Jerome, DO ☘️

@VikingRobVWO 3rd 🤙🏼

34th. 💪

@xrgifs @BuckeyeGrad1999 @HansAmato If you’re training hard enough that you need 200+g of protein per day, then you are an athlete, the office job is irrelevant. And you better also have a nutrition plan and eat those other foods. Access to the information easy, anyone can find it and read online

@BuckeyeGrad1999 @HansAmato Also athletes have access to and focus on everything like nutrition plan and other foods that helps to digest heavy amount of protein. Normal people after office jobs have no way to burn all the food required to consume 200 gm of protein.

The gym bro eating 200g protein a day has the same testosterone as his 55 year old dad Half that protein is rotting in his gut instead of building muscle His stomach acid is gone. Protein isn't breaking down. Bacteria are feeding on the undigested food and producing a toxin that goes straight into his blood That toxin suppresses the cells in his balls that make testosterone. Directly So he eats more protein. His gut ferments more of it. More toxin. More inflammation. Lower T. Worse recovery. Less muscle. More fat around the waist His doctor says 380 is "within range" Meanwhile the guy at his gym who eats less, trains 3x a week, and tracks nothing is growing faster His gut works. Same chicken breast. One guy turns it into muscle tissue. The other turns it into bacterial fuel Had a client drop from 200g to 120g protein while we fixed his gut. Put on more size in 8 weeks than the previous 6 months Ate less. Grew more Because he was finally absorbing what he ate instead of fermenting it Your gains are behind your digestion full breakdown on my substack. link in bio

@work_distract_ Haha the day I signed out of post is the last day I was clean shaved in nearly 2 years

I’m going to use Chris’s post to try and get a greater reach. How many of my fellow vets grew a beard as soon as they could when they got out of the service?

@Katheri91933801 @AshleyGWinter now I feel fortunate. I guess that’s like “the man who complained about having no shoes until he met the man with no legs” kinda thing.

@jjbarron @AshleyGWinter Our lab wont reflex to a culture at all. It’s quite annoying.

The most common lab criteria for UTI, >100,000 cFu/ml, was derived from one study over half a century ago in asymptomatic patients and makes no sense for defining a UTI in SYMPTOMATIC patients.

@SGTWipper1Each Resiliency. The things that my colleagues get all spun up about are sometimes laughable. I learned to just roll with things, be comfortable being uncomfortable. Just do the work.

What skill from the Military do you use the most in your civilian life?

@ApuAkkad1 @Ee_Oulo What i don’t want to create in clinic is when patients say “I’ve had all these UTIs” when in fact there’s never been any UA that actually supports the diagnosis and their symptoms just keep getting chalked up to a UTI, perhaps incorrectly

@ApuAkkad1 @Ee_Oulo My clinic approach: Classic symptoms + history of UTI (because they can relate those symptoms). I’m probly gonna treat if something else isn’t more likely while we send urine Symptoms and no history, I usually wanna see at least one thing positive in the urine

Agree. Quantity of bacteria in urine has no true real world value. If pt is symptomatic, pyuria on UA etc- then treat. If asymptomatic - unless meeting specific criteria (can anyone name?)..don’t give antibiotics

@Ee_Oulo @ApuAkkad1 Pyuria is most sensitive but nitrites are most specific. LE is more sensitive but less specific than nitrites. If I have a symptomatic patient with +LE and Nitrites on dip, I treat

@ApuAkkad1 Thanks. I was under the impression + nitrites is definitive + uti

@DanyRaeArras @SassySouthBlond @AlanRoberts Big picture, 2 vs 3oz of most things, doesn’t matter. Err on the side of caution, round up. It’s about progress, not perfection.

@SassySouthBlond @AlanRoberts yep. 1tsp butter vs 1tbl sp butter over time adds up to a lot. even counting calories is hard because idk was it 2oz of OJ or 3oz? plus its boring. the level of consistency required makes life pretty bland. I count myself among the people who can do it for 2-3 weeks then give up

This is gaslighting women to believe that a 130-pound, moderately active woman can eat 1200 calories and maintain weight. Even with PCOS, the BMR would be reduced by 10%, putting it around 1200, and activity would create the deficit.

@SassySouthBlond @AlanRoberts And that was good advice. The “where do I start”. The absolute most simple starting point: Eat whatever you normally would. But only eat half.

I was eating pretty clean and counting my calories and had to cut everything I was eating in half to lose weight. I was in a deficit, so I thought. I finally started cutting. We eat more calories than we think is the thing. Unless you are weighing foods and dolling out portions carefully you have no idea. Our portions in America are huge. Especially restaurants. I just had to avoid them completely. There was no other way. I went to my doctor and he was like tell me everything you are eating in a day when I told him my weight loss plateaued. He is a trainer and a pretty good dietitian. He said take everything you eat and cut it in half for a month and message me the results. I did it and it made a huge difference. I wasn’t even that hungry. I drop 2-3 pounds a week now. I am about 5 pounds away from my goal.

@SassySouthBlond @AlanRoberts I try to tell all my patients that if you’re not using an app to track calories (at the very least), you have absolutely no idea what you’re actually eating. Anything that goes into the mouth hole gets logged. It’s eye opening

@gotrice2024 No harm no foul

This woman rented an Airbnb for a few days. One morning while using a curling iron, she melted the toilet seat. Feeling handy she went to the local hardware store, got another one and fixed it. Then she took the old one yo dispose of to get rid of the evidence. If this was your house would you be okay with this, why get rid of the evidence without telling the owner if you are going to put a video of you doing it online anyway?

@realkyndr @DamienStanwood1 @PeteHegseth Should be qualifying at least annually at a minimum anyway

@jjbarron @DamienStanwood1 @PeteHegseth Re Qual/Proficiency would have to be a component

Thanks for sharing. Our team is reviewing. This is unacceptable.

@akafaceUS I’ve seen end grain wood used like that. Larger cuts though. Can’t remember exactly where but it was somewhere in Savannah, GA. The floor was definitely old. Looked like cobblestones.

Have you ever seen a floor like this in the US?

@DamienStanwood1 @realkyndr @PeteHegseth As long as that training serves to also satisfy requirements by the state for CCW (if that state requires a CCW class). I can’t imagine that it wouldn’t. But… politics and stuff

I agree, but carrying a weapon in public is different than a weapons qual. Services members are already licensed to ride motorcycles, but the base still requires motorcycle safety training. I think service members will gladly attend training that covers safety, conduct on base, and state and local gun laws. An ounce of prevention goes a long way.

@realkyndr @DamienStanwood1 @PeteHegseth On one hand I agree. I’ve been to the range with other medical professionals and it can be a terrifying experience. On another, I have an issue with assuming service members are less capable of competently carrying a firearm than the general public

@jjbarron @DamienStanwood1 @PeteHegseth Do a re-qual on occasion would not be unreasonable for those concerned about weapon competency

@DamienStanwood1 @realkyndr @PeteHegseth They already do… weapons qual

@realkyndr @PeteHegseth I would like to see some kind of safety training requirement for carrying on base. Similar to the required motorcycle safety training.

@BuckeyeGrad1999 @RojaGarimella Honestly, this is a fantastic analogy

@RojaGarimella US healthcare is like a Porsche. If you can afford it, it is incredible. The problem is most people just need a reliable car to get to work, not a luxury vehicle they cannot afford.

in med school i spent a few weeks rotating at a top ICU in Germany it made me appreciate how strong clinical care is at major academic medical centers in the states the uncomfortable reality: US healthcare is best in the world if you ignore affordability