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Wasting Away Again in My Mounjaroville

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(sung to the tune of “Margaritaville”, with apologies to the late Jimmy Buffet)

Wastin’ away in my Mounjaroville
Searchin’ for my lost avoirdupois.
Some people claim that their genes are to blame,
But I know… it’s my own damn fault.

Mounjaro Update: Week 20

How do you like our latest musical plagiarism? I think one verse of the Margaritaville chorus qualifies as fair use. The purloined lyrics reflect my personal feelings that being fat is my own damn fault. If I initiated drug therapy just wanting to lose some weight, it would be a cop-out. However, in combination with Metformin, Mounjaro is doing an excellent job of controlling my blood sugar. So, I’ll shamelessly take the weight loss as a by-product.

As I explained in last week’s update, “Mount Kilimanjaro Travelogue“, I must avoid using the bare word “Mounjaro” in my title. I must also avoid including photos of Mounjaro injectors, as an accommodation to Facebook’s spam detection algorithm. They think I’m leveraging the vogue drug’s name as clickbait. The only clickbait I offer here is commentary from personal perspective with Mounjaro. It works for me and could work for others. I am not seeking millions of clicks, just desiring to share my story and add a few editorial comments. If I can help one or two people who happen into my weekly rants, I feel good. Furthermore, penning my thoughs keeps me focused on my goals. Thus, it is a win-win for all of us.

(Except the Facebook morons).

This week, I will write about cost issues and insurance changes affecting the future of my Mounjaro therapy. I touch on insulin resistance, a precursor to Type Two diabetes. I will tell you how to determine whether you have this metabolic disorder, a result of our crappy Western diet. Next, I have long suffered back pain. The situation is getting worse, so I share recent MRI results and potential treatment plan. Finally, as always, I’ll report on my progress since the beginning of my Mounjaro therapy.

My Mounjaro Story

This is Week 20 of Mounjaro therapy. For those of you who are new to my blog, my background follows. I am a Type Two diabetic with a history of attempts at dietary control and associated up-and-down weight patterns. I am also a veteran of drug therapy. At various times, I have taken Janumet, metformin, and glipizide (but never insulin). In June, my doctor felt that Mounjaro would be “right for me”, as the direct-to-consumer ads go. Since then, I inject it weekly, concomitantly with a 500 mg daily dose of extended-release metformin.

My current weekly Mounjaro dose is 5 mg, which is a low dose. If you are wondering about side-effects, I am past that point, at least with respect to detectable adverse effects. When I started with the drug, I had some appetite suppression. This disappeared after the first six weeks on the 2.5 mg starter dose. I never experienced nausea or indigestion, but I had some constipation, which has abated. The only side-effect I notice is a slightly metallic taste in my mouth within an hour or two following an injection.

As I mentioned, I am taking a low dosage. Furthermore, we are all different, so my experience might not be representative of what you can expect. People on doses of 10 mg and higher (usually those are people who seek rapid weight loss), might experience some more serious side-effects.

Risks vs. Rewards

Mounjaro therapy is a risk because it has not been studied thoroughly enough to discover many likely side-effects, particularly long-term ones. This drug, along with its GLP-1 cousins, took the fast track to market with the complicity of a well-greased FDA and several Big Pharma funded studies. Anything one injects into one’s body needs to be well studied and needs a demonstrated positive history. Therefore, I know I’m taking chances, especially at my advanced age. So, I’ll gladly ditch the drug when I can.

New Mounjaro Cost Considerations for 2025

One good non-medical reason to get off Mounjaro is the cost. My insurance situation is changing with respect to Mounjaro as of the new year. Because of what I call the Great Misnomer Act, better known as the Biden Administration’s Inflation Reduction Act, the Medicare Part D drug situation will change significantly in 2025. The so-called “donut hole”, in which one must pay for expensive drugs on a cost-sharing basis with one’s insurer until reaching an annual spending limit, goes away.

I had been paying $11 for a four-week supply of Mounjaro until I reached the “donut hole” this month. Mounjaro will now cost me about $250 per four weeks until the end of 2024. Beginning next year in my current Part D prescription drug plan, Mounjaro will move from a Tier 6 drug to a Tier 3, meaning that I will pay 25% of the cost of the drug. That’s about $250 per four weeks, too, but the difference is that it will be every month. So, my annual cost will rise significantly.

