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My orthopedist mentioned surgery as the next step, and thats when I started researching alternatives

Urea cycle and reprogramming of ammonia metabolism Ammonia excretion occurs primarily through the urea cycle which converts ammonia from amino acid metabolism into non-toxic urea, which subsequently enters the bloodstream and is excreted through the urine

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FOXO4-DRI acts as a competitive inhibitor of this interaction binding directly to the transactivation domain 2 (TAD2) of p53, displacing FOXO4, and allowing phosphorylated p53 to be exported from the nucleus and directed to mitochondria, where it activates BAX, triggers caspase-3 cleavage (via the p53/BCL-2/Caspase-3 signalling pathway), and drives cell-intrinsic apoptosis

The shot is quick and easy to repeat often, which is why it works well as a weekly visit woven through a longer-term plan