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The same old line about too much B12 being harmful (which is complete rubbish) is often used in these letters and if the patient is unaware of the truth about B12 they might quietly comply with the harmful removal of their vital treatment

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Peripheral neuropathy, characterized by weakness, numbness, and pain resulting from nerve damage beyond the brain and spinal cord, is common

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thus, appropriate tests need to be carried out to rule out this condition if suspected.[16] Therapeutic response to cyanocobalamin may decrease due to elderly age, infection, renal insufficiency, diabetes mellitus, marrow suppressants use (e.g