sleeve in 2017, currently at 175 on 10mg tirz, been holding at this dose for about 6 weeks now. the sulfur burps came back hard at week 6 of the hold. not during uptitration. i ramped slower than the standard protocol – my bariatric surgeon had me hold each step 8 weeks instead of 4, because the sleeve handles restriction already and there’s less urgency to push dose – and throughout the whole ramp from 2.5 to 10mg, the burps were manageable. then i stabilized. week 6 of the hold: back with a vengeance. my working hypothesis: during uptitration, the GLP-1-driven gastric emptying slowdown is still adjusting week to week, so your gut has a moving target. once you stabilize, the motility suppression reaches a steady state. for a sleeve patient, that stacks on top of already-reduced gastric capacity in a different way than it does for someone with intact anatomy. the interaction might not land the same way during the dose ramp as it does once things flatten out. i don’t have a gastric emptying study to anchor this. asked my surgeon about getting one around 8 months post-op and she said sleeve patients aren’t typically referred unless there’s a stricture suspicion or severe dumping, so i never established a motility baseline before starting tirz. flying without that reference point. what’s helped: cold or room temp foods, smaller protein portions earlier in the day, avoiding eggs on injection day and the 24 hours after. eggs are a consistent trigger – no idea why, but it’s held for 6 months across different dose levels. for context: i spent about a month on compounded sema before insurance switched me to tirz. nausea, yes. sulfur burps, not really. different GI footprint, at least for me post-sleeve. so the mechanism difference seems to show up in where the GI side effects land, not just whether they show up