnutrition and overdoses). Same thing for Big Pharma. Get ’em started young! Damn the torpedoes! Full speed ahead!

We’re not fixing the problem. We’re allowing the food industry to proceed unchecked, making our kids unhealthy. Instead of doing something about the crap we feed our kids, we are coerced to subject them to expensive, injectable drugs to fix what the food industry fucked up while we sat back with our thumbs up our asses. Why do we allow this perpetual motion machine to wreak havoc on our youth? We make them sick, then we drug them. We’re not fixing their lives. We’re ruining them.

Parents, stop feeding your kids crap. Stop tolerating school lunch programs that serve crap. Get their asses off the video gaming chair and into the playground. And please don’t drug your children!

My Health Update: Mounjaro and Whatever the Hell Else

First, I’ll tell you that we finally have closure on the urinary tract infection. A urine culture ordered by The Irascible Dr. Scrooge came back with no indication that anything is growing in my pee. The first urinalysis he had ordered a couple of weeks ago showed som leukocytes, which indicated that the infection had persisted. That is why he ordered the culture. Now, it looks like the Serratia marcescens have departed. Good riddance!

The rest of the tests ordered by Scrooge came back negative, too. Negative for celiac disease, and negative for occult blood from the digestive tract. These are all good things. However, along with the good comes the need for further invasive exploration to determine the cause of my functional iron deficiency. What Scrooge had originally proposed was an upper GI endoscopy and a colonoscopy, followed by a capsule endoscopy of the small bowel. I imagine I’ll be getting a call from his people to schedule those diagnostics.

Mounjaro by the Numbers

I mentioned last week that I have noticed a rebound in my numbers, suggesting that my Mounjaro dose might need an increase. I have been at the minimum therapeutic dose of 5 mg/0.5 ml since September. (Earlier, I was at the starter dose of 2.5 mg). This puts me on the horns of a dilemma, as I do not want to be chasing increasing doses up to the maximum dose of 15 mg. If my aging carcass develops a resistance at that level, then what?

Recall that I had discontinued metformin back in November. The key to getting this situation back under control might be to resume the metformin along with a modest increase in the Mounjaro, to 7.5 mg. I will discuss this with the doctor at our February 24 encounter.

My average blood glucose for the week was 108 mg/dL (6 mmol/L), about the same as last week. However, fasting glucose, my first thing in the morning reading, has sucked, averaging 107 mg/dL (5.94 mmol/L), up from 100 mg/dL (5.56 mmol/L) last week and 93 mg/dL (5.17 mmol/L) the previous week. This puts me back in the pre-diabetic range. Apart from clinical thresholds and characterizations, the increased glucose levels will cause damage. That ain’t good.

My weight was up 1.6 lbs (0.8 kg) for the week. I wanted to hold at the current level, so the gain is yet another indication that something is awry.

What have I been doing differently that might be responsible for the reversal? If anything, I have increased my energy expenditures by adopting a rigorous exercise schedule. At the same time, I have diligently tracked daily protein intake, which I have increased commensurately with the workout program. Perhaps I am getting too much protein, which can’t help my marginally functional kidneys.

That’s it for this week. Thanks for reading! Writing this drivel is therapeutic for me, as well as imposing the need to keep track of my numbers on a weekly schedule. If anyone else can derive some benefit from my shared experiences, I’m doubly happy. Stay healthy!

Still Awaiting Lab Results

Hello and welcome to my latest weekly update of my experience with the Type 2 Diabetes drug Mounjaro, along with some insights into my approach to controlling the condition. Although I give too much information (TMI) about my various health issues, it is my hope that you will find my experiences helpful in some way.

Today, I’ll share some information about how I track various health and wellness factors: glucose, weight, blood pressure, diet, and exercise. I covered this ground back in Week Six, but I have changed a few things since then. I’ll also give you a progress update on the current health mishegaas, my functional iron deficiency. I’ll wrap up this edition with the usual Mounjaro progress by the numbers. But first, for the sake of my new readers, I’ll give you a little background.

Who Am I and What Am I Doing Here?

I’m a seventy-eight-year-old Type 2 Diabetic who has been injecting the GLP-1 RA drug Mounjaro weekly since June 2024. The lowest therapeutic dose of 5mg/0.5ml has done the job well thus far. Still, I might need an upward adjustment. My HbA1c has improved from 7.6% (60 mmol/mol) to 5.5% (37 mmol/mol) (as of November 2024). Mounjaro is only a part of the story. While using the drug, I have adopted a high-protein, low-carbohydrate diet and a vigorous exercise program hoping to preserve muscle mass and bone density.

