Michael Drystan Ross MD

The state of primary care in America is •Average wait time: 24 days •Average patient panel: 1,200–2,000 patients •Average visit length: 18 minutes (often less than 12 minutes of face time) I envision a world with 1 week wait times, panels small enough to know each of your patients, and visits that are as long as the patient needs. Anything else is a disaster.

@RogerSeheult @esanzi Millennial, same. Why would anyone wear shoes in their own home?

@esanzi I’m Gen X and we’ve been removing shoes my whole life.

Hosting an event or a party at your home and requiring that guests remove their shoes when they arrive is rude. And weird. And reveals an irrational concern over dirt and germs. If you insist on doing this, make sure the invitation includes a warning!

@CoffeeBlackMD It’s so bad. I go to kimchi

Sauerkraut may have kept my people alive during the winter in byegone eras. That doesn’t mean I have to like or even respect the nasty bullsh*t.

@stinkybitsstick @LawsuitsOrg I only work with adults, but yes.

@DrystanMD @LawsuitsOrg I get that but are you adequately warning the patient of the long term life altering risks? Especially to teens and children who are being prescribed these when their brain is still developing...

🚨 EMERGING INVESTIGATION: Finasteride (Propecia) — Depression. Anxiety. Suicidal thoughts. Millions of men are prescribed the hair loss drug every year. Recent research links it to serious psychiatric side effects. The FDA added suicide risk to the label in 2022. Reply with helpful info. We're organizing 👇

@stinkybitsstick @LawsuitsOrg They can be very helpful for the right patient at the right time.

@DrystanMD @LawsuitsOrg What about SSRIs they cause the same thing... PSSD

@RogerSeheult Never seen or heard this

Is there anyone out there who doesn't know what we are talking about?

Tensor tympani voluntary contraction. I can do this and I've thought everybody could as well. I sounds like a torrent of rushing water or thunder but at a conversational level of sound. Not too loud.

@cheryl0854os @anishmoonka He lived to be about 23 😢😭

@DrystanMD @anishmoonka So cute

Your dog could soon get a daily pill that slows aging. 1,300 dogs are already testing it across 70 vet clinics, and it just passed its second FDA safety review in January. The drug is LOY-002. A San Francisco startup called Loyal makes it. Celine Halioua started the company in 2019 when she was 24. They have raised $250 million so far, including $100 million in February from Baillie Gifford, the same firm that bet early on Tesla and Amazon. The simplest way to explain what it does: if you put a dog on a strict diet where it eats way less food, that dog tends to live about two years longer. Cancer and arthritis both show up later. The body just ages more slowly. LOY-002 gives the dog those exact benefits without actually eating less. The dog keeps its appetite and its weight; it just ages more slowly. The trial is called STAY. Half the dogs get a beef-flavored pill every day, and the other half get a fake version that looks and tastes the same. The FDA reviewed safety data from over 400 dogs. Zero serious side effects, even at five times the normal dose. Loyal has now cleared two of three hurdles for conditional approval, which basically means they could start selling the drug while the full trial keeps going. The last piece, manufacturing, goes to the FDA in 2027. One thing the tweet gets a bit wrong: the pill is for senior dogs aged 10 and older, at least 14 pounds. And Loyal is being careful about the "years" claim. Right now, they are saying at least one extra year of healthy life. They want to prove more, but the trial needs to finish first. If LOY-002 gets approved, it would be the first drug the FDA has ever cleared to slow aging in any species, human or animal. Loyal also has two more drugs coming for big breeds like Great Danes and Rottweilers. Those dogs die younger partly because of a hormone called IGF-1, which makes them grow fast but also wears their bodies out quicker. And a separate project backed by a $7 million grant from the NIH (the agency that funds medical research) is testing a human organ transplant drug called rapamycin in 580 dogs to see if it slows aging, too. The global pet care market hit $261 billion last year. A once-a-day pill that gives your dog even one extra healthy year could easily become one of the best-selling veterinary drugs on the planet.

