 Any adverse effects on oral medications and injections B12 or placebo will be monitored and documented on a progress sheet in patient folder and treated according to the guidelines and standard of care. In case of an unfortunate rare event such as anaphylactic shock the patient will be managed according to the AKUH protocol. A crash cart will be available at the clinic all the time. The registered nurse is always present at the clinic who is ACLS certified Instruments 