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Step 5: Receive Your Medication What Arrives: Package Contents: Medication vials or syringes Syringes and needles (if using vials) Alcohol prep pads Sharps container for safe needle disposal Instruction guide Storage information Immediate Actions: Verify package arrived cold (ice packs present) Check medication appearance (should be clear, colorless) Confirm expiration/beyond-use date Store in refrigerator immediately (36-46F) Dont freeze Keep in original packaging Step 6: Prepare for First Injection Before Your First Dose: Watch Training Video: Most providers supply injection tutorials See technique demonstrated Learn proper steps Review safety measures Gather Supplies: Medication from refrigerator (can sit at room temp 15-30 min) Syringe and needle (if using vial) Alcohol prep pad Sharps container Cotton ball or gauze (optional) Choose Injection Site: Abdomen (2+ inches from belly button) Front/side of thigh Back of upper arm (may need help) Rotate sites each week Step 7: Administer First Injection Injection Steps: Wash hands thoroughly with soap and water Prepare injection site Clean with alcohol pad Let air dry (dont blow on it) Prepare medication If using vial: Draw prescribed dose into syringe If using pre-filled syringe: Remove cap Check for air bubbles, tap syringe to remove Pinch skin gently between thumb and fingers Insert needle at 90-degree angle Quick, dart-like motion Needle should go fully under skin Inject medication Push plunger slowly and steadily Hold for 5 seconds after injecting Remove needle Pull straight out Release pinched skin Apply gentle pressure if needed Dispose of needle Place directly into sharps container Never recap needle First Injection Tips: Take your timeno need to rush Most people find it much easier than expected Needle is very small and thin Quick insertion hurts less than slow Contact provider support if you need help Step 8: Manage First Week What to Expect: Days 1-2: May not notice much initially Medication building up in system Continue eating normally Days 3-5: Appetite may start decreasing Food might sound less appealing Some mild nausea possible Days 6-7: Reduced hunger more noticeable Smaller portions satisfying First pounds of weight loss (water weight) Managing Early Side Effects: For Nausea: Eat smaller, frequent meals Choose bland, easy-to-digest foods Avoid fatty and spicy foods Ginger tea helps Stay hydrated For Fatigue: Dont restrict calories too much Ensure adequate protein Get regular sleep Light activity helps For GI Upset: Increase fiber gradually Stay hydrated Avoid trigger foods Usually improves within weeks Step 9: Establish Your Routine Weekly Injection Schedule: Pick Same Day Each Week: Choose a day that works for your schedule Many prefer Sunday evening (forget about it all week) Set phone reminder Can inject same day 2 days if needed Create Routine: Set medication out 30 minutes early (room temp comfort) Prepare injection area Inject at same general time Track in calendar or app Note any side effects Lifestyle Practices: Nutrition: Prioritize protein (20-30g per meal) Eat vegetables with every meal Stay hydrated (64+ oz water daily) Avoid drinking calories Listen to hunger cues Physical Activity: Start with daily walking (30 minutes) Add strength training 2-3x/week Preserve muscle during weight loss Gradually increase as weight decreases Tracking: Weekly weigh-ins (same day, same time) Measurements (waist, hips) Progress photos (monthly) How you feel (energy, mobility) Non-scale victories Step 10: Attend Follow-Up Appointments Typical Schedule: Week 2: Check in on side effects Review injection technique Answer questions Assess initial tolerance Month 1: First dose increase (if tolerating well) Review weight loss progress Adjust management strategies Prescription refill Monthly Thereafter: Continue dose escalation Monitor progress toward goals Manage any issues Optimize treatment Between Appointments: Message provider with questions Report concerning side effects Request help if struggling Update on any health changes Troubleshooting Common Early Issues: Im Not Losing Weight Yet Normal in first 2-3 weeks Takes time to reach therapeutic levels Weight loss accelerates as dose increases Be patient The Nausea Is Really Bad Contact provider about anti-nausea medication May slow down dose escalation Try dietary modifications Usually improves significantly by week 6-8 I Forgot My Injection Take as soon as you remember if within 5 days If more than 5 days late, skip and take next dose on schedule Dont double up Set reminders to prevent forgetting I Dont Like Injections Use numbing cream before injection (topical lidocaine) Inject slowly to reduce discomfort Distract yourself during injection Gets easier with practice Most people adjust within 2-3 weeks Success Tips: For Best Results: Take medication consistently every week Follow dietary recommendations Stay physically active Attend all follow-up appointments Communicate openly with provider Be patient with timeline (16-20 months) Focus on non-scale victories too Commit to long-term treatment Avoid: Skipping doses Ignoring side effects that persist Expecting rapid results (takes time) Relying solely on medication (combine with lifestyle) Stopping too soon Comparing your results to others When to Contact Provider: Urgent: Severe abdominal pain Cant keep fluids down Signs of allergic reaction Vision changes Severe side effects Non-Urgent but Important: Side effects not improving after 4 weeks Questions about dose escalation Weight loss concerns Need anti-nausea medication General questions about treatment Ready to Start

41 This finding also suggests an effect of striatal metabolites on behavior

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This normalization permits oxygen consumption analysis independent of differences in mitochondrial content