Who is right? : I'm really confused... - Pernicious Anaemi...

Pernicious Anaemia Society

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Who is right?

Cb1963 profile image
8 Replies

I'm really confused here, now I don't know if I have PA, I started the loading doses every other week well over a year ago, and then went onto the 3 monthly cycle, and have had to take folic acid 5mg just recently, now I've read that some folk on here are on a 2 monthly cycle, I'm based in Scotland and I wonder how many other people are on different cycles? I've had numerous problems with my stomach over the years and also have had a lot of general anaesthetics, and also on lifetime omeprazole, which can all affect vitamin B12 absorbtion, I just feel that doctors are either not to concerned about the problems or are just following each health authority procedure, the symptoms are progressive and without being to forceful with my gp I mentioned that my tongue is constantly tingling and have a ringing sensation in my ears, more symptoms to be added to the list, it just seems like there is a lot of confusion, as for PA or not I haven't got a clue, anyone else in this situation, many thanks guys for any input, cheers.

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Cb1963
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8 Replies
Ritchie1268 profile image
Ritchie1268

Someone with more knowledge than me will answer this for you but, after keeping a diary, 3 monthly was nowhere near enough for me. So after self injecting every other day since Xmas most of my symptoms have now disappeared.

Everyone is different but, you sound like one of many of us with PA that need way more often than the 2-3 months.

I know injections should be every other day until symptoms ease.

Cb1963 profile image
Cb1963 in reply toRitchie1268

Yep I did start originally with the loading doses, and then went onto the 3 monthly cycle, I don't even know if I have PA, but obviously I must have some sort of problems, and like I said on top of the pins and needles, muscle twitching, headaches, and generally feeling dog tired, I've ended up with the tongue issues and ringing in my ears, there just doesn't seem to be any consistency, it's bad enough trying to get your point over to the doctors, but I just don't think this condition is taken seriously enough,what a nightmare, thank you so much for your swift reply, it can make you feel like a fraudsters trying to put this point over, and I really feel it needs a bigger audience for the medical profession to understand how it affects the day to day lives of folk. Cheers.

Ritchie1268 profile image
Ritchie1268 in reply toCb1963

I felt like a hypocondriac with all the symptoms, very many have said exactly the same thing.

I was told I had IBS around 20 years ago but it was never confirmed.

Up until diagnosed with PA last year, my Dr prescribed me omeprazole for acid reflux that I'd suffered for years with also, but since I learned how it depletes B12, I know longer take it. The acid reflux has now almost vanished since self injecting every other day.

It is a constant battle due to many certain uneducated dr's.

Are you a member of the PAS? They are a great help.

Cb1963 profile image
Cb1963 in reply toRitchie1268

I am a little unsure stopping the omeprazole is the best case scenario for me, as I had an internal stomach bleeding, either caused by excessive acid or the h pylori stomach bug, as I was treated for the bug, I knew I was ill at the time but a lot was happening, my uncle had died and two weeks later my father died, and I ignored my health, only to ring the NHS 111 service for advice, and was immediately admitted to hospital, I think knowing how serious the stomach acid can be, I'd rather take the tablet to keep the acid at bay, I suppose its down to personal choices, even though I don't have reflux that often I think it's a small price to pay, perhaps its the area where I live and maybe doctors not understanding the effects of these antacids that can cause these symptoms, I reckon anyone who is on omeprazole should be automatically called in for blood tests say after six months to see if folk are starting to suffer with the symptoms, I doubt I'll ever get rid of the pins and needles, the burning sensations, and all the other symptoms that come along with B12 deficiency, I feel my condition had been ignored for far too long, and trying for the nerves to repair themselves is on the sell buy date, over 7 years now, and no improvement, and started with the tongue sensation and ringing in the ears, all new symptoms, I hope you condition improves in time, and many thanks for your reply, cheers.

Ritchie1268 profile image
Ritchie1268 in reply toCb1963

Thank you.

You've had a lot to deal with!

What I would say is don't give up & you're definitely in the right place being on here.

Any concerns or advice etc, there are loads of amazing people on here with way more knowledge than me that can offer not only advice, but also hope.

I don't know where I would be without the advice from others on here.

Good luck & take care.

Lurcher-lady profile image
Lurcher-lady in reply toCb1963

My friend who put me in touch with the pas after being diagnosed with low b12, takes omeprazole too. She’s not got P.A., but because of the omeprazole the treatment is the same. My doc did an intrinsic test which came back clear, so not P.A.

