Feeling tired, bloated and uncomfortable.

[pepperpot99]

Hi

I’m a newly qualified midwife who after starting a job in April started feeling anxious, depressed, exhausted had difficulty walking and getting up and down.

I requested some blood work done from my GP as I had low B12, Vit D, folate and Iron deficiency 5 years ago which was all treated. Negative intrinsic factors on testing.

I was called to my GP practice this week to be told my results were as follows;

B12- 92, serum Folate- 2.19, serum ferritin, 7.9, Vit d- 40, serum iron 5.8, HB 121, MCV-77, MCH - 24, MCHC - 311 red cell distribution width- 17.1

Blood test last year said I had a level of 28 for my Vit d which I wasn’t told about nor given a prescription.

I started on my 6 loading doses of B12 injections on Tuesday and have been prescribed and taking ferrous fumerate three times a day.

I’ve also had a celiac screen bloods taken. I usually avoid bread but was told to eat gluten as to not skew the test.

My dr has said he’ll treat the B12 first then treat the folate as supplements can mask the B12.

I just feel so awful- bloated and uncomfortable firstly having to load up on gluten and now taking three iron tablets a day. The iron Tablets feel like they’re are burning my stomach.. I’m not sleeping properly as I’m so uncomfortable and restless legs, numb hands don’t help.

I have let work know about what’s going on and they don’t seem to care other than when I’m expected back. .. worst thing is that I’m aware of the link between nitrous oxcide( gas and air) and depletion on B12 stores. I worked every other day on the labour ward with women puffing away on the stuff.. no ventilation. This had certainly added to my problem and I’m facing having to make a career change to save my health... although I’ll probably be pushed out due to still being in my probation period.

Thanks for reading my waffle but it seems so good to air my worries and feelings.

Off to get my 2nd loading dose. Take care everyone.

[Sairbear1]

I'm not in a great place myself to offer insightful and helpful advice but I wanted you to know that you're not alone ❤️

No wonder you feel how you feel... all your levels are so low!

Instead of iron tablets, could you try the liquid ferrous furmarate and take tiny drops on a spoon with a shot of orange juice? That's what I had to do as I couldn't bear the iron tablets.

Good luck & i'm sure another member will be along soon to give better advice than I can. xxx

[pepperpot99 in reply to Sairbear1]

Thanks for reply. Yes will probably need to do something different. During my 2nd loading dose dr tried to lecture me about how he thinks we don’t need to have as many loading dose shots and to taper them. I advised him of the evidence and recommendations and how my B12 was over 1000 5 years ago and has depleted and I’m also symptomatic. Was not listening.

Hope you start to feel better soon

[Gen89 in reply to Sairbear1]

just wondering where you got liquid ferrous fumarate? I am low in iron but have had to give up on tablets due to gut problems.

[Nackapan]

I hope you do get through your probation or can restart it when well?

3 iron tablets a day I couldn't tolerate. Try every other day will some only her form. Space the doses away from food and caffeine. I thought as you've had your blood tests and on B12 injections you csn get going on folic acid and vitamin d. Do ask . I've been given ferrous fumarate with folic acid!

Hoper you feel the benefits soon. It will take a while. Take care

[pepperpot99 in reply to Nackapan]

Thank you. I will raise this when I see my dr next week. Had such a good effect last time with the B12, folate & Vit d and iron.

Work wise I feel there is no way I can avoid enthonox in the labour room which has the link with depletion of B12. Nor can I skip a placement here. Have lots to think about but first need to get my health sorted. Thanks for reply.

[Nackapan in reply to pepperpot99]

Yes you health comes first.

I didnt realise you would be that exposed to enthonox these

days because of the mouth pieces. There always community midwifery ?

Sounds like an ongoing problem for you to keep the levels up. Also I had a loading dose of vit D then went on a maintenence dose. I think in Nice guidelines. Gps don't seem to notice vit D unless ridiculously low. Mine went to 21 when working indoors all the time. T c

[pepperpot99 in reply to Nackapan]

I’d love to do community midwifery but a preceptorship requires you to rotate in all areas of maternity before choosing your place to practice in. I’m exhausted with the hours, demands and night shifts ... they don’t seem to be able to put me on just short days despite my health.

I’m possibly contemplating going independent when I’m well x

[Nackapan in reply to pepperpot99]

Are you in a union? Occupational health should help you. I know what you have to do. I was on Maternity for 5 years many years ago assisting midwives in the labour ward and alater bating in special care and post Natalie wards. Grueling and not possible with your blood levels!! We need mis wives si there should accommodate you until you better

[pepperpot99 in reply to Nackapan]

Yes I am with the RCM union and will do what is necessary occupational health wise. The nhs have strict sickness policies though so will have to see.

Good on you supporting us midwives, we can’t do our jobs without assistants!

[Nackapan in reply to Nackapan]

Alternate days take another form of iron . That meant to read!

[pvanderaa]

Sorry to say this but You may just need to find another job. Good thing you found this early.

Nitrous oxide is toxic to B12 and eliminates it from your blood stream. You may need daily B12 injections to replenish at the end of each day.

[pepperpot99 in reply to pvanderaa]

Yes I’m concentrating on getting my health better then will have to decide what I can do with my Degree. I can retrain as a health visitor or teacher.

I did read a BJM article on B12 and nitrous oxide and various midwife specialists have documented the risks ..I’m too glad I’ve hopefully caught it before it’s done too much damage. Thanks for your reply

[pvanderaa]

Also forget the celiac tests. You control your diet so just go gluten and dairy free. It is hard at first but keep a logbook of food, drink and meds to help sort it out.

