Neurological misadventures - B12 [Archive]

MegaMama

02-27-2007, 12:53 PM

First, thanks to any of you who read this and reply. It's a long story that I'll try to summarize.
About 1 1/2 years ago I developed cramping (like a torn muscle) in my left quad with exertion. Soon afterward, my right leg started doing the same thing, and with some cramps, small bruises developed on top. After a long time, I gave up and went to my primary doctor. My blood volume was large (MCV) and he suggested I quit drinking alchohol (in my case wine), which I did. Very little improvement and then I got bilateral tingling in the front of my shins and feet. Pain developed in ankles and was misdiagnosed by a few podiatrists. When burning, grinding and twitching developed in my feet and twitching up my calves, one doctor recommended I see a neurologist. That was 8 months after the quads started to hurt.

After lots of blood work and a nerve conduction test, my B-12 level was on the High side of low (400s) but my methamalonic acid level was elevated. My primary thought I might have a mild B-12 deficiency. Started me on shots every 3 weeks last November. Needless to say, by that time I was having trouble with my memory, felt confused and my vision was imparied. I felt poisoned and couldn't tolerate certain foods.

Now, some of my symptoms are better than last November, some are more diffuse. The twitching is in my arms, face, legs, feet, thorax, groin, etc. and the tingling is now also in my fore and upper arms.

My last B-12 shot was a week ago Monday (1M), as in the past, I witnessed almost remarkable reduction in symptoms (85% less.) But over a 24 hour period the symptoms returned. On a lark, I started adding 1500 mg sublingual B-12 (methylcobalamin.) In just a week, I felt great, no stomach upset, mind is sharp as a tack (now I'm getting fatigued). For most of the day, symptoms are greatly reduced, but by night, they start to come back. Told neuro and he seemed surprised. But said to stay on the oral supplementation. I'm getting another MMA test tomorrow and a new B-12 level.

Is this strange or what??? Could all this really be B-12 induced? By the way, I'm 46, strong (I exercise to keep out of back pain), I have taken multis and B complex for years, by last december, couldn't stomach and vitamins.

Again, thanks for the feedback

copperhead

02-27-2007, 02:40 PM

I needed to supplement some iron and would have tingling sensations in my feet because of my low iron levels.

I think you may have some kind of anemia that is not being recognized perhaps. This might explain why the b12 injections are helping with the sypmtoms. But you must be missing something else besides the b12.

I am not suggesting you take iron or any other supplements, but find a doctor who knows more about nutrition than what most mainstream doctors know.

Anemia could be any number of deficiencies, including b6 or copper. If you are getting b12 shots and that is helping then I think that is a clear indication that you have nutritional problems that should be followed up on. I think you need more tests to determine what nutrients you may be lacking besides b12. It may be possible that you need to supplement several different nutrients and this process can be a bit complex; that is why the right doctor is important.

But I hope that you are not taking just b12 sublingual because with this supplement you should also be getting folic acid and vitamin b6, besides some other things. These two supplements are important when taking b12 in any form.

If something works but then wears off in a couple of hours that means you are not taking enough of that supplement or could be missing something else. The rate limiting factor (what is causing a return of those symptoms) is probably some other nutrient.

If you have a problem with not being able to stomach any vitamins that could be any number of problems like malasbortion, other types of GI issues or some severe deficiency that is not being corrected. If you keep taking a supplement that needs another supplement to work in your body and that second supplement is missing, then your body could react to any vitamins you take. And if you keep on taking that first supplement it only makes the deficiency of the second supplement worse. If you keep taking those supplements and are still missing the critical nutrient your body may react like you experienced, I think.

I think you have a nutritional deficiency that is not being treated and that is why you get only limited relief from the b12 supplements.

Nutritional treatment is not so simple.

You really need to go to a doctor who understands about nutrition otherwise it is really the blind leading the blind.

Also consider reading up on the symptoms of low histamine levels or histapenia. For you to need b12 that might indicate that you have low histamine levels. Histapenia is treated with folic acid, niacin, b6, and b12 plus some other nutrients.

Do you take any form of niacin now? There is a test you can take to see if you have low histamine levels using niacin. The b12 injections (and the sublingual form to a lesser degree) help to raise histamine levels. If you do not have all of the necessary nurtrients for balanced histamine levels than that would cause symptoms to develop after the b12 injections.

