I’ve been thinking about trying this and am aware of the shortcomings of the calories-in/calories out approach, including the down- regulation of metabolism. I would imagine that, even though Maunjaro makes eating less much easier, there is still the same issue of lower metabolism. That wouldn’t matter so much, as long as Maunjaro continues to work and one doesn’t have significant safety or tolerability issues down the road. If one of these wild cards forces you to discontinue Maunjaro some day, aren’t you concerned that your metabolism will be shot?
My metabolism is shot anyway. I have mentioned that in order to lose weight, my caloric intake must be less than 8oo/day. And I have also said that in the event that I have to stop Mounjaro, I am quite certain that the weight regain will be intense and rapid. It is what it is.
Just as if I were to stop taking Atorvastatin, within a month or so my total cholesterol would rise to levels above 440, and my blood pressure would once again become dangerously high were I to stop my BP meds.
Which is why I don't intend to stop taking any of them.
You should also understand my approach to these matters, which always includes a look at as many downsides as I can find, and a consequent risk/reward ratio based on these. In this case, the risk of T2D/Obesity far outweighs the risk of taking Mounjaro, even with a theoretical downside such as you describe. (And which I was aware of, and thus was taken into consideration when I made my decision).
It is easier to take these medications because of the need for blood sugar regulation. Diabetes is a silent killer and it has racked my body without me knowing it until too late. I'm on Ozempic and for the past three years, I haven't gained weight - but then, I wasn't overweight to begin with. But I need this medication because I want to stay alive. To those taking these medications as a weight loss drug, I would be more hesitant to recommend. Unless you are uncontrollably obese, I wouldn't go that route. There could be side effects. I know of healthy people taking these drugs for weight loss and they have had serious side effects, as though it wasn't meant for healthy systems. So I don't recommend these diabetic drugs for weight loss.
This is a common divide between the type 2s taking these meds for blood sugar control, and those who wish to take it for weight management (and their docs). lt is temporary, and will pass. Everybody is cranking up their manufacturing capabilities. Lilly is building an entire new facility on its campus to make it. Availability will shortly no longer be the problem it has been.
Keep in mind, though, that obesity (and not "uncontrollably obese," by the way) is in itself a life-threatening disease. Type 2 is only one of its many malign manifestations.
One more thought on "uncontrollable obesity." If you are obese, it's a fairly good indicator that your problem is uncontrollable. Nobody enjoys being obese, and nobody says that if they could choose not to be obese, they would prefer to stay fat. I've already addressed the abject failure of all traditional "cures" for obesity.
Also, it would be helpful if you could tell us what these "serious side effects" were.
Thanks Bill. Not specifically to the Instapundit thread, I see an eight assertion, "8. The side effects are horrible and dangerous, potentially life-threatening." What was your experience?
Not in my case. In fact, because I eschew carbs as a general matter, and since many report that carbs, especially highly refined carbs, exacerbate the gastro side effects, it probably explains why mine were so minor.
This is a different matter than the actual warnings that come with the drug. If you have pancreatitis, you shouldn't take it. It increases your risk for thyroid cancer. Everybody will need to evaluate the risk/reward ratios on these as to their own personal situation and desires.
A big issue that concerns me (as someone that has struggled with weight all my life) is that this drug will have to be taken until you die, because you haven’t really “solved” or “healed” the underlying problem that’s causing the issue. There is no way to know the long term effects or downsides, until it manifests (if it does). Anytime an unnatural chemical is introduced into the body, unless the body has a chance to detox from it, chronic use is bound to have some negative effect eventually. As Thomas Sowell said, there are no solutions, only tradeoffs. This one seems potentially risky to me.
There a lot of people taking a lot of different drugs for the rest of their lives. Cholesterol meds, BP meds, heart meds, and so on. In life, just about everything is potentially risky. You have to evaluate based on the amount of risk you are willing to sustain, versus the immediate benefits of losing a great deal of weight.
Agree. This is the "Patch Adams" school of medicine. The body can heal itself if only you get off the drugs and give it enough time. The problem is most of us don't have four or five months to devote exclusively to our health. We have jobs, families, hobbies, etc. We want to get back to feeling better pronto.
Except the body does not heal itself in far too many instances, no matter how drug-free it is, or how much time you give it. Untreated (Disease X) can and will kill you if you don't treat it. There are hundreds of diseases that fit into that classification.
May 11, 2023·edited May 11, 2023Liked by Bill Quick
I, too, am a Type 2 diabetic, and have been for ~20 years. My weight gain experience with metaformin by itself was similar to yours (20+ lb in a few months). I changed endocrinologists and switched to Janumet (a combination of Januva and Metaformin) which did not have the weight gain problem. Learned to count carbohydrates, added moderate exercise. Lost 50 lb over 9-10 months, brought A1c level down to 6….have maintained weight and A1c under 6.3 since 2008 (knock wood!). All without the magic new drug…oh, and I eat whatever I want (just not the amounts….) and drink (mostly) moderate amounts of wine….
I think you'll find there are those who are willing to 'count' (calories, grams, push-ups, minutes, miles, etc) for the rest of their lives ... and those who've tried and failed - again and again! - to maintain counting, monitoring, resisting in the long run. For the second group, to escape these cycles of imposed restraint is like a door opening on freedom - for the first time ever!
95% of people can't. (I made that up, but I actually bet the real number is higher.)
If I count my carbs, deny myself every food I grew up liking, and push away my cravings and hunger, I can lose weight. Slowly. Until I fall off the wagon for a special occasion. Or I can confront my hunger, and do some fasting, where I think about food incessantly. And try not to binge when I come off the fast.
I'm still skeptical of long term issues with the new drugs, but the extra 50 to 70 pounds I'm carrying represent their own issues. Which is worse? Known problems carrying extra weight, or unknown issues with a new drug?
Sep 18, 2023·edited Oct 26, 2023Liked by Bill Quick
Bullseye. When I was in my late 20's, I was crowding three bills and resolved to lose weight. Basically, I starved myself and began power walking, doing 10 miles every day. It took 18 months, and I lost 100 lbs. But my social life went to h*ll because I was terrified I would find myself in a place or at an event where I would overeat and knock myself off the wagon. I was single at the time, though, so I only had myself to worry about. Twenty years later, when my weight shot up again, I was married with two kids and couldn't do that again. Mounjaro has been a lifesaver.
1. Do you go OFF the Mounjaro at any point? Losing the weight should make the Type2 go away, shouldn't it? Do you get to stop the injections and see if the weight comes back and the diabetes stays away?
