Tag Archives: Beloved

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A weight loss drug complication

People are ordering versions related to semaglutide (ozempic) and dulaglutide (trulicity) from compounding pharmacies for various reasons. Their insurance may not cover the prescription or they may actually not qualify by their weight and complications. Here are the guidelines from the American Gastroenterological Association: https://www.aafp.org/pubs/afp/issues/2023/1000/practice-guidelines-medications-weight-loss.html. Those criteria: a body mass index (BMI) greater than 30 kg per m2 or BMI of 27 kg per m2 or greater with associated complications (e.g., hypertension, diabetes mellitus, and hyperlipidemia).

I have already had requests in clinic for a prescription sent to compounding pharmacy. I am refusing to send prescriptions out of state or to compounding pharmacies, because of the FDA warning. Here: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss. There are a bunch of issues: some compounding pharmacies are not using the FDA approved medicines, they are using something similar, but not the same. Also, the medicine does not come in the pen that injects a controlled amount. People have to draw the drug up and inject it. Some have injected ten times the amount that they should and have been hospitalized. It’s also worrisome that the compounding pharmacies, unlike state-licensed pharmacies, do not have to report complications.

A recent patient has deteriorating kidney function, with his creatinine jumping from 1.10 to 1.58. Creatinine is produced as a waste product by our cells and the kidneys need to clear it. His 1.10 was normal but the 1.58 is high, indicating the his kidneys aren’t clearing well, and that was only a six month interval. He is taking compounded semaglutide and compounded testosterone, with some online approval. That is, he did not get a prescription from our clinic. He started the semaglutide five months ago. The testosterone has been for years. “Stop the semaglutide and we will recheck your kidney function in a month.” His creatinine drops back to 1.10. Acute renal failure is listed as an uncommon side effect of the FDA approved semaglutide, but we don’t know if that is what he’s getting. I tell him the good news about his kidney function and say, “I think you should stay off the compounded drug.” I have not seen the same thing with the FDA approved semaglutide.

It’s complicated, isn’t it? We picked up the problem because he is on other medications and I do yearly labs on people who are on prescription medicines, to check whether their kidney or liver function is deteriorating. Almost all drugs, prescription or over the counter or supplements, are metabolized by either the liver or the kidneys. I only know of two that are not absorbed and not metabolized.

For the Ragtag Daily Prompt: pristine. I would like a pristine pill free body for as long as possible. Ok, I took one tylenol last week and I’d be dead three times over it wasn’t for penicillin.

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Why mean?

Why do people do that smiling mean thing? Where they are teasing too close to the bone, meanly, with a smile. If you object, then you are labeled as someone who can’t take a joke or who has no sense of humor. How do people handle them? I put them on avoid and do not want to be around them. But really, what motivates them? Power? Humiliate others to feel better about themselves? What a very sad and pathetic way to go through one’s life.

This is related to me thinking about what people think about. I think about what motivates people a lot and why they do what they do. This, apparently, is NOT what most people think about. My curiosity about people dates back to being a very small child and being passed from household to household because my mother had tuberculosis. I decided that adults did not understand children and that they loved me but didn’t understand that babies should be kept and loved. My sister was born when I was three and I told people that she was MY baby. I was determined to take care of her. Alcohol continued to make the adults in my household unpredictable and sometimes dangerous, at least emotionally.

My mother could charm a room and all visitors, but sometimes she would talk about them after they left. My family tended to ignore me if I was reading, because I really did not listen if I was deep in a book. Books were an escape and a safe place. People would have to call me three times to get me out of one. But sometimes my brain would click me out and I would listen to the conversation. My mother would talk about people’s motivations and was often quite negative and not nice. Interesting, but not nice.

When I realized that most people don’t think about others’ motivations most of the time, I felt rather freed and enlightened. I promptly ran into not one, but two mean people, at different sites. I do not understand meanness. I worry that it will be in the White House soon, as well. And what, that meanness wants to annex part or all of two other countries? Is this fascist envy? That’s what I think. So there.

The photograph is Sol Duc in 2022.

For the Ragtag Daily Prompt: mean.

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Thinking about this and that

I am thinking about thinking. What do people think about most of the time?

This partly comes from my ex. He thinks out loud a lot, an external processor. My daughter and I wanted to know what he thinks about. My son asked. “Dad, what do you think about?”

“Golf.”

“Golf?”

“Yes.”

“Anything else?” says my son.

“No.” says my ex.

I have no idea if this is true or not. Sounds hella boring to me, honestly, but he seems entirely happy with it. De gustibus non est desputandem.

I had lovely winter holidays, celebrating EVERYTHING. I went to my son and daughter-in-law’s out east. My daughter and her significant other came out and we did presents on December 27th. Then we went to see my two aunts and uncle for a couple days. They are in their 80s and delightful! Back to my son’s and we saw my kids’ remaining grandparent, my ex-husband’s father’s significant other. Got that? And one of my kids’ paternal cousins with her significant other. I stayed with old friends for the last three days, which was also delightful. We went to the Smithsonian American History Museum and read every single thing. But only in two exhibits because that place is huge.