MegaMama

02-27-2007, 03:21 PM

Thanks for your thoughtful reply.

Finding a nutrition based doctor is rather difficult. Through this process I have consulted a nutritionist who reviewed my diet and simply recommended more red meat. Back in December when I was having cognitive and vision problems, I was tested for each of the B vitamins (based on one doctor's thought that I had B6 toxicity). At that time I was high on B6 (46 with high acceptable being 32), high on thiamine 93 based on a high acceptable of 75, B3 was in range and B2 were normal. In May, my folate was 22 (well above deficient) and B-12 was 430 (out of 211-911) ... last November Methylmalonic acid was 548 (high, normal is 73-376).

copperhead

02-27-2007, 03:33 PM

I assume those levels were a simple blood test. Those results do not indicate deficiency state or lack of one. The body closely maintains homostasis of certain things in the bloodstream. And that is why a blood test does not tell you much about your levels of vitamin, minerals or electrolytes.

I am sorry but that information is I think misleading to you. And I have to say that going to a nutritionist is really a big waste of time and money. A nurtitionist is really a registed dietician and can only go over your diet for you. They are not allowed to diagnose or treat any problems. So for nutritional help don't bother with a dietician or a mainstream doctor.

Sorry but having a blood test is not in any way an indication of nutritional deficiencies or adequate levels of those nutrients.

The test for b6 that is accurate is never performed. I have a b6 dependency and have never had any tests for this nutrient.

ainee

02-27-2007, 05:59 PM

MegaMama - If you can't or don't want to take vitamins, maybe the treatments I've experimented with for over 5 years may give you better health. Through my research, I believe that if the oxygen content to the nerves, tissuses and cells in the body is right, then a lot of symptoms and illnesses wouldn't develop in the first place - and in my case, the treatment I experimented with, suppressed and eventually reversed most of my symptoms - some similar to yours.

I experimented with many treatments which raises the oxygen content in my body, without drugs or machines, also helped to give me better health. I've posted info of my successful treatment in Complementary and Alternative Medicines in a thread - Salt Lamps, pipes etc - started by Buttons2. Also in Child Neurology in thread - Low Circulation and Wounds - started by Trishmomof4. Hope it helps.
Have a nice day.
ainee.

rose

02-28-2007, 02:08 PM

What you describe is almost certainly B12 deficiency. Many do not have the elevated MCV, and few doctors know enough to check methylmalonic acid (good for that doc!!!).

Many if not most people do better on sufficient daily doses of oral B12 rather than just periodic shots, so that also is not unnusual.

Some show an immediate response to shots, and some do not. A lot is going on in the body that we cannot see or feel.

Fatigue as the body begins to do the harder work of repairs is very common. Those who have gone untreated for a longer time and have incurred significant damage are likely to experience that after a honeymoon period of dramatic improvement.

Responses differ from person to person. Some unlucky people have to wait for many months to see any results.

The repair process can be very long and "weird." Symptoms can worsen drastically before improving dramatically.

To make sure that nothing is lacking, it is a good idea to take a B complex (lower doses of the better forms of the vitamins are available), eat iron-rich and potassium-rich foods, and if possible get a ferritin test to see where your iron stores are.

Many people who malabsorb B12 also malabsorb iron to a lesser degree. This is because the most common cause of malabsorption is an insufficient quantity of stomach acid (with or without symptoms, which can seem like too much acid).

http://roseannster.googlepages.com/home

rose

MegaMama

02-28-2007, 03:10 PM

Hi Rose, thanks for the reply. I had already visited your Google pages and found them to be very helpful. Thank you!

I have been on the oral B-12 supplements for just one week yet I have have some very positive results. First, the arrythmia (irregular or extra heartbeat) is gone. I had that since last November. The stomach issues are gone too. YOu are right, I went from a fabulous rock and roll first 6 days to now finding old aches, tingles and twitches, resurface with a vengeance, then, almost as quickly as they come on, disappear. Very weird. I'm going for the B-12, homocysteine and MMA levels tomorrow. On your rec, I'll call the doctor and see if I can also get a scrip for iron (get it all done in one shot, ha ha).

I stopped taking all vitamins late last December b/c I would literally feel ill after taking them. I'm a little reluctant to add the Bs supplements back in ... do you think it's critical?

