Descending Mount Mounjaro Part II

Wrapping up the journey (Part I is here)

Part One is here: Descending Mount Mounjaro

CAVEAT: I am not a medical professional, and none of what follows is to be considered medical advice. This is a recounting of my experiences after starting the Eli Lilly drug Mounjaro, no more, no less.

The easiest way to sum up the journey is this before-and-after comparison from my medical provider’s records:

Before.

Office visit on November 20, 2022

Physical Exam: Vitals & Measurements

HR: 91

BP: 150/60

SpO2: 95%

HT: 5’9”

WT: 245.8 lbs

BMI: 36.34

Pertinent Lab results: Nov 10, 2022

CHOLESTEROL: 215 mg/dL (High)

TRYGLICERIDES: 180 mg/dL

HDL: 93 mg/dL (HIGH)

NON-HDL CHOLESTEROL: 122 mg/dL

LDL, CALCULATED: 102 mg/dL

VLDL CHOLESTEROL: 36 mg/dL

GLUCOSE LEVEL: 117 mg/dL (High)

HEMOGLOBIN A1C: 5.6%

UA KETONES: 3+ (Abnormal)

Office visit on July 10, 2023

Physical Exam: Vitals & Measurements

HR: 75

BP: 118/80

SpO2: 98%

HT: 5’9”

WT: 157.4 lbs

BMI: 23.31

Pertinent lab results: Jul 05, 2023

CHOLESTEROL: 166 mg/dL

TRYGLICERIDES: 81 mg/dL

HDL: 84 mg/dL:

NON-HDL CHOLESTEROL: 82 mg/dL

LDL, CALCULATED: 66 mg/dL

VLDL CHOLESTEROL: 16 mg/dL

GLUCOSE LEVEL: 81 mg/dL

HEMOGLOBIN A1C: 5.0%

UA KETONES: 3+ (Abnormal)

Some closing notes:

I remain on Mounjaro, and intend to continue to take it for the rest of my life, or until something even more effective comes along - and it, or more likely they, will come along fairly soon, given that the whole field is undergoing something of a gold rush phenomenon at the moment. Strangely, my doc, who simply can’t help reflexively regurgitating medical conventional wisdom that is neither wise nor accurate, asked me if I planned to lower my dosage, and I told her no, on the principle of “If it ain’t broke, don’t fix it.”

I achieved spectacular results. All of the stuff most likely to kill me - obesity, cholesterol, high blood sugar and accompanying high blood pressure, heart rates, oxygen intake, etc. - have gone from high or dangerously high to normal. Given that I have familial hypercholesterolemia (genetic high cholesterol) that total cholesterol reading of 166 is amazing. I’ve never tested that low in my life.

I was particularly amused (in a quite sour way) by this on the clinical notes when I waddled into her office weighing 245 pounds and sporting a BMI that indicated morbid obesity:

BMI 36.0-36.9,adult

Recommended maintaining healthy diet and regular exercise to stay healthy and decrease risk of uncontrolled chronic illness- diabetes, hypercholesterolemia, and HTN. Discussed goal 150 minutes of aerobic exercise/week. Patient verbalized understanding.

As opposed to, I suppose, verbalizing my unmitigated scorn for this boilerplate recommendation almost guaranteed to fail for most patients who receive it, followed by protests from the physician that the patient hadn’t followed his recommendations, therefore there was nothing wrong with the recommendation, the problem was with the patient. Otherwise known as “blame the patient for the doctor’s failure.” Unfortunately, since nobody understood more profoundly than doctors that they had nothing better to offer, this was what they handed out like placebos. Since placebo was really the only way to describe that particular prescription.

I alluded earlier to my medico’s not so veiled suggestion that since I had now, solely with the aid of Mounjaro, achieved remission of all my weight, and weight-related problems, I should probably consider cutting back on the Mounjaro.

She blinked when I immediately and flatly told her “No.” I tell her no on a fairly regular basis, and she always blinks and pauses for a moment, as if she’s unused to patients telling that to her. I suspect that doctors hate admitting even to themselves that they are high-level body mechanics with an extremely imperfect knowledge of the fleshy vehicle on which they are trained to work. (And we won’t even talk about mental health, or for that matter, mental function as it applies to medicine).

I always toss her a little bone for face-serving purposes (on her part) and to let her know I am not simply being obstinate. “I don’t plan to cut back on my blood pressure, cholesterol, COPD, or BHP medications because those disorders are well controlled, either.”

It is going to take a while, I fear, before the immense benefits of drugs like Mounjaro filter out into the medical community (as opposed to the guaranteed fails they’ve been accustomed to prescribing), let alone the public at large, who have bought into the “eat less, exercise more,” and “calories in, calories out” misunderstandings even more than the docs themselves. And this after most of them who had tried it eventually failed miserably. And blamed themselves.

Anyway, my current weight for the past month has remained in a narrow band between 156 and 152. That 157 at the doc’s office was with me wearing clothes - a practice I’ve never understood the usefulness of if you are trying to determine bodyweight - a bit of common sense that was once well understood. When I was at boarding school. we got physicals at the beginning and end of the school year, and the results, along with pictures of us lined up in our jockstraps waiting for our turn on the scale, were sent to our paren ts so that mom and dad could see what was what with us. Much to our embarrassment when we discovered this, as we always did.

I am finding it much more enjoyable to exercise these days, since I am no longer hauling the equivalent of an Olympic barbell with fifty pounds of plates on it (the bar is 45 pounds for a total of the 95 pounds), that I have lost since I began my descent of Mount Mounjaro a bit more than half a year ago. My joints hurt less, my stamina is much improved, my COPD seems mostly in abeyance, and I now toss off a six-to-ten mile ride on my single-speed bike with ease and panache, where before I found myself at times unable to walk more than a few steps without having to stop and catch my wheezing breath.

The only exercise I enjoy other than cycling is weightlifting, and my strength is returning. I have set up certain goals - bodyweight bench presses, 20 continuous pullups, deadlifts of 225 pounds, squats at 175 - and I will decide, if and when I reach them (and all are considerably beneath my 1RMs (one repetition maximum) achieved back in the mid-2010s - and I rather suspect I won’t try to better them. At my age - 77 - injury becomes ever more of a paramount concern, especially because you can’t lift if you are injured - or sometimes do a lot of other things, either. Like walk, when you blow out a knee doing deadlifts or squats with too much confidence in your own invulnerability.

As always, your questions and comments are welcome, although I probably won’t spend a lot of energy defending my contentions about the abject failure of the calories in, calories out medical fantasy. And while I heartily congratulate any and all who have lost weight and kept it off by any method, I probably won’t say much beyond “good for you!” unless you are somebody who has lost 40% of your bodyweight and kept it off for more than five years using only diet and exercise. I’ve lost 39% so far, and while that’s probably an end to it, keep in mind that I did it in a bit less than seven months with no exercise, and no hunger. So if you did lose that 40% with solely diet and exercise, and kept it off for at least two years, do let me know how that went for you.