2. I'm also not a needle person. Giving MYSELF a shot? Yikes. Can you expound on why you didn't find that more of an issue?
3. I know someone who was a vibrant, active professional who is now a severely disabled special needs adult needing constant supervision/care. Can't drive, can't work, can't be left alone, was a marketing exec and now can barely string a sentence together. She took FenPhen when that as a "approved for other things but great for weight loss!" fad and had an aneurysm/stroke. I'm hesitant about these too-good-to-be-true options. Any ideas how all these new drugs different are from that?
Note that there is no hypodermic needle, poking around trying to find a vein, or any of the other paraphernalia people associate with self-injection. Mounjaro is injected subcutaneously, which means the needle stick itself is no more than a quarter inch deep, and the injection itself takes no more than ten seconds, usually less. I alternate weekly injections from one side of my belly to the other. It doesn't even seem like a "shot," because I never see a needle, the penetration is minor and takes only a tiny bit of time, and it doesn't hurt.
"Do you go OFF the Mounjaro at any point? Losing the weight should make the Type2 go away, shouldn't it? Do you get to stop the injections and see if the weight comes back and the diabetes stays away?"
I have no plans to do so. Losing weight usually causes T2D to go into *remission." It will return as soon as you regain the weight you lost. And you will regain it quite quickly if you stop taking Mounjaro.
I usually respond to this question by saying that my high blood pressure and high cholesterol has "gone away" because of the drugs I take to control it. Doesn't mean that I'm going to stop any of those meds either. I'd be a fool to do so.
I have never been overweight, yet I developed Type 2. I ran for 30 years daily, and have little body fat - but I still got it. I know a lot of people think Type 2 is caused by obesity, and perhaps for perhaps a majority, that is the case. I am lucky to be on a drug like this. So I don't believe that if you need a diabetic injection like me, you should be expecting to get off of it because you are no longer overweight - your diabetes can be the result of other unknown circumstances like mine.
"More than 90% of patients with type 2 diabetes have a BMI ≥25.0 kg/m2 (1). In 2013, the American Medical Association designated obesity as a chronic disease (2), and there is growing appreciation of obesity as a complex chronic condition caused by multiple factors, including behaviors, genetics, and the environment."
If you have T2D, odds heavily favor you having the chronic disease of obesity, or you are at least overweight. And if you have the chronic disease of obesity, expect to be treating it for the rest of your life.
Yes, but is that BMI a result of type 2? I think the drugs given (especially sulfonylureas) increase insulin production. The muscles don't need the glucose so gets stored as fat. And very easily. Doesn't take much to gain weight as a diabetic. I was on glyburide at one point. Made me ravenous as I dieted and exercised. (also made me gain 20 lbs as I was put on blood pressure medicine that left me on the couch for a couple months). Once we sorted the BP medicine, I could not lose a single pound. I am now 173 (143 lean body mass) and I struggle with my glucose numbers every day. Woke this morning and they had risen from 90s in the middle of the night to 160s upon waking with no intake of food or drink. It is genetic in my case.
"What we know now about Type 2 Diabetes and Metabolic Syndrome is that insulin resistance prevents glucose from entering our cells and results in elevated blood glucose. The elevated glucose is then converted in fatty acids and with the aid of insulin gets stored as fat in adipose tissue, resulting in obesity."
On the other hand, here is a paper which takes the opposite stance:
"The accumulation of an excessive amount of body fat can cause type 2 diabetes, and the risk of type 2 diabetes increases linearly with an increase in body mass index. Accordingly, the worldwide increase in the prevalence of obesity has led to a concomitant increase in the prevalence of type 2 diabetes. The cellular and physiological mechanisms responsible for the link between obesity and type 2 diabetes are complex and involve adiposity-induced alterations in b cell function, adipose tissue biology, and multi-organ insulin resistance, which are often ameliorated and can even be normalized with adequate weight loss."
Basically, Attia contends that Metabolic Syndrome causes insulin resistance, which results in obesity, while the clinical paper contends that fat itself causes insulin resistance, which results in T2D.
My layman's opinion is that the clinicians are more likely to be correct, since losing the fat and bringing your weight into a normal range will most likely resolve your T2D as well. I also think Attia is indulging in circular reasoning, since he cites Metabolic Syndrome as causing obesity, when, in fact, one of the characteristics of Metabolic Syndrome is overweight/obesity.
Of course, I may not actually understand his argument, and might need to take a harder look at it.
As for fat itself, it hasn't been until relatively recently that scientists began to understand the massive role it plays in the regulation of our energy homeostasis:
"In the late 1980s to mid 1990s came the discovery of adipose-derived serum factors like adipsin, TNF-α and leptin. Suddenly, adipose tissue had to be regarded as an endocrine organ at the center of energy homeostasis. From this point forward, studies on the developmental, functional, and pathophysiological aspects of adipose tissue have expanded markedly. "
Also:
"Until the late 1940s, adipose tissue was characterized as a form of connective tissue that happened to contain lipid droplets, without linking this fact to the metabolism of the organism in any meaningful way."
It is certainly bad to be overweight. I am happy for the weight loss that trulicity has helped me with (it just isn't as good as ozempic or mounjaro). But, I have to exercise like a beast (5-6 hours strength training a week and 210 minutes on the elliptical). All this for a 6.5 A1C (estimated by Dexcom).
I watched the biggest losers drop 200+lbs and get off their diabetes medicines. So weight is a component. I am not expecting to ever be off the meds as my numbers are too great. I do expect to be 170 by end of June and 165 by year end.
As to Peter, I listen to him. A guest said in one podcast that those who were inactive showed higher lipids as evidenced by triglycerides. I found an old blood test I took about 30 years ago (10 years before i was diagnosed). My triglycerides were 509. Unbelievable (i think my last test was 109). So do the high lipids lead to diabetes or does metabolic syndrome lead to high lipids? I am unsure.
The first cholesterol test I ever took had my total cholesterol at 440. At the time I was 29 years old, a fairly strict vegetarian, weighed 140 pounds at 5'10", and as a 24 hour 200 seat restaurant manager/owner, spent at least ten hours a day on my feet, moving fairly fast. I found out about the cholesterol reading when I was turned down for key man insurance for the restaurant.
