Anxiety vs low B12 - interesting Doctor consultation

[BluebellPettle]

So I just had another appointment with a different GP. It was a very difficult consultation. I gave him my notes on medical history, symptoms and info on B12 deficiency. He scanned it and then went through all of my bloods, saying they were normal. He said something very derogative about the place I live with regards to low folic acid levels to 'KFC diets'! I bit my tongue and said I have only just moved back into the area. My folic acid is good (according to range anyway). He then broached the subject of anxiety and said i exacerbate stress and anxiety - If only to look at me! I wasn’t happy when he suggested this as I felt like he was implying I was imagining the symptoms. HOWEVER he is not wrong when he says I have issues with mental health. I have in the past suffered with depression (approx. 12 years ago) and I am under a lot of stress at the moment and have noticed my anxiety levels increase… so he has a point. However, aren’t they closely related, similar symptoms? And although my bloods don’t show I am deficient I am low... surely. He offered me anti depressants- I quickly said no thank you .

Anyway he said he will help me rule out things, sending me got Vit D test and a CT scan to see if there any neurological issues ( really don’t think there will be but we discussed my high Prolactin levels)

Despite the difficult parts, he did listen and I was in there for at least 30 minutes.

So nearer to the end I broached the discussion about ranges and how they vary and could it be possible that I am one of those people that doesn’t function on 275. He said there is ‘limited truth’ in that and then offered me a B12 injection! Just like that. Now I’m not naïve as to thing that one injection will make it better but I now have a dilemma.

I go back and say oh no nothing changed I still have symptoms and he says oh dear it cant be B12 then or I say oh yes I feel better, brilliant and he might say ‘ ah well one injection cant possibly make you feel better it must have been a placebo effect.

Sorry – it’s a bit of a ramble but it was a very odd consultation! I can post full results if needed.

Thanks Bluebell

[Gambit62 Administrator]

think you have to stick to your guns and push for treatment per the BCSH guidelines,ie loading shots - as you say - one shot isn't necesarily going to prove anything.

[Marybrown06]

Anxiety was my first symptom to disappear with supplementation (it was almost immediate, while after 5 weeks many other symptoms are still there), so anyway you should try injections to see if you feel better. And if your GP does not want more injections, you can still try a new one.

Good luck!

[BluebellPettle in reply to Marybrown06]

thank you Marybrown06 that gives me hope. Do you mean try a new GP? Also as he said he was just giving me the one injection when do you think I should go back and push for a course?

[Marybrown06 in reply to BluebellPettle]

Yes I was meaning taking the injection, and then telling him the truth (if it worked or not).

If he does not allow you for more injections, you should probably try another GP or try to SI to check if B12 helps

Concerning SI, gambit or other people on the forum will be able to answer your questions.

Maybe you could also take oral supplements in addition.

But don't expect an immediate effect on all your symptoms, I have the feeling by reading the forum it can take months, we must be patient but there is hope!

Good luck!

[Frodo]

I find B12 injections very helpful for anxiety. I observed immediate effect from one injection. You should have your first injection under medical supervision anyway.

[BluebellPettle in reply to Frodo]

Interesting thank you. Can I ask - is your anxiety a symptom of low b12 or not linked?

[Frodo in reply to BluebellPettle]

I'm sure it's linked. When I was first very ill (physically ill) it was through the roof. However, it can also become a learned response physiologically if it goes on long enough so it's useful to learn self help methods for dealing with it alongside any other treatment.

[BluebellPettle in reply to Frodo]

Thank you -makes sense. I’m getting things in place now to stop it worsening 😊

[Sleepybunny]

Hi,

On an older post of yours, healthunlocked.com/pasoc/po...

I posted links to BMJ B12 article and BSH Cobalamin and Folate Guidelines. These UK documents make it clear that in UK, people who are symptomatic for B12 deficiency should be treated even if B12 is within range. Flowchart I gave a link to makes it clear that symptomatic patients should have an Intrinsic Factor Antibody test.

