At last! The day after seeing new Fab GP I received the long-awaited phone call from Traumatology saying I had an appointment for my shoulder this coming Monday. After the ultrasound in February I did actually get an appointment in March (for a few days before my knee one) but had to ask for it to be rescheduled. But there was some kind of problem because I never did get another appointment and when I saw Nice GP in May she saw that they had mixed the two March appointments up, assuming I’d gone to the shoulder one, and cancelled the request. So she requested another one. In May. When I saw her last month for the Mounjaro thing she said it was still in the system, nothing she could do. Then I asked Fab GP about it yesterday, who said the same thing but… maybe she tweaked it somehow?
Anyhow, I sure hope they can do something about this because between shoulder pain and knee pain I honestly don’t know which is worse now, and it makes hobbling on the crutches pure hell. These days I mostly drag the right-hand crutch because I can’t lift it enough to use, but I still need to have it with me for things like stairs, very uneven pavement etc. At least they shouldn’t be able to blame this on my being fat and refuse treatment until I lose weight… I hope! 🤞
Today I went to see my GP about getting my Mounjaro prescription refilled and possibly “upgraded”. In case you don’t know, they start you off at the lowest dosage (2.5 mg) which is supposed to get your body used to the medication without too many side effects. Then the usual thing is to up the dosage to 5 mg and see how you get on with that. If you are losing weight at a reasonable rate then you stay where you are, but if you need more (of whatever it is this thing does) then your dose can be steadily increased up to what sounds to me like a whopping 15 mg dose. Each pen holds four doses and the higher the dosage, the higher the price.
2.5 mg
208€
5 mg
272€
7.5 mg
359€
10 mg
359€
12.5 mg
446€
15 mg
446€
At 208€ per 4-dose pen, the 2.5 mg dose is already too expensive for me, especially as this is meant to be a long-term treatment. So I was going to ask my GP if she thought I could stay with the initial dosage and see how I go, but it turned out my GP wasn’t there (on holiday?) and I ended up seeing someone new. Oh well. You may recall that when my old GP (and friend) Agustín retired just after Covid lockdown his replacement was (I’m sorry but she was) a really horrible woman who seemed miserable at her job. She didn’t listen to me at all, sent me for treatment I never asked for or wanted, like fucking bariatric surgery, without informing me. I was thinking about changing clinics when one day I went to an appointment and Heartless GP was gone and there was a new doctor there. Another woman, but this time a nice one. Well, I mean she was a bit cold and clinical but she did get things done, things I asked for. So I have been more or less happy with Nice GP though I can’t actually talk to her (I’ve tried). Anyhow, then today…
Another woman. I still don’t know if she is now my new GP or if Nice GP is on holiday, but the first thing she did was apologise for taking another patient ahead of me saying she had seen me in the waiting room but it looked like I was waiting for someone else (well I was, so I wasn’t sitting outside her door) but no harm done. Then I sat down and told her that I was there for a new prescription but wasn’t sure if I should continue with the original 2.5 mg dose because it seemed everyone switched to 5 mg after the first month. But I’d already lost 2.5 kilos in three weeks and I thought that was a good rate of weight loss (slow but sure), and she agreed. I told her that price was a factor and, indeed, forking out 208€ a month was probably better motivation and more effective than whatever the medication was doing. And she laughed. SHE LAUGHED. Omg. Then she showed me the price chart above and said… you know “hay una trampa” (there’s a trick) and I was all ears.
Then she leaned in and said that when they were first showing them this new medication and how it worked they also showed them this “trampa” which was this. Say, like me, you are paying 208€ for four 25 mg doses a month. That is what that pen is going to always cost. BUT… if you bought the 5 mg one at 272€ and only took a half dose each time then it would last twice as long and cost 136€ per month. And I was like… whaaat? Even better if you go for the 10 mg one, which would last for four months at 90€ a month. I was a bit overwhelmed. First of all, that Mounjaro pen took a while to master (I have it down now, can administer it without needing the video 😅) but cutting the dose? Tricky. New Fab GP said she didn’t know how all the different pens actually worked, saying they could explain it to me at the farmacia, but I was unsure. So we agreed that I would continue on the 2.5 mg dose for another month while I did more research on this. So far everything on google is saying I SHOULD NOT do this, but they would say that, wouldn’t they?
Meanwhile, we talked about how my weight gain happened after all that chemo (2008-2009), followed directly by menopause and, well, just getting older, and she’s the first doctor has agreed that chemo can seriously affect metabolism. She said another benefit of Mounjaro is that it helps not only with blood sugar levels and lowering appetite, but it also metabolically “rebalances” your body. Hmmm. I dunno about that but I do know I’ll stick with it for now because I really really want a new knee.
… my journey into Weight Loss Injection Land. In the end Peter popped back to the farmacia yesterday evening to pick up the first hideously expensive batch of Mounjaro – 4 injections for 210 euros. I decided to wait until this morning to get started but upon opening the box and seeing THESE INSTRUCTIONS (gee just 17 easy steps) I was a bit overwhelmed to say the least. And then I read the fateful words NEEDLES NOT INCLUDED and was like… what the FUCK. Also, why the fuck didn’t anyone ask Peter if he had needles or needed to buy some?
So it was back to the farmacia today and hey, they only had boxes of 100 NEEDLES that are compatible with Mounjaro, but whatever. Bought them. Then it was back home to do the deed. Luckily my friend Jane had sent me this very helpful video, which made more sense to me than a metre long fold out page of printed instructions. And then I did it! It’s a bit faffy because you have to work out the dosage each time and “prime” the thing (unlike the easy one-shot belly injections I had to do after all my cancer operations) but I am now INJECTED. And so now what?