Again, thanks so much. Your advice is very, very helpful
Meg

rose

02-28-2007, 07:06 PM

Please do not get iron unless you really need to. I'm rushing through these today---did you have a low ferritin?

It sounds like you are on the fast track to improvement. Good! Maybe many months instead of several years---I hope so.

rose

cariqueen

02-28-2007, 09:50 PM

Because of the cramping and twitching, magnesium deficiency comes to mind. But if you supplement, make sure it is an easily absorbable form like glycinate, taurate or malate, NOT mag oxide. It's use is primarily in laxatives for the reason that it is not well absorbed, but merely passes through.

best wishes,

karen

MegaMama

03-01-2007, 11:26 AM

Hi Rose, in reply to your query about ferritin ... frankly I don't think I have been tested for it! So, I should know status next week.

re: the healing process, it's very peculiar. Since the daily supplementation (1 1/2 weeks) spots that used to twitch or tingle, suddenly ache. I mean suddenly. Or they vibrate with activity in a specific inch of nerve area. I suppose that's in keeping with your observation that one actually gets worse b/4 improving. I have to keep the faith (even though sometimes fear prevails.) Since I have had such remarkable improvement in two areas: heart arrythmia and gastric craziness resolved almost immediately, I have to reassure myself that I'm helping myself, not further hurting myself. Also I have noticed that repair doesn't seem to have anything do with the chronology of the advancement of the damage. It's almost like everything's getter better, in its own way, at the same time. Does that make sense???

Thanks again, talking with you is very reassuring.

Meg

rose

03-01-2007, 04:26 PM

Cry Tears

03-02-2007, 09:30 PM

Fatigue as the body begins to do the harder work of repairs is very common. Those who have gone untreated for a longer time and have incurred significant damage are likely to experience that after a honeymoon period of dramatic improvement.
The repair process can be very long and "weird." Symptoms can worsen drastically before improving dramatically.
http://roseannster.googlepages.com/home
rose
Boy is this ever right on! I'm a B12 def poster child for sure!
The repairs have not been fun! Often frightening and scarey for sure.
I'm sure your doctor would have told you had your hemaglobin been on the low side.
Just ask for your results. For women normal is about 12-14.
I had severe anemia for 2+ years...low as 5.1 hgb...thats deadly low! I had an intestinal anuerism like mass aka AVM.
I learned alot about iron...very dangerous to take too much! So make sure you monitor your intake.
Children can die from taking too many vits that contain iron...so its nothing to mess with.

Several years ago I was diagnosed with having Benign muscle fasciculations. It started out of the blue all in one week.
I've been seen by way too many stupid neurologist...and only a few good ones. Mayo Clinic had the best.

My muscles twitch, wiggle, buzz, vibrate and often feels as if I'm hooked up to electrical outlet...its sooo weird and bothersome all the time. You can see my legs, arms, face muscle twitching away round the clock.
But then some days they're completly gone.

Thats why I wonder if this is tied into vit or min deficency and I'm just not getting the right combo yet.
Its such a mystery.

I was B12 def for many years...even had spinal cord involvment
that cleared up soon after beging the sublingual Methyl B12.
But a few months ago I began having some very weird and scary symptoms and my spine began hurting once again.

I thought it was from lifting something the wrong way...
but now I'm thinking its the same pain I had when I was B12 def, same pain.
My muscle twitching began to get worse as well. With all this excersise you'd think I'd be skin and bones!
Here's a link to what I'm talking about.
http://www.answers.com/topic/benign-fasciculation-syndrome
Its not been easy with my body's repairs,
But thank God I'm on the right track! Thanks so much!
hugs, cheryl

Cry Tears

03-05-2007, 09:04 PM

megamom...did you say you also have a rash that won't go away?
Check this link out. Says rash is tied to a zinc defiency.
Blessings, cheryl

http://ibdcrohns.about.com/library/weekly/aa070501a.htm

MegaMama

03-08-2007, 07:57 PM

thank goodness, I don't have a rash too! I certainly have enough going on without a rash. Thanks for your post.

MegaMama

03-09-2007, 02:59 PM

Hi Rose, if you get this correspondence, I got my blood results back. MMA is very low (73 out of range of 87-318 (normal)), iron is normal (120 out of 35-175), homocysteine is 6.2 (in range), folate is normal, as is Ferritin (26 out of 10-232), and Vitamin B12 is now 737 (out of 200-1110).

