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Initial treatment for B12 deficiency with neurological involvement: When elderly patients present with neurological symptoms (peripheral neuropathy, cognitive impairment, subacute combined degeneration of the cord), urgent and aggressive replacement is essential to prevent irreversible damage

The first day you descend about 15 km to the river, the second day you climb 12 km to Santa Rosa, the third day you climb 8 km to Choquequirao, and the fourth and fifth days you return