Atlas

You cannot feel an oligodendrocyte dying. The cells that insulate your nerves, that make thought fast and movement precise, undergo programmed death quietly, cumulatively, without pain. A compressed cord loses its myelin the way a forest loses its canopy: leaf by leaf, no single loss registering, until one afternoon the light has changed entirely and you cannot remember when. The remedy is not vigilance-as-fear. It is attention to the small signal, early. It is trusting the report of the partner who says you walk differently now more than the report of our own felt sense that everything is fine. The self is a late witness. The people who love us, and the clinicians who examine us well, can sometimes read the whisper before we can.

The body does not always scream when it is injured. Sometimes it speaks in dropped cups and missed buttons and a hand that numbs briefly and recovers. We are trained to attend to the dramatic — the fracture, the bleed, the cry for help. We are not trained to attend to the whisper. But the whisper is where pathology begins. By the time the body shouts, it has often been trying to tell us something for months. A spinal cord under chronic compression does not ache the way a torn muscle aches. It dispatches odd, inconsistent symptoms and waits to see if anyone is listening. There is an ethics in this. To hear the whisper requires a posture the modern clinical encounter rarely allows: sustained attention to the small, the strange, the easily dismissed. It is slower than diagnosis by algorithm. It is less impressive than the dramatic save. And yet the quiet seeing is the more consequential act. A cord caught whispering can be preserved. A cord caught shouting has often already lost what it was warning us about. The clinician who learns to listen to whispers is doing nothing less than protecting the future self of the patient from the carelessness of the present encounter. The question is never only What is wrong? It is also What is this person trying to tell me that they don't yet have the words for?

@BrianSuttererMD Delivered in a sparkling soda!

@TheRealOpsGuy @HoosierKid31 I take a cloth hand towel, get it wet, and nuke it in the microwave for 30 seconds. Then wrap the syringe in the hot towel for a minute or two.

Been on TRT for 10 years, cyp is relatively easy to pin. 3xwk, easy to remember & execute against. 1 think I didn’t do until recently to reduce same spot tenderness is: Draw your dose Grab a deep coffee cup Fill with filtered water Heat for 60 seconds in the microwave Throw capped syringe (needle down) Go do something else for a few mins come back pull and pin SMOOTH AS BUTTER 🧈 Water temp: a bit over luke warm PS that’s only if doing IM. SubQ forget everything I said. PPS if doing IM, draw with an 18 gauge vs your pinning needle Enjoy brother!

My TRT test is on the way. I have a tracking number and a delivery date. 📫 To say I'm excited is an understatement. 🙌 The ester is cypionate. I plan on pinning 3x a week on the same days to keep it simple. M/W/F. Anything else I should know or consider? ❓❓

@DrDavidSLiu @EvidenceOpen @CedarsSinai yes, but it will be a trade school where you learn motor skills to treat the patient.

@EvidenceOpen @CedarsSinai Wow, do we still need medical school?

Until now, physicians using AI in clinic had to assemble the patient’s context themselves. Allergies, comorbidities, medications, prior procedures, copy-pasted in from the chart. Today we’re announcing a partnership with @CedarsSinai. OpenEvidence now works directly inside Epic, drawing on the patient’s full record and interpreting the medical literature through the lens of that specific patient. Cedars-Sinai is the first academic health system to deploy patient-aware clinical intelligence at enterprise scale. The clinician asks a complex question in natural language. The answer reflects both the best available evidence and the patient in front of them. Patient data is never stored after the clinical session or used for any other purpose.

@ygivenx @EvidenceOpen @CedarsSinai I think the accuracy falls on the shoulders of the doctors. Use AI to gather information and make recommendations, but also double check it and question it if it doesn't add up.

@EvidenceOpen @CedarsSinai Very interesting. How do you measure the reliability of this agentic system?

@TTL_inc @jyendurance @maxmarchione Side effects include lower LDL, triglycerides, blood pressure, improved blood oxygen during sleep...

@jyendurance @Atlas_adjust @maxmarchione Peptides are naturally produced in your body. I know multiple people who've been taking them for years with zero side effects.

