If the B-12 test result is clearly deficient, B-12 therapy should be given immediately and follow up tests should be scheduled within a month or so. B-12 treatment should be continued, because most people who malabsorb usually continue to do so for life (and in many cases malabsorption becomes more severe later in life).

Please obtain copes of your B-12 and other lab results. Hearing "It's normal" or "everything is fine" from most doctors is meaningless, because most don't know how to rule out or diagnose deficiency. In addition, it is surprising how often out-of-range results, along with other clues, are ignored.
Many doctors think that a B12 serum result within "normal" range rules out deficiency----it clearly does not, especially in a patient with neurological symptoms.

Many doctors still believe that ruling out anemia eliminates the possibility of B-12 deficiency--on the contrary, people low in B-12 who do not become anemic are more at risk for severe neurologic damage.

Many patients are damaged, even disabled while testing well into normal. Rare patients are deficient even when blood levels are high (in very rare cases into the 700s), because B-12 does not work in the blood. B12 works in the tissues. Some people have difficulty moving B12 from blood to tissues.

If the B-12 result is not clearly deficient, the patient with neurologic symptoms should have follow up tests: methylmalonic acid and homocysteine. The two follow-up tests have a good, but not perfect, record for exposing deficiency. In case you are one of the few who test "normal" all round but still need B12, it is a good idea to take at least 1000 mcg B-12 per day to cover the possibility that you are in that minority. In that case, one can only hope.

rose