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Pernicious Anaemia Society

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Neurologists & hematologists in London for B12 neurological symptoms - recs pls?

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7 Replies

Hi all - Can anyone recommend a good neurologist & hematologist in London to consult with privately about my B12 treatment/symptoms?

I’ve recently been found to be B12 deficient (150), high MMA, I’m 40 yrs old. I just finished getting injections over 2 weeks. My symptoms have worsened a lot during this time - it’s been scary. I’m now feeling like my whole body is vibrating much of the time, very strange sensation esp. in head & feet. I understand this can happen related to the b12 deficiency and doesn’t mean the injections are causing the problem. However isn’t it odd the symptoms have worsened so suddenly?

I’m concerned, should I not be stopping treatment now given these neurological symptoms? I also want to make sure there aren’t other underlying issues not detected yet. GP doesn’t seem to know what to do & suggested maybe it’s anxiety - I don’t think so. Appreciate any help!

My intrinsic factor antibody test came back negative. Other blood tests came back normal (thyroid, blood counts, kidney function, gastric parietal, etc).

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Sleepybunny profile image
Sleepybunny

Hi,

Hopefully someone will help you out with recommendations.

It's against forum rules to name health professionals on the forum but there's nothing to stop people sending you a Private Message (PM).

B12 deficiency is not always as well understood as it should be by health professionals so if you have the energy, try to read about B12 deficiency prior to any neuro appointment.

Some links I post may have details that could be upsetting.

If PA is suspected, PAS can offer support and pass on useful info.

PAS membership is separate to membership of this forum.

PAS (Pernicious Anaemia Society)

Based in Wales, UK. Has some overseas members.

pernicious-anaemia-society....

There is a helpline number that PAS members can ring.

Testing for PA

pernicious-anaemia-society....

"GP doesn’t seem to know what to do "

PAS website has useful leaflets/articles and a page for health professionals that your doctors may find helpful.

pernicious-anaemia-society....

pernicious-anaemia-society....

Link about "What to do next" if B12 deficiency suspected or recently diagnosed

b12deficiency.info/what-to-...

Unhappy with Treatment (UK info)?

Letters to GPs about B12 deficiency

b12deficiency.info/b12-writ...

UK B12 documents

NHS article about B12 deficiency and folate deficiency (simply written)

nhs.uk/conditions/vitamin-b...

BSH Cobalamin and Folate Guidelines (aimed at health professionals)

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

Summary of BSH Cobalamin and Folate Guidelines

pernicious-anaemia-society....

Diagnostic flowchart from BSH Cobalamin and Folate Guidelines which mentions Antibody Negative PA.

stichtingb12tekort.nl/engli...

BNF link outlines two patterns of treatment for B12 deficiency in UK

1) for those without neuro symptoms

2) for those WITH neuro symptoms

BNF Hydroxocobalamin

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

NICE CKS B12 deficiency and folate deficiency

cks.nice.org.uk/topics/anae...

There are currently new NICE guidelines in development for Pernicious Anaemia and B12 deficiency. These should be published in 2023.

nice.org.uk/guidance/indeve...

If you click on "project documents" then on "consultation comments and responses" it gives a good insight into current issues around diagnosis and treatment (over 40 pages).

Local B12 deficiency guidelines

CCGs (Clinical Commissioning Groups) in England were replaced by ICBs (Integrated Care Boards) on July 1st 2022. It's likely that ICBs will take on the clinical guidelines of the CCGs they replaced.

Worth tracking down the local B12 deficiency guidelines for your ICB or Health Board and comparing the info with BNF, BSH and NICE CKS links. Some local guidelines have been posted on the forum.

Misconceptions (wrong ideas) about B12 deficiency

B12 article from Mayo Clinic in US

The Many Faces of Cobalamin (Vitamin B12) Deficiency

ncbi.nlm.nih.gov/pmc/articl...