Is your GP aware of these documents?

Proof of Symptoms

I ticked all mine on PAS Symptoms checklist plus I added others not on list.

pernicious-anaemia-society.... see Checklist PDF on right of page.

I'm glad to hear he listened.

A good GP will do some homework on b12 deficiency if it's a possibility. I gave my GPs a copy of Martyn Hooper's book "What You Need to Know About Pernicious Anaemia and Vitamin B12 Deficiency".

Link about writing letters to GPs about B12 deficiency

Point 5 is about being symptomatic for B12 with an in range b12 result.

b12deficiency.info/b12-writ...

Mental Health and B12

B12 deficiency can have a severe effect on mental health

b12deficiency.info/b12-and-...

martynhooper.com/2017/01/22...

Think it's quite likely that people with B12 deficiency would score low on a depression questionnaire because the questionnaires can include questions on lack of energy.

My mental health is better since being on B12.

I am not medically trained.

[BluebellPettle in reply to Sleepybunny]

Sleepybunny Yes, your links were really helpful, I paticularly liked the PA PDF as if clearly states that if you have nuerological symtoms you should be treated. I highlighted this and my symtoms and added notes. To be honest, he looked at the print out of my medical history and (I think) honed in on the fact that Id put that two members of my family have blood cancers ( my mum being one) and then coupled with my anxiety lept to the conclusion that I was worried about having Cancer! Which I am not!! He did not look at the PDF which was a shame, in hinsight maybe I should have left them there, but where would they have ended up? in the bin? I guess my perisitent paid off a little with him giving me the injection, but I can't help feeling that he gave it to me to 'shut me up' for want of a better phrase!

[Sleepybunny in reply to BluebellPettle]

Hi,

"He did not look at the PDF which was a shame, in hinsight maybe I should have left them there, but where would they have ended up? in the bin?"

If you put extracts/quotes from documents into a formal letter addressed to GP, they won't go in the bin because my understanding is that letters to GP are filed with a patient's medical records.

Patients can always include a request within letter to place a copy of letter with medical records to make extra sure. Letters could be sent prior to an appointment to give GP time to consider the contents. I will add that sometimes writing letters can irritate some GPs but the letters still have to be filed. I always kept copies of letters I'd written as well ..in case they got lost....

[BluebellPettle in reply to Sleepybunny]

Sleepybunny Thank you - I will follow up the consultation with a letter and notes and drop it off at the surgery. Do you think it would be to bold to state in the letter that I think I think it would be appropriate to treat my symtoms with further b12 injections (as he made no reference to me having more)

[Sleepybunny in reply to BluebellPettle]

Notes might get lost so might be better to put everything into a letter.

I'd suggest looking at this link before writing a letter.

b12deficiency.info/b12-writ...

In my personal opinion it's best to keep letters as short and polite as possible.

I think it's appropriate for UK patients to include quotes from UK articles that emphasise that symptomatic patients should be treated even if B12 is normal range.

eg BMJ B12 article

bmj.com/content/349/bmj.g5226

BSH Cobalamin and Folate Guidelines

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

Flowchart from BSH Cobalamin and Folate Guidelines

stichtingb12tekort.nl/weten...

UK NEQAS B12 Alert

Link to NEQAS B12 Alert in Point 5 of letter writing link above.

There is a useful summary of B12 documents in third pinned post on this forum.

Some people on forum have pointed out the potential neurological consequences of untreated or under treated B12 deficiency to their doctors.

If you're a PAS member might be worth talking to PAS. Membership costs £20 for a year.

pernicious-anaemia-society....

[phone] answerphone

There are stories on Martyn Hooper's blog about PAS members seeking diagnosis.

martynhooper.com/2017/07/01...

PAS news item on Neuro Consequences of PA

pernicious-anaemia-society....

PAS article on SACD, sub acute combined degeneration of the spinal cord (available to PAS members)

pernicious-anaemia-society.... on page 2 of articles

Blog post mentions SACD

martynhooper.com/2010/09/21...