I avoid using the word “journey” to describe my health progress because that is the stupidest metaphor ever. I am not Marco Polo, just a fat old dude with some chronic conditions to treat. I’m not a poet, either. I’m just here to give you straight information and my curmudgeonly opinions. Invoking the words of the late sports wordsmith, Howard Cosell, I tell it like it is with a dose of sarcastic humor. He made that phrase his own, and now it is mine.

How Do I Track My Mounjaro Progress?

I want to share how I track my progress with weight, glucose, blood pressure, etc. Each of my measuring instruments communicates with my smartphone via Bluetooth. Their associated smartphone apps keep good track of the data. Below, I’ll tell you about the devices and their cost.

Glucose

Blood Glucometer

For glucose, I use the Contour Next One glucometer from Ascensia (free from Ascensia if you are privately insured or $28.50 at Amazon.com). I have verified its readings with lab tests processed by Quest, finding the results remarkably close. For convenience, I have two Contour Next Ones. I keep one in the master bathroom upstairs for morning, fasting readings. The other one is downstairs in the family room so I can enjoy recreational finger-pricking while watching TV.

A package of seventy Contour test strips costs about $27 on Amazon.com. The Contour Next One does not need a code entry with each new batch of test strips. (But I need to index each new set of strips with the appropriate test solution for accuracy). The Contour app provides excellent long-term tracking and detailed reports I can share with my doctors.

Continuous Glucose Monitor (CGM)

Back in September as I was recovering from COVID-19, I discovered that the FDA had approved a new product from Dexcom. Called Stelo, it is a wearable device like a continuous glucose monitor (CGM). It does not need a prescription and is available to anyone directly from the company for under $100 for a month’s supply, or $90 for a monthly subscription.

I had earlier eschewed CGMs, like the Dexcom G7. Our Medicare regulators would not cover their cost for Type 2 diabetics unless they: 1) are on prescribed insulin, or 2) have had documented hypoglycemic episodes. Even if my doctor were to prescribe a CGM, the out-of-pocket cost would have been over $300/month. Thus, this new Stelo product offered by Dexcom for less than $100 per month piqued my interest.

Whyfor the Stelo?

Dexcom, makers of the flagship, full blown continuous glucose monitor G7, saw the need for people in my category who want to track their glucose variations. They developed Stelo, a dumbed-down version. Each monitor, which sticks to the back of my upper arm, works for fifteen days. Dexcom labels Stelo as a “glucose biosensor”, not as a continuous glucose monitor. The distinction must be clear only to the Dexcom legal department.

The Stelo app provides a graph that displays 3, 6, 12, or 24 hours at a time in five-minute increments. The sensor updates information via low-power Bluetooth every fifteen minutes. The app covers a limit of twenty-four hours and “loses” the trailing information. Nonetheless, Dexcom stores the numbers in the “cloud” where I can access them through Dexcom’s “Clarity” app. Clarity, also used with the G7, displays detailed, downloadable longer-term data and graphs.

In its advertising, Dexcom presents Stelo as an information device rather than a serious medical device. You must not base your medical decisions on its readings under penalty of the Dexcom legal department declaring you an idiot. For example, you can’t integrate Stelo with an insulin pump. Also, Stelo reads interstitial glucose, which differs from blood glucose in a couple of respects.

So what good is it? While the absolute numbers will be off, it is useful tracking glucose spikes from eating carb-laden food. I also can view the relative effect of exercise on my glucose. Thus, I use Stelo as a training device to give me a visual depiction of my insulin response.

Weight

My weight is recorded each morning by the sleek glass and metal pride of China, a Renpho Smart Scale. Currently, it costs $19.99 at Amazon.com, and the app (available for Android and iPhone) is free (no damn subscription, thank God). The scale also does a bio-impedance measurement to find BMI and body composition. The phone app does an outstanding job of tracking weight and all those body composition measures over time, providing handy interactive graphs to show progress or lack of same.

Blood Pressure

Blood pressure tracking is via an Omron BPS5450 Platinum Series (presently $109.29 at Walmart.com). I have checked its accuracy against two of my doctors’ instruments, finding the results close. Once you set its Bluetooth link with the smartphone, it automatically transfers each reading. The app does an excellent job of tracking and averaging blood pressure, plus identifying peaks and heart rate abnormalities.

