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Improper diet and poor lifestyle may cause vitamin B12 deficiency, leading to fatigue, weakness, and neurological problems like numbness and tingling in the limbs

These effects are well-documented across multiple animal models of intestinal injury, ulcerative colitis, and inflammatory bowel disease

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Van Winkle also talks candidly about her challenges in life like her hip replacement surgery and the loss of her husband and son

67 One case report of off-facial treatment detailed complications following polyalkylimide placement to the buttocks to improve HIV lipoatrophy

I would not be surprised if she has many of the side effects which have been reported (such as sore arm, fatigue, and so on)