Just an update: I've been diagnosed with drug-induced peripheral neuropathy (DIPN) in my feet from tirzepatide (zepbound). Titrating down on the dosage and then switching to semaglutide has halted the progression, but my neurologist tells me that the initial damage is likely permanent -- fortunately, it's sensory, without pain. I've been on trazodone for migraines which worked well, but ultimately produced tingling and numbness in my arms, so perhaps I had a propensity in this direction. At any rate, it's a known, extremely low probabillity (< 0.4%) side effect.

For what it's worth, I was ultimately diagnosed by neurologist who works with cancer patients. For them, DIPN is a horse -- it occurs in 60% of chemotherapy patients, so they are familiar with it and know how to identify it. For any other neurologist, it's a zebra -- it's so unlikely that they rarely consider it. I was referred to oncology when my PN labs indicated MGUS. Turned out to be a temporary indicator of a prior infection, but it got me in the door to the right person for a diagnosis.

I'm old enough and have been on enough drugs over the years that sooner or later the odds were going to catch up with me, and I would be one of those people who actually turn out to have one of those extremely rare side effects. If we took seriously the possibility that we would be that person, we would probably never take any drugs, and would just die young and in pain from something that could have been treated. So most of the time, I'm just philosophical about losing this particular lottery. Some of the time, though, I can get a bit bitchy about it.