So I thought about this too when I saw those posts. We know there are plenty of people with normal LDL that have sclerosis I think the point of their post is that we’re clearly missing something. As you pointed out, that thing could clearly be blood pressure, glycation products, etc. Won’t fix those with a statin.

The current asinine point being made in anti-statin world is: “What about the veins, coffee?!?? What about them?!!? CHECKMATE!!” Typed while drooling, directly, onto the keyboard. Blood pressure MFer. Can you think? Can you physiology? No you can’t. And look at the venous grafts in bypass patients. You all need to slowly back away from this “point” without making eye contact and pretend you’d never said it. If you’ve enough shame to be embarrassed? Good.

@DocPriyamMD Respiratory drive in COPD patient

The night shift was quiet until my intern yelled... "Sir, the COPD patient in Bed 2 came in gasping with an O2 saturation of 82%! I fixed it, but now he won't wake up!" The Catch: The intern had put him on a 15-Liter Non-Rebreather mask. The monitor now showed an SpO2 of 100%, but the patient was unarousable, breathing shallowly and bounding pulses. The intern was confused: "His saturation is perfect now! Why is his GCS dropping?" A classic ward tragedy. Med-X, what did the intern just do, and how do we fix it?

@Doctors_GUILD Chlordiazepoxide, aka Librium, a long acting Benzo.

In delirium tremors, the choice of drug is: a. Diazepam b. Morphine c. Disulphiram d. Chlordiazepoxide

I have no idea if grounding is in some way medicinal to you. But I do know it feels good to put your bare feet on the raw earth. 🌍 That’s good enough for me.

@KevinNunnally1 @BrianPrescott48 This is crazy talk. A statin did not zero out anything. Ask the 50% of people who have an MI with completely normal cholesterol. LDL cholesterol is some fraction of the whole picture, not to be mistaken with the picture itself.

@BrianPrescott48 Been on a statin for 24 years, zero side effects. Zero. Incredible, effective drug that has zeroed out my family risk of heart disease. I have read every side of this argument and have to say stains are miraculous.

They don't want you dead; they want you dependent. They manage your decline with statins and BP meds, draining Testosterone and hardening arteries. It's a subscription to mediocrity. The antidote isn't another pill; it's what they buried: D3 + K2.… twitter.com/i/web/status/1…

Insurance-beholden medicine is horrible. 15-minute visits that are actually just 5 minutes of real conversation and face-to-face time are not conducive to a true patient-doctor relationship. The reality is: if you want quality care — and let me emphasize that medicine today is powerful and life-changing — you need access to the best doctors, the best medicines, therapies, and treatments. When you do, you’ll likely live a better, more fulfilling, more successful life — whatever that looks like to you. There’s a model of medicine out there called Direct Primary Care and Concierge Care. Look into these models. Find a doctor you can have for the rest of your life. Find yourself a doctor who isn’t beholden to Big Pharma or big insurance. Someone you can get to know deeply — who knows you, your family, and your goals. Someone willing to take a little risk for a lot of benefit in your life

@drpablocorral What? You cannot have healthy myelin and cell walls without cholesterol. You cannot have life without cholesterol.

👉No. You can have CVD without insulin resistance. But you cannot have atherosclerosis without cholesterol. LDLc isn’t “just another risk factor”—it’s a prerequisite. Insulin resistance may accelerate the fire… but cholesterol lights it.

Butyrate is incredibly important for longevity and health. What food is stacked with butyrate? Butter.

@CarlisleDiana I believe it. Less confidence, less facial hair, less stability.

The men on hormone wrecking hair loss drugs are calling me fat for telling the truth but I will not stop #hairlossdrugsruinyourlife #wecantell

@RealRossU I hope you are doing well. Prayers for you.

Had a vivid dream early this morning. I was sent back to prison on some technicality. It felt so real that when I woke up, I really thought I was in a cell. Then the truth hit me. I was next to my wife in our big comfy bed. Freedom washed over me all over again.