Last December, B12 was 498 (211-911 range)
Last November, B12 was 512 (211-911 range), MMA was 548 (out of 73-376)
Last May 2006, B12 was 430 (211-911)

What seems to have thrown the docs is the fairly normal B12 level.

Would appreciate your feedback:) Many thanks Meg

MegaMama

03-09-2007, 06:50 PM

Meg,

Most people are not tested for ferritin level. That is very unfortunate, since it is much more sensitive than the usual tests. And too little or too much iron is a bad thing.

It really does sound like you are on a fast track to repairs. :) I hope so.

Repair experiences vary tremendously, and it is not surprising that many people arrive at the same description after being at it for a while: "Weird." I am one of those who didn't have any buzzing or tingling until nerves started healing. An unbelievable variety of symptoms can occur when nerves begin to regenerate. One reason it varies so much is that the type and extent of damage varies so much.

Yes, it makes sense.

rose
Hi Rose, if you get this correspondence, I got my blood results back. MMA is very low (73 out of range of 87-318 (normal)), iron is normal (120 out of 35-175), homocysteine is 6.2 (in range), folate is normal, as is Ferritin (26 out of 10-232), and Vitamin B12 is now 737 (out of 200-1110).

Last December, B12 was 498 (211-911 range)
Last November, B12 was 512 (211-911 range), MMA was 548 (out of 73-376)
Last May 2006, B12 was 430 (211-911)

What seems to have thrown the docs is the fairly normal B12 level.

Would appreciate your feedback Many thanks Meg

rose

03-10-2007, 02:32 AM

Unfortunately, most docs are decades behind and believe that a normal
B12 result rules out deficiency. That is absolutely wrong, and has been known to be wrong for many, many years.

Your symptoms, and the high MMA which came down as B12 went up, make it almost a sure thing that you were being damaged by B12 deficiency.

If I were you, I would want the B12 level to be lot higher than that. I would take daily oral B12 in doses of at least 2000 mcg.

rose

MegaMama

03-10-2007, 08:15 AM

I am taking 2000/day now. I'm getting another shot on Monday, the 5th (or maybe sixth) of a shot every 3 weeks. The doc won't do more frequently. I'll continue with the 2000/day, Tuesday will be the end of the 3rd week with 2000/day. Don't know when to taper to 1000/day. And my doc didn't prescribe the 2000/day. I did based on my reading of your Google site.

rose

03-11-2007, 11:18 PM

I wouldn't worry about cutting back to 1000 mcg until you have provided your body with lots of B12 for at least several months.

Then, if you want to, fine. If not, fine.

rose

MegaMama

03-14-2007, 05:59 PM

rose

03-15-2007, 02:05 AM

I must have given you the wrong impression. I certainly did develop neurological symptoms long before being treated.

However, as you mentioned, some of the problems (and some that had been so subtle I hadn't noticed them) did become much worse during repairs----prior to great improvement. In some cases, the improvement was complete. In others it has not been, but continue things continue to change for the better. :)

Yes, for many it is very weird.

rose

jcc

03-15-2007, 10:26 AM

I have given your comment about you not having neurological symptoms until after you started B12 supplementation. In hindsight, my situation is somewhat similar. From August 2005-April 2006, I just had quad pain, then the tingling in the front of my shins began and burning in heels (textbook neuro symptoms.) I remained that way for some time. After I started getting the B12 supplementation in Nov. 2006, the symptoms of tingling and twitching spread like a vine up my body, very rapidly. This must correlate to you advice that "you get much worse before you get better." And I did. It's been 3 1/2 months since I started treatment, now the back of my neck burns and hurts. A lot. meanwhile other symptoms are getting better. Again, it's all weird. Thanks for staying in touch with me. It helps to have contact with others who have been through this. Meg :-)

Hi MegaMama~

I was another who was B12 deficient with a low normal B12 level of 294... discovered several years after the initial onset of symptoms. I remember a 'hit by a truck' fatigue during those early months of supplementing~ Here is a list of the symptoms I had. http://jccglutenfree.googlepages.com/b12deficiencysymptoms

Hope you continue to see improvement over time!

Cara

rose

03-15-2007, 01:33 PM

It is rare, but one of the B12 stores who has become a good friend was deficient with a B12 serum level well above 400. This would be more likely in an older person, but she was around 40.

