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On line weight loss drugs

Don’t buy it. Apparently a company call Him is selling a compounded GLP-1 like drug, have worked around the DEA for the moment, but people are getting really sick and there have been some deaths. Article here.

The workaround is that the DEA will let compounding pharmacies make a drug if there is a shortage. Unfortunately, online companies are doing 734,000 prescriptions a month. People can get them on line without a doctor visit or labs, though there may be a doctor signing off. Remember that they are selling an untested GLP-1, and the side effects of the tested ones can include gall bladder disease, pancreatitis and gastroparesis, where the food sits in the stomach and doesn’t leave. And yes, there have been deaths. This may be the salt of the drug, so that it doesn’t have the slow absorption when injected, and hits all at once. Is weight loss that important?

The guidelines for weight loss drugs are here: https://www.aafp.org/pubs/afp/issues/2023/1000/practice-guidelines-medications-weight-loss.html. This article is from October 2023, so doesn’t have the latest offering. I recently saw a person who did not fall into those guidelines. I refused to prescribe. The person responded, “I’ll go to Mexico and get it.” I reply, “Be sure that they do laboratory work and talk to you about the potential side effects.” I am also reading that now there are faked weight loss injector pens circulating. I don’t know what is in them. Fentanyl? Floor sweepings? Who knows.

Meanwhile I am still working on a little weight loss myself. I don’t know if I’ve lost much but clothes are fitting better. The climbing gym and hiking are having an effect. Muscle burns 9 kcal per gram and fat only 4 kcal per gram, so building muscle slims one even if the weight stays the same. My endurance is rising. That feels so good after being on oxygen for a year and a half. I am still trying to eat 1/2 green/yellow or orange vegetables at each meal and I think that is helping too. All this discipline stuff, eeyuk. Oh well.

Anyhow, be careful out there. I do not recommend getting weight loss drugs off the internet or buying it from “friends of friends”. Bad news.

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Summer sunset

Last night my daughter and I went up on dinosaur hill for the sunset. What a summer thing to do!

Afterwards we walked on around the hill. We saw a very beautiful fox! This is zoomed all the way in on my phone, so the colors are not good. She watched us for a while and went on.

For the Ragtag Daily Prompt: summer.

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Food, food, food

When I get pneumonia, I drop ten pounds the first week. Since I had influenza viral pneumonia in 2003, I don’t run a fever. I just have a fast heart rate resting and get short of breath walking across the room. With Covid, I needed oxygen.

Each time, it takes longer to gain the weight back. Then I go over my normal weight and eventually have to rebuild muscle. This time I did not gain any weight back for over a year. But now it’s been three years and I am in the muscle rebuilding and weight loss section.

It does get harder as I get more mature. Older and wiser, right? Well, maybe. At any rate, I am trying to lose weight without any drugs or injectables or herbs. I am trying to eat the way the diabetic educators tell us to: half the meal should be vegetables. Every meal. A small grain and a small protein and not too much fat and vegetables. Corn really falls into the grains.

In clinic I often do a diet history of the day before. What did the person eat? I think about half of the histories come back with almost no vegetables. Pizza is NOT a vegetable, it’s mostly in the grain department. Grains are plants, I agree, but they send blood sugar up a lot more than celery and kale and collards.

Meanwhile, where is CHOCOLATE on that plate half covered with vegetables? Darn. My dessert could be a small piece of chocolate with a carrot on the side? Chocolate dipped carrots? I honestly do not like celery. Celeriac yes, celery no, though I have it in the curried chicken salad I made yesterday. That chicken salad is not half vegetables. It has some celery for crunch but it also has grapes. So, I ate it last night with an equal amount of mixed lettuce and sugar snap peas from the Farmer’s Market.

I do not have diabetes, but if I am recommending a dietary change, I think I should be able to do it too. We shall see. I think right now my diet is about 1/3 vegetables. Fruit does not count as a vegetable for this.

The other thing about vegetables is you have to cut them up. Ok, wash them too. And it’s not like one doesn’t have to cook beans or rice or meat, but vegetables do take time. If I have a person with low blood sugar or who is feeling awful, saying make half the meal vegetables may not be realistic. When someone is really frail or ill, it may be that getting out of bed, washed and dressed and to the table is overwhelming. Cut up vegetables? Cook from scratch? Maybe not.

For the Ragtag Daily Prompt: lunch.