They wouldn't tell me why, but did tell me to go to my own doc and get my cholesterol tested. That was when I clocked the 440. They tested me again, and this time it was 445. This was about 50 years ago, and statins did not yes exist. I went on those godawful bile sequestrants and stayed on the for many years, until the first statins came along. But even with them, it took the highest dose of the third generation - atorvastatin - to finally bring my total cholesterol a few points below 200. Which is why I tend to pass gas wetly in the general direction of all those who assure me long term meds are deadly and will kill me. Without statins, I am absolutely positive I would have been dead, dead, dead at least 20 years ago.
I don't personally think there is a credible connection between high lipids and T2D. Correlation, perhaps, but not predictably, and I haven't seen anybody come up with a believable causation pathway. Doesn't mean there isn't one, but I, at least, haven't see it demonstrated yet.
And what bugs me is that i see so many comments, just eat less and workout more... duh. It ain't working.
my friends brother has just lost 30 pounds in 1 month (I think he too is on mounjaro). Looks better and feels better. Of course, his smoking will lead him to an early grave (he's stopped but diagnosed with COPD). COPD killed my dad (at 87), though he had quit at 73.
Pharma companies are ABSOLUTELY in the business of eliminating future customers. What do you think the contraceptive and abortifacient drug market is, except a way to get rid of future customers? That's an 8.3 billion dollar market growing at 5 percent per year.
Planned Parenthood's entire business model is built around killing it's future customers. Why would you think a diabetic obese person with high blood pressure will merit some kind of special loving care from the pharma industry?
1) From 2007 through 2021, I worked in Hospital IT, a lot of it as a traveling consultant. I worked with doctors, for doctors, and at 3 medical schools. Any illusions I had about how smart or competent doctors were have long since evaporated. Even (or maybe especially) the ones who keep using words like "evidence-based medicine" are actually just shills for big Pharma, and don't give a rat's ass for patients.
2) Since I'm a candidate for effortless major weight loss, I'd love to see more detail, including things like a peek at your food diary, managing electrolytes, beverages (non-alcoholic), alcohol, and what specific sites you use for your research. I'm not demanding, mind you. Just throwing out some writing prompts...
I'll try to take those up in depth in some later piece. A quickie:
Electrolytes: I've always taken calcium and magnesium supplements. I like salt. I occasionally add New Salt (pure potassium chloride) to a cup of hot chicken broth.
Alcohol: I've lost my taste for hard liquor with Mounjaro, and haven't had a beer in fifty years. I have an occasional glass of red wine - rarely more than once a week.
The Mounjaro site itself. And a host of other sites I find by simply inputting Mounjaro together with any other modifiers I want into a search engine. I get a lot of stuff from PubMed, from Drugs.com, and similar sites. Wikipedia is useful as well, since the subject doesn't seem to be politically charged, and is handled there in a straightforward manner.
My food diary is simple to the point of monotony. I start the day with a couple of cups of decaffeinated coffee with 1/2 and 1/2. I usually eat a couple of hard-boiled eggs at some point. Some sort of green veg - either romaine lettuce with ranch dressing, or a can of green beans, something like that. A couple of teaspoons of choc/chip cookie dough ice cream for dessert. A few pork rinds for crunch. Broiled chicken, skin on, either a drumstick or a thigh (I usually can't manage more than one). I drink ice tea and electrolyte water throughout the day. It is a very low carb, low calorie diet overall. I rarely eat more than one meal a day.
Hello Bill, I appreciate the post. I'm interested in the actual mechanics- the details of how- for Mounjaro and how you experienced them. How often did you take injections? Did you stay at 2.5mg? Related to the frequency of injections did you feel any differences in your hunger nearing the next injection?
I take one injection a week, on Mondays. I alternate the injection site from right to left belly, as the instructions advise. I started at 2.5mg, and increased the dose by 2.5mg every month thereafter, also as advised. I just started the highest dose, 15mg, last Monday. Yes, I did notice, especially at the lowest levels, a modest increase in hunger at the end of the week. That disappeared when I hit the 10mg level.
I used to weigh 280 lbs,, at 5'9", so I was morbidly obese. I had developed metabolic syndrome, so low thyroid and Type II diabetes. My doc had put me on Ozempic and after 1 year my A1C, while better, was still over 7 and I had not lost any weight. I had the side effects of nausea and vomiting, but no weight loss and still had the hunger issues. Right before Christmas I had the gastric sleeve bariatric surgery, and, no, it is not a form a lap band, its where 80% of your stomach gets removed. Most importantly, the part of the stomach that gets removed is the part that makes the majority of the hunger hormone. In 5 months, I have lost 85 lbs, so only 15 lbs left to get to my goal weight. I did have the issue of "body thinks you're starving, so metabolism slows down" . My body temperature dropped to 96.7 and I'm only losing 1 lb per week, even though I'm getting 500 to 700 calories a day with minimal carbohydrates. The only saving grace is that I no longer get "HUNGRY" and crave the carbs and sugar like I used to. My A1C is now 5.5 and still getting better, and I've gone from a 44" waist to 33", and I now enjoy shopping for clothes vs ordering the fat pants from Amazon :).
We know that gastric bypass patients like you see better blood sugar results and in Europe and undergoing tests now, there is a procedure to send a balloon immediately pass your stomach right before it reaches the small intestine - then the balloon is filled with boiling water and it burns the lining there. After a week in the hospital, patients are able to return to a regular diet, and they have had a remarkable reduction in blood sugar reading when the lining was replaced by they body's healing. I failed to qualify for the US tests due to the fact that I was already on insulin, but I hope that this works and can be done for diabetics like myself.
I wish I could get Mounjaro. I take trulicity (have for 4 years or so). My weight used to stabilize at 210 (5' 9"). Down to 190 in the summer (runner); as I increased the mileage, started to eat more. Back to 210 by winter. Yoyoed up and down like this for years. A1Cs started getting higher (Metformin and glimiperide stopped working as well and I had knee surgery so no more running). Started Jardiance. Still too high so added trulicity. I've slowly lost weight on trulicity (now 173). I exercise consistently so that is a factor, but it is the fact that I'm less hungry, therefore, I tend to eat less. I can gain weight if I drink alcohol (such as I did on the large number of cruises I took at the end of 21 and early 22) ending at 188 lbs in mid 2022. I struggled last year with other issues so didn't exercise, but I wasn't cruising so I wasn't drinking and was back at 181 by year end. This year (as I am retired), I've been working out 5-6 days a week (strength training and elliptical) about 9 hours of exercise each week. I am hungrier as the exercise blunts the effects of trulicity. But, I am dropping about 1 1/2 pounds a month and it isn't quite as hard as it used to be. In all, I've gone from 30% body fat to 17% with a goal of 12-15% eventually. So even trulicity is a godsend for those who are active like me (though I want to take mounjaro as it helps diabetes more than trulicity does). I still have issues with diabetes and struggle with the big swings in glucose from day to day so I may get mounjaro at a later date (BCBS doesn't pay for it yet).
