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For complete structural tears, surgery remains indicated

Keep away the methycobal injection (methylcobalamin) from the reach of children Do not use the methycobal injection if it appears cloudy, discolored, or contains particles

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The groups most likely to develop B12-related hair and skin changes are the same ones at risk for deficiency generally: vegans and vegetarians, adults over 50, people on long-term metformin or proton pump inhibitors, anyone who's had bariatric surgery, and people on GLP-1 protocols whose reduced appetite has significantly lowered their overall nutrient intake for an extended period