B12 serum is just not reliable. One persons 400 can be equivalent to another person's 130, etc.

I was at 138, and several weeks after beginning B12 treatment I began to experience fatigue like hadn't known existed. But prior to that, at least one of my most recent symptoms had gone and my body was in the process of eliminating my symptoms of impending heart failure (that took months) and other problems that would disappear over the next several years. The fatigue was so bad that my legs felt encased in concrete after only a few steps.

Thank you so much, Cara, for continuing to dig for information and contribute soooo much to the health of others. Informing you about B12 was like throwing a pebble in a lake.

rose

B12Bob

03-15-2007, 02:40 PM

Another of my strange theories about feeling worse after starting B12 is that you are actually beginning to feel again. My feet started to hurt after starting B12, but after feeling nothing for years the pain seemed positive to me. I was feeling again.

MegaMama

03-18-2007, 11:34 AM

Hi Cara, I had already visited your site and saw that you had more organ issues than I, but the twitching (every 3 seconds), yeast infections (yuchh), tongue, etc. were very similar. Thanks for the listing. Misery loves company! Of all my doctors, my internist, not the THREE neuros I saw, picked up the B12 possibility. The lowest level I had was 419 B12 serum, but a high MMA. I am STARTING to feel better, after almost 4 months of supplementation. I think my B12 was elevated b/c I took B-complex daily as a force of habit. The first month of supplementation was mostly getting worse (heart beat became irregular, stomach problems developed, tingling spread UP body, twitching covered body), while most recent symptoms b/4 supplementation disappeared immediately. I have read that after a year, things just don't get better. (Doesn't sound accurate b/c Rose continues to improve)And, if you've been symptomatic for awhile, one may not experience improvement until the 6-12 month range.

MegaMama

03-18-2007, 11:35 AM

Hi Rose, thanks for the reply. It is strange to have a B12 of 419 and still be B12 deficient. See post to Cara above re: that topic. When are you going to finish your website? it's soooo helpful to all of us lost out there in B12 deficiency land? Meg

rose

03-18-2007, 09:36 PM

The references stating that things can't improve beyond a year (or even 6 months) are blatantly wrong. That is assuming that B12 deficiency was diagnosed and treated right away, which it very often is not.

At least a few reasons B12 serum is not reliable. Here are two of them: 1) B12analogues that cannot be used by the body are often measured. 2) There may be too little transcobalamin to move B12 from blood to tissues where it is used (cannot be used at all in the blood).

I guess I will never finish it :) , but I hope to add to it much more quickly when the current rash of family emergencies slows down or ends.

Thank you! :o

rose

metta

03-24-2007, 12:22 PM

Several years ago I was diagnosed with having Benign muscle fasciculations....Here's a link to what I'm talking about.
http://www.answers.com/topic/benign-fasciculation-syndrome

A lot more good resources on Benign Fasciculation Syndrome are posted here: www.AboutBFS.com

Hope this helps!

RuthM

03-25-2007, 01:07 PM

Hi MegaMama~

I was another who was B12 deficient with a low normal B12 level of 294... discovered several years after the initial onset of symptoms. I remember a 'hit by a truck' fatigue during those early months of supplementing~ Here is a list of the symptoms I had. http://jccglutenfree.googlepages.com/b12deficiencysymptoms

Hope you continue to see improvement over time!

Cara

Thanks for listing your symptoms...I have the majority of those. My level was at 173. I felt better a few months after starting treatment. I was worried when my symptoms came back but it was nice to know I was just healing. It has been quite a while now though and they are still coming and going.

jcc

03-26-2007, 07:35 PM

Hi Ruth,

I remember searching the Peripheral Neuropathy forum years ago for 'buzzing' and was so excited to find someone else who experienced the same symptom. My neurologist acted as if I was the first one to complain of this... and previously my PCP thought I was HEARING the buzzing rather than feeling the buzzing :rolleyes:. Then you meet up with a whole group of people who know what you are talking about! I remember being excited to hear someone describe "bee sting" pains, like someone snapping a rubber band on your arm. I had previously just called them deep pinpoint pains, but I knew exactly what the person was referring to when I read it.

In any case, I know it is a long list of symptoms suspect of hypochondria (:rolleyes:)... but I put it all out there hoping others will recognize their symptoms and follow up on the B12 deficiency possibility, or just be reassured that a B12 deficiency can cause these things.