Hey Bill: The VA -does- do weight loss HOWEVER going thru the program itself is a year long festival of the stupid as only a DotGov project can be... takes about a year before they'll do a script... once through it tho? They got me on Ozempic which worked pretty well... I'm down 25, but have plateaued. Just an FYI
Thanks, man. I got this info from a vet posting on the Mounjaro subreddit, who said the hospital he went to just flat refused to pay for it.
Your situation sounds like another deliberate roadblock I've heard about fairly frequently, and not just from DotGov docs. Some private docs/insurance companies demand that you do the diet/exercise stuff for a year, which invariably fails (as I suspect they know it will) but it lets them keep from having to pay for the weight loss drugs for another year. I also think they hope you'll just give up, go away, and stop bothering them.
I am a retired whitewater paddler (solo canoe). I have been slightly overweight nearly all my life. At one time or another I have tried dozens of diets/exercise programs. Training for marathons was the most effective, but too hard on my skeleton. Then came the trigger. I was paddling with a friend on a multi day trip with a canoe full of gear/food/water etc. He lost his paddle and I cut sharply to recover it for him when I blew out and my jacket (not a life jacket) got caught in some roots in this very swift spot. I self rescued and lost nothing, but I decided that if I weighed less I’d avoid such accidents.
I was working on dietary change, but it was a slog. Then came Covid. I hadn’t seen my brother for quite a while, but when I did I was shocked at how much weight he had lost. I presumed he was seriously ill, but he credited his wife with doing the research on nutrition and weight loss. He is a physician. In large part their conclusion was that most of the advice on nutrition from the public health experts was not based upon science at all.
He said sugar was bad along with highly refined carbs. The conversation was brief and I left with only a vague idea of their new dietary regime. I imagined what it was and concocted my version. I ate most of the things the experts said to avoid and vice versa. I used bacon grease regularly, ate meat, dairy and of course bacon. I mostly avoided bread, potatoes, rice, pizza, hamburgers, corn, Nabs, ketchup and soft drinks (due to the sugar content). I did not follow this plan with fanaticism, but when I didn’t I greatly reduced the amount of a forbidden food. Every now and then I’d go for a break and get a burger and fries (although that now happens less and less often). I ignored that my sushi was rolled up in rice.
I am 6’3” and weighed 240 lbs to begin. I lost about 25-30 lbs over about a year and a half. Then the love of my life died unexpectedly alone in a hospital before I could get a chance for a last hug and to say goodbye. Over the next 6-8 months I lost down about 40 lbs. About two years ago my weight stabilized around 170 lbs. Physically I feel fine. I haven’t blown out with a canoe full of gear and I have a lot more chores tending to the house and yard to keep me physically active.
I am glad for any cure for obesity (except for the D.C. jail route), but I prefer staying active and eating less. Smaller portions is a huge factor in my weight loss. Even if you are eating a lot of salads, huge servings will create the hunger craving which I suspect has a lot to do with most diet failures. I snack on a mix of cocktail peanuts, spicy almonds and cashews. The only fruit I eat are raisins and a tiny bit of banana with a gob of peanut butter on each bite.
I lost 70 pounds. My blood pressure stayed about the same because I eat a huge amount of salt. But I take BP meds. No cholesterol issue. I eat a lot of fried squirrel, Spam, Vienna Sausages and Underwood Deviled Ham. Lots of eggs, mostly fried in bacon grease.
I may not outlive Keith Richards, but then who has?
Sure. Low carb dieting worked for you. I've been doing low-carb since before Atkins, when it was called The Air Force Diet, and claimed you could drink all you wanted and still lose weight. Since I was still in my twenties, that was the deal clincher for me.
And for years straight low-carb - under 50 grams of carbs a day, so that I was in ketosis - worked for me. I would gain thirty pounds, lose it in two months, and repeat the process a year or so later.
And then it stopped working. And the big roller coaster ride began. Forty years later, I would joke to people, (gallows humor, I'd say), that I'd gained and lost the same seventy pounds at least five times, which wasn't quite true. I'd *lost* the same seventy pounds, but I'd *gained* seventy-five, or eighty, or ninety pounds.
I'm glad that what you are doing is working for you. But keep in mind that it doesn't work for most people. Nothing does. If it did, we wouldn't be a nation that is sixty-plus percent overweight and starting to push fifty percent obese.
By the way, I lost another 2.3 pounds as of this morning. That brings me within seven pounds of hitting my goal range - 150 to 160 pounds - where I intend to establish maintenance. And that will be another kettle of fish to take a hard look at. The real proof of that pudding will be in how well I do maintain the weight loss. (Is that enough homily/cliché for the day?)
John, I like your attitude. I wish more patients were willing to push back against doctors who don't meet their needs, instead of worshiping them and massaging their god complexes.
I've only found the need to fire one of my (too many) doctors in the past 20 years. He had a real political agenda that I failed to see how it applied to my case. All my docs seem to respond to rational, logical discussion. Maybe I'm just lucky.
Indeed. I'm actually enjoying writing these longer chin pullers for Substack. Blogging at DP had become a bit of a slog after more than 21 years doing it. A change seemed in order. Not that I'm giving up on DP, but it won't be my primary focus going forward.
I've been using Moujaro since May 2023 and I am down 40 lbs. Another 40 to go, but I am definitely sold!
Congratulations!
I’ve been thinking about trying this and am aware of the shortcomings of the calories-in/calories out approach, including the down- regulation of metabolism. I would imagine that, even though Maunjaro makes eating less much easier, there is still the same issue of lower metabolism. That wouldn’t matter so much, as long as Maunjaro continues to work and one doesn’t have significant safety or tolerability issues down the road. If one of these wild cards forces you to discontinue Maunjaro some day, aren’t you concerned that your metabolism will be shot?
My metabolism is shot anyway. I have mentioned that in order to lose weight, my caloric intake must be less than 8oo/day. And I have also said that in the event that I have to stop Mounjaro, I am quite certain that the weight regain will be intense and rapid. It is what it is.
Just as if I were to stop taking Atorvastatin, within a month or so my total cholesterol would rise to levels above 440, and my blood pressure would once again become dangerously high were I to stop my BP meds.