That’s all the more reason to try to get off Mounjaro when my progress on it is sufficient. While Eli Lilly & Company, manufacturers of the drug, would prefer that I am dependent and addicted for life, I have no such desire. The stories I’m hearing about people left in a lurch by Lilly’s attempts to protect its patent because those individuals are “dependent” on tirzepatide (the generic name for Mounjaro and its weight-loss approved co-product, Zepbound), reinforce my belief that I sure as hell do not want to become dependent on Mounjaro–or any other drug.

Addiction, By Any Other Name

Addiction, by any other name, would smell as foul. Drug dependence, whether it is to legitimate, semi-legitimate, or illegal drugs, is still undesirable addiction. Big pharma will not put me in that cage. My heart goes out to those who have unwittingly succumbed to the addictive potential of these drugs much like they succumbed to the addictive Western ultra-processed food diet that put them in a position to need them. I hope these victims will stop funding both Big Pharma and the parasitic compounding pharmacies, which I call “little pharma”, and get on with their drug-free lives.

But for some, it’s not sufficient to feel marvelous. One must look marvelous.

Insulin Resistance

The underlying feature of Type Two Diabetes as well as porking up from ultra-processed food is insulin resistance. By eating the crap that dominates supermarket shelves and fast food restaurants, we have set ourselves up for developing insulin resistance, metabolic syndrome, and Type Two Diabetes. Obviously, changing our crappy diet is the first key to ameliorating that negative situation. However, some of the damage we do to ourselves by eating Doritos and M&Ms–or even nibblin’ on sponge cake–is irreversible.

Determining whether you have insulin resistance is the key to heading diabetes off at the pass. Thus forewarned, we can empower ourselves to take a healthier approach to what we shove in our mouths going forward.

HOMA-IR

Some of the signs of increasing insulin resistance are subtle. If your belly is getting bigger, or if you experience “sugar highs” and “dawn phenomenon”, like my friend Mike, you might want to do a simple lab test to determine your degree of insulin resistance. The test is HOMA-IR, which stands for homeostasis model assessment for insulin resistance. HOMA-IR is a combination of two tests: fasting glucose and fasting insulin. Its value, denoting one’s degree of insulin resistance, can be predictive of Type Two diabetes and metabolic syndrome.

Many doctors do not apprise patients of this simple screening test. However, our modern medical system, particularly in the United States, is broken. Preventive medicine takes a backseat to ex post facto treatment, a favorite of Big Pharma. Middle-aged and older people should get it, especially if they suspect insulin resistance. The good news is that you do not even need to get a prescription from your doctor for blood tests anymore.

Disclaimer: I’m not a doctor, so please take my medical assessments with a grain of sodium chloride. (I’m not a chemist, either, and I don’t play one on TV). While a diagnosis of diabetes might not be in your immediate future, getting there is not an overnight process. HOMA-IR will tell you whether you’re heading in that direction. I wish I had this simple diagnostic tool years before my diabetes diagnosis. I could have cleaned up my damn diet before it did its damage.

How to Do It

HOMA-IR is indeed an early predictor of new onset Type Two diabetes and chronic kidney disease, regardless of HbA1c in non-diabetic individuals

Clin Diabetes Endocrinol. 2023; 9: 7.

So, how do you get this test without a doctor’s prescription? You can deal directly with Ulta Lab Tests, LLC, ordering your tests through the internet. You order the test from them, they have a rent-a-doc write a lab order, and then Quest or another service can draw blood for the test. You’ll receive your results in a day or so. My link will take you directly to the test package, which costs about $46 and includes insulin, glucose, and HbA1c tests, and Ulta frequently offers discount “deals”.

Upon receiving your results, HOMA-IR is the product of the insulin and glucose values divided by a constant. Specifically, it is calculated by using the following formula: fasting glucose (mg/dL) X fasting insulin (mU/L) / 405 (for SI units: fasting glucose (mmol/L) X fasting insulin (mU/L) / 22.5). For those of you with math resistance to accompany your insulin resistance, calculators exist online where you can plug in your values and see the result. A value of two or greater strongly correlates with insulin resistance.