Table 1 in above article is about frequent misconceptions about B12 deficiency that health professionals may have.

Misconceptions about a B12 deficiency

(From Dutch B12 website - units, ref ranges, treatment patterns may vary from UK)

stichtingb12tekort.nl/engli...

UK blog post that mentions misconceptions about B12 deficiency

b12deficiency.info/a-b12-se...

Diagnosis and Treatment Pitfalls

(B12 Institute in Netherlands - units, ref ranges, treatment patterns may vary from UK)

b12-institute.nl/en/diagnos...

Two useful B12 books

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

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

UK BNF treatment info is out of date in above book. See BNF hydroxocobalamin link.

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

Very comprehensive with lots of case studies.

Films and videos about PA and B12 deficiency

PAS conferences

pernicious-anaemia-society....

Films about b12 deficiency

b12deficiency.info/films/

I am not medically trained.

Sleepybunny profile image
Sleepybunny in reply to Sleepybunny

Forum members often report that symptoms get worse before they start to get better.

"My intrinsic factor antibody test came back negative"

A negative result in IFAb test does not rule out PA.

It's possible to have Antibody Negative PA, see diagnostic flowchart from BSH guidelines in my other reply.

About 50% of people with PA get a negative result on IFAb test.

About 20% of people with PA get a negative result in PCA test.

Have you had a Parietal Cell Antibody test?

A gastrin test may also be helpful in diagnosing PA.

There are many other possible causes of B12 deficiency.

Have you been tested for coeliac disease?

NICE guidelines Coeliac Disease below suggests that anyone with unexplained B12, folate or iron deficiency should be checked for coeliac disease.

nice.org.uk/guidance/ng20/c...

If you were tested in the past and you got a negative result, check that the doctors followed the recommended diagnostic process, some don't.

Risk Factors for PA and Causes of B12 Deficiency

pernicious-anaemia-society....

b12deficiency.info/what-are...

b12deficiency.info/who-is-a...

Next link about causes is from a Dutch B12 website

b12-institute.nl/en/causes-...

Sleepybunny profile image
Sleepybunny in reply to Sleepybunny

If you're a PAS member, it may be possible to arrange for your GP/specialist to speak to PAS. Talk to PAS if interested.

pernicious-anaemia-society....

PAS membership

pernicious-anaemia-society....

People do not need a confirmed diagnosis of PA to join PAS.

Sleepybunny profile image
Sleepybunny in reply to Sleepybunny

Some people may develop low levels of potassium when B12 treatment starts so your GP may want to test your potassium levels.

Have you got recent results for folate, ferritin (and other iron tests) and Vitamin D?Forum members often report deficiencies in these as well as B12.

It's quite common for people on this forum to also have thyroid issues.

Might be worth putting any thyroid results on Thyroid UK forum on HU.

In UK, GPs often only test TSH which won't give a full picture of thyroid function.

Thyroid tests

thyroiduk.org/thyroid-funct...

"Other blood tests came back normal"

Have you accessed all your blood test results?

I was told everything was normal/no action in the past but when I got copies, I found abnormal and borderline results.

Sleepybunny profile image
Sleepybunny

Read the blog post below if you want to know why I urge UK forum members to find out what's in local B12 deficiency guidelines for their ICB (Integrated Care Board) or Health Board.

b12deficiency.info/gloucest...

Gambit62 profile image
Gambit62Administrator

I am closing this thread to responses as it is against HU and forum policies to name or promote specific medical practitioners. People can message you privately if they want to.

Gambit62 profile image
Gambit62Administrator

IF test is good for proving you do have PA but a negative doesn't rule it out because the test isn't very sensitive and gives false negatives up to 60% of the time (varies with test methodology).

It isn't uncommon for symptoms to get worse before they get better. On the neurological side (because B12 is involved in the process that resets neurotransmitters) this is because your brain needs time to adjust to the fact that signals are now coming through much stronger.

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