Prior to starting the Wegovy I committed to truly starting behaviors in a consistent way that would help me keep the weight off once I get to my goal. I have been eating smaller portions, trying not to snack and really exercising every day. Today will be day 14 of consistent exercise – weight training, cycling or elliptical.
What I experienced during my first week of Wegovy was perhaps a small sense of early satiety if I really thought about it, a couple of times where I felt slightly nauseous after eating and maybe a inkling that my intestines are responding in a positive way. That said, I could have imagined it all because nothing is really the same day to day anyway. I was not expecting to have lost much weight the week just based on how I felt, but I was hoping for a bit more the .8 pounds, not even 1 whole pound. BUT I will not be discouraged.
However if after my 4th injection, if I am still losing at this VERY slow rate, I will talk to my doctor about increasing the dose the second month rather than the 3rd or switching to Monjaro which is a GLP and GLP-1 receptor agonist while Wegovy is only a GLP-1 agonist.
Clinical trials for drugs have two basic goals – to determine whether the drug works for a specific indication and what adverse effects it has. I can’t think of any drug that has only one effect in the body. The goal is that advantage of the desired effect far outweighs any adverse (unwanted) effects that it may have.
The information is collected on case report forms. Our knowledge (facts) is determined by the information that is systematically collected in the forms. There are often important and interesting questions that could be answered in the trial but there is significant tension between the amount of data collected and the participant burden of participating in a trial. The more burden (time it takes to complete the data gathering) the less likely it is that the participant will stay in the trial. Drop outs from the study are BAD and expensive so studies strive to gather only the necessary information so everyone completes the study.
Studies will always gather basic information like weight, blood pressure, pulse, oxygenation and tests for the target of the drug if different from weight, blood pressure, pulse, oxygenation – for example a drug for psoriasis, additional information will be gathered such as examination of the skin. This determines the benefit of the treatment.
Adverse events or side-effects can be determined in one of two ways – spontaneous report or prompted. Spontaneous report occurs in response to a general question – “have you noticed other unwanted symptoms or changes in your health since you started the treatment” or asking about specific symptoms – “have you experienced nausea”. Most studies use spontaneous reporting not prompted. In the past, a spontaneously reported positive unexpected outcome would not have been systematically gathered on the case report forms so it can take a while to learn that a drug has additional positive benefits.
Sildenafil (Viagra) was initially in clinical trials for treating angina. When men were done with the study, they did not want to return their unused medication because they found that it improved their erections. It wasn’t an adverse event for them so they did not report it spontaneously because it was not unwanted or negative. So the clinical program for development of drug treatment for impotence started with patient observation rather than an animal study that is the normal drug discovery process.
This is what is happening with the GLP receptor agonists now. Enough people have noted unexpected positive benefits that more research is being done. In the meantime, doctors can prescribe an approved medication for reasons other than what it is FDA approved for. However, insurance often may not pay for drugs outside of their approved indication. Those who can afford to pay the full cost of the drug will be the front line of observing the full range of benefits of the drug (such as Hollywood stars).
This is what it looks like when you drop an open can of ebony stain and it lands on the bottom – it turns into a fountain. Interestingly, it didn’t stick to my glasses or my Baggallini front pack that I had not taken time to remove after dashing to Walgrens to get wound closure materials for another Tools volunteer that had tripped and gotten a superficial cut at his hairline. I was the only one in the shop when I dropped the can so there was no one to hear my expletives or laugh with me. It was all over my hands and arms and shirt as well. I only had a bit o staining left to do so I dried my hands and arms which just spread it around more. I left my face alone until I got back to the condo which turned out to be good plan.
Once I finished I called Craig to see what kind of solvent would work best to remove the stain. He said lacquer thinner. I found a nearly empty can and went to the condo. The dried stain on my face came right off. Some was very near my eye so I used a Qtip there. What was smeared around on my hands and arms did not come off in the same way but I got enough off that I could do my grocery shopping. Later I discovered that Dawn dishwashing liguid really worked well on what on my hands.