A 2023 study concluded that high HOMA-IR is indeed an early predictor of new onset Type Two diabetes and chronic kidney disease, regardless of HbA1c in non-diabetic individuals, although further research is necessary regarding the specific cut-off value.

Back to Back (Mine)

Last week, I told you I would be getting an MRI of my spine because of back symptoms resembling sciatica. The results are in. I’ll share them and tell you what my treatment plan will be.

The report contains a lot of medical terminology, but it boils down to severe degeneration in my lumbar spine, with nerve root compression in several areas. For those wanting the gruesome details, here are the findings:

  1. Levoscoliosis with multilevel spondylolithiasis and extensive moderate to severe multilevel lumbar degenerative spine disease from T10 through S1 as above with moderate spinal stenosis at T10-T11 and at L2-L3 with severe spinal stenosis at L4-L5.
  2. Impingement of the descending left L1, descending right L2, and descending bilateral L5 nerve roots.

My doctor and I agreed to schedule physical therapy first, hoping that those sadistic PT geniuses can fix my back and leg pain/numbness. If PT doesn’t do the job, obtaining an x-ray guided steroid injection is next. The last resort will be surgery, which I will carefully consider, weighing the risks versus the potential rewards. The outcome I seek is an abatement of pain and numbness, plus forestalling muscular atrophy in the affected leg.

I want to resume regular exercise, including resistance training. However, erring on the side of caution, I’ll await the exercise assessment from the physical therapists.

We’ll see…

And now, finally, my Mounjaro numbers…

We’re at that part of my weekly update where I let you know how I’m doing. No, really! Yes, I love to write. I hope you have stuck with me to this point and have not bolted due to boredom.

Stelo Shenanigans

I changed my Stelo glucose biosensor on Tuesday, so its numbers are wacko. It might be a little wacko anyway, because I noticed during my Yom Kippur fast that I had a minor glucose spike associated with taking a shower. Obviously, I was not ingesting any food or drink. The shower was the only significant event at the time the glucose began to increase. Accordingly, I am dubious that the Stelo device will be a useful long-term solution. By eliminating the $90/month cost of the Stelo, I could subsidize a third of the cost of my Mounjaro therapy, assuming that I continue on the drug.

I’ll stick with Stelo for another month or so to see what useful information I can glean from it, but right now it is pissing me off because of its divergence from my blood glucometer. A case in point presented itself during my Yom Kippur fast. My glucometer measured 79 mg/dL, while the Stelo read 102. Whereas I was originally more interested in relative values (peaks and valleys), I wish the device was more accurate with absolute values. Thus, the device might turn out to be an expensive, slightly disfunctional educational toy.

The Week in Review

Several significant events during the week affected my glucose, blood pressure, and weight. Hurricane Milton, named after Jerry Chait’s father (inside joke), raged through Central Florida, where I live. The Jewish holy day of Yom Kippur and its required twenty-five hour fast also occured during the week. Finally, I removed the Stelo for the MRI and installed a new one, so as I mentioned above, the numbers are wacky.

My morning glucose, measured by my glucometer, averaged 93.4. I am still pleased with my glucose results. My blood pressure has been doing better, too, averaging 126/75, which improved from 134/76 last week. It had been high ever since I returned from my August/September vacation with a case of COVID-19.

Finally, I lost 4.2 pounds during the week. This is an unsustainably high rate, which I hope will settle down. If not, we’ll need to start looking for some underlying pathology. Since starting Mounjaro therapy, I have lost 44.4 pounds.

That’s Enough Overshare!

I hope that by sharing my Mounjaro experience and my intimate medical details, I have provided useful information. Furthermore, I hope people who have not (yet) been diagnosed with Type Two diabetes or with metabolic syndrome will develop an interest in the subject of insulin resistance, for which I suggested a simple lab test. Awareness of how our bodies function is empowering. If you know what’s going wrong, you can do something about it!

I’ll be back next week with more. In the meanwhile, stay healthy!

Mount Kilimanjaro Travelogue: Weekly Update

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Hurricane Milton, now a Category 5, bears down on the Florida peninsula. As I write this, I am preparing for the worst. I have often stated that writing is therapeutic for me, so I’ll take a break from my hurricane preparations to share my Mounjaro update and my damn fool opinions with you.