Sleepybunny profile image
Sleepybunny

Hi,

Have you considered joining and talking to PAS? You do not have to have a confirmed diagnosis of PA to be a PAS member.

PAS (Pernicious Anaemia Society)

Based in Wales, UK.

pernicious-anaemia-society....

PAS tel no +44 (0)1656 769717 answerphone

PAS support groups in UK

pernicious-anaemia-society....

Blog post about how PAS can support those seeking PA diagnosis

martynhooper.com/2017/06/24...

"as for PA or not I haven't got a clue"

Flowchart from BSH Cobalamin and Folate Guidelines

stichtingb12tekort.nl/weten...

Flowchart outlines process for doctors to diagnose PA and Antibody Negative PA in UK.

Other UK B12 documents

BSH Cobalamin and Folate Guidelines

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

BMJ B12 article

bmj.com/content/349/bmj.g5226

BNF

bnf.nice.org.uk/drug/hydrox...

BNF link outlines recommended UK treatment for B12 deficiency.

BNF advice on B12 treatment changed recently.

pernicious-anaemia-society....

NICE CKS

cks.nice.org.uk/anaemia-b12...

B12 books I found useful

"What You Need to Know About Pernicious Anaemia and B12 Deficiency" by Martyn Hooper

Martyn Hooper is the chair of PAS (Pernicious Anaemia Society).

"Living with Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

Has several case studies.

"Could it Be B12?: An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (USA authors)

Very comprehensive with lots of case studies. There is also a paediatric version of this book "Could It Be B12? Paediatric Edition: What Every Parent Needs to Know".

"without being to forceful with my gp I mentioned that my tongue is constantly tingling and have a ringing sensation in my ears, more symptoms to be added to the list, "

My personal opinion is that it is better to put queries about treatment in a letter to GP. In UK, my understanding is that letters to GPs are filed with medical notes so hopefully less likely to be ignored.

Letters could contain symptoms, test results, questions about treatment, extracts from UK B12 documents, relevant personal and family medical history etc

You mention symptoms such as tingling and ringing in ears (tinnitus?), twitching, pins and needles that would usually be considered as neurological.

In UK, patients with B12 deficiency with neuro symptoms are supposed to get more intensive treatment.

UK recommended treatment for B12 deficiency without neuro symptoms is .....

6 b12 loading jabs over 2 weeks followed by a jab every 2 or 3 months

UK recommended treatment for B12 deficiency WITH neuro symptoms is .....

A B12 loading jab every other day for as long as symptoms continue to get better then a jab every 2 months

Unhappy with Treatment (UK info)?

Letters to GPs about B12 deficiency

b12deficiency.info/b12-writ...

Link above has letter templates. Point 1 in link is about under treatment of B12 deficiency with neuro symptoms.

CAB NHS Complaints

citizensadvice.org.uk/healt...

HDA patient care trust

UK charity that offers free second opinions on medical diagnoses and medical treatment.

hdapatientcaretrust.com/

I have written other more detailed posts recently which might be worth searching for.

More B12 info in pinned posts.

I am not medically trained.

Gambit62 profile image
Gambit62Administrator

There currently isn't a good differential test for diagnosing B12 as a cause of a B12 absorption problem. If your B12 was low and you aren't vegan/eating very little by way of meat/fish/dairy/eggs - then you had an absorption problem. PA is the most common and, unless you had a treatable condition (and most aren't) you would be on B12 injections for life whatever the actual cause.

There is an awful lot about how the body responds to and uses B12 that still isn't understood. In the UK we have the BCSH guidelines but most authorities have their own local guidelines and these don't necessarily get updated when the BCSH is changed - some people are still being treated according to protocols that date back to before a major revision in 2014.

The name PA doesn't help either because it means that people have a tendency to think it is all about anaemia whereas anaemia is a potential symptom.

There was a very recent change to the BNF to make treatment where there wasn't neurological involvement 2-3 months - though prior it was 3 months. Treatment with neurological involvement should be 2 monthly maintenance doses. Licencing arrangements in the UK mean that hydroxocobolamin is only licensed for use every 2 months though more frequent isn't dangerous and many of us do need it more frequently.

Sorry, can't wave a wand and introduce clarity to the world.

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