Warning! This post includes references to poop which some readers might find offensive.
I used to watch the comedy show Cheers on television every week, and while I initially identified with Cliff Claven (John Ratzenberger) who appeared to be an Aspie like me–though in a USPS uniform–I later found that, in fact, I could relate to Kirstie Alley more than I could with any other character in the show. And this relationship had to do with weight.
The ups and downs of it
I was 5’9” all of my adult life. When I was a teenager, my weight was 180, which is eleven pounds overweight using current medical and insurance tables. By the time I joined the Air Force a year after high school graduation, I had climbed to 202. After basic training, I dropped to 190, and by the time I came back from Vietnam, I was 170. I got married and my (late) wife and I had children, so it was common to gain weight after having kids, right? I climbed back to 200 pounds and the Air Force started to take notice. By the time I reached my early thirties, I had had enough. I decided to switch from being orally acquisitive to anally retentive and over seven months’ time, my weight dropped to 135. My family and the people around me didn’t know what to think. Then, once again, during the next few years it crept up to 185 by the time I retired from the military. Over the next twenty years, I gained an additional sixty pounds, and then with Type II diabetes (T2DM) and fatty liver disease staring me in the face, I dropped to 212 on a keto diet. The diabetes was controlled and the ultrasound of my liver was unremarkable once again. Having remarried after the death of my first wife, I slowly gained weight over the next five years until I reached 235. That was last December. In February of this year, at 230 pounds, I was placed on OzempicTM by my cardiologist
This post is a story about a seventy-five-year-old, obese, white guy inspired to try this drug by the television divas whom we all know, respect or resent.
At the moment, I can walk at a fairly brisk pace for thirty minutes or more without breaking into a sweat (unless it’s in Texas where the heat is oppressive just standing outside your front door.) And, I can climb four or five flights of steps without complaining or crying “Momma!” But I have a rocky road ahead and I am in no hurry to see my wonderful, loving wife Deena made a widow again.
A perfect storm
I will face sometime in the future, a “perfect storm” in terms of my health. Those of you who know me, also know I’m being treated for bladder cancer which, at the moment, seems to be in remission (though I don’t think my urological oncologist would put it quite in those terms.) Plus, I have another chemo treatment next week. And a cystoscope the following month. My cancer was/is high grade, so it is aggressive and difficult to exterminate.
I also have “moderate” plaque buildup in my arteries, which is always noted on my quarterly CT scans that are ordered for the purpose of detecting cancer. My atherosclerotic heart disease (ASHD) is also suggested by my coronary artery calcium (CAC) score. According to the National Institute of Health, the average CAC score for someone of my age and sex is 69.1. My CAC score is 779.0! The buildup is not just in my three cardiac arteries, but the subclavian arteries, possibly the carotid arteries and to some extent the aorta is affected as well. There is no occlusion anywhere so far which would necessitate surgery. But there is an abnormal difference in my right arm blood pressure when compared to the blood pressure in my left arm, so when I see my cardiologist next month, he will refer me to a vascular surgeon for further evaluation. My cardiologist and I have already discussed this.
So, the fact that I have lost eighteen pounds since starting OzempicTM in February is one way that I hope to improve my health prior to any future surgeries (for cancer or otherwise.) Ultimately, my end-of-the-year goal is to reach 190. However, medical authorities have been extolling the collateral health benefits of OzempicTM including the reduction of stroke risk, heart attack risk, kidney failure, risk of developing colon cancer and, of course, glucose control in Type II diabetics. Even a person’s cognitive health can benefit from this drug.
OzempicTM is designed to be taken for life. My insurance has approved my use of it until the year 2048 (by which time I will thinking about my 100th birthday assuming I know where I am or I have not departed this life.)
How the program works
My cardiologist’s order for me to receive the drug was necessary but not sufficient. He actually prescribed OzempicTM for me last October. However, I had to be interviewed by a pharmacy representative attached to the practice, and the earliest appointment was February 2024. I’m not sure why there are extra “hoops to jump through.” Perhaps it is because of the short supply of the drug or to placate the insurance companies. So, I had an hour-long interview at the pharmacy clinic and I was put on OzempicTM rather than WegovyTM because of my T2DM. Having the diagnosis of T2DM seems to move you to the front of the line.
Once I left the pharmacy clinic, I only had to wait forty-eight hours until I had the first injector in my hands. I was started on .25 mg, once a week times four weeks, and then .5 mg once a week for a month, and then 1.0 mg, etc.. At that point, you see the pharmacist at the practice again. The side affects are basically nausea (including the possibility of vomiting) and diarrhea. I had the diarrhea. There is a war going on in my colon between the tendency to dump via diarrhea caused by surgery I had half a century ago, and the constipating effect of Parkinson’s Disease. It took only hours for OzempicTM to choose sides. I find it helpful to take a probiotic every day (I take Florastor.) My kidneys should take me home as they are, but I flirt with Stage 3 Chronic Kidney Disease (CKD) so I don’t want to get too dehydrated too often. When I graduated to the half a milligram dose, the diarrhea got worse, so I contacted the clinic and now I’m more or less back to .25 for the time being. At the higher dose, I was losing just over a pound a week and after two weeks on the lower dose, I’m still losing the same amount of weight. Besides weighing myself each day, I have to report my weight and vital signs twice a week to the pharmacy (OzempicTM) clinic as well as answer a dozen or so questions about my health.
There are other advisories about the drug, including serious worst case scenarios involving a patient’s thyroid and pancreas. These can be and should be viewed here.
How does it feel when you are on OzempicTM?
Being on OzempicTM means that you cannot possibly eat as much of a meal in one sitting as you did before. If your OzempicTM experience is like mine, you don’t gradually become satiated as you eat. You take a forkful of this or a spoonful of that and suddenly you know intuitively that you cannot eat another single bite (or you risk getting ill if you try.) Again, it’s not a gradual senesation of “filling up.” You swallow and then you stomach slams shut. Nor can I tolerate some of the same fatty foods I once lived for. I’ve gone the better part of a day without eating anything and without feeling the least bit hungry. Of course, you are not supposed to do that, but when I did, it was because there were unusual circumstances. So, your food choices tend to change and this helps the weight loss as well. I try to follow a sketchy sort of Mediterranean diet which in my version is mostly fruit and nuts for snacks in addition to a smaller serving of whatever Dee makes for dinner. I eat hard-boiled eggs for protein, less bread and so on.
My only regret is that absent T2DM, Deena has not been able to enjoy the many benefits of semaglutide, the GLP-1 receptor agonist in the medication. Deena’s mom died at an early age from a stroke and Deena has a long history of hypertension which is now pretty well controlled. Deena is not even noticably overweight and she has an extraordinary history of completing a marathon one month before climbing 14,000 feet to the top of Pikes Peak shortly after. Whatever few extra pounds she has is very frustrating for her to lose. But her cardiologist does not prescribe WegovyTM because of its unavailability and while her PCP has prescribed it, the prescription clinic she went to was not sympathetic to a patient that has spend years going through Weight Watchers and carefully monitoring her caloric intake. Also, they may not have thought she had that much weight to lose to enroll her in a WegovyTM program. We haven’t given up as I’m hoping my cardiologist might see her on a referral and prescribe WegovyTM, but in the meantime, I’m increasing my activity to match Deena’s so we can share at least some part of this story together.
Weight gain appears to be envitable once someone stops OzempicTM or WegovyTM. This is because a patient’s appetite comes back with a vengeance. There are certain strategies that might prove useful and some physicians are considering switching patients to existing oral weight loss medications.
Warning icon credit: Vector DSGNR (iStock.)