BUT... So many other things can cause these symptoms. I know I was going to further pursue Lyme Disease testing if my symptoms returned or worsened.

It can take a long time for healing, depending about how long and how severe the deficiency... but if at some point you are still concerned more is going on there is always the possibility that another co-exisiting condition is contributing to your symptoms. I've known people with gluten sensitivity who have described some very similar symptoms, too, that resolve on a gluten free diet.

For me, most of my major symptoms did resolve within months, but some milder versions of twitching/buzzing, and some of the cognitive problems, hung on past the first year. Rose has said she continued to see improvement several years later.

I also remember that symptoms seemed to worsen when I'd get sick, or was under stress of any kind, really... and others have said the same happened to them.

Hope you have continuing improvement!

Cara

jcc

03-26-2007, 07:45 PM

I have read that after a year, things just don't get better. (Doesn't sound accurate b/c Rose continues to improve)And, if you've been symptomatic for awhile, one may not experience improvement until the 6-12 month range.

I've got a reference for you :). Cara

From: The Neurological Manifestations of Gastrointestinal Disease by Mark Skeen, MD.
Neurologic Clinics
Volume 20 € Number 1 € February 2002

"Subacute combined degeneration has also been reported in a patient with a
high serum vitamin B12 level and an abnormal plasma vitamin B12 -binding
protein.[130] Serum methylmalonic acid and homocysteine levels rise as a
marker of tissue deficiency of cobalamin and decline in response to
therapy.[81] [89] [106] Although serum methylmalonic acid level appears to
be the most sensitive single test for tissue deficiency, further sensitivity
results from the determination of both metabolites.[81] [89] [106] In
addition, the demonstration of falling metabolite levels after therapy adds
diagnostic certainty in atypical cases.[89]

"Although rare patients may demonstrate an exacerbation of neurologic
manifestations soon after beginning therapy, these patients subsequently
respond to therapy. Most patients respond dramatically to therapy, with a
decrease in paresthesias beginning within a few days of therapy and maximal
improvement within 1 to 3 months. Other neurologic manifestations begin to
improve in 2 to 4 weeks, with maximal response within 6 months.[61] Healton
et al reported one patient in whom objective functional improvement in signs
of myelopathy occurred beyond the third year of treatment.[61] Recovery is
inversely related to the severity and duration of symptoms prior to therapy."

MegaMama

04-03-2007, 05:02 PM

Hi Cara, I'm seeing yet another doctor at the end of this week. All docs agree that my symptoms are not typical of B12 ... is the B12 a "red herring?" I have been in treatment for 4 months now. I'd like to know how complete your recovery has been ... what symptoms lingered and over what period of time? Thanks much. Hope you're well. Meg

rose

04-03-2007, 06:44 PM

Unfortunately, most medical people still believe there is a typical presentation of symptoms and signs with B12 deficiency. They are sadly behind.

There is no typical presentation, unless one is lucky enough ;) to have a sore tongue and megaloblastic anemia. A large percentage of those being damaged by B12 deficiency do not have either of those or any other "typical" symptom or sign.

rose

MegaMama

04-03-2007, 07:12 PM

hi Rose! Long time!

I have just completed my fourth month of injections every 3 weeks. Two shots ago, I developed pain, tingling, burning and limited range of motion high in my neck. This time, I got my shot (6 weeks later) and the pain subsided almost immediately. Never, know what's going to come back, disappear ... I know wonder if I had some spinal cord damage ... That would definitely be problematic. I have now done the math, since my onset of symptoms, 15 months passed before I got treatment. Would you call that early? I've read a lot of scientific stuff and they all say "early detection" but I don't know what that means ... any idea?

rose

04-04-2007, 05:39 PM

No. That is not early. When they speak of early detection they generally speak in terms of weeks.

However, many have eventual improvements even when symptoms have been present for much much longer. Depending on the severity of your deficiency and your malabsorption, your spinal cord may have been affected in ways that are not visible with an MRI and are repairable. Even when lesions have formed, much improvement may be possible.

Whatever the case, it sound like you are responding (any change due to getting the B12 is a good thing, even though it may not seem like it at the time) and your body is working on it. I do hope you are taking oral B12 (methylcobalamin if possible) as well.

Best wishes,

rose