Food Logging

Finally, for tracking what I eat, MyFitnessPal app with premium subscription ($79 per year) keeps the food diary. It has a barcode scanner and a robust database of food items. The developers have vetted many of the database entries. MyFitnessPal is way more than a calorie counter. It keeps me well informed of macro and micro nutritional intake in comparison with goals I have set. I have used it off and on for four years.

Lab Tests

Sometimes, you want to track your progress scientifically. Typically, doctors stick with staid protocols. Most doctors lack the time and patience to deviate. So, if you’re like me, your scientific curiosity impels you to want test results beyond what the doctor orders. I can order my own blood tests via Ulta Labs. They work with the usual storefront labs like Quest. You order the test, they generate a lab order, and you take it to your neighborhood Quest for the blood draw.

Ulta reports results directly to you. If you have a Quest account, you get them from Quest, too. Costs vary with the type of test. For example, the HbA1c test costs $21.95, which Ulta typically discounts 15-20% as a daily or seasonal promotion. At the other end of the scale, a comprehensive celiac disease panel consisting of 79 biomarkers goes for $644.95.

Of course, the results do not automatically go to your doctor. The lab order comes from a house doctor at Ulta. Nevertheless, Quest provides a straightforward way to fax results to your preferred doctor if you have a Quest account. Otherwise, you can communicate the results directly — at your own peril. (Editorial comments follow).

Ramifications of DIY Testing

Depending on your doctor’s psychological maturity level, you’ll get a defensive reaction from him, her, or “them” when you discuss results of self-ordered tests with them. Some will hand-wave away results if the test wasn’t their idea in the first place. The haughty, self-protective medical profession wants to stick with its bulk-processing protocols. I pity the fool who wants to explore his own body operation without a medical degree and a license to practice. It is not uncommon for doctors to gaslight us, attempting to convince us that we’re idiots, even if we have the mental capabilities to do research and interpret studies. This amounts to protection of territory. In the next section, I’ll tell a relevant story about how my own doctor reacted defensively.

Back to the Iron Deficiency

Exploration of my functional iron deficiency was an example of the medical gaslighting paradigm. At my September follow-up visit, I had remarked to my doctor that graphs provided by the blood bank that my hemoglobin has been low. He told me to stop giving blood and did not order any tests. So, I had my iron, ferritin, etc., tested on my own and communicated the adverse results in October. Again, he told me to stop donating blood. Further, he suggested Feosol (an ferrous sulfate supplement) and a follow-up blood test in sixty days.

So, I stopped donating blood, took the supplement daily, observing the manufacturer’s instructions, on which I was never briefed by the doctor, and had the re-test. The test results came back with even worse numbers than before two months of supplementation. So, again, his simple, dismissive advice was to stop giving blood. Further, he stated that he did not know why free iron was low while ferritin was in the normal range. No range of possibilities, just stonewalling. In other words, a blow-off.

Say What? You Don’t Know? That’s It?

I can accept “I don’t know”, but if the topic is of concern to me, I want more information. I’ll be the one to decide whether to go further. Some research on my part convinced me that I was right not to accept the handwave. Several scenarios exist where iron is low but ferritin is in range. Subclinical gastrointestinal (GI) bleeding is one cause. In that area, I have a history of chronic erosive gastritis, esophagitis, colon polyps, etc. Furthermore, anemia of chronic disease (like colon cancer) is a possibility, as is poor absorption of iron due to GI issues. The in-range ferritin can result from its role as an acute phase reactant. Recall that I had a urinary tract infection (UTI) at the time of the follow-up blood test.

Taking Matters into My Own Hands

So, I told my doctor that the handwave was not good enough. I scheduled an appointment with my gastroenterologist, The Irascible Dr. Scrooge, which I chronicled last week in this column. To summarize the visit, he reviewed my history and the iron blood tests, then ordered blood tests for celiac disease, a fecal test for occult blood, and a follow-up urinalysis to confirm that my UTI had not left me with lingering microhematuria (small amounts of blood in the urine). The urinalysis is something my regular doctor should have ordered even though the UTI had resolved.

Results from the lab tests from January 28 are still pending as of this morning. It turns out that the celiac test can take up to two weeks. Quest will hold up the simple tests to report everything together.