The main issue is that symptoms don’t appear immediately and there is a 3 to 48 hour delay as the toxins cycle around your hepatic loop (probably don’t need to tell you, but for others reading this: small intestine, portal vein, liver, bile, duodenum and back into small intestine). It takes about 24 hours to make one pass around the loop and different symptoms appear as it does.

The logbook can also help sort out food versus B12D versus new symptoms from repair of neurological damage from getting B12 injections.

I’ve gone gluten and dairy (casein protein) free and basically cook everything from scratch as I cannot trust ready made foods. Can’t trust anything deep fat fried due to cross contamination in the oil.

I also got rid of sugar, MSG, soya, whey protein, autolyzed anything and “natural flavor “ as any ingredient.

Basically I eat meats, green vegetables and fruit. I’ve found a “whole grain” gluten free bread from Udi which is great toasted.

Been doing this for 8 years and so far so good with very rare occasional contamination incidents.

[pepperpot99 in reply to pvanderaa]

Thanks for your in-depth explanation... it has jogged my memory of those pathology lectures!

I will definitely start looking into your suggestions... don’t know where to start to be honest! I naturally avoid bread anyway so that won’t be so difficult. My appetite hasn’t been good for a while but this bloating is the most uncomfortable I’ve experienced... could it just be the B12 loading doses, iron and eating gluten for my test?

I’ll look for an alternate iron supplement anyway.

Thank you

[pvanderaa in reply to pepperpot99]

Keep a logbook and pick something to eliminate from your diet. Stay off it for two weeks to cleanse your hepatic loop. Then reintroduce and monitor all your symptoms. Unfortunately, the offending food is probably a favorite and you eat it quite regularly so that you’ve built up a tolerance.

By going off it for 2 weeks, your body will get rid of any tolerance build up. You will know within 3 hours if it will impact you.

Once you have about 6 items you can trust, then try going only with what works for a couple of weeks. Symptoms should taper off and go away completely. It gets kind of monotonous eating the same thing all the time. But you need to build a foundation again.

Then build back others items one at a time and leave 3 days between new items. Any symptoms show up, then investigate and reevaluate.

Prepare your own food so you know what’s in it. Don’t trust ready prepared meals until you have a good foundation.

[Judithdalston]

Suggest you take vit C with ferrous fumarate...helps absorption and can help stop getting so bunged up! Bit difficult to comment on your blood tests without ranges too, but it looks like you are low across the board...have you some form of absorption problem in the gut...might be a problem other than just nitrous oxide assuming you have a healthy mixed diet?

[pepperpot99 in reply to Judithdalston]

I do take my iron with fresh orange juice as this is what I advise the women I support to do thankfully- preachings what I teach.

. Yes I do believe I have an absorption issue of some sort and on the beginning of a journey to find the answer hopefully.

Thanks for your help

[Judithdalston in reply to pepperpot99]

My problem re gut absorption relates to hypothyroidism/ autoimmune antibodies of Hashimoto’s disease( plus things like17 years of metformin re b12)

[Nackapan]

Ferrous fumarate is already chelated. As is Solgar gentle iron. There has been alot of posts about iron recently if you look through the posts. Just taking iron bloats me. Lots of water helos as does beetroot

[pepperpot99 in reply to Nackapan]

I really hope this is temporary as I can’t feel like this everyday. Hope it’s just me getting used to Injections and iron... my stomach was already sensitive from eating the white bread for my celiac test and now I have a permanent bloat, wind, pain and taking gaviscon and paracetamol to ease those symptoms.

I’m off on holiday the afternoon of my last B12 loading dose so want to feel better by then!

[Baggy8]

My daughter is a midwife and due to the effects of the gas (and punishing 13hr shifts!) has had to leave the delivery suites, which she loved. But there are other very valid uses of your skills, a couple of which have been mentioned. At the moment your health is your priority!

[fancycake1946]

Instead of all that iron, and yes it can make you sick. H a be you asked your doc about the new iron infusion. The just put it into your arm through the veins. It doesn't have the same horrible effects.

[Gen89 in reply to fancycake1946]

did you have to have this in a hospital setting. I have had to stop iron tablets as causing so many problems but my Gp said iron infusions were only for very anaemic patients. Would seem to me to be better to have the iron 8nfusion to stop me deteriorating that far but that would be too sensible!

[Marz]

Have you ruled out Hashimotos - Auto-immune Thyroiditis ? it is a condition that can trash the absorption of vitamins - B12 - Folate - Ferritin and VitD. Sadly the thyroid is rarely tested correctly within the NHS - so many have to go Privately with Home Testing Kits to have the correct testing - a diagnosis - or the correct treatment. You will need the TSH - FT4 - FT3 and Anti-bodies TPO & Tg. The symptoms of LOW B12 and Low Thyroid do and can overlap ... Click onto - About Testing - in the link below ...

thyroiduk.org

I have/had Crohns - inject B12 weekly and was diagnosed with Hashimotos at 59 back in 2005. Do not leave it that long before having the correct testing. It has taken me so long to get back on track and now I am faced with returning to the UK where the thyroid medication I take is restricted/banned - depending on the Post Code. In Greece the treatment has been good ..

Hope you soon feel better ...

[Hectorsmum2]

Pepperpot. as you are having injections the workplace exposure should be too much of an issue. You might just need jabs more frequently. It might be an idea to source them yourself. A negative intrisic factor result does not rule out PA and there is no point retesting B12 once injections have started, this is in the guidelines. Have you had your thyroid tested as your low vits and minerals suggest there could be a problem in your gut by low acid, this often happens with thyroid issues.