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Frail

I wrote this poem about my father at least a year before he died. He was on oxygen, on steroids, terrible emphysema from 55 years of unfiltered Camel cigarettes. He would not accept much help and became more and more of a hermit. He did continue with the Rainshadow Chorale and because of it he quit smoking three years before he died.

Frail

We are going sailing
My partner says to me
β€œInvite him if you want.”

Then I am busy for a while

I think of calling, then forget

He was not at chorus on Monday

At last I say,
β€œI haven’t called. We’ll just sail.
Just us today.”

I haven’t called
because he was not at chorus on Monday

He is frail
55 years of camels
two packs a day
as if each cigarette
destroyed one alveolus
in his lungs
one tiny air/blood interface
built to exchange oxygen
and carbon dioxide
the loss is cumulative


He is frail
he is proud that the choral director
says, β€œI need you.”
He can’t sustain
but his entrances and time
are the best
among the basses.
They need him.

Chorus
is our winter link
two introverts
we hug at the start of chorus
sing for two hours
and talk for a few minutes at the end

Occasionally we go for a beer
I invite him for dinner
but he comes less and less
he often does not feel well at night

He looks smaller at chorus
this season
this is normal in emphysema
the body sheds weight
too much tissue to oxygenate
too hard for the lungs
and the heart, working overtime
to make up the difference
he is blessed with low blood pressure
genetic, from his father,
tough English stock,
otherwise I think he’d be dead

I didn’t call
before we went sailing
because I am afraid

I’ve driven out before
when he has not answered the phone
for a day or two
wondering if I would find him dead

I didn’t call
before we went sailing
because he was not at chorus on Monday
because if he didn’t answer today
I would not go

______________________

For the Ragtag Daily Prompt: frail.

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Wash, wadi, arroyo

A friend and I did a hike in Palisade this morning. It goes up, up and then there is a loop at the top. This is the fabulous view from the top, towards the west, with the Colorado River and the rest of Grand Junction.

On the loop we look for these:

Petroglyphs! And the bottom one really looks like an elk. Most looked like deer.

I also found this site, about the difference between a wash, a wadi and an arroyo. https://seethesouthwest.com/what-is-the-difference-between-an-arroyo-a-wash-and-a-wadi/

This is the canyon on our right on the way down, but I would bet that there is a wash at the base. These amazing mesas and rocks are carved by water and time.

And here is the mesa across from us to the north, from the top again.

For the Ragtag Daily Prompt: wash.

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Coping or manipulation?

I see someone in clinic with a difficult boss.

This brought up work stories. Now, are these coping skills or manipulation or a bit of both? You decide.

Long ago I work in a lab at the National Institutes of Health. We are super busy and doing a lot of overtime and have some media pressure as well. Our boss gets us together and gives us hell, about making mistakes. I am annoyed, because I’ve been really careful. I stew. I write a letter, what I think he should have said, which is telling us all great job, you’ve worked super hard, we are under pressure and also we need to not make mistakes. I circulate it to the four other lab techs, who enjoy it. The lab cheers up a bit. Eventually I get brave and give it to the boss. He likes it and reads it to everyone, who try not to laugh. A year after I leave the lab, I visit, and he has that letter up on his bulletin board.

Long ago I am made chief of staff at a hospital. My goal is to finish the monthly meeting in an hour. I have two senior doctors who always blow up about something in the meeting. I decide to be proactive and go to each one before the meeting and prime them. I pick a topic, say I am worrying about it, and what do they think? They each then blow up in the meeting, but now they have no opposition so there is no brawl. I prime them about something that is not really controversial. I do get the meetings done in an hour.

One year I go to the lake with my family. My children are small. My father has been drinking heavily. I call ahead and say, “Will you treat our tent site like my house and not come there if you are drinking?” “You don’t own the lake land,” says my father. “We don’t have to come.” I reply. He agrees not to drink at our tent site.

He is angry, though, and pretty much won’t speak to me. I ask if he would come to a family sing at my site. He says no. I think about it for a while and ask my cousin to hold a sing at her cabin. My father agrees to that, not knowing that I am the instigator. He is happy at it because he’s said no to me and yes to her, and I am happy too, because I love to sing and sing with him.

My father was one of eight people to start Rainshadow Chorale in 1997. I sang with him in the chorale from 2000 until the year he died.

Where is the line between manipulation and coping with a difficult person?

I think this is a time travelogue, so let it be my Ragtag Daily Prompt for today.

The photograph is of my father in 2012. He died in 2013.