No, I am not on a journey and this is not a travelogue. Yes, I am crazy. So where did the title come from?

An Ernest Hemingway fan, I’m not. I have never been to Tanzania. What’s up with Mount Kilimanjaro, already? Well, I’ll tell ya. Facebook removed my last update because their CommunityStandardBot detected the name of a current vogue drug, Mounjaro. Throughout the history of the commercialized Internet, spammers have used popular keywords to attract attention to unrelated posts. Therefore, Facebook shit a brick thinking I’m spamming my Facebook friends.

I’ve appealed their decisions, but because they’re idiots in charge of social media lunacy and have complete control, I’m not likely to win.

Moon over Mounjaro

Posting a picture of a Mounjaro (there, I said it again) injector pen also triggers Facebook’s schizophrenic paranoia. Therefore, I have replaced that image with something more consistent with the title of this week’s column. The picture at right adds a full moon rising over Mount Kilimanjaro. It is symbolic of the moon I would love to shoot at the entire Facebook executive suite. In any case, I will continue to provide these weekly updates while I am on Mounjaro.

Subscribe and Save

If you want, you can subscribe to this blog by entering your email address. You’ll receive an email notification whenever I post a new column. Then, we won’t need to dick with Facebook. Nevertheless, I shall continue to attempt to post links to my Facebook accounts.

Mounjaro Off Shortage List

During the week, the US FDA removed all doses of Mounjaro and Zepbound from their shortage list. As I reported last week, this means compounding pharmacies and their telehealth partners are in deep shit. They will be unable to sell copycat tirzepatide, the generic name of those two drugs.

Panic is evident among the gratuitous weight loss community. They feel that they have a right to the generic drug at whatever price they feel is “fair”. Sensing the forthcoming shutdown of the compounders, they are now exhorting manufacturer Eli Lilly & Company to provide them “fairly priced” name-branded Zepbound. Their logic is that Lilly giveth and Lilly taketh away, so maybe give back a little. By declaring to the FDA that the shortage is over, Lilly set the process in motion for disallowing most compounded alternatives. By rule, most compounding pharmacies must cease and desist. Thus, addicted customers are denied their fix and are whining up a storm.

Money Talks and Bullshit Walks

We all know that money talks and bullshit walks. Those alarmed customers will make much crowd-sourced noise, thinking they have sufficient market power to impel Lilly to think twice about pricing their now monosourced product. After all, “influencers” used their influence to influence Lilly to “release the vials” at a reduced price. (I explained that move in a prior post). Lilly prices their name-branded product too high for some current buyers of the generic product. But why would Lilly care? They’re not in business for our health, as the saying goes.

Bernie Sanders and the U.S. Senate can conduct showboat investigations of drug prices all they want. Are you taking that pre-election bait? It’s all nudge-nudge, wink-wink shenanigans. They know that money talks and bullshit walks. Politicians are always spewing the latter, because the money will flow to them one way or another.

I do not blame Lilly for wanting to recoup their investment in the product’s development, manufacturing, and marketing. Parasitic compounders can provide cheaper products because they did not make those heavy investments, and now the jig is up. No more gravy train.

When Did Crying Poor Mouth Ever Work?

Lilly should therefore use its big bucks and the legal system to protect its patents. The “but I can’t afford the brand-name prices” argument is specious. It is tantamount to my HOA neighbors loudly protesting a well justified fee increase because they personally cannot afford it. The increase is necessary because irresponsible prior HOA boards had kept fees too low for too long, acceding to the wishes of the poor-mouthers and compounding the problem as time passed. The objectors ignore what the community budget makes plainly evident. It’s all about them, you know, even when they altruistically band together to rectify systemic injustices that imperil their personal coffers.

If they cannot afford the prevailing prices, they can find weight-loss alternatives that are more affordable. Not eating is dirt cheap, for example. I’ve often stated that those who want to lose weight could use the money they are spending on tirzepatide to hire a dietitian, a psychological counselor, and a personal trainer, and still have leftover money for a Glamour Shot of their slimmed-down bod.

That concludes my weekly Mounjaro-related rant. Now onto other subjects.

How Am I Doing on Mounjaro?