I read an article today about how “Hollywood” is microdosing GLP receptor agonists for things other than weight loss. There is early evidence to suggest that macrodosing can improve Improved mood, lower anxiety, promote clearer thinking, increase focus and attention, decrease substance abuse and increase sense of well-being as well as improve cardiovascular disease and improve cognitive ability in Alzheimer’s.
It will be interesting to see what holds up over time and which of these self-reported benefits are studied for approved indications. As the early expensive testing is already done for the initial approval, it is way less expensive to do the testing to get a new indication which could increase demand. It will be interesting to see at what point if any, the cost of these products starts to decrease.
During my first week, I have not noted much of anything yet. I am trying to eat smaller amounts to avoid the nausea which may be working except that I feel hungrier. I am curious if I will have lost any weight when I weigh on Saturday. I continually remind myself that this is a journey. I have a 11 day streak now of either aerobic exercise (cycling or elliptical) or weight training. I want to minimize muscle loss and have good habits established to keep the weight off.
GLP-1 receptor agonists were initially studied and approved for the treatment of diabetes. As often happens with treatments, once they are used in humans, people start to experience adverse events and benefits that were not previously known about. Pharma companies do extensive research on new drugs before (Phases 1, 2 and 3) and AFTER (Phase 4) they are approved. However, no matter how much is known about a particular drug, there is only one person in the world that has the exact anatomy and physiology and health conditions that I have and that is ME. So my experience will likely be within all that is known about the medication, but I could experience something unique or unexpected that is not in the FDA approved label. Should this happen, I would report it to the FDA and and the Pharma company. This is the process that leads to drugs being withdrawn from the market years after they are approved.
Adverse events that are very rare do not show up until the drug is used by a magnitude more of people than is studied in the initial clinical trials. Prior to approval, drugs are studied in usually less than 5,000 patients. After approved drugs can be prescribed to hundreds of thousands of patients so new outcomes show up – good and bad. These outcomes need to be reported and aggregated in order to determine if an action is necessary. Unfortunately the reporting process is time consuming for patient and physician so often reports are incomplete which can delay important actions.
Most clinical trials compare groups of subjects on different treatments but there is a type of research know as “N of 1” studies where the subject is his/her own control. I am conduction a N of 1 trial on myself.
I lost 40 pounds nearly 5 years ago and have kept much of it off. I always intended to lose another 20-30 pounds using the same Weight Watcher diet but a couple of health issues got in the way: persistent loss of taste from Covid and onset of a variation of irritable bowel syndrome which makes eating the same foods I used for weight loss more difficult. I didn’t really gain back weight until I started cooking and baking for Craig.
I had my routine colonoscopy a month ago with a hope that colon biopsies might reveal a treatable cause for the IBS. The good news is that I had NO polyps for the first time ever. The bad news – no colitis. The cause of my IBS remains unclear and I will continue to manage it.
So after months of making attempts to eat less, the plantar fasciitis set in which curtailed activity for several months and I gained 8 pounds over the winter.
I have a couple of friends who had used GLP-1 receptor agonists with good results. They both talked about the significant constipation as an undesirable side-effect. For me that would be a benefit and not a bad thing. So at may annual Medicare Wellness visit a couple of weeks ago, I asked my doctor what she thought me using the GLP-1 receptor agonist for weight loss. She said the following – obesity is a chronic condition and if I am successful with getting off the 30-40 pounds I would like, I would have to work very hard to keep it off and may need the injections chronically to maintain it. In addition to losing fat, I would lose muscle mass and the potential for nausea, diarrhea or more likely constipation. She said she had avoided giving me a diagnosis of obesity so she was not sure if insurance would cover it. She suggested Wegovy, (ozempic specifically approved for weight loss) and I waited to see if insurance would cover it. I still wasn’t sure if I was going to ahead or not.
My main rationale for doing it is that this is my 70th year and while I hope to have a couple of more “healthy” decades, I am most concerned about the wear and tear on my joints as the major impediment to maintaining good health over time. The weight loss will be very beneficial for my joints and for my enjoyment of physical activities which are crucial for my mental and physical health and keeping the weight off. Also I am hoping for constipation and the potential of a “reset” to my dysfunctional intestines.