Now I am back to my current home and hello, cat! Back at work as well. More about that next time. The sands are shifting and I may be in another clinic. Monday a patient asked if I am their new doctor or am I a floater? I said I prefer “Temp” to “Floater”. She laughed.

For the Ragtag Daily Prompt: think.

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All home

My daughter and her significant other arrive two nights ago and we open packages and stockings yesterday morning. Lots of laughter and chocolate and much contentment. Now I have a climbing harness in pale green! We did not climb yesterday, I was too tired. We did go for a park walk on an old golf course and had a delicious dinner. It is lovely to all be gathered here and trading stories and jokes and family silliness.

Today I am up early. We will drive down to see my two aunts and my uncle. The great aunts and uncle to the kids. A very delight!

For the Ragtag Daily Prompt: contentment.

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Today and tomorrow and the day after

Good morning! I hope you are having a happy day today! I am up and having tea and reading and listening to music, waiting for the rest of the household. They may be a while.

I arrived at my son and daughter in law’s on Sunday. The glitch was that my son and I couldn’t find each other in the pick up area and got frustrated. Turns out that I was at National Airport and he was at Dulles, which does make it more of a challenge. I took my bags and hopped the metro out into Maryland, and they picked me up at the station. Whew.

We are talking, eating, wrapping things and climbing. We went to their climbing gym yesterday and I did a respectable job on some 5.6 and 5.7 climbs. Today my arms want to fall off. Last year my climbing style was panicked sloth. This year I am much better since I have been going to my climbing gym once a week. Arm muscles! How amazing!

We are going to continue wrapping today. My daughter and her boyfriend arrive late tomorrow so we aren’t going to tear paper off stuff until Friday morning. My inner little kid suggests that we unwrap today, wrap it back up, and do it AGAIN on Friday. This waiting frustrates her! Oh, well. No, dear, we aren’t going to do that.

Have a lovely today and tomorrow and day after tomorrow!

For the Ragtag Daily Prompt: today!

The photograph is Elwha looking up at the Christmas stick last year. I miss him!

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Austere choice

What could be more austere than rock?

Taken in Echo Canyon in the Colorado National Monument, Thanksgiving, 2024.

Austere choice

Why do I still feel sad when I think
that I am best off with my cat
and that I should eschew dating.
Why do I feel like I am rejecting love?
I don’t have that sort of love.
It’s not like I am rejecting anything.
I am rejecting looking for it.
I am rejecting active interest in a partner
other than my cat.
What is wrong with that?

I do not ever want to reject hope.
I am not trying to reject wanting.
Hope and want are the deep and terrible ache
for the Beloved. I do not reject that.
I am still open, Beloved, to what you send,
though getting more particular in middle age.
A writer says that he uses a pencil and a pad,
because no better tool has been invented.
I take the same approach to wanting love.
If the relationship is more work than my cat,
for less love, why bother? It seems silly
and until I go home to the Beloved,
so far, I am best off with my cat.

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The first thing Sol Duc does when we go out for a walk, is roll on the sun warmed dusty sidewalk. The house faces south.

For the Ragtag Daily Prompt: austere.

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Vision

What will peace look like? People
will still disagree often
but like my parents they will appreciate
evidence and science. They will listen
to each other with interest, with respect.
They will bet a penny or a quarter or a million
imaginary dollars and one will go to look up
the correct capital of Azerbaijan, while
the other argues that they MEANT back in 1478,
really, so they do not owe one million imaginary
dollars and they both start laughing again.

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The photograph is of the ice in Echo Canyon, two days ago. Or maybe it is angels, waiting.

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Print or cursive?

My father’s father was a pressman and the head pressman when he was in Knoxville, Tennessee. This is back in the lead type times, when the type had to be set before printing the newspapers. Before they moved to Knoxville, they lived in Connecticut. My father said that my grandfather helped develop the four color process for the comics. My father would get the new comic books, Superman, straight off of my grandfather’s press. Too bad those were thrown out!

I started cursive in school in about fourth grade and I did not like it. I learned, but I thought it was ugly. My father knew how to write in italics. I liked italics much more and asked him to teach me. I adapted the capital letters to make them easier and then I wrote my papers in italics when we were not allowed to print. The teachers objected but I pointed out that we weren’t allowed to print in the papers, but it did not say, “No italics.” I imagine that some teachers found me difficult.

My cursive is still stuck in about fifth grade and I almost never use it.

Meanwhile fast forward. A law is passed in Washington State that prescriptions cannot be written in cursive. However, it does not say that we have to print. The same loophole. I usually printed prescriptions anyhow, so that the pharmacist could read it. I got compliments occasionally for printing in a legible way. I didn’t spell certain medicines correctly, but the pharmacists never seemed to care about that. Now it is all by fax and since Covid started, even the controlled substances go by fax.

For the Ragtag Daily Prompt: print.