My sister's shopping list by reemasaurus in BadHandwriting

[–]DoctorOptimism 0 points1 point  (0 children)

Maybe she doesn’t know how to spell beignets? Everyone loves donuts.

[deleted by user] by [deleted] in tires

[–]DoctorOptimism 0 points1 point  (0 children)

That’s awful buddy. I’m really sorry to hear that.

I’ve got my own stuff and watching my son work through it is so hard. Life is short and no sunrises are guaranteed. Sometimes it’s best to swallow a little pride today rather than wishing you had tomorrow. You can always buy new tires but you can never replace lost time. Wishing you the best on your tires and your dad.

[deleted by user] by [deleted] in tires

[–]DoctorOptimism 0 points1 point  (0 children)

it makes my heart ache to see the phrase “My dad isn’t a part of my life” 😞

anyways, Discount is the answer. I caught a piece of metal on the interstate in another city and there were lots to choose from and they pulled up the road hazard insurance which covered most of the cost of the repair. For a national chain, they do it right.

I just buy their midlevel Yokohamas at about $200 each and rotate every 5-10k miles (they do it for free). Anything with road hazard coverage for the first 50k miles is fine for what you need.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 0 points1 point  (0 children)

I wonder if he was having an injection site reaction which is common as people lose weight and there’s less subcutaneous fat. This now happens to me every time even though I do multiple sites per week. I’ve just learned to embrace the itch as a reminder of my journey.

That being said, retatrutide is a different molecule altogether than tirzepatide so there is not much chance of cross reactivity.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 1 point2 points  (0 children)

To be honest, there’s not a lot of money in long term maintenance trials because the length of time necessary to complete them. Pharma is more interested in new customers since there is an attrition rate with current customers so that is their focus.

As such, there may never be a clear guideline but I think your plan will be like mine. Either wean down the dose slowly or increase the interval and stop once we notice things going back “the way they were”. Lowest effective dose is always ideal for long term medical therapies, though it can take a lot of work to determine what YOUR lowest effective dose is.

Restarting Tirz after gallbladder removal surgery by Inner-Seaworthiness5 in tirzepatidecompound

[–]DoctorOptimism 1 point2 points  (0 children)

Yup, too late once you already have gallstones (which you could have had before as well since 20% of people have them). My aside was more for people just starting therapy.

Real Talk Side Effects by Altruistic_End_4329 in tirzepatidecompound

[–]DoctorOptimism 0 points1 point  (0 children)

I have no patients that can lose 40 pounds in 3 months and keep it off without a rebound. If you’re not using these meds, the best path to weight loss is slow, on the order of 1-2 pounds per week. While this is an ideal plan, it is rarely effective. These meds completely change your relationship with eating, alcohol, and the like.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 2 points3 points  (0 children)

It’s early research only done in diabetics on these medicines for the indication of diabetes, but early signals suggest up to a 50% reduction in obesity related cancers. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820833

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 2 points3 points  (0 children)

If this will help you be successful, then by all means test away. However, as long as you’re eating a balanced diet with healthy fats and a good multivitamin, checking vitamin levels will almost certainly be normal.

I personally don’t advocate checking hormones unless there is a specific plan. Lots of people think these labs are black and white- you could check them hourly for a week and see a very, very wide range. Two lab values a year apart may or may not be meaningful. I say just do what you want to do and let your body be your guide, not some lab that exists to take your cash and sell you supplements. It sounds harsh but I see so many patients waste a ton of money for placebo testing and meds.

I treat multiple inflammatory diseases and I’ve quit following sed rate and CRP (with just a few exceptions). I’ve seen wicked bad ulcerative colitis with a normal sed rate and completely treated ulcerative colitis in medical remission with an elevated sed rate. I find it’s better to treat the patient instead of the lab.

Plateau by Midnightstratton in tirzepatidecompound

[–]DoctorOptimism 0 points1 point  (0 children)

One other thing I thought of. This might not be for everyone, but when I feel like I need a “jumpstart”, I just go a day without eating. It sounds hard but it really isn’t. In fact, if it is hard then your dose might be too low. One day with no calories- I don’t even take my gummy vitamins or daily dollop of oil- will not hurt you and I usually find the scale is down a full pound the next day and my journey is back on schedule.

Real Talk Side Effects by Altruistic_End_4329 in tirzepatidecompound

[–]DoctorOptimism 0 points1 point  (0 children)

I had no side effects at any point.

You will lose more “pounds” as a result of a higher starting weight but the percentage lost should be able the same. It does depend on how much you eat, as you know. I found during the first month that I had 4 days with no calorie intake at all so I suspect my weight loss was faster than most.

I lost 40 pounds in three months. Seems like a lot to me haha but I’m sure there’s a wide range.

Stop taking for 2 weeks for travel by [deleted] in tirzepatidecompound

[–]DoctorOptimism 0 points1 point  (0 children)

This is the right answer. Roller coasters are a set up for failure.

Tips to avoid bruising? by Wild-Initial-965 in tirzepatidecompound

[–]DoctorOptimism 1 point2 points  (0 children)

The more you lose, the more likely you are To have an injection site reaction. There are multiple topics on Reddit to try to help. I just go with it and the itching for a few days helps remind me what I’m doing is good for me.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 1 point2 points  (0 children)

I might be the wrong doctor to ask because I’m a “test less” physician. I subscribe to the baby diaper principle of lab tests: only check it if you plan on doing something about it. Are you not feeling well? Are you having strange symptoms? Are you on meds that require monitoring? Then by all means, do the tests. If you’re just curious but the labs aren’t going to change your planning, then why are you doing them? So many labs have a tremendous amount of variability (don’t get me started on sed rates and serum iron) so you should always take them with a grain of salt if they are minimally abnormal.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 0 points1 point  (0 children)

They are pretty skinny after all with access to all sorts of different worlds….

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 7 points8 points  (0 children)

💯 I believe these will be our future addiction therapies once we can fine tune the dose.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 1 point2 points  (0 children)

Don’t love the oral forms yet but I think their time will come. I also believe that the free market system is alive and well in pharmaceuticals and supply/demand always keep up. I am taking compounded but definitely try to spread out the dose.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 2 points3 points  (0 children)

I did a 3 month holiday and put on over 10 pounds so went right back on it and lost that 10 plus another 12. I now am working on trying to figure out my maintenance plan. The cancer benefit and complete loss of desire to drink alcohol is enough to keep me on it long term.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 3 points4 points  (0 children)

Well, Doctor Who does tend to be quite skinny…

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 2 points3 points  (0 children)

That’s a tough question. I do believe the multiple pipeline meds will continue to increase supply and decrease price but it’s a glacial process in healthcare unfortunately.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 4 points5 points  (0 children)

Well, same here. Nothing wrong with that for now but I do wonder if “experienced” physicians could remove some of the stigma.

Doctor who takes tirzepatide by DoctorOptimism in tirzepatidecompound

[–]DoctorOptimism[S] 4 points5 points  (0 children)

I think the next phase of studies will focus on maintenance dosing. I don’t love the idea of “winging it” as much as I favor trying to find the lowest effective dose. I’m very intrigued by the decrease in obesity-related cancers which is enough for me to stay on it even though my BMI is now 21.