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Ensure laterality (right, left, unspecified) is properly documented

"I typically recommend meeting protein requirements (many people fall short of this, especially as they age), choosing mostly plant-based sources of protein (these tend to not have the same associations with cancer and mortality), and not going overboard with protein (the goal is optimal, not excess!)." For people who work out and are trying to build or maintain lean muscle, the general consensus is to aim for up to 0.7 grams of protein per pound of body weight, per a 2018 report in the British Journal of Sports Medicine

Another possibility is that obesity could lower serum vitamin B12 levels through decreased dietary intake or absorption, increased catabolism, and sequestration in adipose tissue, or changes in the gut microbiota profiles which could affect the metabolism of vitamin B12

This approach avoids the digestive system, resulting in rapid absorption

The telling sign of this is elevated homocysteine and methylmalonic acid despite normal folic acid, B6, & B12 levels (11)

Keep in mind prolactin only stimulates milk production