Which is why I don't intend to stop taking any of them.
You should also understand my approach to these matters, which always includes a look at as many downsides as I can find, and a consequent risk/reward ratio based on these. In this case, the risk of T2D/Obesity far outweighs the risk of taking Mounjaro, even with a theoretical downside such as you describe. (And which I was aware of, and thus was taken into consideration when I made my decision).
It is easier to take these medications because of the need for blood sugar regulation. Diabetes is a silent killer and it has racked my body without me knowing it until too late. I'm on Ozempic and for the past three years, I haven't gained weight - but then, I wasn't overweight to begin with. But I need this medication because I want to stay alive. To those taking these medications as a weight loss drug, I would be more hesitant to recommend. Unless you are uncontrollably obese, I wouldn't go that route. There could be side effects. I know of healthy people taking these drugs for weight loss and they have had serious side effects, as though it wasn't meant for healthy systems. So I don't recommend these diabetic drugs for weight loss.
This is a common divide between the type 2s taking these meds for blood sugar control, and those who wish to take it for weight management (and their docs). lt is temporary, and will pass. Everybody is cranking up their manufacturing capabilities. Lilly is building an entire new facility on its campus to make it. Availability will shortly no longer be the problem it has been.
Keep in mind, though, that obesity (and not "uncontrollably obese," by the way) is in itself a life-threatening disease. Type 2 is only one of its many malign manifestations.
One more thought on "uncontrollable obesity." If you are obese, it's a fairly good indicator that your problem is uncontrollable. Nobody enjoys being obese, and nobody says that if they could choose not to be obese, they would prefer to stay fat. I've already addressed the abject failure of all traditional "cures" for obesity.
Also, it would be helpful if you could tell us what these "serious side effects" were.
Thanks Bill. Not specifically to the Instapundit thread, I see an eight assertion, "8. The side effects are horrible and dangerous, potentially life-threatening." What was your experience?
Not in my case. In fact, because I eschew carbs as a general matter, and since many report that carbs, especially highly refined carbs, exacerbate the gastro side effects, it probably explains why mine were so minor.
This is a different matter than the actual warnings that come with the drug. If you have pancreatitis, you shouldn't take it. It increases your risk for thyroid cancer. Everybody will need to evaluate the risk/reward ratios on these as to their own personal situation and desires.
A big issue that concerns me (as someone that has struggled with weight all my life) is that this drug will have to be taken until you die, because you haven’t really “solved” or “healed” the underlying problem that’s causing the issue. There is no way to know the long term effects or downsides, until it manifests (if it does). Anytime an unnatural chemical is introduced into the body, unless the body has a chance to detox from it, chronic use is bound to have some negative effect eventually. As Thomas Sowell said, there are no solutions, only tradeoffs. This one seems potentially risky to me.
There a lot of people taking a lot of different drugs for the rest of their lives. Cholesterol meds, BP meds, heart meds, and so on. In life, just about everything is potentially risky. You have to evaluate based on the amount of risk you are willing to sustain, versus the immediate benefits of losing a great deal of weight.
This is the new medical slavery. The American medical (and food delivery) system has been redesigned around this goal. Get healthy and be free. https://amidwesterndoctor.substack.com/p/when-industries-value-profit-over?utm_source=post-email-title&publication_id=748806&post_id=115252075&isFreemail=true&utm_medium=email
I'm sorry, but once you start talking about "medical slavery," I tend to stop listening.
Agree. This is the "Patch Adams" school of medicine. The body can heal itself if only you get off the drugs and give it enough time. The problem is most of us don't have four or five months to devote exclusively to our health. We have jobs, families, hobbies, etc. We want to get back to feeling better pronto.
Except the body does not heal itself in far too many instances, no matter how drug-free it is, or how much time you give it. Untreated (Disease X) can and will kill you if you don't treat it. There are hundreds of diseases that fit into that classification.
That is a terrible accusation. I follow medical science, my experience over the past years, and common sense. Thanks to modern medicine I am alive.
I, too, am a Type 2 diabetic, and have been for ~20 years. My weight gain experience with metaformin by itself was similar to yours (20+ lb in a few months). I changed endocrinologists and switched to Janumet (a combination of Januva and Metaformin) which did not have the weight gain problem. Learned to count carbohydrates, added moderate exercise. Lost 50 lb over 9-10 months, brought A1c level down to 6….have maintained weight and A1c under 6.3 since 2008 (knock wood!). All without the magic new drug…oh, and I eat whatever I want (just not the amounts….) and drink (mostly) moderate amounts of wine….
I think you'll find there are those who are willing to 'count' (calories, grams, push-ups, minutes, miles, etc) for the rest of their lives ... and those who've tried and failed - again and again! - to maintain counting, monitoring, resisting in the long run. For the second group, to escape these cycles of imposed restraint is like a door opening on freedom - for the first time ever!
Good for you!
"without the magic new drug"
It's great for you that you could do that.
95% of people can't. (I made that up, but I actually bet the real number is higher.)
If I count my carbs, deny myself every food I grew up liking, and push away my cravings and hunger, I can lose weight. Slowly. Until I fall off the wagon for a special occasion. Or I can confront my hunger, and do some fasting, where I think about food incessantly. And try not to binge when I come off the fast.
I'm still skeptical of long term issues with the new drugs, but the extra 50 to 70 pounds I'm carrying represent their own issues. Which is worse? Known problems carrying extra weight, or unknown issues with a new drug?
Bullseye. When I was in my late 20's, I was crowding three bills and resolved to lose weight. Basically, I starved myself and began power walking, doing 10 miles every day. It took 18 months, and I lost 100 lbs. But my social life went to h*ll because I was terrified I would find myself in a place or at an event where I would overeat and knock myself off the wagon. I was single at the time, though, so I only had myself to worry about. Twenty years later, when my weight shot up again, I was married with two kids and couldn't do that again. Mounjaro has been a lifesaver.
Exactly.
1. Do you go OFF the Mounjaro at any point? Losing the weight should make the Type2 go away, shouldn't it? Do you get to stop the injections and see if the weight comes back and the diabetes stays away?
2. I'm also not a needle person. Giving MYSELF a shot? Yikes. Can you expound on why you didn't find that more of an issue?
3. I know someone who was a vibrant, active professional who is now a severely disabled special needs adult needing constant supervision/care. Can't drive, can't work, can't be left alone, was a marketing exec and now can barely string a sentence together. She took FenPhen when that as a "approved for other things but great for weight loss!" fad and had an aneurysm/stroke. I'm hesitant about these too-good-to-be-true options. Any ideas how all these new drugs different are from that?