Path Forward

If the celiac disease test is positive, it can explain why I am not absorbing efficiently. That would entail treatment for celiac plus continued iron supplementation. (Not much one can do about celiac disease other than avoiding gluten). If the celiac test comes back negative, the gastrointestinal fun will start. Dr. Scrooge feels that what I need is a capsule endoscopy of the small bowel. Being sensitive to the whims of the health insurance industry, he tells me that they won’t approve the capsule endoscopy without having a recent upper endoscopy and colonoscopy to rule out issues in those areas.

A capsule endoscopy is a diagnostic procedure to examine the small intestine. It involves swallowing a small, pill-sized camera that takes thousands of images as it travels through the digestive tract. This method is particularly useful for detecting bleeding, Crohn’s disease, small bowel tumors, celiac disease-related damage, and other abnormalities that may not be visible with traditional endoscopy or colonoscopy. Kinda cool to have a camera free-falling through my gut. (My electronic background might inspire me to retrieve it and do an autopsy on it).

And so, I wait.

The Week’s Mounjaro Numbers

In the intro, I mentioned that I might need a dose adjustment, as my numbers are flattening or increasing. The body can acclimate to drugs, so perhaps I am at that point. I see no other reasons for the numbers increasing. I have not significantly changed my diet, and I have increased my activity level at the gym and at home.

Fasting glucose, my first thing in the morning measurement, averaged 100 mg/dL (5.56 mmol/L), up from 93 mg/dL (5.17 mmol/L) last week. Overall average blood glucose, as measured by my Stelo, was 108 mg/dL, up from 105 mg/dL (5.83 mmol/L). This is equivalent to HbA1c of 5.4% (36 mmol/mol). My target value, which admittedly I pulled out of my ass, is 5.2% (33 mmol/mol).

Body weight was nominally the same from last week to this week, at 188.2 lbs (85.5 kg). My eventual goal is around 160 lbs (72.7 kg) (oh, yeah, for Brits, 11 stone 6). Still, I want to get there very slowly while I tackle the need to preserve muscle mass and bone density. So, I’m not expecting any dramatic weight loss numbers anytime soon. Obviously, I want to deal with glucose first, and any weight loss is a collateral benefit.

Wrapping It Up

My big concern right now is the functional iron deficiency and its causes. I am patiently awaiting the results of the celiac test from which we decide on the path ahead. Meanwhile, I will keep the diet as-is and continue to pursue the exercise program. I am keeping an eye on the numbers to decide whether I should discuss with Dr. DeLorean (not his real name) whether a Mounjaro dose increase is “right for me.”

Because I did not want to make this a three-hour read, I left out some devices and apps I use for tracking my exercise progress, namely my Fitbit smart watch and the Jefit exercise tracking app, which I will cover next week. Also, after I put this week’s article to bed, I received lab test results. The blood tests were negative for celiac disease but the urinalysis still showed signs of lingering UTI. Next week, I’ll give some added insights into these results. See you then with more information about Mounjaro and my approach to controlling Type 2 diabetes. Go Eagles!

The Week in Review and the Irascible Dr. Scrooge

I’m back to chronicle my progress with the Type 2 diabetes drug Mounjaro and that GLP-1 RA drug’s impact on my life.

Let’s get the UTI out of the way. I’ll tell you that after a few weeks of BS, my nasty UTI symptoms are gone. The second antibiotic, a ten-day course of Cipro, did the trick. Good riddance to Serratia marcescens — I hope I don’t see yo’ pink ass again!

This week’s post is late because I want to tell you about my consult with the gastroenterologist I call The Irascible Dr. Scrooge on Monday afternoon. More on that later, but first I will give you the usual background paragraph in case you’re a new reader. Those who know about me can skip to the next section.

If you’re new here, I’m a seventy-eight-year-old Type 2 Diabetic who has been injecting the GLP-1 RA drug Mounjaro weekly since June 2024. I remain at the minimum therapeutic dose of 5mg/0.5ml, which I have found does the job well. My HbA1c has improved from 7.6% (60 mmol/mol) to 5.5% (37 mmol/mol) (as of November 2024) while on Mounjaro, but Mounjaro is only a part of the story. Concomitant with my use of the drug, I have adopted a low-carb diet with a sufficiently high protein component to maintain muscle mass in conjunction with my commitment to exercise. I work out six days per week for at least an hour per day doing both resistance and cardio training, three days at the gym and three days at home.

