The Bermuda Triangle is a loosely defined patch of the western North Atlantic, roughly bounded by Miami, Bermuda, and San Juan, Puerto Rico, that became famous for supposedly unexplained disappearances of ships and planes. The legend came from a series of events starting with Flight 19, five Navy Avenger bombers lost on a training flight in December 1945, plus the rescue plane sent after them. Before that, the USS Cyclops, a Navy collier, vanished there in 1918 with over 300 aboard. A 1964 magazine article coined the name, and Charles Berlitz’s 1974 bestseller The Bermuda Triangle turned it into a pop-culture mystery, with explanations ranging from Atlantis to alien abduction. But what the evidence says is that the area doesn’t have a higher loss rate than other heavily traveled stretches of ocean. Lloyd’s of London and the U.S. Coast Guard don’t treat it as unusually dangerous, and insurers don’t charge extra to cross it. Many “mysteries” turn out to be exaggerated, mis-located, or ordinary accidents in bad weather. Flight 19, for example, is best explained by navigational disorientation, deteriorating weather, and running out of fuel over open water at night. Real hazards do exist in that zone since it’s one of the busiest shipping and flight corridors in the world, so more traffic means more incidents. It also has sudden squalls, hurricanes, the fast-moving Gulf Stream (which can scatter wreckage quickly), and some very deep water like the Puerto Rico Trench, making debris hard to find. In short, it’s a real place, but perhaps a manufactured mystery.
As a figure of speech, “the Bermuda Triangle” means any place or process where things go in and inexplicably never come out. It’s usually humorous and implies the losses are mysterious, or at least nobody’s taking responsibility. The dryer that eats socks, the couch that swallows remotes, the junk drawer, the office inbox, or the bureaucratic department where paperwork, emails, or requests vanish. “Sending it to legal is the Bermuda Triangle.” For lots of us, money finds its way into the Bermuda Triangle, never to be seen or heard from again. The phrase carries a bit of irony too. Since the real Triangle’s mystery is mostly myth, calling something a “Bermuda Triangle” often hints that the disappearances have an ordinary, if unflattering, explanation. Nobody’s looking closely enough. Hold that thought.
Zepbound is the Eli Lilly trade name for its only active ingredient… tirzepatide. Tirzepatide is a synthetic peptide that acts on both GIP and GLP-1 receptors, which are docking sites on cells that respond to two gut hormones called incretins. Your intestines release them after you eat, and they tell the body that food is arriving so it can manage blood sugar and appetite. Pharmacologically it’s classed as a GLP-1 receptor agonist and a glucose-dependent insulinotropic polypeptide receptor agonist. Sounds as scary as the Bermuda Triangle, right? Zepbound is specifically prescribed for Obstructive Sleep Apnea (OSA) and weight management (codename FAT). About 7 in 10 American adults carry excess weight. CDC’s latest NHANES data show 40.3% of adults aged 20 and older had obesity between August 2021 and August 2023, with 9.7% classified as severe obesity (BMI ≥40) and another 31.7% overweight (BMI 25–29.9). For perspective, obesity among adults 20–74 rose from 13.4% in 1960–1962 to roughly 40.8% in 2021–2023. Sounds like an epidemic. As for OSA, the older, commonly cited figure put prevalence at 12% of U.S. adults, or 29.4 million people, nearly 80% of them undiagnosed. A newer 2025 analysis that adjusts for today’s obesity rates is much higher: 83.7 million adults aged 20 and older were estimated to be living with OSA in 2024, 59% of them male. That works out to about 32% of U.S. adults, with roughly 80% undiagnosed or untreated. The two conditions are tightly linked. Excess weight, particularly around the neck and abdomen, is the primary modifiable risk factor for OSA, and risk rises sharply after age 60. That overlap is why tirzepatide, the dual GIP/GLP-1 drug, also gained FDA approval for moderate-to-severe OSA in adults with obesity.
I first had a sleep study in 1993, ostensibly for snoring. I was told I didn’t have apnea, but was a world-class snorer. After a few less effective treatments (the painful jaw-jutting mouth guard and the very unpleasant NYU laser surgery to cut off my uvula…yep…gonzo), I’ve been sleeping with a CPAP machine for almost 30 years…and it has worked beautifully. So, it’s safe to say that as a member of a form of OSA and the FAT club, I was a prime candidate for tirzepatide. Zepbound was introduced in December, 2024 and I started it (it was my idea, not my doctor’s) nine months later. I started using vials and syringes and graduated to the Multi-dose KwikPen.
I’ve now been on Zepbound for a year. That’s 52 weeks where the first 24 were a gradual titration from a weekly injection of 2.5ml gradually up to 15ml, where’ve been for the last 30 or so weeks. Given that Lilly Direct has made $5,448 from me and insurance, which damn well should have covered a lot of that, has paid $0, I would say that my medication budget went into a version of the Bermuda Triangle. I have written about how Aetna and Optum-Fucking-RX have given me the runaround since July in allowing me to get coverage for my Zepbound to reduce that hole in my wallet. Well, yesterday, I got my first shipment of Zepbound from OptumRX (note the removal of the “Fucking” part of their name since I don’t want to piss them off and go back into the Bermuda Triangle of prescription pre-authorization), and it was in the third form of four weekly AutoPen injectors. I now have two months of KwikPens and one month of AutoPens, so I have a tirzepatide stash of sorts on hand. You know Eli Lilly is coining it when a highly controlled substance is sent to you earlier and earlier over a year and you are able to stockpile it. Last I checked, Eli Lilly understands the calendar as well as I do.
Most of Zepbound’s side effects are digestive. They’re usually worst when you start or move up a dose, and they tend to ease over a few weeks. There is also an inter-week cycle where is starts of tight and then loosens up towards the end of the week. The most common side effects are nausea, diarrhea, vomiting, constipation, stomach pain, indigestion, burping and acid reflux. There can also be fatigue, pancreatitis, gallbladder problems (if I had a gallbladder, which I haven’t since 1988), kidney injury, low blood sugar, dizziness, mood changes, and even suicidal thoughts. I have had many of these side effects though the only suicidal thoughts occurred while on hold with that clarinet music with OptumRX. None of them have been too severe and they are all worth the price (especially now at $60/month rather than $454/month).
Today is overcast here and I feel a little dizzy. Dizziness isn’t on the label’s short list of “most common” side effects, but that list only covers reactions seen in at least 5% of patients. Dizziness falls just below that cutoff, so it appears in the full adverse-reactions table but not the headline list. I don’t have low blood pressure, so it’s probably from a combination of dehydration from eating and drinking less. My one remaining blood pressure medication (Ramapril) may need adjusting as I’m losing weight, so I’ll stay on top of that. In any case, I feel like I can rest easy and consider myself finally out of the Bermuda Tirzepatide.