David Mathis (David Michael Mathis DO)

@fvckerysprinkle Biloxi MS …> Keesler AFB. Assigned there more than once throughout my military career. 🇺🇸🫡

A new study identifies a direct connection inside the brain that links stress to addiction‑related behaviors. The work shows how alcohol disrupts the natural stress‑response system, making it harder for the brain to adapt or make good decisions. ow.ly/36al50YKQPo

USS Idaho (SSN-799) has joined the fleet 🫡

I am a big fan of super low doses of GLP-1, as they have many benefits. They may help improve metabolic flexibility, reduce systemic inflammation, lower cardiovascular risk and quiet “food noise” and compulsive eating behaviors, all of which is good news for bodies as they age.

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I didn’t know, but your collaboration was inevitable. I like to put things out into the universe, in the hopes that if it wasn’t in the works, it’s soon will be. For example, I keep putting out that Eli Lilly, should announce that they will no longer sell their drugs through the three big PMs. This would lower drug cost by billions of dollars and would simplify the process. I’m going to continue to predict that this will happen with the hopes that the CEO, David Rick takes that action. I can’t wait to see what the two of you come up with.

The same companies you say are denying claims, are the ones you prop up buying access to formularies. Tell your members to stop being afraid of the PBMs and the insurance companies that own them, or they own. Your members selling to distribution at WAC and making up categories of Class of Trade to protect PBMs , is costing patients billions per year. Making your medicines unaffordable to many. I get that the PBMs can crush your sales with formulary manipulation, but if you truly care about patients , it’s time for you to stand up to them. Go to the DOJ and the FTC, tell them how it works. Or maybe you want to be able to use rebates to buy market share and let patients die or get sicker because they can’t afford to pay list price. The industry is broken. Stand up to it

Huge thanks to everyone who followed my brothers today and truly appreciate all the new friends who followed me. Let’s keep it going to grow stronger! 🇺🇸👊🏻

This week meant a lot. After 20 years working in emergency departments, I finally opened my own clinic. We’ve already seen patients. People have stopped by just to support us — even from out of state. The reviews we’ve gotten so far… honestly kind of surreal. Still waiting on signs. Still a lot to do. But it’s happening. KaufCare.

Grok provides an excellent summary of does once weekly dosing reach a steady serum state. Once a month dosing implies a half life of around 30 days and that it would take 5 months to completly metabolize the final dose of a monthly injectable medication. This pharmacology principle was taught in pharmacy school.

I see the hack. But the pill needs daily dosing to reach steady state, and at that point, the weekly dose is actually 0.25 mg x 7 days 🟰 1.7 mg per week (ish). This would track with the (very rough) therapeutic equivalences of 25 mg daily oral (14% weight loss) and 1.7-2.4 mg/wk injection. If you pull back to taking the 25 mg pill weekly to approximate 0.25mg/wk, steady state will probably never be achieved or be less than therapeutic levels if it is achieved.

Attention PK nerds, pharmacologists, and clinicians who actually understand serum levels: I haven’t seen this discussed, but it could matter for patients priced out of injectables. If a 25 mg oral semaglutide tablet has ~1% bioavailability, that’s ~0.25 mg systemically… on paper matching a 0.25 mg weekly injection. But given the variability and completely different PK profile, is a once weekly pill (or maybe twice weekly of a lower dose) even remotely comparable, or not even close? Do you smell what I’m stepping in?

What does not seem to be covered on this topic of different formulations and half- lives of the formulation is that taking a once daily medication implies around a 24 hour half- live and about 5 days, or 5 half lives- to totally metabolize the last dose. Once weekly dosing implies a half live of about 5 to 7 days, which indicates that it would take about 5 half-lives, or 25 to 35 days to totally metabolize the once weekly formulation. If there are serious adverse side effects the difference between 5 to 7 days to 25 to 35 days to metabolize the drug can have a signifcant clinical impact. Typically, in informed consent , I have not seen a discussion of what is the strategy to stop and safely get off a drug when it is clinically warrented discussed prior to prescribing medications.

I am picking up what you are putting down. Similar one week half lives. You should be able to approximate the lower subcutaneous doses (at a lower cost monthly cost) using the oral 25mg. Using oral 25 mg weekly being roughly equivalent to 2.4mg weekly, one 25mg weekly MIGHT be roughly equivalent to 0.34mg SC. The nice thing with the oral tablets is that gives you a much more level dose, so it’s possible that 25mg once a week might underperform a bit even relative to 0.25mg SC. But one could certainly experiment.

It is important to be aware of the half life of the GLP-1 or any medication. A decision to take a long acting formulation of any drug informed consent is not complete, if the patient is not adivsed on how to safely stop using the drug, and how long it will take to completely metabolize the drug if their are adverse side effects.

The most overrated GLP-1 metric is total weight loss. If the next wave of drugs does not preserve lean mass better, it is not a real upgrade. It is just a bigger number on the scale.

Today marks the 80th anniversary of the U.S. Navy @BlueAngels. Proudly based @NASPCOLA, these incredible aviators have inspired generations with their unmatched skill and dedication since 1946. Here’s to 80 years of representing the very best of our nation.

Witness the miracle of using advanced technologies in medicine! Influencer Jessica Tawil had a car accident in 2014 that left her paralyzed. Now she has just moved millions as she used a robotic exoskeleton to stand and walk for the first time in 10 years. It might be one of the most popular videos ever published on social media, demonstrating how advanced medical technology can help improve lives. A perfect advertisement for robotic exoskeletons, so maybe policymakers will start reimbursing their use more.

Affecting cognition by using stimulants has lead to heart conditions. Placing children, or adults on stimulants is not without risk. The interaction of neurotransmitters on cognition is complex and involves more than modulation of dopamine. Grok provides a summary on glutamate and dopamine on cognition and prompted me to ask about serotonin and cognition.

The overwhelming majority of my medical school class (2009-2013) was on stimulants, even if they never had an ADHD/ADD diagnosis or took them prior. Curious what things look like nowadays.

@MathisDo64767 Thank you for the follow. I have returned in kind. Very pleased to meet you Dr. Mathis. D.O.'s are my favorite. I have worked with many and prefer them for my care no matter the specialty. I enjoy their holistic approach and care for the life of the patient mission.