Seen GP today - update

[JMN2017]

Previous Blood results

Oct 2016 - B12 165.3 ng/L (197-771); Folate >20 ug/L (4.6-18.7)

Feb 2017 - B12 198 ng/L (197-771); Folate 17.5 ug/L (<3 ug/L suggestive defiency)

I've seen my GP today, having sent him a letter outlining why I would like him to consider further blood tests (Homocysteine, MMA and Anti Intrinsic factor), B12 injections and referal to Haematologist, with several bullet points as to rationale and a list of current health issues that may be due to B12 Deficiency.

As expected, GP disagrees re the need to treat, saying usual garbage that all labs in the country can't be wrong; that individual doctors can't go off and do their own thing etc etc etc. I didn't get any indication suggesting he had done any reading up, of course!

GP then suggested repeat bloods in a few months! ARGH!!! Good ol' delay tactics, eh? So, I asked if we could meet halfway and could have homocysteine and MMA levels checked, at least. I decided not to ask for AIF as it's not known to be reliable and, if the result was negative, that would be the final indication (to GP) that there was no need to persue the matter.

So, I've had blood taken this afternoon for Full blood count, Vit B12, Folate plus the two I particularly felt relevant, Homocysteine and MMA, at the hosptial and the phlebotomist handed it directly to the lab porter with instructions that one bottle needed urgent attention in the lab. I found it interesting that she phlebotomist had to ask a colleague about bottles and they both decided to check in their file! I did suggest they don't do this test very often then - and they both agreed that they don't. That says a bit too much, I feel.

Also, although I've not heard of fasting for Homocysteine, apparently it's 'preferable' according to their files so I hope that by not fasting the result still be relevant and not skewed in any way. Does anyone have any information about this, please?

Fortunately, the GP was quite affable, complimented me on my letter, saying it was very well written and concise and it was GP that suggested I make appt to see him again. I've made a further appt to see GP again on 25 March (a week tomorrow) to discuss results.

Now that I've had blood taken for Homocysteine and MMA, I'm considering trying a sub-lingual B12 product in the hope that I might feel some improvement, as it doesn't seem my GP is going to agree to treat me, or trial, by injections any time soon. Any advice, please?

Many thanks

[fbirder]

Congratulations on finally getting what you want, if only in part. It does sound like you might have a good GP there. You may want to do what I did. I gave my GP a copy of Martyn Hooper's book. He's now passed it around his colleagues, so the whole practice should be up to date an all matters B12.

Yes, the hCys test isn't done regularly, mainly because it is a bit of a hassle. The sample really needs to be analysed within a couple of hours. Fasting doesn't seem to make any significant difference (and is, in theory, more likely to push levels up, giving a positive result).

I might hold off the sublingual so until next week, just in case one of the tests need repeating.

[JMN2017 in reply to fbirder]

Thanks fbirder

It would have been to easy if I'd got all that I had suggested but, working on the basis of asking for more than I expect tends to give room for 'compromise', hence I'm pleased that GP agreed to me having to two blood tests in the end. At least that is progress.

If the results indicate B12 deficiency, then more strings to my bow. If they come back not indicating deficiency, then I'm probably barking up the wrong tree, don't you think?

Unfortunately, I can see your reasoning re not taking any sub linguinal meds until seeing the GP again. It's just so tempting to see if they would make a difference but it could really stump my fight if something SL worked and then needed retesting for some reason, skewing results and shooting myself in the foot!!!

So, many thanks for your post. Good advice, as always

[Sleepybunny]

Hi JMN2017,

"As expected, GP disagrees re the need to treat"

Has your GP seen the BSH Cobalamin and Folate Guidelines? This document makes it clear that in UK, people who are symptomatic for B12 deficiency should have an IFA test and start initial b12 treatment. This applies whether they have low B12 or a within range B12 result.

b-s-h.org.uk/guidelines/gui...

stichtingb12tekort.nl/weten...

B12 Deficiency Symptoms lists

Are you symptomatic? I gave my GPs a copy of PAS symptoms checklist with all my sympotms ticked.

pernicious-anaemia-society....

b12deficiency.info/signs-an...

Unhappy with treatment?

b12deficiency.info/what-to-...

b12deficiency.info/b12-writ...