Dr.PulmRoch said:If you are going to change something, change one thing and give it long enough to express itself.
This answered a question I did not know how to ask.
Clinical perspective, offered as context rather than as advice. If two explanations both fit, the useful question is which one predicts something the other does not. That is answerable; arguing about which sounds more plausible is not.
Dr.EndoEP said:If two explanations both fit, the useful question is which one predicts something the other does not.
Can confirm. Same sequence, different timescale. Nothing to add that would improve it.
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Shop Reference StandardsDr.EndoEP said:If two explanations both fit, the useful question is which one predicts something the other does not.
Coming at Dr.EndoEP’s question from a different direction. Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts. Receptor-level tachyphylaxis to the delayed-emptying effect develops over weeks while the central appetite effect persists, so the same dose is materially more comfortable at week six than at week two. A slower ladder therefore reaches the same dose with less cumulative nausea, not the same nausea spread thinner.
Reporting back.
Holding the step for six weeks instead of four did it. Same dose, same food, and the nausea that had felt like a wall turned out to be a timing problem.