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The OS for personalized medicine, practice by practice

iksa is the harness for n‑of‑1 medicine. The markers change from one practice to the next, and in each your decision reaches the nurse and the patient from your own note. The method, n‑of‑1 medicine →

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Move a patient’s ApoB target in your note, and your nurse’s list moves with it, along with the answer the patient gets when they ask. See longevity

Patient J, 51, Longevity program, Year 2. Coronary CT angiography, Year 2 assessment. Calcium score 38 Agatston, 77 percentile, White men aged 51, MESA. CAD-RADS 1: Minimal narrowing, 1 to 24%. Plaque: Non-calcified, proximal LAD; calcified, mid LAD; Narrowing: Under 25%; Plaque burden: P1, mild; total volume 104 mm³; High-risk features: Low attenuation only, no HRP modifier. Genome: LPA rs10455872, one copy, Inherited high Lp(a), measured at 168 nmol/L. Next: ApoB target lowered to under 60; Coronary CT again in two years on the same scanner and plaque software, read by plaque volume, counting only a change larger than scan-to-scan variation; Lp(a) offered to his siblings and children.

Put strength before the drug a patient asked about, and your reason is what they hear when they ask again. See anti‑aging

Patient K, 56, Anti‑aging program, Year 1. Exercise test, grip and DEXA, Year 1 assessment: VO2 max 35.2 mL/kg/min, 38th percentile for men 50 to 59, Cooper norms; Grip strength 39 kg, 22nd percentile for men 55 to 59, UK norms; Appendicular lean mass index 8.0 kg/m², 26th percentile for men 50 to 59, Ball State DEXA norms. Epigenetic pace of aging: DunedinPACE 1.09 (Years of aging per year lived; 1.00 is the typical pace in a reference population). Next: Two strength sessions and one interval session a week, the biguanide held, to be revisited at the six-month DEXA; Exercise test, grip and DEXA again in six months; DunedinPACE again in a year, as context.

Ask what you decided in Year 3 and why, and your own note answers, with its source, ten years in. See concierge medicine

Patient L, 63, Executive program, Year 4. Year 4 assessment, read against the years before, by pillar. Heart: Coronary CT, Calcium score 12, 65th percentile (MESA, white women 63); no non-calcified plaque. Next: Lipid plan held. Cancer: Multi-cancer screen, No cancer signal detected; Whole-body MRI, Thyroid nodule, 16 mm, new since Year 2. Next: Thyroid ultrasound and TSH. Metabolism: DEXA, Visceral fat 1,040 g, above the 800 g risk line for women over 40. Next: Aerobic block and strength added. Brain: Brain MRI, No findings beyond her age; Cognitive screen, Within norms for her age. Next: Alternate form of the screen next year.

Her heart, bones and breasts set the plan, and her nurse opens each review with what she’s reported and the labs you’re watching. See women’s health

Patient M, 51, Midlife women’s program, Year 2. Screening before and through hormone therapy, Month 0 to Month 24, today Month 14. Mammogram, yearly: Month 0, BI-RADS 1, density D; Month 12, BI-RADS 1, density D; due at Month 24. Breast MRI, yearly, for density: Month 1, BI-RADS 1; Month 13, BI-RADS 1. Coronary calcium, once, before therapy: Month 1, Score 0. DEXA, every two years: Month 1, Spine T −1.6; due at Month 24. Coronary calcium score: 0 Agatston, No detectable calcium, before hormone therapy. Decisions: Month 1, Breast MRI added for dense tissue; Month 2, Transdermal hormone therapy started, with endometrial protection; Month 12, Therapy continued after the Year 1 mammogram.

Decide no biopsy and the same dose, and his nurse follows the next PSA while he hears why from your note. See men’s health

Patient N, 54, Testosterone therapy, Year 2. Prostate MRI, 3T, Month 15, after a confirmed rise in his PSA. PSA density 0.08 ng/mL/cm³, reference Under 0.15. PI-RADS 2: Clinically significant cancer unlikely. Prostate volume: 38 cm³; Transition zone: Mostly encapsulated nodule; Peripheral zone: No focal lesion; Before therapy: Coronary calcium score 0. Next: No biopsy, same testosterone dose; PSA every six months; Prostate MRI again if density reaches 0.10.