Retatrutide phase 3 obesity trial just came out and the results are genuinely insane: - 28.3% bodyweight lost on 12mg over 80 weeks - 70.3 pounds on avg. or 31.9 kg - 45.3% of patients hit 30%+ weight loss (this is bariatric surgery territory) - 30.3% weight loss (85 lbs) at 104 weeks in higher-BMI patients - 65.3% of 12mg patients dropped below the obesity BMI threshold - 19% loss on 4mg over 80 weeks (47.2 lbs) with fewer dropouts than placebo (4.1% vs 4.9%) - significant drops in blood pressure, triglycerides, non-HDL cholesterol, waist circumference, and hsCRP - no cardiac or liver signals Retatrutide is going to completely overshadow tirzepatide and semaglutide, and take the throne as the best-selling drug of all time.

@drmikehart Absolutely!

If you are taking a GLP-1 drug, strength train 3x/week and eat 1 gram of protein per pound/day.

@jyendurance @maxmarchione Have you even been obese?

@Atlas_adjust @maxmarchione if you're morbidly obese you can lose the fat naturally.

@jyendurance @maxmarchione Imagine how much you pay if you're morbidly obese.

@Atlas_adjust @maxmarchione every shortcut or quick fix be it steroids/anabolics, peptides, ozempic you will pay eventually. either in patience, or side effects and consequences in the (near) future.

@jyendurance @maxmarchione Why not both?

@maxmarchione peptides this peptides that how about some natural willpower to not be a bitch instead of injecting

@stackapp @maxmarchione Because they don't know any better?

@maxmarchione It will do well, but most Drs will prescribe Tirz over Reta

Participants with ≥10% baseline liver fat saw mean relative liver fat reductions of 81.4% at 8 mg and 82.4% at 12 mg, with 86% of the 12 mg group reaching normal liver fat (<5%) by 24 weeks. The reductions kept going through 48 weeks. That's hepatic steatosis essentially resolving in the majority of treated patients.

@TheBodtrainer @maxmarchione At 48 weeks on 12 mg, roughly 74–76% of weight lost was fat mass, with 24–26% lean mass.

@grim_tonal @maxmarchione I know a guy in Germany who is on 12mg a week.

@maxmarchione why invest in better food quality and production when ts exists literally no market for this in EU for a reason

@TheBodtrainer @maxmarchione Wait. Have you not tried reta yet?

@maxmarchione I wonder if Lilly and I use the same Chinese supplier. Great price but slow shipping!

How your cervical motor control looks in the first six weeks after whiplash predicts where you’ll be twelve months later — not your pain score, and not your imaging. Stenneberg and colleagues, in a 2017 systematic review, found that reduced active cervical range of motion and disturbed kinaesthesia in the early weeks were established predictors of chronic disability at one year. Two patients can have identical MRIs and identical acute pain scores. The one whose deep stabilizers are already substituting — already delayed, already running the wrong muscles for the job — is the one who becomes a chronic case. Boudreau and colleagues showed that novel motor skill training drives measurable cortical reorganization in the direction of recovery, in a way that general exercise and passive treatment do not. The window for changing the trajectory is early. In whiplash, movement-based evaluation in the first weeks is the most prognostically accurate tool available — more than the scan, more than the pain scale, more than time. adjust.clinic/adapting-witho…

@YannickBuccella X-rays can have a hormesis effect too.

This is absolutely wrong, CT scans do not cause cancer. One CT scan equals the radiation dose of roughly one year as a long haul pilot or FA, because you are also exposed to radiation up in the air above 30000 feet. We need CTs for staging of almost every cancer, especially lung cancer for example, as an MRI is not useful here. If you don’t have a CT scan every day, your patient journey as a cancer patient will most likely never see a total radiation dose more than that of a pilot’s career. And we don’t see a cancer pandemic amongst pilots and FAs.

@pepfessions @drmikehart Link?

@drmikehart I mean I can buy cocaine for 20$ a gram with 50% chance of fentanyl or wasting my time and money or 200$ a gram from Columbia without any surprises I'm picking the columbian. And anyone picking the 20$ gram should consider confessing

You can't expect people not to buy grey-market peptides when they're 1/10th the cost.