While not Mounjaro related, I’m going to get an MRI later today—that is, if the imaging center doesn’t decide to close for the coming storm. Last week, I mentioned that I had tweaked my back while on vacation in September. I have been dealing with back pain and sciatica symptoms since then. We’ll see where the imaging leads. I’ll keep you in the loop. Back to my ongoing Mounjaro therapy and related subjects.

Glucose Tracking

I had previously mentioned that I started using a Dexcom Stelo glucose biosensor, an over-the-counter continuous glucose monitor. The first 15-day sensor worked well. However, the second one started giving me erratic readings, typically 20-30 mg/dL higher than my blood glucometers. I contacted Dexcom customer service, who investigated my claim and agreed to provide a replacement. It arrived three days after they opened my case. Now THAT’S excellent customer service!

I’ll wait until after my MRI to attach the new biosensor. Dexcom warns customers not to wear them while undergoing magnetic resonance imaging, lest they incur damage to the product. I’d also be worried about causing the little lithium battery in it to explode on my arm, but no need—the radiological techs would make me remove it, anyway. In this connection, my lovely, comedic wife Jenny retorted that someday, the Israelis will figure out how to incorporate Semtex and a detonator in Hezbollah continuous glucose monitors, much as they had done with pagers and handheld transceivers. But I digress.

The Numbers, Already!

My average glucose for the week, as measured by my glucometer (Ascensia Contour Next One), was 109 mg/dL, up one from last week. Call it flat. I am pleased with my glucose progress, the result of dietary adjustments and Mounjaro.

Blood pressure continues to be higher than it was before my vacation and my bout with Covid, which raises concerns about undetected Covid-related issues causing secondary hypertension. Also, my back problem cannot be helping. The average for the week was 134/76; last week, it was 135/80.

Finally, my weight decreased by five pounds during the week, perhaps related to some “distress in the lower tract,” as the old Pepto-Bismol commercials called it. Over two weeks, my weight loss was 3.6 pounds, which is in the acceptable range. I do not want to be losing more than one to one-and-a-half pounds per week. The main objective is to control blood glucose; my doctor and I agree that we’ll take the weight loss if it comes. Accordingly, I remain on a low dose of Mounjaro, still 5 mg.

Hurricane Milton

As I write this, Hurricane Milton is a Category 5 storm. It has taken direct aim on Central Florida, where we live.

We were preparing to breathe a sigh of relief, thinking we got off easy when Hurricane Helene dealt only a glancing blow less than two weeks ago. Alas, now we’re more directly threatened by Milton. To compound our problem, debris associated with Helene still hasn’t been completely removed.

Furthermore, another rainmaking storm has been hanging around our area dumping several inches of rain since Sunday morning. Forecasters expect Milton to produce an additional eight to twelve inches, hence flooding will be a severe problem. Some Central Florida communities have not yet recovered from the flooding associated with Hurricane Ian, two years ago.

We have not had a hurricane as powerful as Milton in Central Florida in my forty-eight years here. In 2017, we had Hurricane Irma, which precipitated my re-roofing and interior drywall repair. Twenty years ago, Hurricane Charley, who made landfall on the Southwest Coast and whose sustained winds were down to 100 mph when he arrived was a more compact and faster moving storm. Nevertheless, it dealt a catastrophic blow to the Orlando area. A good friend of mine lost his house to Charley. It was damaged beyond repair.

Mounjaro Shipment Delayed

I just got a call from Express Scripts, the dreaded PBM that fulfills my prescriptions when I get pissed off at Publix. I had ordered a three-month supply of Mounjaro from them, which they say will be delayed due to Hurricane Milton. They will wait for carriers to resume operation, then they will expedite my shipment via an express delivery agent. I was grateful for the call, because I had been concerned that my Mounjaro would be blown away or ruined if delivered around Milton’s impact period. So, one fewer thing to worry about.

My current stock of Mounjaro is sufficient to get me through a few weeks. However, I still have some concerns about how I will refrigerate it if we have a protracted power outage. I do not have a generator, but I have a couple of battery powered refrigeration devices that will work until the batteries lose their charge. I have enough fully charged LiFePO4 batteries to keep things going for a couple of days. After that, unless I can find a local friend with power and refrigerator space, I would need to accept Eli Lilly’s word that the drug is good stored at room temperature for up to twenty-one days.

