Me: examining patient with weird CNS complaint "Well let's send you to neurology, I'm concerned" Patient: ....how concerned Me: Um well let's get a second opinion from the experts Today, check EPIC notice that patient is getting entire CNS MRI w/wo contrast 😬😬😬

It's also on the WADA anti doping monitoring list for 2026 along with caffeine and nicotine but WADA doesn't want you buzzing on caffeine and wants you to lose weight the old fashion way* * But also Zepbound is probably performance enhancing no joke

Amazing that such phenomenal results are available with modern medicine. Much has been written about Ozempic and it's benefits over the last few years, but the reality of this trial is that Mounjaro is actually *better* in multiple ways and also we're still improving upon these drugs!

Really questioning this study for a few reasons. It comes to opposite conclusions about glucagon in regards to lipid oxidation, it proposes a GCGR antibody can slow DKD when we know GCGR antibodies have failed in human trials. It doesn't seem to focus on other downstream effects.

Do you want to decrease your chance of dying? Take tirzepatide. Do you want to preserve kidney function? Tirzepatide. My latest blog post on the remarkable data from the SURPASS CVOT trial. We live in a time of medical miracles. Please read and share

Do you want to decrease your chance of dying? Take tirzepatide. Do you want to preserve kidney function? Tirzepatide. My latest blog post on the remarkable data from the SURPASS CVOT trial. We live in a time of medical miracles. Please read and share

4 year old requested steak tonight. We had a beautiful flat iron steak in the freezer so I dry brined it, seared hard to 120F and served with homemade potatoes gratin. She loves it all!!

Lookie what made the WADA anti doping monitoring list for 2026! Caffeine(party poopers!) But also tirzepatide and semaglutide! I've said before tirzepatide especially might give a performance benefit due to GIP helping directly with insulin sensitivity/glucose uptake.

Sunday morning medical thoughts: Stop prescribing hydralazine Insulin for type 2 diabetes should be like 3rd or 4th line Losartan sucks and is usually inappropriately dosed. Telmisartan is infinitely better. We should draw screening ferritin levels for all women under age 50

Good Saturday evening to all. My beverage to sip on for the evening courtesy of the best brewery in ATL

Childhood nostalgia but as an adult beverage!!

Two thoughts: What fresh hell is this? *rubs temples* Also these MFers said we give "too many shots" and now are recommending EVEN MORE SHOTS.

Friday morning mood as I head to the clinic (It's a kick ass cover too, the fiddle solo mid song is *chefs kiss*)

Of the many dumb things he's done, this is probably the dumbest. This will actually hurt people very very quickly. This is actual fucking madness.

2 years ago today I took the first dose of what ended up being retatrutide. 21 tubes of blood. One injection in front of the lead investigator. I was the 498th patient (out of 2300) to get Reta. My life has wildly changed for the positive because of it. Can't wait for the trial data on spring 2026!

Almost done writing up my SURPASS CVOT blog. Made a little graph using data from a couple trials to visualize the GFR slope decline and uh. Oh my, Tirzepatide 😳😳

Almost done writing up my SURPASS CVOT blog. Made a little graph using data from a couple trials to visualize the GFR slope decline and uh. Oh my, Tirzepatide 😳😳

GFR slope decline for tirzepatide: -1.66ml/min/year in the high risk CKD population based on the data presented at yr 3. -1.35ml/min/year when extrapolated out to yr 4 Semaglutide in the FLOW trial was -2.19ml/min/year over yr 4 That's staggering @brianrifkin.bsky.social @hswapnil.medsky.social

Just gonna slide these 2 slides in. Reduced UACR, reduced decline in GFR slope in surpass CVOT trial and these high risk patients died less(about 16% reduction in all cause mortality). I imagine thanks to tirzepatide they had reduced inflammatory markers but I don't have that data just yet...

Eli Lilly & others vs Big Food. Weird to see the two compete directly against each other but my money is on the pharma companies. The drugs are getting more potent, though the lack of access is creating a huge issue right now that Big Food is capitalizing on.

If you wanna know the toll that the anti vaccine rhetoric is having on regular people, I had to convince an 80 year ON OXYGEN WITH LUNG DISEASE that she needed her COVID and flu vaccine this year after she took it religiously without issue in prior years 🙃🙃

That didn't take long. Already have a patient asking about the safety of Tylenol and it's link to autism. *Sigh*

When your last patient of the day has physical exam findings that are so concerning that you're putting in an urgent referral to a subspecialty clinic at your research hospital while maintaining a calm and cool demeanor in front of them so they don't panic

I'm an autistic adult and I don't have a disease. I just think differently. There's nothing wrong with me. In fact I joke it's my super power because I remember damn near every random fact and figure! It's super helpful for my job in healthcare! I hate this so so much

It's a remarkable state of things that we have a drug that reduces your chances of dying of any cause by FORTY PERCENT and reduces your risk of cardiovascular death, stroke or heart attack by 28% if you're a diabetic and yet barely a peep from traditional media. @proptermalone.bsky.social

I've been on some form on GLP-1 med for nearly 2 years and still sometimes they catch you off guard. Woke up absolutely starving and had a small breakfast thinking that would end it. It didn't. So I started drinking a protein shake. Halfway through the protein shake the satiety hit and now I'm like:

This is a really good write up. It's also likely that women have larger effect size for the better weight loss meds. www.nytimes.com/2025/09/18/w...

