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This can be made worse with the deficiency of necessary elements for manufacturing and production of red blood cells, for example, vitamin B12 or iron deficiency

During the off-cycle, focus on diet, probiotics, and lifestyle measures

Many factors can contribute to reduced or cessation of normal thiamine production in adult ruminants, including dietary issues or certain medications

Alternatively (and this is the approach I take for many patients), if you are experiencing significant symptomatic improvement then you can just continue to take the B12 shots indefinitely