Educating doctors

[Jeast]

Just read Martin Hoopers latest book and was struck by his emphasis on educating to change the medical community's reluctance to address b12 deficiency. Wish he'd send a note to this guy who is on the USA Today board. kevinmd.com/blog/2013/02/fe...

[Hillwoman]

Goodness me... I thought he was making fairly reasonable points, in a bombastic way, until the paragraph on methods of administration. Dear oh dear.

[pvanderaa]

B12 Supplements taken orally don't work when you have an absorption problem in the gut.

[helvella]

Love the way he bangs on about evidence and placebos.

a) What evidence is needed beyond it working in an individual?

b) Is there truly a harmful placebo? (Latin: "I please")

c) Whose fault it is that "These confirmatory tests are rarely done."?

d) He mentions poor diet, some medicines and autoimmune PA as causes. Then effectively dismisses the cause with "whatever...". Completely missing what many in the thyroid community suspect is the effect of low stomach acid. That could end up being the biggest single group!

[Hillwoman in reply to helvella]

For some reason I didn't register the remarks about placebos, but you're quite right.

The thyroid connection is rarely acknowledged in B12D.

[Gambit62 Administrator in reply to helvella]

part of the definition of a placebo is that it is an inert substance that could not cause the observed effects ... so has a very poor understanding, like most other medics, of what a placebo actually is and generally about how B12 deficiency works.

The blog is actually 4 years old and there is a lot of argue back in the replies - think he is just one of those idiots who thinks that you can diagnose everything by looking at test results without actually referring back to the patient ...

[helvella]

Actually the USA uses mostly cyanocobalamin so far as I can see.

[JGBH]

Hello Hillwoman... and happy new year!

What is the connection between thyroid function and B12D ? I am hypo (removal of majority of thyroid gland in 1980) taking 100mcg and 75 mcg levothyroxine on alternate days. Have been feeling so unwell, complete exhaustion for a very long time, fainting, etc. doctor not really helpful (am 70, have RA and other auto-immune diseases)... So am interested to know more about this connection. Thanks if you can help.

JGBH

[Hillwoman in reply to JGBH]

Hello and Happy New Year to you too!

I think what helvella is referring to is the reduced stomach acid production which occurs in hypothyroidism. Low acid will lead by steps to malabsorption of B12, and thus cause deficiency.

Have you got any recent test results for thyroid function, along with lab ranges? FT3 is the most indicative of thyroid function. On the other hand, the inflammation caused by AI conditions can be fatiguing in itself. I've had success treating early RA and a milder form of Sjogren's with Low Dose Naltrexone (LDN).

ldnresearchtrust.org

[Hillwoman in reply to Hillwoman]

Forgot to say, but you probably know already that you need T3 meds as well as T4 after total thyroidectomy.

[JGBH in reply to Hillwoman]

No, I did not know that I required T3 medication as well as T4. No so called medical professional made me aware of it... amazing! So does your GP or any GP will prescribe T3? Is it best to see a descend endocrinologist rather than GP? Thanks again Hillwoman.

[Hillwoman in reply to JGBH]

Where to start...! If you join the Thyroid UK forum, another community on Health Unlocked, you will find this is a current hot topic. The reasons are complex, but one is that it has been very difficult for a long time to get GPs and endocrinologists in the UK to prescribe T3.

Currently, there is an outcry about price gouging by the sole supplier of generic liothyronine to the NHS. I can't remember the current price to the NHS of a bottle of 28 x 20 mcg tablets, but it's several hundred quid. A packet of 30 x 25 mcg tablets (various manufacturers) in other European countries can purchased over the counter and costs a couple of euros!

[Hillwoman in reply to Hillwoman]

Meant to say, I buy my own T3 online, usually the Tiromel brand, made in Turkey by Abdi Ibrahim. It doesn't suit everyone, but I find it a very consistent product.

[JGBH in reply to Hillwoman]

Thanks again for very prompt reply. I have recently joined the Thyroid forum so will need to do more reading now that the Christmas madness is over.

To be quite honest am now rather tired of "fighting" uneducated and blinkered GP... Am seriously questioning their role and lack of apparent care. All they want to do is deal with simple everyday matters, as soon as something more complex is presented to them they seem unable and mostly unwilling to do some research themselves in order to help the patient. Adding insult to injury, when the patient does all the research they spend ages saying "it's not under Nice or the NHS guidelines"... So no help whatsoever but they still get a fat salary... very scary for patients who feel ill and worried, and can't function properly therefore cannot enjoy a good quality of life, especially in latter years.

[Hillwoman in reply to JGBH]

I think you've summed up the situation very well. Long gone are the days - as related by my late grandparents, aunts, and uncles - of the local family doctor, who was not highly paid, but who did have some degree of genuine vocation.

[JGBH in reply to Hillwoman]

Thanks for reply. I don't have any recent thyroid function tests so will try and get some organised or even look at my past results (of course GP always said everything was alright... ALL NORMAL...) So will request tests results.

[Jeast]

I got loading doses of hydroxycobalamin in the hospital (US), my friend has a prescription to si for methyl (once monthly), but it has to be compounded. I think most US drs still use cyano, but only with prescription. At least in the U.K. You can get what you need from the other euro members who sell it otc. I buy mine from Canada, and evidently they only have cyano.