Insurance is covering 50% of the cost so I decided to “go for maximum health” in my 70th year. This is smart for my insurance company because if successful, I should be able to avoid a knee replacement.
Wegovy has weekly injections and I didn’t feel the needle at all. I wouldn’t have minded daily injections because if there are significant side-effects, they won’t last as long. Wegovy starts at half dose for 2 months and then dose is increased. So far I have not really noted anything – except perhaps a slight nausea after eating. I have decreased portion sizes as suggested and am doing some form of exercise every day to help minimize the muscle loss.
I have not blogged since October and every time I approach doing some writing, I cannot figure out what to say. All I wanted for my birthday on November 6th was the election or likely election of Kamala Harris. It then became of weeks long exercise in sorting through the stages of grief and the many shades of depression.
Craig and I have arrived at the need to check in on our feelings about our microenvironment (us), environment (family and friends) and the macroenvironment (country and global concerns) separately.
We traveled for Thanksgiving and stayed local for Christmas. We did the best we could. I am between my first and second cataract surgery. All is going fine but the 4 weeks in between is strange with respect to vision. I have remove my corrective lens from the right side of the glasses that was done first. My vision is off in both eyes but in different ways. Hopefully when both eyes are done and my brain has adjusted to the trifocal lenses, I will have great vision without glasses.
I have had significant heel pain for about 8 weeks now. It preceded the election or I would say it was psychosomatic. I have purchased more shoe inserts, shoes, night splints for plantar fasciitis with no help. I have tried to stay off of it and tried to walk through pain. I am taking dicolfenac pills and tried the topical which made it tolerable. I then remembered a dear friend told me about arnica several years back so I got some of that about 10 days ago. If I apply it every few hours, I can periodically forget about the pain. I have an appointment with a podiatrist next week.
If I were to do a validated questionnaire about depression, I would not have depression so I have come up with a term for how I feel – slumpy.
I am alive, well and about midway on the slumpiness scale.
On our first day of sorting and loading wood, this shed had the 3 large lumber racks inside completely covered in wood. One rack was across the back and there was on along each side wall. There were 3 feet of walking space in between filled with random pieces of lumber. The first day we unloaded the wood on the racks and the second day we disassembled the racks. The floor of each of the shelves for the lumber were also pieces of lumbar.
Within an hour or so of getting started, I ran a nail sticking out from a board completely through the sole of my work boot. Fortunately the nail went between my toes. I stopped to examine my foot and make sure there was not blood. In the afternoon, with the ground covered in various piles of wood and steel that was being sorted, Craig lost his balance, fell and scraped his forehead. He broke the skin and it looked like he had a significant cut but it did not really bleed more that just at the edges. He did not even stop to get it cleaned up which I strongly suggested. He was right, he is healing fine with no signs of infection.
We were both incredibly lucky. Fortunately we are both inclined to let our bodies heal our injuries rather than seek medical care quickly so we are tolerant of that behavior in each other even though it might be uncomfortable.
We went from the “high” of Natalie and Craig’s Songwriter Round to 3 days of sorting, lifting and hauling old lumbar from a property that is being sold next week. Craig can not walk away from good lumber. We hauled out 3 pick up trucks and one 16 foot trailer of wood and steel. This haul is not only the lumber, but 3 steel huge lumber racks, steel saw horses. It was a great upper body work out.
It was very dusty work and after the first day we said we should have worn masks which we failed to do on both subsequent days. Not sure if this truck is more Ma and Pa Kettle or Jed and Granny.
Now we need to assemble the lumber racks behind the shop. The spot for the racks was occupied by an old RV that we have decided not to restore. So after spending 2 days loading lumber, we(he) spent Sunday figuring out how to move the RV. He tried Katie the tractor to tow her but she was not quite enough. Fortunately the truck was up to the task.