Cut a dose with a patient’s level still in range, and they hear it was the acne you noted. See hormone therapy

Patient P, 47, After menopause, testosterone added for hypoactive sexual desire. Total testosterone in ng/dL, against the band Women, 8 to 60 and her first level, dotted: 11 at month 0, 42 at month 2, 47 at month 6, 31 at month 7.5, 36 at month 12, 29 at month 18, 38 at month 24, 33 at month 30, 11 at month 36. The dose runs as a ribbon under the curve, stepping at each decision: Month 1, Testosterone started; Month 6, Dose reduced for acne; Month 20, Dose kept, desire steady; Month 31, Stopped at her request.

Hold a patient’s dose twelve weeks for their arms and legs, and they can ask why while your nurse watches kidney function and HbA1c. See GLP‑1 and metabolic health

Patient Q, 44, Metabolic program on a GLP‑1 medicine, Month 4. DEXA, whole body, Month 4, before the next dose step. Lean mass and fat by region: arms 4.1 kg, 46% fat; trunk 22.4 kg, 49% fat; legs 12.6 kg, 45% fat. Body fat 47%. Visceral fat 1,310 g, 95th percentile for European women aged 44 (LEAD cohort). Appendicular lean mass index 5.92 kg/m², 22nd percentile. Next: Dose kept twelve weeks; Resistance work three times a week to protect lean mass; DEXA again before the next step.

Your clinic prescribes peptides of every kind, and iksa brings a research team’s intelligence, evidence and oversight to each one. See peptide therapy

Patient R, 55, Peptide protocol in cycles, Year 2. Each cycle starts with every check current. Cycle 1, Month 0: IGF‑1, for his age in range, HbA1c and fasting glucose in range, PSA, once a year in range, Colonoscopy, every ten years clear at 45. Started. Cycle 2, Month 7: IGF‑1, for his age in range, HbA1c and fasting glucose in range, PSA, once a year current, Colonoscopy, every ten years current. Started. Cycle 3, Month 12: IGF‑1, for his age in range, HbA1c and fasting glucose in range, PSA, once a year in range, Colonoscopy, every ten years due at 55. Held until the colonoscopy is done.

When a patient asks for a second injection, the procedure note from their first and every measure around it come back quoted. See regenerative medicine

Patient S, 58, Knee program, Month 6. Knee MRI, right, 3T, Month 6, before a second injection. Cartilage defect, medial femoral condyle 14 mm. ICRS cartilage grade 3: Loss of more than half the thickness. Medial meniscus: Degenerative tear, posterior horn; Bone marrow: Small edema, medial femoral condyle; Joint fluid: Small effusion. Stair-climb test: 13.6 s, Up and down nine steps, timed the same way at every visit. Next: Second injection deferred; A 12-week rehab block first.

The ferritin you’re following stays on your nurse’s list though the lab never flagged it, and the patient hears what to watch for as dairy returns. See functional medicine

Patient T, 38, Root-cause program, results visit. Results visit, Month 1. Stool analysis: Calprotectin 34 µg/g, reference Under 173; Pancreatic elastase 412 µg/g, reference Over 200; Secretory IgA 2,310 µg/g, high, reference 510 to 2,010. Celiac screen, blood: tTG‑IgA Under 1.0 U/mL, reference Under 4.0; Total IgA 182 mg/dL, reference 70 to 400. Micronutrients: Vitamin D, 25‑OH 22 ng/mL, low, reference 30 to 100; Red-cell magnesium 3.9 mg/dL, low, reference 4.2 to 6.8; Ferritin 31 ng/mL, reference 15 to 150. Metals, blood: Mercury 12 µg/L, high, reference Under 10; Lead 0.9 µg/dL, reference Under 3.5. Next: An elimination phase: wheat and dairy out for eight weeks; Small fish in place of large; Iron, vitamin D and magnesium replaced, and re-tested at three months because each started low for her.

