Susan Maria Leach
Founder of Bariatric Eating
Author Before and After - Living & Eating Well After Weight Loss Surgery (HarperCollins Publishers)
I've had an abrupt change of heart when it comes to taking weight loss medications after having Bariatric Surgery.
I have always been adamant that there is NOTHING after weight loss surgery. That is IT. What else can you do after having organs cut apart and rearranged or removed? It is the ultimate, last and biggest thing to do. Well, I was wrong. There IS something else and these GLP1 drugs are MAGIC! If you have not had Bariatric Surgery and are still considering it, STOP RIGHT NOW. There is no longer a need to have 80% of your stomach removed without first trying GLP1 medications. Period.
Where do I begin?
I had relented to the fact that while happy and healthy, I would never again be as slim as I was in the first years after my bariatric surgery. It was okay as I was happy with myself, my style and body type. I had settled into a look - body con long slim black dress with heels, a splash of turquoise jewelry and of course my silver hair in soft curls framing my face. Yep, I was truly the happiest Ive ever been with myself. Life is good at age 62, and definitely better than the alternative.
THEN, about ten days ago, I was drinking coffee at my computer and my friend Lynnda Shep posted a quasi cryptic message on Facebook about having lost lost over fifty pounds using one of the new weight loss drugs and that she finally feels comfortable talking about it. WHAT??? Just when I was at peace they pull me back in.
After reading her cathartic post, I headed straight down the rabbit hole of weight loss drugs. Of course I knew about Ozempic from catty remarks on TMZ and Social Media about the Real Housewives using it to slim down their already slim bodies. Surely this is not available to mere mortals, but it was and is. Where had I been that I missed any and all News of the Magic of these drugs and especially for those who have had bariatric surgery?
In a blink, it was 2am and I was reading, “Have you had Weight Loss Surgery regain and want help? The new class of GLP1 meds might be your answer.” Bariatric surgeons are on TikTok talking about these meds. The ones who know about them, love them. Especially for their WLS patients that can’t seem to get all the weight off with surgery. These meds are starting to be used to push people past stalls or to reel them back in from a regain. Nothing will help those who did not use surgery as a catalyst to change eating habits, but if you have changed your life and still struggle to maintain, this is for you!
Maybe I AM broken!
I eat good fresh food, in reasonable portions as my surgical restriction is still strong after 22 years, consume minimal bad carbs, don’t use sugar, and play golf at least three times a week for good exercise as our courses are the side of a mountain range and I have to hit the ball more than most. Yet I had managed to meander my way back over two hundred pounds again. How the hell does this happen???
It is the irrefutable proof that the way I process food is broken. Lynnda had come to this conclusion as well after a six week exercise boot camp produced a silly three pound weight loss when the rest of the class had lost twenty or more.
She excitedly shared that the Mounjaro she was taking was Freakin Magic! Since she also eats healthy small portions and exercises regularly, the simple addition of this medication produced the mind-blowing results that had eluded her after her bariatric surgery had aged. She gave me a quick primer on the three drugs that people are taking - Mounjaro™, Ozempic™, & Wegovy™, also known as GLP-1 medications.
The small problem is that Mounjaro™ and Ozempic™ are diabetes meds and if you do not have type 2 diabetes, your insurance will not cover them. While Wegovy is Ozempic relabeled for weight loss, it may or may not be covered by your health insurance but most do not cover weight loss medications.
Many primary care docs are sticking to diet and exercise as their hill to die on and will not use these meds off label, meaning for weight loss rather than diabetes. So if a prescription friendly doctor is a coin flip and the high price is not covered by insurance, what can I do? How do I get them? I need them now!
Enter Heroes
Lynnda told me about Mochi Health. (https://www.joinmochi.com) Its founder and CEO Dr. Myra Ahmad has one of the smartest and most modern comprehensive weight loss strategies I have ever read. When I read her Mission info, I was all in.
Through Mochi, I can make a telemedicine appointment with an MD who is board certified in Obesity Medicine, who can assess my current health status and provide me with an evidence based weight loss plan that may include these *new* prescription medications. With Mochi there is no judgement and they understand it’s not always just diet and exercise.
I joined Mochi Health for a three month membership on Monday, checked the Next Available box for selection of my doctor, and the calendar of Dr. Leonid Kim showed an availability the following Monday at 9am. Click. In the meantime, I completed a multitude of medical questions so that before our session, Dr. Kim could see where I was with my health and weight. I also uploaded my last couple sets of lab results as I monitor my labs in order to treat any bariatric deficiencies should one occur. I met with Dr. Kim virtually and we spent a solid 45 minutes talking about my RNY surgery and how I live. He concurred that Mounjaro would be an appropriate medication for me.
After our appointment, he sent the prescription through to the drugstore listed in my profile. My insurance will not cover this medication, but there are work arounds, using GoodRx is one, downloading Eli Lilly coupons are another. However prepare yourself for $500 a month to $1250 a month for the name brand trademarked medications.
