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In osteoarthritis, inflammation and destruction reinforce each other, forming a vicious cycle of pain, stiffness, and limited mobility

The B12 deficiency itself getting worse, either because not enough unhealthy red blood cells have expired and been replaced by healthy ones (each one of them has a 90 day life-cycle), or because the B12 wasnt injected on a daily schedule

Targeted supplementation must be combined with aggressive radical rest, meticulous symptom tracking, autonomic nervous system regulation, and strict adherence to pacing to avoid triggering post-exertional malaise