That’s All for Now

I’ve prattled on long enough, letting you know about the end of the shortage, my progress on Mounjaro, and the one thing on everyone’s mind here in Central Florida, Hurricane Milton.

While I am uneasy (to put it mildly), I’ll “hunker down” and hope for the best. I plan to be back here writing another weekly update for you next week, come hell or high water—and we’ll have plenty of both! I’ll let you know how Milton treated us.

Mounjaro Weekly Rant: Big Pharma, Little Pharma, No Pharma

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Mounjaro

This is my weekly Mounjaro update, which chronicles my progress with the current vogue GLP-1/GIP-1 drug. Writing is therapeutic for me, and if it provides a modicum of useful information to my readers, I’m happy.

First, I want to comment on a hot topic. An Internet rumor is circulating about the possible end of compounded tirzepatide, the generic version of Mounjaro and Zepbound. After I blow enough wind about that rumor and its implications, I’ll get to my numbers. This will be a shorter overall rant than last week’s because we both deserve a break.

In Reddit We Trust

The hot, rapidly spreading Reddit rumor is that the USFDA is preparing to remove Mounjaro and Zepbound from the shortage list in October. This is causing great distress among those who rely on compounding pharmacies for a cheaper alternative than the branded drugs. The basis for the rumor is an FDA response to a citizen’s query, in which that regulatory organization unwittingly dropped a hint about the shortage’s end. The upshot is that if the FDA says, “no shortage”, compounding pharmacies will not be permitted to sell tirzepatide.

No doubt, Eli Lilly & Company, the manufacturer of Mounjaro and Zepbound (both of which are brand names for tirzepatide), will push the FDA to move their case along. Of course, aggrieved parties, namely, the compounding pharmacies, will file lawsuits. Likely, Eli Lilly, a huge multinational corporation with deep pockets and massive lobbying influence, will prevail. Once the ball starts rolling, it is just a matter of time before the compounders are unable to sell tirzepatide. The headline will read, “Big Pharma to Little Pharma: Drop Dead!“

Compound Fractures

Two types of compounders, designated by their legal classification 503a and 503b, are affected. Right now, both sell uncompounded, generic tirzepatide, but after the drug comes off the shortage list, neither can legally do that.

In the case of 503a pharmacies, the good old-fashioned compounders, they still can accept legitimate prescriptions for compounded tirzepatide. Here, compounding means that the drug is mixed with Vitamin B12, for example, due to prescribed requirements for specific patients. However, they will need to stop selling uncompounded tirzepatide immediately.

A Hard Pill to Swallow

The 503b pharmacies, the ones that sell plain old tirzepatide, are typically mail-order pill mills. Some of them sprang up to sell boner pills after Pfizer created a market for them after the seminal introduction of Viagra (pun intended) and the fun drug subsequently went off patent. The FDA will allow a grace period during which 503b pharmacies can fulfill existing orders. I’m hearing that this can be for up to sixty days.

Presently, we are dealing with more speculation than fact. However, the shortage resolution will happen eventually if not in October, at which time the FDA will impose the restrictions. Certainly, Eli Lilly will push to hasten that outcome. It is their drug, they brought it to market at considerable expense for R&D, patentng, advertising, and production, so they want to protect what is theirs.

The parasitic compounders will suffer, as will those who opted to take the risk of using them. Ignorance of the enabling situation, namely, the necessarily temporary shortages of Mounjaro, Zepbound, Ozempic, and Wegovy, exacerbated by the marketing efforts of the compounders and their telehealth partners, lulled these patients into a false sense of security. What to do when the compounding channel goes away?

Will Widespread Panic Prevail?

I suspect that tirzepatide addicts using the compounded products will panic due to Internet-fed rumors about the supply shutdown. Some will exhort their doctors to prescribe compounded versions for which they might not have a specific need. However, Lilly has been getting nosy about such contrived scripts and I could see them using the courts to pressure doctors with the threat of losing their licenses.

Other tirzepatide junkies might order huge quantities of the precious drug. Either they will feed their own habits or, when the dawn of profitability realization breaks on their thick skulls, they might enter the resale market, which, of course, is illegal as hell.

Any way you slice it, there will be chaos in the tirzepatide market!

