Pernicious Anaemia Society
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My first SI - Done!

My first SI - Done!

So my hydroxy arrived this morning. I didn't want to give myself time to overthink it or build it up in my head. So I watched a few videos about technique and just did it! I was shaking. But took a few breaths, harnessed 4 years of frustration and switched it into cool (ish) determination, held my nerve and it's done. IM into thigh. I didn't "dart" the needle but pushed it in slowly. Only the initial breaking of the skin gave me any sensation. But not painful. Pushed the needle all the way in completely painlessly. Slowly pushed the plunger. Withdrew the needle. Barely a speck of blood. Now to wait and see.

Questions for the hive mind. I just wanted to check about the way the vial snapped. It doesn't look like a particularly clean break to me. Does it look ok to you seasoned self injectors?

Also, I intend initially to inject twice a week. I have 5mg methylfolate capsules. I took one just prior to the injection. I had read somewhere that when injecting daily or every other day, then one should take 5mg folate daily. But am intending to inject less frequently. Am thinking in my case 5mg folate every other day would cover it? Any input gratefully received!

Feeling pretty proud of myself as am a bit of a wuss with blood tests and injections done by a nurse! Although I have to say...I think my technique may be better than some heavy handed nurses I've encountered in the past, lol!

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Well done! There is a white spot where you start the break, as it is the weakest point or if you like is thinnest point. I also inject ever so slowly, sometimes you hit a nerve ending head on, if so move to a different area. Bon voyage.

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Thank you! Yes I pushed forward at the white dot. Obvs need more practice! Lol!

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I may have misinterpreted you but I would be holding the lower section and pushing back on the top part with the white dot at the front. It will start to break at the white dot as that is where it is the weakest.

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Yes. That's exactly what I did. :)

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You see, that's what I'm scared if - hitting a nerve. Had a terrible experience with a private doctor trying to give a steroid injection in my foot. He couldn't complete it because of the pain though I don't think he should have injected into a swollen, inflamed foot, and days later it still felt i had gone into shock as i kept crying. That's why hitting a nerve worries me.

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Poor you😭! some doctors aren't very good. If you really need to si the least painful place is to inject into your belly, as you don't have to inject into muscle. Subcutaneous is fine. Good luck.

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Hi Portia1974. Well done - sounds like it all went okay.

About the vial - top of the ampoule looks a little ragged. If hold the ampoule with the white spot under your thumb and break in the opposite direction, that should give a clean break.

Methylfolate - 5mg dose is way to high if you don't have a proven folate deficiency and, despite what you may read in some places, it's not required when doing frequent injections. And methylfolate is usually started at low doses (200-400mcg) and increased slowly, if required. Folic acid is perfectly adequate for most people, so unless you know you have a problem with folic acid...

Also - some people react very badly to methylfolate (look up the potential side effects on the internet) - and 5mg is a huge dose! I tried it and it made me feel very ill indeed - and that was just 400mcg doses.

5mg doses of folic acid are only prescribed when a deficiency is present and then only for three to four months. After that further testing is done to assess efficacy of treatment and then dosage is adjusted accordingly, and usually reduced to 400mcg daily - and some don't even need that. An exception may be if other medications are taken which reduce the absorption of folate.

Supplements are always a very individual thing and there is no 'one-size-fits-all' regime for any supplement (as we know with B12 😉). The best way to assess folate requirement is to start by knowing what your levels are, be aware of the symptoms of folate deficiency and over-supplementation, and keep an eye out for any of those symptoms appearing (or disappearing).

There are some who discover that they need higher doses of folic acid than others and they do this by initial close monitoring of folate levels and symptoms, then determine supplement requirements accordingly.

As to the folic acid / methylfolate debate - if you need to supplement this, think I'd try the folic acid first (400mcg if no proven deficency) and then try methylfolate if that doesn't appear to work (but start on low 400mcg doses, if needed 😉).

Consistent over-supplementation with folic acid or methylfolate can produce some very unpleasant side effects. I inadvertently did this once in the early stages and suffered from the most appalling insomnia - plus other things 😖).

So...pleased that all went well for you. The first one is always the worst! Hope the additional injections make a difference for you.

Good luck 👍

👍

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Yep my folate levels are low and have been for a while (despite folate rich diet). I tried the methylfolate when I had my last GP administered jab. And the difference was marked. I "woke up" for 2 or 3 days and "warmed up". Previous injections had no such effect. So I credit the methylfolate with making the difference. But yes, definitely will be monitoring my levels and keeping an eye out for symptoms. Thank you. Maybe I'll take them just on injection days and not in between 🤔 (so 10mg a week).

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Ah ha...so perhaps you're one of the few who do benefit from methylfolate 😉😀.