THANKS for sharing.
"2. I'm also not a needle person. Giving MYSELF a shot? Yikes. Can you expound on why you didn't find that more of an issue?"
Here is a short video of the process:
https://www.youtube.com/watch?v=xUZWM_90qR0
Note that there is no hypodermic needle, poking around trying to find a vein, or any of the other paraphernalia people associate with self-injection. Mounjaro is injected subcutaneously, which means the needle stick itself is no more than a quarter inch deep, and the injection itself takes no more than ten seconds, usually less. I alternate weekly injections from one side of my belly to the other. It doesn't even seem like a "shot," because I never see a needle, the penetration is minor and takes only a tiny bit of time, and it doesn't hurt.
"Do you go OFF the Mounjaro at any point? Losing the weight should make the Type2 go away, shouldn't it? Do you get to stop the injections and see if the weight comes back and the diabetes stays away?"
I have no plans to do so. Losing weight usually causes T2D to go into *remission." It will return as soon as you regain the weight you lost. And you will regain it quite quickly if you stop taking Mounjaro.
I usually respond to this question by saying that my high blood pressure and high cholesterol has "gone away" because of the drugs I take to control it. Doesn't mean that I'm going to stop any of those meds either. I'd be a fool to do so.
I have never been overweight, yet I developed Type 2. I ran for 30 years daily, and have little body fat - but I still got it. I know a lot of people think Type 2 is caused by obesity, and perhaps for perhaps a majority, that is the case. I am lucky to be on a drug like this. So I don't believe that if you need a diabetic injection like me, you should be expecting to get off of it because you are no longer overweight - your diabetes can be the result of other unknown circumstances like mine.
https://diabetesjournals.org/spectrum/article/30/4/237/32838/Treatment-of-Obesity-in-Patients-With-Diabetes
"More than 90% of patients with type 2 diabetes have a BMI ≥25.0 kg/m2 (1). In 2013, the American Medical Association designated obesity as a chronic disease (2), and there is growing appreciation of obesity as a complex chronic condition caused by multiple factors, including behaviors, genetics, and the environment."
If you have T2D, odds heavily favor you having the chronic disease of obesity, or you are at least overweight. And if you have the chronic disease of obesity, expect to be treating it for the rest of your life.
Yes, but is that BMI a result of type 2? I think the drugs given (especially sulfonylureas) increase insulin production. The muscles don't need the glucose so gets stored as fat. And very easily. Doesn't take much to gain weight as a diabetic. I was on glyburide at one point. Made me ravenous as I dieted and exercised. (also made me gain 20 lbs as I was put on blood pressure medicine that left me on the couch for a couple months). Once we sorted the BP medicine, I could not lose a single pound. I am now 173 (143 lean body mass) and I struggle with my glucose numbers every day. Woke this morning and they had risen from 90s in the middle of the night to 160s upon waking with no intake of food or drink. It is genetic in my case.
Dr. Peter Attia, (whom I respect) certainly thinks so.
https://www.aabc-certification.org/blog/does-obesity-cause-diabetes-or-does-diabetes-cause-obesity/
"What we know now about Type 2 Diabetes and Metabolic Syndrome is that insulin resistance prevents glucose from entering our cells and results in elevated blood glucose. The elevated glucose is then converted in fatty acids and with the aid of insulin gets stored as fat in adipose tissue, resulting in obesity."
On the other hand, here is a paper which takes the opposite stance:
https://www.cell.com/cell-metabolism/pdf/S1550-4131(21)00631-8.pdf
"The accumulation of an excessive amount of body fat can cause type 2 diabetes, and the risk of type 2 diabetes increases linearly with an increase in body mass index. Accordingly, the worldwide increase in the prevalence of obesity has led to a concomitant increase in the prevalence of type 2 diabetes. The cellular and physiological mechanisms responsible for the link between obesity and type 2 diabetes are complex and involve adiposity-induced alterations in b cell function, adipose tissue biology, and multi-organ insulin resistance, which are often ameliorated and can even be normalized with adequate weight loss."
Basically, Attia contends that Metabolic Syndrome causes insulin resistance, which results in obesity, while the clinical paper contends that fat itself causes insulin resistance, which results in T2D.
My layman's opinion is that the clinicians are more likely to be correct, since losing the fat and bringing your weight into a normal range will most likely resolve your T2D as well. I also think Attia is indulging in circular reasoning, since he cites Metabolic Syndrome as causing obesity, when, in fact, one of the characteristics of Metabolic Syndrome is overweight/obesity.
Of course, I may not actually understand his argument, and might need to take a harder look at it.
As for fat itself, it hasn't been until relatively recently that scientists began to understand the massive role it plays in the regulation of our energy homeostasis:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934003/
"In the late 1980s to mid 1990s came the discovery of adipose-derived serum factors like adipsin, TNF-α and leptin. Suddenly, adipose tissue had to be regarded as an endocrine organ at the center of energy homeostasis. From this point forward, studies on the developmental, functional, and pathophysiological aspects of adipose tissue have expanded markedly. "
Also:
"Until the late 1940s, adipose tissue was characterized as a form of connective tissue that happened to contain lipid droplets, without linking this fact to the metabolism of the organism in any meaningful way."
That's a real wowser if you think about it.
It is certainly bad to be overweight. I am happy for the weight loss that trulicity has helped me with (it just isn't as good as ozempic or mounjaro). But, I have to exercise like a beast (5-6 hours strength training a week and 210 minutes on the elliptical). All this for a 6.5 A1C (estimated by Dexcom).
I watched the biggest losers drop 200+lbs and get off their diabetes medicines. So weight is a component. I am not expecting to ever be off the meds as my numbers are too great. I do expect to be 170 by end of June and 165 by year end.
As to Peter, I listen to him. A guest said in one podcast that those who were inactive showed higher lipids as evidenced by triglycerides. I found an old blood test I took about 30 years ago (10 years before i was diagnosed). My triglycerides were 509. Unbelievable (i think my last test was 109). So do the high lipids lead to diabetes or does metabolic syndrome lead to high lipids? I am unsure.
The first cholesterol test I ever took had my total cholesterol at 440. At the time I was 29 years old, a fairly strict vegetarian, weighed 140 pounds at 5'10", and as a 24 hour 200 seat restaurant manager/owner, spent at least ten hours a day on my feet, moving fairly fast. I found out about the cholesterol reading when I was turned down for key man insurance for the restaurant.
