Better living through chemistry

If you know me IRL (“in real life”), and if you have known me for a while, you know at least two things about me.  One is that I used to smoke – a lot.  After a major incident in 2013 that landed me in a pulmonary ICU unable to breath for 15 days, I gave up ciggies for good, as I decided I was into breathing.  Ironically, the medical crisis that landed me in the ICU had nothing to do with smoking and everything to do with being sedentary, although I’m sure the smoking didn’t help!

I am not sedentary because I am lazy, or unmotivated.  I cannot walk or stand on my own, the result of a neurological disorder known as Progressive Multifocal Leukoencephalopathy (PML).  I get around pretty good in my motorized wheelchair, in fact I do quite a bit of gardening, but I am seated when I do it.  If I am not in my wheelchair, I am seated in my recliner.  And if I am not seated in my recliner, I’m lying in my bed.

For most of my life up to this point, I was skinny.  I mean, it was a bit ridiculous.  My diet was atrocious.  Pasta, pasta, and more pasta, preferably with bread. I had a very well-developed sweet tooth. But despite all that, I could not gain weight!  Back when I was “in the scene” and “on the prowl,” I even hired a personal trainer named Hector:  he had me lifting these heavy things at a place full of heavy things called a “gym,” running around my neighborhood in skimpy little nylon shorts with no place in particular to get to, other than back where I started, and drinking something he called a “shake,” which, while made in a blender and with dairy, involved a powder that made the whole thing taste like milky sand.  I did not gain a single pound.  After six months, I fired Hector.

I asked my doctor if there was something wrong with me.  He immediately responded yes, but added it had nothing to do with my weight!  He’s dead now (car accident). In all seriousness, he told me I had a fast metabolism and that this meant that I was “naturally skinny.”  He also told me to enjoy it while it lasted, because one day it would all change.

That day has come. Over the course of the last several years I have ballooned from a svelte 140 lbs. (which had been my weight for most of my adult life) to an unbelievable 270 lbs.  Taken last December, this picture shocked even me!

Please forgive the sweater – it was our annual “ugly sweater contest,” a holiday tradition here at Stonewall Gardens.  The gentleman (and I use the term loosely) on the right is our Sales & Marketing director, Brian, and Gordon is sitting on my lap, staring off into space, thinking ‘oh the shame of being seen in public with these two dressed like that!’

So let’s face it:  I’m fat.  Don’t worry, I can say the ‘F’ word, I’ve got slur immunity.  It’s like when you’re black you can use the ‘N’ word.  After discussing this with my doctor, who reiterated the only way to lose weight was to burn more calories than you take in, which my fast metabolism had done for me up to this point, he said he’d normally prescribe some kind of regular exercise regimen in cases of obesity, but we both realized in my case that is, quite literally, impossible.

Like a good Stoic, I accepted this new reality over which I had no control.  Epictetus said there’s no sense in trying to change things outside your control in the Enchiridion, so I embraced the new me:  just last month, I opened an online account at DXL, the “big and tall” man’s store; I bought four new shirts, and after some back-and-forth, found that I now require what is called a “double extra-large” (2XL or XXL).

Then, after some recent, routine, lab tests related to managing my HIV, I got this message from my doctor:

Since your glucose level was elevated on your recent routine labs for our visit, I had you check an A1C… the best measure for diabetes assessment. Until now, we have been following your A1C and it has never met criterion for diabetes. Unfortunately, on the labs you just had drawn, the A1C was 6.7%; any value of 6.5% or higher is a diagnosis of diabetes. You had never previously exceeded 6.0%. This diabetes diagnosis represents inefficient glucose metabolism by the cells of your body and is directly related to sedentary lifestyle, weight gain and food choices (I recognize you have little control over your food choices except to the extent you can ask for what you want within your living situation). Diabetes can and may be playing a role in the deterioration of your kidney function, so we need to get it under control. Weight loss, exercise of any sort and lean/clean diet of whole foods are interventions that will help, but I believe you need a medication to help get your A1C down.

So, universe, HIV/AIDS has caused me to develop a neurological disorder called PML which makes me sedentary and has affected my A1C which is an indicator of diabetes, meaning that one life-threatening disease wasn’t enough, you thought I needed another!  As Harvey Fierstein says in Torch Song Trilogy, “Ain’t that a kick in the rubber parts?”  My doctor mentions a problem with my kidneys, and in another message refers to something called my ‘GFR’ (glomerular filtration rate).  Now tell me, what’s with the acronyms?  It can be hard to keep up with them all. I feel like I suffer from alphabet soup!