10mg a week in 2 x 5mg doses is still a hugh dose of methylfolate (it's much more powerful than folic acid). Once folate levels are raised, over-supplementation will become more and more likely. So...keep an eye out for symptoms of over supplementation, just in case 😉.

Might be better to take 400mcg daily (total weekly dose of 2,800mg) and see how you do with that.

And yes, epilepsy drugs can make a difference - on that basis your GP should be monitoring folate levels regularly, so should help with adjusting the supplements so that you can find out what's the right maintenance dose for you.

Waking up and warming up - brilliant - keep it up 😀

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I should have said I also take anti epilepsy drugs that interfere with folate and vit d metabolism. So may be a factor!

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Congratulations Portia1974! Happy to hear your first SI has gone well. I saw your earlier post and it’s encouraging to see you were able to take back control of your health despite some of the setbacks you ran into with your doctors. Conquering your first SI must feel very empowering!

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Oh it does feel SO good yes! Thank you!

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My breaks always look like yours - yes I do break them at the white spot, but they are never clean.

Another thing I sometimes forget is flicking B12 that has collected in the top part of the bottle.

Well done, it is so good to have the injections when you need them.

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Ah that's good to know. I did ut and the white dot. Guess it doesn't matter too much! Yes! Good to know I can inject at will as and when I feel I need it!

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I wrap the bottle bottom in a fold of kitchen roll and the top of it in another. It has eliminated cutting my fingers, and I find it grips better.

Glad you have got the first one over, it's ok from there on.

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In your photo, you can see the white dot on the top portion between the needles. Put your thumb on the dot when you break it open.

Before you open it, wrap the ampoule in tissue in case it shatters when you open it.

You did well.

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Yes that's what I did. Curious! Thank you 😊

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Well done Portia1974 You are an inspiration.

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Aw, you lot on here are the inspiration! But thank you!

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well done Portia glad all went well :)

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Well done. It’s a great feeling when you first successfuly inject.

And don’t worry about the break, mine always look exactly like that. It just follows the natural stress lines. I’d only be concerned if there were loose specs of glass after the break but that has never happened to me.

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That's brilliant Portia 😀 very well done you.

It's such a relief to get your first one out the way.

Do you know your ferritin/iron store level? That needs to be optimum to help the absorption of the B12, along with the folate you're already taking. 80+ is the starting optimum level. But you need to know your level first as too much iron supplementation is not good.

Also, your potassium level is likely to drop, so taking potassium rich foods and drink, particularly on injection days, is advised. Bananas and coconut water are good. Others have had magnesium via Epsom Salt baths to help with aches and pains.

Onwards and upwards 😀

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Thank you 😊 Yes I supplement with magnesium and hydrate with coconut water. I also take a b complex alongside. My iron remains an issue but have had an infusion agreed and am awaiting a date in the next couple of weeks for that. As well as an endometrial ablation on 3rd Oct to future proof my iron levels if that makes sense. Ideally I'd like to be injecting b12 more frequently than once or twice a week. But dont feel I can do that until my iron stores are addressed. So gonna be playing it by ear until then.

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That's good that you've got that all in place and are having your low iron addressed. I thought you probably had but it doesn't hurt to reply with some info to help others reading your post 😊

I hope everything starts settling down for you soon.

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Totally. I learnt so much from reading these kinds of replies on other people's posts. Thanks so much 😊

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Me too 😊 this forum has made a huge difference to my health, recovery and given me so much information along the way.

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fab portia74 you’ve given me confidence to SI inbetween my jabs from GP love this site they really are an inspiration and so helpful 😊

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It took me a while to bite the bullet. But the reality of it is far less scary than we build it up to be. I wish you luck!

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Congratulations👏 very well done; like you I started with help from the wonderful people who post here. My vial usually looks pretty much like yours, once in a blue moon it breaks in a nice straight line. I hold the vial with two small pieces of gauze, one on the top and one on the bottom with the dot facing me. Keep well😃

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Thank you! And you too!

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I have some vials with a dot to mark the weak spot and others which are scored with a line all the way round. The vials with the dot always look like yours once broken. The scored vials break with a neat line! As others do I protect my fingers when breaking the vial. Good luck!

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Thank you!

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You can get ampoule cutters from amazon. That may help. I use an antiseptic swab but wait a while before injecting to let the alcohol in it evaporate. Then i use the waste packet to hold the top of the ampoule to avoid cuts. WEll done.

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Love everyone's tips and techniques! Thank you 😊

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That look very similar to the ones I had opened in the past 3 years. You appear to be doing to job just about right.

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Well done first one is the hardest, you'll be a pro at injecting in a few months 👍

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You can buy an ‘ampoule opener’ online if having issues or worried about cutting yourself. Less than £14 I think they were.

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