Mounjaro: No Catchy Title Yet

Five weeks into Mounjaro therapy, and still without a cool title for this sub-blog. The YouTube channel names for similar ventures suggest that I need a fancy moniker to match the likes of: A Little Less Lisa, Countess of Shopping, Downsized, Fit Fat Fun, On the Pen with Dave, Mounjarbro, etc., etc., ad nauseam. I will give you some more thoughts about YouTubers and then touch on my progress. Finally, I will relate a story that has me on the verge of going legal with the medical system.

As for YouTubers, they talk about their “weight loss journey” and give tips to those who are too lazy to do their own research, hoping to impel them to follow them down the primrose path while earning a little YouTube scratch. As you will see later, some doctors are just as bad as the “influencers” when it comes to prescribing drugs without considering the context. But for now, I need to pick on the YouTubers.

Pushing Drugs

“Monetizing channels” is the way of YouTube, where you can pick a popular topic like Mounjaro, which is all the rage at fat salons and shady telehealth profiteers, make some videos, and get compensated for it based on the almighty YouTube algorithm. Why not cut in on the Mounjaro action while talking about yourself? Woo-hoo! And while you are at it, why not pass along dangerous tips about how to obtain the drugs from on-line sellers or telehealth operators and then divide doses? Loosing (sic) weight is a big money business. Everywhere you turn, someone is authoring a book, selling a diet plan, producing a video, or now more than ever, pushing drugs.

While Eli Lilly & Company, manufacturers of Mounjaro, might ordinarily be grateful for all the free publicity, they are not amused. Many of these YouTubers proselytize the use of compounding pharmacies to obtain generic, compounded versions of tirzepatide to an audience of people ill-equipped to vet them. I seriously doubt that any of them have investigated where the ingredients for the compounded tirzepatide come from. (I have seen one compounding pharmacy’s video which shows it being reconstituted from a powdered form; however, does anyone know who makes the powder? Is it made under tightly controlled conditions?). On June 20, Eli Lilly wrote an open letter to the public, published on their shareholder website and on social media decrying the use of potentially dangerous generic alternatives.

Naturally, the Internet weight-loss crowd ganged up on them, declaring rampant self-interest and accused Lilly of making too much money. We’re capitalists here, you know, fellas and fellatrixes. You are just mad that they are trying to take your cheap tirzepatide away so you will not loose wait (sic).

Are Compounding Pharmacies Safe?

Tough question. Many compounding pharmacies perform worthwhile services, but others are shady. While Lilly might have overstated its case, how do you ensure that you are getting a pure drug that stays pure? The FDA has spot-inspected compounding pharmacies who participated in their risk-based volunteer inspection program. Many came out clean, but some notable findings were a toaster oven being used as a sterilizer, a dog bed near a sterile workstation, and workers not wearing gloves while formulating medicines. Pet hair, dander, and human skin create dust, a transport mechanism for pathogens just waiting for a suitable medium to land in to multiply and mess you up. So, you better know a lot about the compounding pharmacy you choose and its sources of the medicine you will inject into your body.

The well-known case of a compounding facility in Massachusetts a decade ago underscores the need for scrutiny of sources. The lab supplied a contaminated methyl prednisolone compound to joint and back pain clinics around the country. Seven hundred fifty people in twenty U.S. states were affected and more than sixty people died. In Michigan alone, eleven people died. The lab and its principals were found guilty of falsifying inspection records, resulting in a fifteen-year jail sentence for the bigshot. That ex post facto resolution does nothing for the families of the those who perished from the fungal meningitis infections caused by the tainted drug, which was manufactured under unsanitary conditions. Read the synopsis from the CDC here.

Be Careful and Do Your Homework

Other incidents have occurred with compounded drugs since then, according to the FDA. I am not trying to steer you away from a cost-saving alternative to brand-name medicine, but I do want to scare you enough to impel you to protect yourself against potentially harmful suppliers and products, emphasizing once again that you are injecting this stuff into your body. Any microbial, fungal, or even inorganic contamination is dangerous. For the “damn the torpedoes, full speed ahead” weight loss crowd, please proceed cautiously. And if you don’t wish to heed my advice, fine. In the words of Davy Crockett to the people of Tennessee after losing his U.S. Senate bid, “You may all go to hell, and I’ll go to Texas.”

