THE 9.8 MANIFESTO
Here's the uncomfortable truth:
most of our profession doesn't stay up to date.
We memorize protocols instead of understanding them.
We go to conferences that reaffirm what we believe,
regardless of the evidence. We wonder why we're not taken seriously
— or not busy.
We are not here to flatter the profession. We are here to upgrade it.
Question rituals that don't serve patients.
Highlight what actually works.
Hold ourselves to the standards we claim to practise by.
Guidelines are the floor, not the ceiling.
But you're busy.
You don't have time to live in PubMed, and you shouldn't have to.
So our job, via this newsletter, is to do that for you.
And when we offer a course, it's because the topic deserved it — iron infusions, histamine, GLP-1s, and beyond.
If you're content to practise the way you always have, you won't like it here.
If you're ready to earn the title of primary care provider — let's go.
Grounded in science. Always accelerating.
Welcome to the 9.8.
Look at us, taking our GLP-1 gig on the road... this time to BC wine country and the prairies.
Sponsored by the iconic Cytomatrix, who incredibly encourages us to share our know-how on GLP-1RA use in all kinds of surprising conditions - migraines, IBS, fibromyalgia and MCAS.
The audiences were anything but flat, so engaging.
We’re quite pleased that we had a record turnout for this tour.
GLP-1RAs for IBS — The ROSE study
A study that broke our brains recently:
ROSE-010, an experimental short-acting GLP-1 analogue, given as on-demand SC injection for acute IBS pain, gave ≥50% pain relief at 120 min. IBS-C and IBS-M responded best. Pain relief was independent of plasma glucose. n=166.
IBS isn't just a motility disorder, but a pain condition. GLP-1 receptor agonism not only lessens muscle spasms, but also reduces visceral nerve reactivity. More relaxation, less pain, more satisfying BMs.
Though constipation can be a side effect in those without IBS, we've seen (and the research confirms) surprisingly strong benefit in those with IBS, including and especially IBS-C.
Don't be afraid of using GLP-1RAs (Ozempic, Mounjaro, etc.) in IBS! They're actually one of the best things you could prescribe!
More to come via Weight Rx - hang tight!
Do I need FHR monitoring when giving IV iron in pregnancy?
Short answer: no — and requiring it just slows care.
We've been using exclusively Monoferric (ferric derisomaltose) in pregnancy for a year now. And have a lot to say about it.
But in the FLIP study (n=514 high‑risk pregnancies), patients received iron sucrose or Monoferric in an outpatient obstetric infusion clinic where FHR was not routinely monitored during infusions. And adverse reactions were actually less common with Monoferric than Venofer (5.4% vs 13.0%; mostly mild, one triage visit, no fetal safety signal).
Continuous FHR monitoring doesn’t make IV iron safer — it just traps it in busy L&D units and delays treatment for iron deficiency anemia, which does carry real risks for birther and baby.
More to come in Iron Rx Part 3 (advanced) - stay tuned!
Most NALS trainings feel like a flatline. Ain't nobody got time fodat. So we re-built it, from scratch — for us, by us. Because emergency training should be fast, fun, and leave you way more confident than you walked in.
Introducing NALS by Gravity:
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2-hour online pre-learning (yes, pyjamas are fine)
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7-hour in-person training day at Gravity Health Vancouver (903-750 W Broadway) — storytelling, in-depth cases, advanced discussion
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Printable algorithms, checklists, and clinic-ready protocols for your crash cart
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Escape-room hands-on scenarios. The winning duo signs our G.O.A.T. trophy.
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20-question exam (easy peasy)
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NALS certificate valid for 2 years (CCHPBC-approved)
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BLS not included — but we'll point you to the same convenient, high-quality spot we use every year
May 31, 2025
May you never do another boring NALS again.
Want to go deeper on a clinical topic, talk through a complex case, or see how we run things at Gravity Health?
