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Here's the breakdown: Before Reconstitution (Lyophilized Powder): The powder is quite stable

Your pharmacist will advise what is appropriate

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[26] A complication of severe chronic PA is subacute combined degeneration of spinal cord, which leads to distal sensory loss (posterior column), absent ankle reflex, increased knee reflex response, and extensor plantar reflex response

Patients typically report feeling more energized and mentally clear within a few days to a week after treatment

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