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However, ultrasound should be considered for patients with: Suggestive symptoms or examination findings Significantly elevated liver enzymes History of previous biliary symptoms Ongoing Monitoring during treatment includes: Regular clinical follow-up (typically every 412 weeks initially) Patient education about warning symptoms requiring urgent evaluation Periodic liver function monitoring if clinically indicated Gradual dose titration to moderate weight loss velocity when feasible Red Flag Symptoms requiring immediate medical attention include: Severe, persistent right upper quadrant or epigastric pain Fever with abdominal pain Jaundice (yellowing of skin or eyes) Dark urine or pale stools Persistent nausea and vomiting Patients experiencing these symptoms should seek urgent medical evaluation

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I feel full longer and have energy due to the B12 addition