Start each letter to the oncologist from what the patient’s record says they take, cited, with anything missing marked before it goes. See integrative oncology

Patient U, 61, Surveillance after colon cancer, Year 1. Months since chemotherapy ended, Month 0 to Month 24, today Month 8. ctDNA, tumor-informed, every three months: done at Month 3, Not detected; Month 6, Not detected; due at months 9, 12, 15, 18, 21 and 24. CEA, every three months: done at Month 3, Normal; Month 6, Normal; due at months 9, 12, 15, 18, 21 and 24. CT chest, abdomen and pelvis, every six months: done at Month 6, No evidence of disease; due at months 12, 18 and 24. Colonoscopy, a year after surgery: done at Month 5, No polyps. Decisions: Month 7, Exercise plan signed off by his oncologist.

Your brain health program answers a patient’s mask questions from what you wrote, with their morning headache waiting on your list. See solo practice

Patient V, 57, Brain health program, a practice of one. Whole genome, read at baseline: APOE ε3/ε4. One copy of ε4: a higher risk of Alzheimer’s that varies by ancestry, and not a diagnosis. Cognitive baseline, against men 55 to 59: Memory 52nd percentile, Attention 47th percentile, Processing speed 21st percentile, Executive function 38th percentile. Home sleep study, Month 2: Respiratory event index 22 an hour (Moderate, 15 to 30); Lowest oxygen 84 % (90 or more). Next: Sleep apnea treatment started; Cognitive re-test each year.

When a patient feels faint on a long session and writes in, a nurse gets that report, your NP’s last note and what your dietitian charted. See care team

Patient W's cardiopulmonary exercise test, cycle: her heart rate climbs as the work rate rises, crossing her first threshold at 146 and her second at 164 and peaking at 178, with a Peak VO2 of 36.4 mL/kg/min, and her doctor's four training zones are set from those thresholds and handed to her coach.

A nurse in their first month at your newest clinic works a patient’s ApoB to the plan your group already wrote. See multi-site group

Patient X, 60, Heart program, the group’s first clinic. Coronary calcium score, Year 1 assessment, The group’s first clinic. Calcium score 146 Agatston, 73 percentile, White men aged 60, MESA. CAC-DRS A2: Moderate, 100 to 299; two vessels. Arteries: LAD and RCA. Next: Statin and its dose chosen by his SLCO1B1 on file, ALT before it starts; ApoB under 70, re-tested in three months; Muscle symptoms asked at each visit. Patient Y, 62, Heart program, the newest of a group’s clinics. Coronary calcium score, Year 1 assessment, Its newest clinic. Calcium score 152 Agatston, 69 percentile, White men aged 62, MESA. CAC-DRS A2: Moderate, 100 to 299; three vessels. Arteries: LAD, RCA and circumflex. Next: Statin and its dose chosen by his SLCO1B1 on file, ALT before it starts; ApoB under 70, re-tested in three months; Muscle symptoms asked at each visit. The same plan at both sites.

Illustrative

Showing Longevity

An empty MRI suite in cream and white, with the scanner and its table.

Questions about fit

Our clinic began in aesthetics or wellness. Is iksa for us?

Yes, and aesthetics is medicine.Aesthetics runs on a protocol: a neuromodulator lasts three to four months and is repeated for years. It sits beside the hormones and incretins the same clinics prescribe, where incretin weight loss can thin the face and testosterone can bring acne. It runs on iksa the way they do, as does the medicine a wellness practice grows into.

We run more than one of these programs. Which page is ours?

Each of them.Each program keeps its own protocol and its own markers on the same patient record, so a patient on two programs is read as one person.

Our practice is something else, sports or sleep medicine. Does it fit?

If it runs on protocols, yes.These eleven are examples of one method. A practice that writes a protocol for each patient, reads markers against it and keeps patients for years runs on iksa the same way, and so do the therapies clinics now add, from IV and NAD+ to full-pressure hyperbaric oxygen, mTOR inhibition and plasma exchange.

Is this one OS for personalized medicine, or a different product for each practice?

One, for all of them.We call it the harness for n‑of‑1 medicine, because what these medicines share is one patient read against their own years, and each page here shows what that reading is in yours.

What n‑of‑1 medicine isHow clinics startWhat iksa adds to your cliniciksa beside your EHRPractice management software, comparedProtocol management software

See your own practice on iksa

Bring a protocol you run. We’ll walk one patient through it.

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