Goals and More

I’ve got some goals, and I’m working toward them. I would like to see the HbA1c at 5.2% (33 mmol/mol) and my weight below 170 lbs (77 kg). Although I have lost over 60 lbs (27 kg) in the eight months since starting Mounjaro to get to my current weight of 188 lbs (85.5 kg), losing another twenty to thirty pounds (9-14 kg) might take twice that long or it might not even happen. I weigh the same as I did in my freshman year at Penn State, but I had much more muscle mass then. This leads in to my current paradigm: I want to concentrate on increasing muscle mass, if that is even possible for an old fart toward the end of his eighth decade. At least I want to preserve my remaining muscle.

We all begin to lose muscle starting around age forty, but we can lessen its effect through resistance training. My poor relative weight-lifting performance between the present and the distant past reflects that muscle loss. I wish I could lift as much as when I was twenty, but we all know that ain’t gonna happen! My compromise position is just to remain functionally strong as long as possible. My gym time and weight training at home is directed at that goal, not toward body building or setting personal records.

We Don’t Offer Advice

I am not here to give advice like you get on those smarmy YouTube channels, which are replete with dilettantes calling themselves “influencers” and shepherding their flocks of clueless sheep. It’s the blind leading the blind out there in that vast YouTube wasteland. Unlike the “influencers”, I won’t tell you what to eat or what drugs you should be taking. My purpose here is to relate my experiences, not to suggest that you should be doing the same.

I am not a doctor, but I have dealt with enough of them to know that they don’t have all the answers. Far from it! I don’t give answers here, just observations and opinions. I urge you to discuss any dietary changes, drug dosage, and exercise programs with a real, live, local doctor, not some hired hand working tele-medicine over the internet at a profit-driven compounding pharmacy.

In past issues, I have given you details about the tools I use to monitor my glucose, weight, and body composition. In succeeding issues, I will update that information to include exercise equipment. For now, though, I’m going to take you back to my medical travails.

So, What’s Up with The Irascible Dr. Scrooge

Dr. Scrooge is my gastroenterologist. Although he has performed three or four colonoscopies on me, he once baffled me by favoring me with the unprovoked declaration, “I don’t have to do colonoscopies.” I didn’t ask him what the hell he meant by that. I just figured he was telling me, “Look at me. I’m a big doctor, who owns this large GI practice, and I still get my hands dirty.” Or maybe he was trying to tell me that his practice is not a colonoscopy mill. I’ll never know unless it comes up again. In the meantime, I get a lot of mileage out of that story. But I digress.

Ironically Speaking…

Back in my Week 31 update, I told you about my low iron situation. At that time, I had scheduled an appointment for a follow-up with The Irascible Dr. Scrooge because my regular doctor hand-waved me through my concerns. Even though my low iron numbers decreased even more although I had been supplementing with Feosol 65 per his direction for two months, he declared that ferritin was the important number and pooh-poohed the crappy iron saturation. In fact, he said, he did not have a clue why those numbers would be low while ferritin was low-normal. My complete blood count showed no signs of anemia, so he was willing to let the whole matter drop.

I wanted to investigate possibilities such as chronic inflammation and subclinical gastrointestinal bleeds. The latter prompted me to schedule the appointment with The Irascible Dr. Scrooge, as I believe my gut is the root of all bodily evils. Lord knows I have enough diagnoses to kill me six ways to Sunday: IPMNs, chronic erosive gastritis, and Barrett’s Esophagus, to name a few. Therefore, I decided to subject myself to requesting an audience with the old curmudgeonly GI doc.

Could DeLorean Be Right?

In defense of my regular doctor’s assessment, I must say I’m not showing outward symptoms of iron deficiency anemia. I’m not pale, I don’t get dizzy, and I am not suffering from horrible fatigue. I push myself at the gym and still have plenty of energy. For example, last Wednesday, I worked out for an hour-and-a-half in the morning, came home, ate lunch, then went for a four-mile hike in my favorite state park. Then, I came back and did the laundry. So, perhaps Dr. DeLorean (not his real name) was right about iron not being a big problem. We’ll see.

I’m writing this on Sunday night. Tomorrow, I’ll go to the gym in the morning, then see Dr. Scrooge in the afternoon. I’ll finish the column with a recap of the consult and my weekly numbers when I return. I’m bound to have some good stories to season the otherwise boring medical TMI.