I was aware of these new wonder-drugs being touted as weight loss miracles.  You see these commercials on tv and they always end, “ask your doctor if [insert name here] is right for you,” so I did. ‘Right for you’ is code for “can you afford it?” 

If you’re addressing obesity only, and get a prescription for Wegovy (semaglutide) or Zepbound (tirzepatide), insurance will deny your coverage.  Ding. Wrong. Sorry. Thanks for playing. But… add a diabetes diagnosis, and the exact same medications go by different names – Wegovy becomes Ozempic even though it is still just a drug called semaglutide, and Zepbound becomes Mounjaro, again even though it is still just a drug called tirzepatide.  Diabetes and a scrip for Ozempic or Mounjaro?  Good news … you’re in luck … insurance will cover it. And you don’t have to take out a second mortgage to pay for it!

So I started Mounjaro last Friday.  It is a weekly injection.  Not to get all sciencey, but tirzepatide activates two receptors in the brain simultaneously, which is why it’s called a dual-targeted or dual-agonist medicine; this dual-action stimulates two hormones: glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). While its exact mechanism is unknown at this time, tirzepatide targets the appetite centers of the brain that initiate a feeling of fullness.  Its dual action not only promotes the release of insulin to help improve glucose control and treat diabetes, but it also leads people to eat less, feel fuller, and, because you’re not constantly stuffing your face, you lose weight.

As I said, my first injection was last Friday.  It took some time for the pharmacist we use here at Stonewall to get it, as it is in extremely high demand.  It has also been the target of theft, with many pharmacies not keeping it on hand due to robberies by thieves breaking in and stealing it.  I presume they are thieves looking to mark up its already high cost and sell it for profit and not fatties looking to get their hands on it to lose weight, because fatties wouldn’t go to all the trouble of breaking into a pharmacy when there’s a Jack in the Box next door selling mint Oreo shakes!  Oh. And remember, it’s okay for me to call them fatties because I am one.

But not for long!  It’s only been four days, and while I can’t say there have been any immediate visible changes, I will tell you I’m experiencing some remarkable psychological ones.  I always feel full; I feel like I just ate.  The thought of eating more, even at our regularly scheduled mealtimes, is repulsive.  I haven’t been to the dining room since last week.  I bought myself some yogurt, some cottage cheese, some bread, and some sandwich fixin’s, so I am eating, but not very much.  I used to be a dedicated snacker.  Now the thought of eating something outside breakfast, lunch, or dinner is revolting.

Our Executive Director was worried I might not be eating enough, so last night I ordered a carne asada burrito, with a huge side of chips and salsa that the local taqueria I order from calls the “Boat o’Chips.”  In the past I’ve devoured both the burrito and the chips in one sitting with the greatest of enthusiasm and elan.  I barely made it a quarter of the way through them and gave the Boat o’Chips to the night staff!

And in a strange way, I “feel” better.  When I was a smoker, if I wasn’t having a cigarette I was thinking about having one.  And I had become that way with food, sometimes starting to think about dinner as soon as I got back to my apartment from lunch!  I have learned that addicts call this “food noise;” it is rather classic addictive behavior.  When I quit smoking, I was amazed at how I felt freed from a kindof “tobacco slavery,” and I’m experiencing the same thing now in regard to food.

It’s not “all in my head” but it is in my head.  According to an article in New Scientist, these drugs activating the GLP-1 hormone are showing surprising potential in treating mental health conditions such as depression, anxiety, addiction, and even neurodegenerative diseases. This is not solely due to “good feelings” because of weight loss; GLP-1 drugs directly affect emotional and cognitive functions in the brain.

The article highlights the weight loss story of Kathy Schwartz, who, in addition to obesity, had struggled with cravings for alcohol, cigarettes, and opiates. Not only did she lose around 60 pounds once on semaglutide, but she also lost the cravings associated with her addictions.  The article goes on to state:

It is early days, but there are hints that these drugs could be repurposed to treat depression, anxiety, addiction and even certain eating disorders – as well as neurological conditions such as Parkinson’s disease and Alzheimer’s. What’s more, it seems that these effects aren’t just mediated via weight loss, but through direct action on the brain.

This is amazing!  I’m as excited as I was back in the mid-90s when science provided the treatment for HIV that keeps me alive today, a year before I was diagnosed with HIV.  So in keeping with my impeccable timing, I am diagnosed as obese and diabetic just as a new wonder-drug comes out. What are the odds?