Is there a vegetarian option if your patients are allergic to fish or do not want to ingest a fish byproduct?

Maybe. There is algae-derived DHA which might be beneficial but I have never seen any of my patients on algae-derived DHA significantly improve. Autonomic improvement and recovery were believed to be medically impossible until I developed The Nemechek Protocol® and have only been realized with fish-derived DHA. The lack of EPA in algae derived DHA might be a reason for it not to seemingly work.