The Danger of Questionable Sources

Another big issue with people buying large quantities of these drugs from questionable suppliers is their unknown shelf-life. What is the danger of things going wrong as they age? Many are reconstituted, and who knows what the labs are using as preservatives?

Unlike with Lilly, the FDA does not exert tight quality control over these compounded products. From some compounding pharmacies, tirzepatide might be perfectly safe, but from others, patients might be taking their life in their hands, injecting tainted substances into their bodies. Remember the case of New England Compounding Pharmacy and the one hundred deaths associated with one of their injectable compounded products? The principals were jailed ex post facto, but too little, too late. People died.

How About Third-World Tirzepatide?

Another possibility is that desperate weight-loss addicts will seek out foreign sources for their substances. I saw an Australian Broadcasting Company programme about a compounding pill mill Down Under that was illegally selling semaglutide (sister drug to tirzepatide) into the U.S. They interviewed some of the Americans who were bilked by the pill mill. They told horror stories about the unusable products they received.

So, I can foresee all kinds of problems arising in the future stemming from people’s outsize desire to lose weight. They’ll flail around blaming Eli Lilly for being greedy, but they’ll either be dealing with Lilly’s prices or with their black-market suppliers.

While the long-term outlook for the pill mills might be uncertain, I bet they will experience a significant bump in sales in the short term. Addicts will be addicts, and addicts must get their fix.

The big question in my mind is: How stupid will desperate people be regarding where and how they get their drugs?

My Progress on Mounjaro

Now, let’s move on to my progress on Mounjaro.

My glucose average for the week, as reported by my Dexcom Stelo, was 107 mg/dL. This is an improvement, and it equates to an A1c of 5.4. We’re homing in on my target of 5.2! My weight increased 1.6 pounds since last Monday, which is no cause for concern in the aftermath of my rapid, COVID-influenced weight loss (ten pounds in a week).

Blood pressure has been an issue since the COVID episode. Back on the 100 mg dose of Losartan, my average was 135/80. Before my vacation, I had been averaging 119/70 after reducing the Losartan to 50 mg. I believe my blood pressure will improve when I can resume a decent exercise regimen, which I suspended due to COVID and back/hip issues. Along those lines, before I close this week’s all-about-me Mounjaro progress journal, I’ll take a side-trip to da hip.

Back and Hip Issues, You Say?

During my vacation, I tweaked my back, and wound up with sciatica-like symptoms, which continue now, close to a month later. My doctor, who opts for conservative treatments first, told me to try Alleve for two weeks. I did, and it didn’t help. I still have thigh pain and numbness. So, I have put in a request for him to order an MRI so we can see what is going on in there. Without the diagnostic imagery, I am flying blind. I have no idea whether I am dealing with a disc issue, a nerve issue, or a hip degeneration issue. I had my left hip replaced in 2001; now, could the right hip be shot, too?

With hopes of confirming that or eliminating it as a possibility, I attempted to make an appointment with Dr. Kahuna, my knee guy, who is also a hip replacement surgeon. In fact, he trained under the surgeon who replaced my left hip. However, without imaging to support the notion that a hip replacement might be necessary, the policy of the orthopedic clinic is to use a physician extender to evaluate the condition before bothering the big kahuna with a case that might not require his expert surgical intervention. So, I made an appointment with an unknown physician assistant named Laura.

Aesthetically Speaking

I did some background checking on Laura. Turns out that she either runs or ran an “aesthetic” clinic. You know what that is? Botox and lip inflation for rich matrons. Her reviews for that clinic were terrific, but what in the bloody hell does vaginal reconstruction have to do with evaluating my hip? This revelation further underscored the need for me to get the damn MRI. While I originally thought it might be fun to have the conversation with Laura to get her story, who the hell has the time for such entertainment?

If the MRI says I need a hip replacement, I can skip the extender evaluation and go straight to Dr. Kahuna. Once I receive the order from Dr. DeLorean, I’ll cancel the vaginal rejuvenation evaluation. If the MRI results point elsewhere, I’ll deal with that. Flying blind sucks!

Wrapping It Up and Putting a Bow on It.

That’s it for this week. In the coming weeks, we’ll no doubt learn more about the travails of the Little Pharma vs. Big Pharma. And I hope to be back next week with some new tidbits associated with my Mounjaro therapy and my general state of being.

Until then…