Not a Mounjaro ‘Journey’

But I digress. Back to the damn “journey” characterization. Well, sheeeit, this ain’t no journey. It is pharmacotherapy with side-effects, not a whoop-de-doo fun excursion on the Tirzepatide Highway. It comes with risks that are not to be minimized by sugar-coated commentary or videographic bubbling over someone’s weight loss. Still, for the hell of it, and to make some light of the crap that is out there, I am thinking of catchy names for my weekly blasts. How about “Tirzeppity Doo Dah”? Wait, that won’t work for some of you wokers, being a politically incorrect reference to Disney Studios’ much maligned “Song of the South”. So, how about “Constipatient”, honoring one notable, common side-effect of Mounjaro. Not catchy enough? Can I propose “The Snows of Kilimounjaro”? Sorry, Ernest. Hemingway is rolling over in his grave over that abuse of his 1936 short story title. Decisions, decisions!

If I was a YouTuber, I would exhort you to leave your own suggestions in the comments below, hit the “like” button, and make sure you subscribe to the channel. Those actions all play directly into their compensation algorithm. However, here, where I am not in it for the money, I will merely ask you to cough up any bright ideas. The author of the winning suggestion will receive — um… uhhh… nothing I can think of.

Before I leave this ridiculous subject, one more comes to mind: “Mounj Veneris”. OK, now that’s out of my system. On to some more serious subjects.

Week’s Progress on Mounjaro

I amped up the exercise during the week, which I believe might account for some of my 2.6-pound weight loss. That’s fourteen pounds in five weeks, an unsustainable rate I hope to slow down. I bought a set of 52.5-pound adjustable dumbbells, because my 25-pound set limited my workouts. Do not laugh and call me a lightweight, you anabolic steroid shooting bodybuilders out there! I’m an old fart not seeking to look like a gorilla, but just wanting to maintain the muscles I have, which are imperiled by rapid weight loss.

While this is a known issue, particularly for “seniors” (i.e., old farts), YouTubers either dismiss it with the generalization, “when you lose weight, you always lose muscle along with the fat”, or they say, “eat more protein”, but they rarely say anything about strength-building exercises. As for me, I hope to forestall the sarcopenia journey, even though even my doctor handwaves, “you lose muscle as you age, anyway.”

Glucose and BP

Moving right along, my glucose average for the week was 103 mg/dL, down from 108 last week. This is equivalent to an HbA1c value of 5.2 — very encouraging! For the past thirty days, the average has been 112, so I am very appreciative of the downward trend. Much of the improvement results from eliminating lots of crap from my diet, which is aided by the Mounjaro. I am no longer thinking of what I am going to eat next while I am eating something, and I no longer have sugar cravings. (Never have I craved sugar itself, just sneaky sugar-laden crap like cereal. However, I will admit to having a donut or two when provided at a meeting or function).

Blood pressure was up for the week. I can loosely relate it to some intestinal cramps that kept me awake on June 26, which I have been experiencing mildly since then. Before that episode, I was averaging 115/65. On the day after the Night of the Cramp it was 140/85. Since then, the average has been about 130/80. While it might be bullshit correlation, I am wondering whether the cramps in da kishkas were related to Mounjaro. We will see how this plays out.

Bad Blood Revisited

Last week, I told you about my abnormal blood test that revealed a steep decline in kidney function. I also told you that my doctor advised me not to panic, ordering a re-test in a month. I prefer the term “proactivity” over “panic”. If something is going wrong, I want to hop on it. I had mentioned that my dehydrating hike might be implicated in the kidney decline — causing acute kidney injury (AKI) — which might mean that it can improve if I maintain decent hydration. Or it might not. So, I went looking for other potential issues relating to drugs I am taking, including Mounjaro.

