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Meanwhile, performing a preoperative assessment for RGC using gastric ultrasound in patients continuing GLP-1RA therapy appears reasonable, given the simplicity and feasibility of point-of-care gastric ultrasound [10, 11, 23]

Baseline bloodwork CBC, CRP, ferritin, IL-6, cortisol AM, metabolic panel, thyroid function Cardiovascular assessment heart rate variability, orthostatic vitals if POTS is suspected Gut health markers stool testing, zonulin, calprotectin if GI symptoms are prominent Mitochondrial function proxies lactate, organic acids panel if PEM is a primary complaint From there, a typical protocol might be structured as: Phase 1 (Weeks 16): Immune and gut foundation Thymosin Alpha-1: 1.6 mg subcutaneous, twice weekly BPC-157: 250500 mcg daily, route determined by predominant symptom (oral for gut, injectable for systemic) Phase 2 (Weeks 412): Tissue repair and cardiovascular recovery TB-500: 2.02.5 mg subcutaneous, twice weekly Continue BPC-157 as indicated Phase 3 (Weeks 816): Maintenance and metabolic support Taper or pulse doses based on clinical response Add mitochondrial support if fatigue persists (see: Mitochondrial Peptides and Insulin Resistance) These are illustrative dosing ranges based on clinical research and published protocols

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doi:10.1086/605933