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The surgeon watches the monitor to guide the surgical tools in doing the Whipple procedure

IGF-1 is a highly anabolic peptide hormone responsible for: Muscle cell proliferation and repair Tendon and ligament regeneration Bone growth Glucose uptake in muscle cells Increased satellite cell activation Oral administration of MK-677 raised serum IGF-1 levels by over 60% in healthy adults without altering cortisol, insulin, or gonadotropin concentrations. Chapman et al., Clinical Pharmacology & Therapeutics This rise in IGF-1 is what leads to muscle growth, improved recovery, and increased physical resilience over time

Routine monitoring discussions should occur if: You have been taking metformin for more than three years without recent B12 testing You are taking high-dose metformin (2g or more daily) You are aged 65 or older You follow a vegan or vegetarian diet You are taking acid-suppressing medications (such as omeprazole or ranitidine) You have other risk factors for B12 deficiency Patients should not commence B12 supplementation without medical advice, as inappropriate supplementation may mask underlying conditions such as pernicious anaemia or other causes of deficiency that require specific investigation and management

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