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You can drop 20 pounds in a healthy timeframe of about 2.5 to 5 months by maintaining a consistent calorie deficit of 500 to 1,000 calories per day below your maintenance level, exercising at least 150 minutes per week, and using metabolic support like the skinny shot or a medically supervised weight loss program

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Vancomycin has a long half-life of 100-200 hours in patients with ESKD or dialysis dependent AKI, and thus may be dosed thrice weekly following dialysis or less frequently if trough levels remain high