I could find only positive information about Mounjaro forestalling the progression of chronic kidney disease (CKD), and I was not cherry picking. This concurs with my doctor’s knowledge of the subject. However, I did find two drugs I was taking that might have exacerbated the CKD. The first, hydrochlorothiazide, I had already discontinued. The second, omeprazole, used to control gastroesophageal reflux disorder (GERD), is a problem. My gastroenterologist prescribed the drug for long-term use at twice the OTC dose. I have been taking it for six months. Recently, I found an observational study in Pharmacology that implicated the drug (brand name Prilosec), in AKI, particularly among us over-65, over-medicated, over-the-hill senior old farts. Later, I found an overview of PPIs and CKD progression in a 2023 review in Cureus, via the NIH.

Prilosec Lawsuits

According to Drugwatch, AstraZeneca, manufacturer of Prilosec, agreed in October 2023, agreed to settle about 11,000 Prilosec and Nexium lawsuits for $425 million dollars. The lawsuits, along with similar kidney injury based Prevacid lawsuits, were combined into a multidistrict litigation in New Jersey federal court. Drugwatch’s legal partners are currently not accepting [any more] Prilosec lawsuits.

Suing the manufacturer is not something I could do, and it is not my style. In my case, I am was taking generic omeprazole, so who am I going to sue? Some lab in India? On the other hand, two doctors, my gastroenterologist, and my primary care physician, who prescribed this crap for long-term use need to do some ‘splaining. How much damage has been done and how it can be related to omeprazole will determine what I do from here.

Taking Action on My Own

Without discussing any of this with my primary care doctor, in whom my confidence regarding proactivity and attention to detail is decreasing, I discontinued the omeprazole. While I have scheduled the one-month re-test he wanted for the end of this month, I also scheduled some testing for today on my own. I want to stay on top of the kidney situation, setting up an appointment with a nephrologist sooner rather than later if things are going south. Do I sound like Chicken Little? In my mind, forewarned is forearmed. Permanent kidney damage is playing for keeps at the highest possible stakes.

Is it any wonder why I tell people to be seriously watchful and knowledgeable about what they are putting in their bodies when doctors cannot even be trusted to keep track of drug effects properly? Overmedication is a scourge, and failure to understand interactions between medications, other medications, still more medications, in combination with a patient’s chronic conditions is a genuine problem.

What about SGLT-2 Inhibitors?

My doctor says he currently has twenty to thirty patients on Mounjaro, his preferred drug for type two diabetes (T2D). However, another class of drugs, called SGLT-2 inhibitors, piqued my interest when I consulted him about doing something more for my worsening T2D. The SGLT-2 inhibitors are oral drugs such as Jardiance and Farxiga, which are well documented to have a positive effect on kidney and heart function while controlling glucose and promoting weight loss. However, one scary side-effect is Fournier Gangrene, a life-threatening necrotizing infection of the perineum (the area between the genitalia and the anus, or the “taint” in street vernacular). Gangrene in the feet is another rare risk. Unpleasant, to say the least.

Three of my friends are taking Jardiance. One has reported no issues. One is newly on the drug for congestive heart failure, an on-label use for non-diabetics. Too soon to get any good data. The third, however, has been taking Jardiance for diabetes for years. He was hospitalized earlier this year for a foot ulcer that became gangrenous. Amputation was a strong possibility, but he managed to avoid that awful fate and recovered completely.

When I mentioned SGLT-2 inhibitors to my doctor in the same conversation in which he promoted Mounjaro, he brushed me aside. Without touching on either the positive kidney effects or the potentially negative side-effects, we quickly moved back to Mounjaro. If this is merely closed-mindedness or lazy preference for a single drug, it is bad enough. I certainly do not want to think there is more to it than that.

Mounjaro Person or Jardiance Person?

In today’s hyperpolarized society, exacerbated by YouTube/Instagram/Facebook tribalism, one must either be a Mounjaro person or a Jardiance person. We cannot engage in constructive discourse to weigh the pros and cons of both. When doctors are subject to the same prejudices and biases as we patients, how does that help us get the best treatment for ourselves?

Having covered my progress, having bashed YouTubers and their drug pushing, and having exposed my doctors and their own brand of drug pushing, I will now terminate this post. I hope you are finding these weekly epistles interesting and worthwhile.

I have babbled long enough. See you here next week.