BOMSS advises specialist multidisciplinary follow-up for at least two years post-surgery, with lifelong monitoring thereafter in primary care
8 weeks (2 vials): 6 mL 1 bottle (10 mL) 12 weeks (3 vials): 9 mL 1 bottles (10 mL each) 16 weeks (4 vials): 12 mL 2 bottles (10 mL each) Alcohol Swabs Use one swab for the vial stopper and one for the injection site per administration
Initial assessment typically includes: Detailed history: Your doctor will ask about B12 supplementation, dietary habits, alcohol consumption, medications, and symptoms suggesting liver disease, kidney disease, or malignancy Physical examination: Looking for signs of liver disease (hepatomegaly, jaundice), lymphadenopathy, splenomegaly, or other abnormalities Medication review: Identifying any supplements or medications that might explain the elevation First-line investigations commonly include: Repeat B12 measurement: Confirming persistent elevation after stopping supplements (if applicable), ideally using the same laboratory Full blood count (FBC): Assessing for anaemia, polycythaemia, or abnormal white cell counts that might suggest haematological disorders Peripheral blood film: May be requested if blood count abnormalities are present Liver function tests: Evaluating for hepatic disease through ALT, AST, alkaline phosphatase, bilirubin, and albumin Renal function tests: Measuring creatinine and estimated glomerular filtration rate (eGFR) Inflammatory markers: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) if inflammation is suspected Further investigations may be arranged based on initial findings: Haematology referral: If FBC abnormalities suggest myeloproliferative disorders (e.g., raised haemoglobin, platelets), specialist assessment with JAK2 mutation testing or bone marrow examination may be necessary Liver imaging: Ultrasound, CT, or MRI scanning if liver disease or hepatic malignancy is suspected Additional blood tests: Including lactate dehydrogenase (LDH) if clinically indicated If results remain unexplained, discussion with the laboratory about possible macro-B12 or assay interference may be helpful
One 55-year-old wound up in the ER with a 30-hour erection after injecting 2 milligrams into his abdomen
Check periodically that temperatures stay between 36 and 46 degrees Fahrenheit
