FlexNP
@rnflex.bsky.social
Jack of all trades nurse practitioner, trail runner photographer, coonhound rescuer, lover of glucagon agonism in the liver, kidney and pancreas, fascinated by obesity medicine, retatrutide fan boy
What have you been using? Tirzepatide?
November 11, 2025 at 10:35 PM
What have you been using? Tirzepatide?
Head to head vs Sema was much closer but still probably slightly better? But yeah it's interesting. I don't have problems drinking but once I started taking these meds it was like I just didn't care as much for alcohol, like I had no desire to even grab a beer anymore for a weekend BBQ
November 11, 2025 at 5:17 PM
Head to head vs Sema was much closer but still probably slightly better? But yeah it's interesting. I don't have problems drinking but once I started taking these meds it was like I just didn't care as much for alcohol, like I had no desire to even grab a beer anymore for a weekend BBQ
I've discovered don't be afraid to order weird labs needed for various zebra diseases if the wait for the sub specialist is long. Helps rule out/in things especially if the patients been bounced around by the health care system. Just dx'ed SLE w/ secondary APS while waiting for rheum. Proud of that!
November 11, 2025 at 12:39 PM
I've discovered don't be afraid to order weird labs needed for various zebra diseases if the wait for the sub specialist is long. Helps rule out/in things especially if the patients been bounced around by the health care system. Just dx'ed SLE w/ secondary APS while waiting for rheum. Proud of that!
Sugar maples!! They're stunning
November 11, 2025 at 12:11 AM
Sugar maples!! They're stunning
Definitely was pretty!
November 10, 2025 at 7:02 PM
Definitely was pretty!
The BCBS community plan at my employer(aka the ACA one) is now 1,200 a month 🤡🤡
My usual employer sponsored plan only went up a few dollars a month so that's good(for now!)
My usual employer sponsored plan only went up a few dollars a month so that's good(for now!)
November 10, 2025 at 6:34 PM
The BCBS community plan at my employer(aka the ACA one) is now 1,200 a month 🤡🤡
My usual employer sponsored plan only went up a few dollars a month so that's good(for now!)
My usual employer sponsored plan only went up a few dollars a month so that's good(for now!)
(I accept this nerdy reference)
a group of young men are sitting together and one of them is wearing a panda movie shirt
ALT: a group of young men are sitting together and one of them is wearing a panda movie shirt
media.tenor.com
November 10, 2025 at 2:52 PM
(I accept this nerdy reference)
Cheap, easily available drug! Dialysis mortality is like 50% at 5 years. Why the F wouldn't you at least start taking this, there are essentially zero side effects!
I don't get how some people's brains work! Ran into similar mental gymnastics talking to some folks at obesity week too *sigh*
I don't get how some people's brains work! Ran into similar mental gymnastics talking to some folks at obesity week too *sigh*
a man in a black sweater is standing in front of a chain link fence with the words `` c mon man '' .
ALT: a man in a black sweater is standing in front of a chain link fence with the words `` c mon man '' .
media.tenor.com
November 10, 2025 at 2:40 PM
Cheap, easily available drug! Dialysis mortality is like 50% at 5 years. Why the F wouldn't you at least start taking this, there are essentially zero side effects!
I don't get how some people's brains work! Ran into similar mental gymnastics talking to some folks at obesity week too *sigh*
I don't get how some people's brains work! Ran into similar mental gymnastics talking to some folks at obesity week too *sigh*
When retatrutide data comes out and matches bariatric surgery outcomes how do you price that given what's already on the market? How do you price less effective drugs still in development?
November 9, 2025 at 10:46 PM
When retatrutide data comes out and matches bariatric surgery outcomes how do you price that given what's already on the market? How do you price less effective drugs still in development?
Novo also uses a slower peptide synthesis process using bioreactors whereas Lilly uses the faster and easier to scale Solid Phase Peptide Synthesis(SPPS) but has also nearly maxed out (current) global capacity on reagents needed for peptide synthesis. We're in unknown territory on value and QALY
November 9, 2025 at 10:46 PM
Novo also uses a slower peptide synthesis process using bioreactors whereas Lilly uses the faster and easier to scale Solid Phase Peptide Synthesis(SPPS) but has also nearly maxed out (current) global capacity on reagents needed for peptide synthesis. We're in unknown territory on value and QALY
Honestly the pricing on GLP-1 meds is just weirdness. Novo priced Ozempic high, Lilly undercut them but still $$$, partially because of the US insurance market. Lilly's drug is significantly more effective but Novo didn't budge on price until very recently.
