I had low b-12 @119 and took oral supplement plus monthly injections until my numbers got above 900. Plus if you didn't stop supplementation prior to testing, your actual numbers may lower than what is indicated. You have quite a lot going on and if you can get your b-12 above 400 you might be a little better in the fatique area. The vegan diet exposes you to this deficiency and it is surprising to me that your GP isn't aggressively addressing this. If you haven't, search b-12 deficiency and there is quite a list of symptoms. Good Luck, Ken in Texas.