Here is the RV that was moved from the spot that is not being prepared for the 3 side to side lumbar racks with wood posts and steel horizontal bars to be reconstructed on top of this gravel. Once constructed Craig has a plan for how to make a cover for the racks to keep the wood dry. There is a large lumber rack inside the shop as well. Hopefully the goal is NOT to fill this storage capacity but to use the space to organize what we have so that we can easily find what we may need. We have a lot of lumber down under the trees where they do not get a lot of rain and perhaps we can move the good stuff up to this rack.
Hopefully we will have the opportunity to make use of all of the lumber that we have.
Craig was well prepared for this event. There was a decent size group in the restaurant where the Round is held. Natalie’s parents drove up to see it. It went by in a blink. They both sounded great and their two styles worked well together. It was so fun to hear Natalie sing one of Craig’s songs and to add violin. AMAZING. They each played 3 songs and it timed out at just under 30 minutes which was perfect.
When Craig came off stage he said “I was out of tune so I held back on guitar”. I didn’t notice either. He sounded great. Most important to me is to be able to hear his lyrics and follow the stories he was telling. Neither James or Natalie noticed he was out of tune. After watching the video a few times, Craig finally said “that was not as bad as I thought” and posted it to YouTube. https://www.youtube.com/watch?v=IMKZkPfx4_w
The pause in all of our projects was worth it. He got back on stage with Natalie’s support and the response of the audiences and other songwriters will keep him going. I am so proud of and happy for Craig. As he said on stage – This was like being a 5 year old in Disneyland.
The next post will explain why I am so behind in posting this.
This household has been balancing the pre-election anxiety with getting Craig ready for his Songwriter Round with Natalie on October 24th. We are less than 36 hours for the event. Last week he decided he needed to do an Open Mic in the venue where the Round with Natalie will be to get familiar with the stage – how it sounds to him and the lights.
Last Thursday we went for the Open Mic. He signed up at 530 PM and we watched 5 Rounds of songwriters before the Open Mic. Craig was the only one that signed up so it was just him on stage. The audience had been pretty attentive during the Rounds but did not appear to be expecting any more performers so Craig started playing to a lot of noise and movement. He was told he would play one song and then when he finished, it was announced he could play a second song but it was difficult for him to hear the instruction. He did his second song. I recorded it. He did just fine.
He came off of the stage convinced he was horrible and announced that he needed to do an open mic every night for the next week. After he watched the video he was able to admit he was not horrible. The Open Mic the next night (Friday) was run by a different organizer. The audience was bigger and there were a dozen songwriters signed up for the Open Mic. Craig was in the middle group of 4 and it was a much better experience. He was more relaxed and felt better about his performance. He got one audible shout out from an enthusiastic audience member. He felt good enough about this performance that he posted it on You Tube https://www.youtube.com/watch?v=JateFBWp_F8
He crashed (slept all day) Saturday and did not have energy for another Open Mic. He called it being “lazy” or perhaps a virus. I called it recharging his introvert batteries. He felt more energetic Sunday and I recharged my introvert batteries sleeping through football games.
Monday we were back to normal and we went to Nashville for a rehearsal with Natalie. She will be singing the female part in his song Misty Morning and harmonies on his other songs and adding some fiddle. It was amazing to watch a professional at work.
Last night Craig went back and did his 3rd and last Open Mic. He was on stage with 4 young songwriters. He played first in the round. He played 2 different songs – one about his grandparents and the audience was silent and attentive. A couple of women told him after that the song made them cry. The second song was about the factory worker/songwriter that longed to play in Nashville. He got several loud whoops from the audience after this one. He asked me if he looked like he was having a good time on stage and it was really hard to see his face under his cowboy hat that he wore working on his grandfather’s ranch.
I got asked for his Instagram account and a lovely couple from Dayton wanted to know where they could go to listen to his music. They were VERY disappointed that he did not yet have this available. He felt MUCH better and his overriding fear that he would embarrass Natalie during their joint Round on Thursday has been pretty much put to rest.
Does anyone get their big break in Nashville in their mid-70’s?????
Tamara Unleashed 