Another option is to order a compounded medication through pharmaceutical labs that Mochi Health has vetted. Compounding means that the lab combines the active medication and combines it with another substrate, usually a B vitamin, that allows it to be marketed at a lower price than the trademarked brand name. Mochi Health has contracted with several large FDA monitored labs throughout the US to offer compounded Tirzepatide for about 1/3 less than the brand name Mounjaro at $325 a month. With a difference of just $175 a month, I am choosing to inject the brand name Mounjaro. With the Mounjaro coupon on their brand website, I paid $500 even. Ouch, but in all fairness, I spend that on Happy Hours in a month, so I will reapportion my funds.
Okay, so here we go!
Three days after my chat with Dr. Kim and a trip to CVS, I had the box of Mounjaro on my desk. Four prefilled single dose self injecting syringes.
I stared at them for about an hour as I watched forty three You Tube Videos demonstrating how easy it is to inject yourself.
No one had any stories similar to my unique issue. I can't do medical procedures on myself. When an older gentleman at our country club was walking back to his seat in one of our restaurants and fell to the floor, I was the first one to get to him, use my dinner napkin to put pressure on his head wound, assess his situation, yell for someone to get help, and calm him while we waited for the EMT’s. I'm the one you want in the room when you hurt yourself.
However, I am paralyzed when faced with doing any medical procedure on myself. After knowing me for many years, my plastic surgeon said with absolute certainty that I could remove the drain coming out the top of my FUPA below my tummy tuck incision by snipping the single stitch securing the tube, taking a deep breath and pulling it out. He knows I am a ‘confident doctor’ in my own mind. Ahhhh, but in reality when I sat on a towel on my bed and attempted to pull the tube, upon seeing how long it was, I passed out and fell off the bed, giving myself a concussion.
Back to the Mounjaro shot - I washed my hands, wiped my target spot with alcohol, removed the bottom stand from the Mounjaro pen, and toyed with pressing it against the flesh of my thigh. Yeah, I'm good. I slid the lever from Locked to OPEN. I put on my reading glasses and looked at the needle. Again I smushed the pen against my thigh BUT COULD NOT BRING MYSELF TO PRESS THE PURPLE BUTTON. I was frozen. Could not press the purple button. I lightly touched my thumb to it but could not muster the courage to press it. I sat there for 30 minutes thinking about pressing it.
Bring In The Big Gun
I sent Lynnda a text. ‘Hey, I cant press the button. Seriously.’ She replied ‘Call me.’
Me: Hey I cant press the button. This is nuts, I cant make myself do it even though I know it doesn’t hurt. The needle is tiny and as thin as a hair.
Lynnda: silence… then, DO IT! DO IT! DO IT NOW!’
Me: But I canttttttttttttttttt.
Lynnda: Yes you can, DO IT DO IT DO IT!
Me: I cant make my thumb work. I know its stupid but I cant.
Lynnda: Sue, go get an ice cube, put it on the spot until its numb, re-wipe it and then do it. You are tricking your brain as now you will KNOW you’ll literally feel nothing.
Me: Good Idea! I’ll call you back.
Me: I DID IT!
The entire dramatic scene was so silly as it didn’t hurt at all and was over in three seconds. I already know my thumb will not work next time either.
And Now We Wait...
By the time 4:30pm rolled around, my husband appeared at the door and said he wanted to go out for a beer and some supper. I had been waiting for the side effects to descend upon me for the last three hours but I felt great, so I put on my makeup and we headed out.
We went to supper at one of our club restaurants. I had a gin and tonic and ordered each of us a Greek Salad with salmon. I ate about half of it but it's not a huge plate to begin with. At home we watched Wheel and Jeopardy. I made Ty a bowl of shortcake and I ate a couple spoonfuls of the homemade blueberry compote.
We go to bed early and occasionally I have a full feeling when my food has not ‘cleared’ by the time I lay down but last night I felt like I was drowning. When I turned over at 3am blueberries were in my throat. Not bad enough to gak them up but enough to wake me. I am sure this was an effect of the Mounjaro I had injected mere hours prior.
Note to self: although I did not eat a large supper last night, I will need to eat less even with my very strong bariatric restriction, and nothing immediately before bed. The food definitely will remain in my very small stomach longer with this course of medication. The drug had not been circulating in my system for even 12 hours and already was creating a marked difference.
Woke Up the Morning Feeling a Little Full
It has almost been 24 hours since my Mounjaro Injection and I do not have any of the laundry list of side effects people love to moan about on Facebook. I feel great but by noon I still felt that I had not digested my supper. I could taste Blackened Salmon on top of Caesar salad. I'm sure things will level out as my organs slowly being to turn.
Well, thats it for now. I will let you know how things go as I lose my target of 60 pounds. Cautiously optimistic but excited for what this could bring.