They wouldn't tell me why, but did tell me to go to my own doc and get my cholesterol tested. That was when I clocked the 440. They tested me again, and this time it was 445. This was about 50 years ago, and statins did not yes exist. I went on those godawful bile sequestrants and stayed on the for many years, until the first statins came along. But even with them, it took the highest dose of the third generation - atorvastatin - to finally bring my total cholesterol a few points below 200. Which is why I tend to pass gas wetly in the general direction of all those who assure me long term meds are deadly and will kill me. Without statins, I am absolutely positive I would have been dead, dead, dead at least 20 years ago.
I don't personally think there is a credible connection between high lipids and T2D. Correlation, perhaps, but not predictably, and I haven't seen anybody come up with a believable causation pathway. Doesn't mean there isn't one, but I, at least, haven't see it demonstrated yet.
And what bugs me is that i see so many comments, just eat less and workout more... duh. It ain't working.
my friends brother has just lost 30 pounds in 1 month (I think he too is on mounjaro). Looks better and feels better. Of course, his smoking will lead him to an early grave (he's stopped but diagnosed with COPD). COPD killed my dad (at 87), though he had quit at 73.
Pharma companies are ABSOLUTELY in the business of eliminating future customers. What do you think the contraceptive and abortifacient drug market is, except a way to get rid of future customers? That's an 8.3 billion dollar market growing at 5 percent per year.
Planned Parenthood's entire business model is built around killing it's future customers. Why would you think a diabetic obese person with high blood pressure will merit some kind of special loving care from the pharma industry?
Keep your slaves scared, sick, stupid, and poor, and they will never revolt or leave the plantation. It’s the Oligarchs’ primary strategy.
I am not a slave.
1) From 2007 through 2021, I worked in Hospital IT, a lot of it as a traveling consultant. I worked with doctors, for doctors, and at 3 medical schools. Any illusions I had about how smart or competent doctors were have long since evaporated. Even (or maybe especially) the ones who keep using words like "evidence-based medicine" are actually just shills for big Pharma, and don't give a rat's ass for patients.
2) Since I'm a candidate for effortless major weight loss, I'd love to see more detail, including things like a peek at your food diary, managing electrolytes, beverages (non-alcoholic), alcohol, and what specific sites you use for your research. I'm not demanding, mind you. Just throwing out some writing prompts...
I'll try to take those up in depth in some later piece. A quickie:
Electrolytes: I've always taken calcium and magnesium supplements. I like salt. I occasionally add New Salt (pure potassium chloride) to a cup of hot chicken broth.
Alcohol: I've lost my taste for hard liquor with Mounjaro, and haven't had a beer in fifty years. I have an occasional glass of red wine - rarely more than once a week.
Research: Anecdata (and lots of it) at Redditt: https://www.reddit.com/r/Mounjaro/
The Mounjaro site itself. And a host of other sites I find by simply inputting Mounjaro together with any other modifiers I want into a search engine. I get a lot of stuff from PubMed, from Drugs.com, and similar sites. Wikipedia is useful as well, since the subject doesn't seem to be politically charged, and is handled there in a straightforward manner.
My food diary is simple to the point of monotony. I start the day with a couple of cups of decaffeinated coffee with 1/2 and 1/2. I usually eat a couple of hard-boiled eggs at some point. Some sort of green veg - either romaine lettuce with ranch dressing, or a can of green beans, something like that. A couple of teaspoons of choc/chip cookie dough ice cream for dessert. A few pork rinds for crunch. Broiled chicken, skin on, either a drumstick or a thigh (I usually can't manage more than one). I drink ice tea and electrolyte water throughout the day. It is a very low carb, low calorie diet overall. I rarely eat more than one meal a day.
Is the green line annual weight measurements?
Yes.
Hello Bill, I appreciate the post. I'm interested in the actual mechanics- the details of how- for Mounjaro and how you experienced them. How often did you take injections? Did you stay at 2.5mg? Related to the frequency of injections did you feel any differences in your hunger nearing the next injection?
I take one injection a week, on Mondays. I alternate the injection site from right to left belly, as the instructions advise. I started at 2.5mg, and increased the dose by 2.5mg every month thereafter, also as advised. I just started the highest dose, 15mg, last Monday. Yes, I did notice, especially at the lowest levels, a modest increase in hunger at the end of the week. That disappeared when I hit the 10mg level.
I used to weigh 280 lbs,, at 5'9", so I was morbidly obese. I had developed metabolic syndrome, so low thyroid and Type II diabetes. My doc had put me on Ozempic and after 1 year my A1C, while better, was still over 7 and I had not lost any weight. I had the side effects of nausea and vomiting, but no weight loss and still had the hunger issues. Right before Christmas I had the gastric sleeve bariatric surgery, and, no, it is not a form a lap band, its where 80% of your stomach gets removed. Most importantly, the part of the stomach that gets removed is the part that makes the majority of the hunger hormone. In 5 months, I have lost 85 lbs, so only 15 lbs left to get to my goal weight. I did have the issue of "body thinks you're starving, so metabolism slows down" . My body temperature dropped to 96.7 and I'm only losing 1 lb per week, even though I'm getting 500 to 700 calories a day with minimal carbohydrates. The only saving grace is that I no longer get "HUNGRY" and crave the carbs and sugar like I used to. My A1C is now 5.5 and still getting better, and I've gone from a 44" waist to 33", and I now enjoy shopping for clothes vs ordering the fat pants from Amazon :).
Congratulations!
We know that gastric bypass patients like you see better blood sugar results and in Europe and undergoing tests now, there is a procedure to send a balloon immediately pass your stomach right before it reaches the small intestine - then the balloon is filled with boiling water and it burns the lining there. After a week in the hospital, patients are able to return to a regular diet, and they have had a remarkable reduction in blood sugar reading when the lining was replaced by they body's healing. I failed to qualify for the US tests due to the fact that I was already on insulin, but I hope that this works and can be done for diabetics like myself.