November 9, 2025 at 10:46 PM
Honestly the pricing on GLP-1 meds is just weirdness. Novo priced Ozempic high, Lilly undercut them but still $$$, partially because of the US insurance market. Lilly's drug is significantly more effective but Novo didn't budge on price until very recently.
For those keeping score at home this is the 3rd preclinical trial showing Retatrutide might have oncology benefits. Two showing benefits in pancreatic cancer, one in lung cancer and one in breast cancer.
November 9, 2025 at 10:05 PM
For those keeping score at home this is the 3rd preclinical trial showing Retatrutide might have oncology benefits. Two showing benefits in pancreatic cancer, one in lung cancer and one in breast cancer.
Yeah. Market dynamics are way different. By this time next year we'll have oral Wegovy and oral orforglipron with CagriSema, Retatrutide and Survodutide probably just a couple months away. Survo breaks the duopoly of companies too. Will be hard to predict what happens next
November 9, 2025 at 9:30 PM
Yeah. Market dynamics are way different. By this time next year we'll have oral Wegovy and oral orforglipron with CagriSema, Retatrutide and Survodutide probably just a couple months away. Survo breaks the duopoly of companies too. Will be hard to predict what happens next
That's the GLP-1 receptor shape!
Here's the actual peptide, it should basically be a big slightly bent alpha helix with a fatty acid sticking off the side. But I just can't find a 3D model unfortunately.
Here's the actual peptide, it should basically be a big slightly bent alpha helix with a fatty acid sticking off the side. But I just can't find a 3D model unfortunately.
November 9, 2025 at 3:30 PM
That's the GLP-1 receptor shape!
Here's the actual peptide, it should basically be a big slightly bent alpha helix with a fatty acid sticking off the side. But I just can't find a 3D model unfortunately.
Here's the actual peptide, it should basically be a big slightly bent alpha helix with a fatty acid sticking off the side. But I just can't find a 3D model unfortunately.
More fish kidney basement membrane EM photos!
November 9, 2025 at 2:25 PM
More fish kidney basement membrane EM photos!
I didn't realize how *tight* the transplant requirements are for BMI so definitely am a fan of getting more patients on the list via that mechanism. Would also love more data on it GLP1 meds help 1.) preserve post transplant GFR better than current SOC 2.) reduce rejection/complications rates
November 9, 2025 at 1:13 PM
I didn't realize how *tight* the transplant requirements are for BMI so definitely am a fan of getting more patients on the list via that mechanism. Would also love more data on it GLP1 meds help 1.) preserve post transplant GFR better than current SOC 2.) reduce rejection/complications rates
Yeah. Thankful for Medicare coverage, but doubt Retatrutide et al. will get the same pricing discounts. But at least it's a start in terms of access/getting more people on the meds who need them.
November 9, 2025 at 12:44 PM
Yeah. Thankful for Medicare coverage, but doubt Retatrutide et al. will get the same pricing discounts. But at least it's a start in terms of access/getting more people on the meds who need them.
I feel the same about this paper and presentation I saw at Obesity Week 2025. Mechanism with GLP1 reducing mortality is certainly more understandable than just fish oil but they are expensive as heck & getting a large RCT would be difficult.
pubmed.ncbi.nlm.nih.gov/40526425/
pubmed.ncbi.nlm.nih.gov/40526425/
November 9, 2025 at 12:21 PM
I feel the same about this paper and presentation I saw at Obesity Week 2025. Mechanism with GLP1 reducing mortality is certainly more understandable than just fish oil but they are expensive as heck & getting a large RCT would be difficult.
pubmed.ncbi.nlm.nih.gov/40526425/
pubmed.ncbi.nlm.nih.gov/40526425/
Reminded as always that "great" human worshipping is a folly.
Love this obit.
Love this obit.
November 9, 2025 at 12:12 PM
Reminded as always that "great" human worshipping is a folly.
Love this obit.
Love this obit.
I am mildly skeptical of such a profound effect but at the same time given how few side effects fish oil has I definitely feel comfortable in recommending this to my ESRD patients. Anything to help their morbidity/mortality at this point
November 9, 2025 at 11:32 AM
I am mildly skeptical of such a profound effect but at the same time given how few side effects fish oil has I definitely feel comfortable in recommending this to my ESRD patients. Anything to help their morbidity/mortality at this point
On an opposite note of data can be pretty, Lilly posted this post hoc analysis of cardiovascular risk improvements by weight loss percentage from Surmount 1 and the incremental improvements as you lose weight is just pretty to see graphed out
November 9, 2025 at 11:18 AM
On an opposite note of data can be pretty, Lilly posted this post hoc analysis of cardiovascular risk improvements by weight loss percentage from Surmount 1 and the incremental improvements as you lose weight is just pretty to see graphed out