The magic word Mounjaro in the title will piss off the Facebook spam algorithm again, but I do it to determine whether the Facebook humanoids have as yet favorably considered my objection to their penchant for removing these posts. Owing to their lack of communication, the only way to test the water is to post one containing the offensive word and picture. Someday, a sentient being at Facebook might read one, which will reveal that this is not attempted keyword spamming, as they accuse.
I encourage anyone who would typically access links to my articles on Facebook to subscribe here directly so you’ll never miss one of my rants.
This Week in Mounjaroville
With the negative opening behind us, we can move forward with another completely innocuous, non-spam report. I have been posting these mostly weekly updates while I proceed with the Mounjaro therapy. This is Week Twenty-One.
Today’s update will begin with some background information for those who are new to this column, and who are curious about who I am, what I am doing, and why I am writing this. Although I sometimes use this space to expound on various issues with the GLP-1 and weight loss industries, this week I will give you a break from the editorialization to touch on various areas of my health, which I hope to improve by coping with type two diabetes.
A Little Background for New Readers
At my doctor’s suggestion, I have been taking Mounjaro for type two diabetes since June 3. During that time, I have seen positive benefits in decreasing HbA1c and daily blood glucose readings, two important measures of severity of diabetes. Along the way, I’ve lost about forty-five pounds of blubber. Weight loss was not and is not the primary object of my Mounjaro therapy, but I’ll take it. Of course, it is not all attributable to Mounjaro. I also adjusted my diet and increased my exercise commitment after initiating the drug.
As I noted in a prior column, my improvements in diet and exercise have given me collateral benefits, such as reduction in chronic pain due to inflammation. My wife Jenny, a biochemist, glutenophobe, and avid follower of health topics, believes that giving up bread is the biggest contributor to easing my joint pain. If that is the case, I will happily avoid bread, as the health reward far outweighs the taste of a chopped liver on rye sandwich.
I do not know how long I will be injecting this drug beyond the next twelve weeks, which is the supply I have on hand. After I achieve my goals, I want to find a way to ease off Mounjaro. Although I am taking a low dose, five milligrams, I am wary of potential long-term adverse effects. My preference is to take as few drugs as I can — I don’t even bother with over-the-counter pain relievers unless pain exceeds my high tolerance. Any way you look at it, I am injecting a foreign substance into my body, which I must take seriously. As a crusty old fart, I am particularly concerned with undisclosed side-effects that have evaded disclosure by the limited research studies to date.
Sarcopenia and Me
One particular concern obliquely connected with Mounjaro is potential loss of muscle mass due to too rapid weight loss. We lose muscle as we age in any case, due to a process called sarcopenia. Some estimates say we lose up to 10% of our muscle mass per decade after age 50. But crash diets and rapid weight loss for any reason causes added muscle loss beyond what aging does to us. With this in mind, I increased my resistance training and upped my daily protein intake, which I check closely. Unfortunately, my back issues have recently caused a temporary halt to resistance training, which I’ll cover next.
How’s My Back Doing?
I’ll follow up on last week’s post, in which I kvetched about my lumbar spine. Yes, I know, this has nothing to do with Mounjaro, but it’s all part of the same old, decrepit body. My ability to exercise is a key factor in my approach to living with type two diabetes, and my back situation could say much about my ability to engage in both cardio and resistance exercise.
Last week, I shared my MRI report. With my collaboration, my doctor decided to put me on a conservative course, first with physical therapy. So, I arranged an evaluation at a local PT operation I have used before, and found the same therapist still there. Old farts like me appreciate familiar things. Julie is an energetic, no-nonsense task master, who looked at my MRI report and delivered the summary assessment, “If you came to me and said your lower back is completely messed up, I would have to agree.” She said she could assuage some of the nerve root compression, but not the spondylolisthesis, the stenosis, the disc degeneration, or the facet arthrosis.
The Plan
So, here’s the plan. I will undergo physical therapy twice a week for six weeks while doing targeted strengthening and stretching exercises daily. During this time, Julie the PT (physical torturer) told me to suspend my dumbbell resistance training. But she said a half-hour of cardio daily would be fine.
The physical therapy outfit gave me a very cool app called MedBridge GO, which directs and records my daily exercise progress. To keep me honest, it can optionally send the daily record to my therapist, which I enabled. In for a penny, in for a pound. The exercises are not difficult, but they work some muscle groups I haven’t accessed for a while, so I feel sore all over, but pleasantly so.
Physical Therapy Begins
Last week, I had my first physical therapy session. Aside from additional targeted exercises and stretching, the therapists strap me onto a traction table to stretch my lower spine. Despite my mental image of Medieval torture I visualized when my therapist briefed me beforehand, it did not turn out to be unpleasant. When the traction session ended, I asked Julie, my sadomistress, whether I was now 6’2″. “You wish!” she quickly retorted.
I hope this physical therapy approach works. I know that my back will never completely heal–it is far too screwed up–so what I am hoping for is pain at a tolerable level. This will allow me to do resistance training, which is essential to combat the muscle loss I described above. If PT doesn’t do the job, the next step will be x-ray-guided epidural injections. The last resort is surgery, a possibility I’ll try to avoid. Although minimally invasive procedures are available, I don’t expect miracles, given the MRI report I shared with you. That’s why I’m pursuing the prescribed exercises and physical therapy with fervor.
How about the Numbers?
Aside from physical therapy, I had a busy week. The high point was Jenny’s birthday on Thursday (she’s thirty-nine again), which we celebrated with a very pleasant three-hour lunch along with friends visiting the Orlando area from Canada and Michigan.
In the old days, a long lunch meant lots of food and booze, but not anymore! I have eschewed alcohol for a couple of years due to yet another one of my old fart ailments, chronic erosive gastritis, and I straightened out my diet in combination with Mounjaro therapy and diabetes. Additionally, considering our guests’ request to avoid spicy food, I chose a restaurant that prides itself on an innovative menu with entrees all at 575 calories or less. I had a delicious cedar plank salmon dinner but I passed on their small, but tasty, desserts. The lunch company was excellent and the banter superb. The food was fine, too, and it had no significant impact on my glucose. Winner, winner, salmon dinner!
Morning blood glucose as measured with a traditional glucometer averaged 94.7 mg/dL for the week. This is up about 1.3 from the prior week, within the margin of error. My Dexcom Stelo reports 114 mg/dL overall average glucose measured from the interstitial fluid, which corresponds to an estimated HbA1c value of 5.6. Man, I’m getting there! I should mention that I am taking Metformin ER 500 mg once daily aside from the Mounjaro.
Since my COVID-19 episode, my first-thing-in-the-morning blood pressure had been elevated. It now, finally, seems to be settling down. Average for the week was 122/73. Note that I am taking losartan at the 100 mg dose.
Finally, my weight fell 0.6 lbs during the week. I am hovering just over 200, where there seems to be a support level. My goal is 165, which I hope to achieve gradually at the rate of one to one-and-a-half pounds per week.
See You Next Week
I enjoy writing these updates, and I hope that those of you who read them can gain from my shared experiences, if not from my kvetching about body aches. Next week, if I look back here to jog my aging brain cells, I might write about my current project, namely, selecting a Medicare Part D prescription drug insurance plan for 2025 that will be the most efficient and economical. Thanks to the misnamed Inflation Reduction Act, lots has changed with Medicare. Taking an expensive drug like Mounjaro makes the annual choice much more consequential to the budget.
Until then, stay healthy!