I wish I could get Mounjaro. I take trulicity (have for 4 years or so). My weight used to stabilize at 210 (5' 9"). Down to 190 in the summer (runner); as I increased the mileage, started to eat more. Back to 210 by winter. Yoyoed up and down like this for years. A1Cs started getting higher (Metformin and glimiperide stopped working as well and I had knee surgery so no more running). Started Jardiance. Still too high so added trulicity. I've slowly lost weight on trulicity (now 173). I exercise consistently so that is a factor, but it is the fact that I'm less hungry, therefore, I tend to eat less. I can gain weight if I drink alcohol (such as I did on the large number of cruises I took at the end of 21 and early 22) ending at 188 lbs in mid 2022. I struggled last year with other issues so didn't exercise, but I wasn't cruising so I wasn't drinking and was back at 181 by year end. This year (as I am retired), I've been working out 5-6 days a week (strength training and elliptical) about 9 hours of exercise each week. I am hungrier as the exercise blunts the effects of trulicity. But, I am dropping about 1 1/2 pounds a month and it isn't quite as hard as it used to be. In all, I've gone from 30% body fat to 17% with a goal of 12-15% eventually. So even trulicity is a godsend for those who are active like me (though I want to take mounjaro as it helps diabetes more than trulicity does). I still have issues with diabetes and struggle with the big swings in glucose from day to day so I may get mounjaro at a later date (BCBS doesn't pay for it yet).
Hey Bill: The VA -does- do weight loss HOWEVER going thru the program itself is a year long festival of the stupid as only a DotGov project can be... takes about a year before they'll do a script... once through it tho? They got me on Ozempic which worked pretty well... I'm down 25, but have plateaued. Just an FYI
Thanks, man. I got this info from a vet posting on the Mounjaro subreddit, who said the hospital he went to just flat refused to pay for it.
Your situation sounds like another deliberate roadblock I've heard about fairly frequently, and not just from DotGov docs. Some private docs/insurance companies demand that you do the diet/exercise stuff for a year, which invariably fails (as I suspect they know it will) but it lets them keep from having to pay for the weight loss drugs for another year. I also think they hope you'll just give up, go away, and stop bothering them.
I am a retired whitewater paddler (solo canoe). I have been slightly overweight nearly all my life. At one time or another I have tried dozens of diets/exercise programs. Training for marathons was the most effective, but too hard on my skeleton. Then came the trigger. I was paddling with a friend on a multi day trip with a canoe full of gear/food/water etc. He lost his paddle and I cut sharply to recover it for him when I blew out and my jacket (not a life jacket) got caught in some roots in this very swift spot. I self rescued and lost nothing, but I decided that if I weighed less I’d avoid such accidents.
I was working on dietary change, but it was a slog. Then came Covid. I hadn’t seen my brother for quite a while, but when I did I was shocked at how much weight he had lost. I presumed he was seriously ill, but he credited his wife with doing the research on nutrition and weight loss. He is a physician. In large part their conclusion was that most of the advice on nutrition from the public health experts was not based upon science at all.
He said sugar was bad along with highly refined carbs. The conversation was brief and I left with only a vague idea of their new dietary regime. I imagined what it was and concocted my version. I ate most of the things the experts said to avoid and vice versa. I used bacon grease regularly, ate meat, dairy and of course bacon. I mostly avoided bread, potatoes, rice, pizza, hamburgers, corn, Nabs, ketchup and soft drinks (due to the sugar content). I did not follow this plan with fanaticism, but when I didn’t I greatly reduced the amount of a forbidden food. Every now and then I’d go for a break and get a burger and fries (although that now happens less and less often). I ignored that my sushi was rolled up in rice.
I am 6’3” and weighed 240 lbs to begin. I lost about 25-30 lbs over about a year and a half. Then the love of my life died unexpectedly alone in a hospital before I could get a chance for a last hug and to say goodbye. Over the next 6-8 months I lost down about 40 lbs. About two years ago my weight stabilized around 170 lbs. Physically I feel fine. I haven’t blown out with a canoe full of gear and I have a lot more chores tending to the house and yard to keep me physically active.
I am glad for any cure for obesity (except for the D.C. jail route), but I prefer staying active and eating less. Smaller portions is a huge factor in my weight loss. Even if you are eating a lot of salads, huge servings will create the hunger craving which I suspect has a lot to do with most diet failures. I snack on a mix of cocktail peanuts, spicy almonds and cashews. The only fruit I eat are raisins and a tiny bit of banana with a gob of peanut butter on each bite.
I lost 70 pounds. My blood pressure stayed about the same because I eat a huge amount of salt. But I take BP meds. No cholesterol issue. I eat a lot of fried squirrel, Spam, Vienna Sausages and Underwood Deviled Ham. Lots of eggs, mostly fried in bacon grease.
I may not outlive Keith Richards, but then who has?
Sure. Low carb dieting worked for you. I've been doing low-carb since before Atkins, when it was called The Air Force Diet, and claimed you could drink all you wanted and still lose weight. Since I was still in my twenties, that was the deal clincher for me.
And for years straight low-carb - under 50 grams of carbs a day, so that I was in ketosis - worked for me. I would gain thirty pounds, lose it in two months, and repeat the process a year or so later.
And then it stopped working. And the big roller coaster ride began. Forty years later, I would joke to people, (gallows humor, I'd say), that I'd gained and lost the same seventy pounds at least five times, which wasn't quite true. I'd *lost* the same seventy pounds, but I'd *gained* seventy-five, or eighty, or ninety pounds.
I'm glad that what you are doing is working for you. But keep in mind that it doesn't work for most people. Nothing does. If it did, we wouldn't be a nation that is sixty-plus percent overweight and starting to push fifty percent obese.
By the way, I lost another 2.3 pounds as of this morning. That brings me within seven pounds of hitting my goal range - 150 to 160 pounds - where I intend to establish maintenance. And that will be another kettle of fish to take a hard look at. The real proof of that pudding will be in how well I do maintain the weight loss. (Is that enough homily/cliché for the day?)
I look forward to your posts on maintenance.
Still haven't pulled the trigger on Mounjaro. But then, I'm currently between doctors, since I'm firing my old one.
John, I like your attitude. I wish more patients were willing to push back against doctors who don't meet their needs, instead of worshiping them and massaging their god complexes.
I've only found the need to fire one of my (too many) doctors in the past 20 years. He had a real political agenda that I failed to see how it applied to my case. All my docs seem to respond to rational, logical discussion. Maybe I'm just lucky.
Is that you, Mckie?
Yes. Like old times, no?
Indeed. I'm actually enjoying writing these longer chin pullers for Substack. Blogging at DP had become a bit of a slog after more than 21 years doing it. A change seemed in order. Not that I'm giving up on DP, but it won't be my primary focus going forward.
My life got very busy for a while and I wandered off from most blogs. Now I'm retired and we moved to NW Indiana to be nearer my wife's family.
I'll probably hang out here a bit. I always enjoyed your writing.