So apparently we're ruling out leptospirosis in the primary care office today. Not on my Friday bingo card

Reposting this one more time because after sleeping on this I can with minimal hyperbole state this is trial and its results are utterly incredible. A 40% reduction in death from a subcutaneous shot once a week sounds like science fiction but it's now reality. Incredible news. Science rules.

For all my #NephJC friends please note this that in high risk CKD Tirzepatide STOPPED GFR decline for 2 years! And that's not a placebo comparison. That's against dulaglutide. That's incredible. Even in the general population it delayed GFR decline for about a year.

This isn't tirzepatide vs placebo. This is a 6-26% reduction in all-freaking-cause mortality compared to dulaglutide. Just ridiculous. Statin mortality reduction in high risk population is around 10-15% compared to PLACEBO.

It's finally here! SURPASS CVOT trial results! This is an interesting blend of benefits. The quick summary is tirzepatide is better for renal outcomes, A1c, weight and all cause mortality. For cardiovascular outcomes it's essentially equivalent/slightly better to a monoagonist GLP1. Let's dive in 🧵

Gonna quote this to point out the average LDL cholesterol of these tirzepatide patients was 80mg/dl. So their cholesterol was already controlled and STILL a large reduction in mortality was observed. Unprecedented in modern medicine.

It's finally here! SURPASS CVOT trial results! This is an interesting blend of benefits. The quick summary is tirzepatide is better for renal outcomes, A1c, weight and all cause mortality. For cardiovascular outcomes it's essentially equivalent/slightly better to a monoagonist GLP1. Let's dive in 🧵

Diving further into these results, and coupled with now 2 trials of orforglipron in diabetics there seems to be some rate limiter in terms of weight loss. I've never seen diabetic weight loss mirror obesity weight loss. But the authors note the trial patients were NOT on a hypocaloric diet 🧵

COVID and flu shot done and updated!! My 4 year old picked out my post vaccine sticker 🥰

Good Lord I cannot wait for these results!!! Ahhhhh

Diving further into these results, and coupled with now 2 trials of orforglipron in diabetics there seems to be some rate limiter in terms of weight loss. I've never seen diabetic weight loss mirror obesity weight loss. But the authors note the trial patients were NOT on a hypocaloric diet 🧵

Lord the GLP-1 news cycle is out of control. Another orforglipron trial. This time against oral semaglutide. Better weight loss and A1c control (-2.2% in 52 weeks!!!) with orforglipron. Downside? More side effects than semaglutide unfortunately. investor.lilly.com/news-release...

More thoughts on this tomorrow, but looks like lower dose semaglutide at first reading. Some interesting confounders such as a whole bunch of placebo patients quitting the trial because of lack of weight loss/efficacy!

4 month update on my sister's retatrutide trial: She's down 30lbs now! Nearly 2lbs a week for 16 weeks straight. Triglycerides down 63% Total cholesterol down 21% LDL down 14% VLDL down 38% GFR is up ~9% Endometriosis symptoms have significantly decreased. Just amazing drug as always.

Big GLP1 news of the day! New Tirzepatide vs Retatrutide for the treatment of fatty liver disease, and this unique trial design. Initially a 2 year trial where you either get one of the 2 drugs or placebo. BUT THEN after 2 years everyone gets the drug if they want it. No placebo!

Big GLP1 news of the day! New Tirzepatide vs Retatrutide for the treatment of fatty liver disease, and this unique trial design. Initially a 2 year trial where you either get one of the 2 drugs or placebo. BUT THEN after 2 years everyone gets the drug if they want it. No placebo!

Hit the 50k mark and decided that I was happy with a 50k PR, despite being seriously undertrained. Beautiful day to spend in the woods!

Update. Half way down in just under 4 hours. 22 miles to go!

It's 55 degrees out. Pitch black. It's about to start pouring rain. Sounds like the perfect weather to run a 40 mile self supported ultramarathon. Catch y'all on the flip side.

Tomorrow morning I'll start running. And I'll keep running. I turned 40 this year. It's only proper I run a 40 mile trail run along a trail called The Dragon, self supported the whole way. I haven't run an ultramarathon in 3 years. Will I make it? Will I implode? Don't know but can't wait to try!!

As heard at the conference I'm at today: "No one can tell you take a blood pressure medicine, or metformin, but **EVERYONE** can tell when you're losing weight with a GLP-1 medication, and some people will celebrate with you and other people will hate you for it"

Name a more Midwestern dinner. Pierogi, sauteed onion and smoked kielbasa(not pictured)

Primary trial results for SURPASS CVOT drop in 5 days but this presentation is the one I'll really be looking at!! Especially if this has kidney parameters as part of the metabolic discussion.