Well apparently “Mounjaro (tirzepatide) starts working within hours of your first injection, though the timeline for visible results varies. Immediate Effects: Appetite suppression and reduced food cravings can begin within 24 to 72 hours.” (googled info)
Which got me thinking yet again… I don’t actually have a big appetite that needs suppressing. I don’t get food CRAVINGS (at least not the all caps variety – probably the only thing I ever actually crave is a nice glass of wine). And once I start eating (thanks to the adhesions) I am not able to overeat in any meaningful way. So do I really need an appetite suppressant drug that works by making people feel nauseous? I guess we shall see.
Meanwhile meanwhile… today I was going over the properties for Wegovy (my first choice before the GP talked me out of it) and dammit, I wish I’d stood my ground. Because Wegovy is a lot more than just a weight loss medicine…
Wegovy (semaglutide) reduces excess body weight (by an average of 15-19%), and lowers the risk of major cardiovascular events like heart attack, stroke, and cardiovascular death. Beyond appetite suppression and weight loss, Wegovy improves several interconnected health factors.
Cardiovascular Risk: It is the first weight-loss drug officially approved to specifically reduce the risk of serious heart and circulatory issues in overweight/obese adults.
Blood Sugar & Insulin: It helps the body release insulin when eating and stops the liver from producing excess sugar, lowering overall blood sugar levels.
Inflammation: Clinical studies show it reduces systemic inflammation markers and lowers blood pressure.
Liver Fat: For individuals with metabolic dysfunction, it reduces fat build up and scarring in the liver.
All of that sounds like it would benefit me more ALONG WITH losing weight. Also… cheaper! Well, just by 30 euros a month but still. And it comes with its own needles, plus is way simpler to use. So I am feeling like I made a mistake going with Mounjaro but I’m in now for at least this first month. Wish me luck!
Spoiler alert… Mounjaro has already “won”, at least for now, but mostly because I was put on the spot today and didn’t want to have to wait another two weeks to see my GP again. It’s like this. Wegovy (semaflutide) and Mounjaro (tirzepatide) are both GLP-1 drugs that slow digestions and suppresses appetite, but Moujaro has another hormone called GIP that has a stronger impact on blood sugar regulation and hunger reduction.
I had been leaning towards Wegovy as I had read that it is also approved not just for weight loss but cardiovascular health, helping to lower blood pressure and inflammation, as well as reducing the risk of “cardiac events” by as much as 20%. Sounded good to me. And I was hoping that today’s blood test results, combined with my heart issues, would mean that it could be prescribed for medical reasons (not just weight loss) so I wouldn’t have to pay.
Mounjaro is mostly prescribed for Type 2 diabetes and weight loss, with no obvious cardiac benefits. The Endo had made it sound like the only way I could get either of these covered by social security was to be diabetic, hence the new blood test. But it turns out that not only am I not diabetic, my GP informed me today that neither of these drugs are covered under SS so I would have to pay in any case.
So then I asked… how much? Wegovy is 180€ for the first month, Moujaro is 210€. Apparently the price will either remain the same or increase depending on whether I need stronger doses going forward. But GP insisted that Mounjaro is the preferred option these days but if I wanted to think it over… no no, no more delays. I went for it.
Effectiveness… Wegovy shows an average weight loss of 15-21% over 72 week, Moujaro 21-22.5% over the same time period.
Meanwhile, I dunno. Yes, I’m going to give it a go. Picking up the prescription this evening (they had to order it in) so will start tomorrow. But everything I read is about it suppressing appetite, even about losing “obsessive thoughts about food” (probably from feeling nauseous from the drug) and this just isn’t my problem. I mean, yes I do obsess about food, but more in the sense of photographing it and, yes, making it too, but not about wanting to eat all the time. Because you may recall, after four major abdominal ops, my belly is full of adhesions (look at your own risk) so if I do ever happen to over eat, which rarely happens anymore… PAIN PAIN OMG VOMIT VOMIT MORE PAIN. I mean, it’s like I have my own built-in Wegovy/Moujaro. Anyhow, we shall see I guess. Wish me luck.
Apparently I should be down to acceptable knee op weight by Oct/Nov and then I’ll have to get my GP to request another Traumatology appt (average waiting time: 6 months) and THEN they’ll put me on the waiting list for an operation (as long as I’ve kept the weight off). Honestly, if I despair at times, can you really blame me? Every day the pain gets worse, walking (hobbling) is becoming almost impossible and now I have a whole year ahead of me before I will even be able to see the slightest bit of light at the end of this awful awful pain-filled tunnel. Anyhoodle… out of words.
Last (also first) time I saw an endo was in July 2023. Heartless GP had set up the appointment for me and I thought it was going to be about, you know, my endocrine system and metabolism, etc. But it turned out she had made an appointment recommending bariatric surgery (!!!) which I would never have consented to and which I was too old for anyhow.
I was hoping for more this time round as Nice GP made today’s appointment asking for treatment re: weight loss for knee surgery suggesting THOSE injections. What the heck, worth a try? Anyhow, this endo was less dismissive than the first one but said she needed an up to date blood analysis (which should happen next week) and then she mentioned two drugs: Wegovy and Munjaro. And then came the clincher… they are only subsidised for treatment of type 2 diabetes, which presumably the new blood test will rule out. She said Wegovy was less expensive than Mounjaro (180€ vs 360€ per month) and my GP could prescribe one or the other for me after I get the blood test results. Then I go back to see her, the endo, in October.
So now what? I really don’t know. Obviously I can’t afford either of these drugs, but I’ll go get the blood work done and then take things from there.
casa azahar 