A Visit with Scrooge

After the usual preliminaries, a female employee who in an earlier time would have been called a “nurse” ushered me into an examination room to await the arrival of the Irascible Dr. Scrooge. Upon his arrival, he issued a perfunctory greeting, then declared that he would be reviewing my chart, after which a two-way conversation could proceed. Dictating the salient features to his transcriptionist sidekick, he described a plethora of gastrointestinal diagnostic results and diagnoses from the past two or three years. Once finished, he turned to me and asked, “What brings you here today?”

I described my functional iron deficiency and asked whether he had the test results, which he did. This was my first time seeing Scrooge about this problem, but he was well prepared. (I had made certain that the lab sent him copies of relevant tests). After some interaction about related symptoms and observations, he opined that a capsule endoscopy of the small bowel would be appropriate. However, first, he wanted to test for celiac disease. If that test was positive, then that would be the endpoint for treatment.

In discussing ferritin levels, which react to acute infections, I disclosed that my UTI’s onset was concurrent with the most recent iron test. He said that unless there was blood in the urine, the UTI wasn’t significantly implicated. However, when I told him about the pink pee, he asked whether Dr. DeLorean had done a follow-up urinalysis to check for residual blood in the urine. Of course, following up is not a DeLorean strong suit, so my answer was no.

Lab Tests and Beyond

Scrooge ordered a celiac panel, a fecal blood test called a Fecal Immunochemical Stool Test (FIT). (Why isn’t it a FIST?) He also ordered that follow-up urinalysis. I’ll get started on those tomorrow. When the results are in, Scrooge’s office will call me and let me know where we go from there. Of course, I’ll have the lab results in hand long before they call me, thanks to Quest Diagnostics’ excellent patient communication and reporting.

If the celiac tests are negative, we’ll do the upper, middle, and lower endoscopies. Scrooge explained to me that insurers won’t let him just do the small bowel, which is where he suspects the problem may lie, without doing the colonoscopy and the upper endoscopy. So, this is the year I thought it would pay off to do a high-deductible Medicare supplement! Oy, vey! Let the bills start rolling in! At least Medicare will be covering 80% and I’ll just be on the hook for 20% of the Medicare negotiated fee schedule.

Like it or not from a TMI sense, I’ll be keeping all my wonderful readers in the loop with respect to this latest old fart malady.

This Week’s Mounjaro Numbers

The week’s numbers show a flattening of the curve. The gratuitous weight loss people in the addiction cycle would call their teledoc and demand a higher dose of Mounjaro, Zepbound, Ozempic, or Wegovy, because their brain is now programmed to recoil at the slightest upward bounce on the scale. That ain’t me. As I mentioned above, I’m taking it very slowly at this point, and I want to hang out at my current weight of 188 lbs (85.5 kg) while addressing the muscle loss caused by rapid weight loss and aging (sarcopenia). Although subject to daily fluctuations, my weight has remained nominally the same for the past three weeks.

We’re treating Type 2 diabetes here. Weight is a secondary issue. My average morning fasting glucose was 93 mg/dL (5.17 mmol/L) down slightly from last week. Average glucose was also about the same as last week, 105 mg/dL (5.83 mmol/L). This level is equivalent to HbA1c of 5.3% (34 mmol/mol), which approaches my target of 5.2% (33 mmol/mol).

As for my diet, I am sticking with low carbs while trying to hit a basic minimum daily protein goal of at least 1.2 grams per kg of body weight, which is about 103 g/day. If I work out more strenuously, I increase the protein. Invoking BYU researcher Ben Bikman’s alliterative characterization, I prioritize protein, I control carbs, and I don’t fear fat.

Wrapping It Up

So that’s it for this week. I hope my continuing health issues don’t drive you away! Although I have a keen interest in medical science, I would rather not be the subject of these clinical manifestations and their investigations.

Lest I forget why we’re here, which is my Mounjaro progress, I have a follow-up appointment with Dr. DeLorean in about a month. I’ll have a new HbA1c result before then, so stay tuned. Will I get to 5.2% (33 mmol/mol)? Will my weight and glucose bounce back because I’m on a less than therapeutic dose of Mounjaro due to developed resistance? I’m still at the minimum dose of 5mg/0.5mL, where I’ll stay as long as my blood glucose stays under control. I look forward to reporting on these and other related stories!