muscle stiffness: Hey guys, I am... - Pernicious Anaemi...

Pernicious Anaemia Society

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muscle stiffness

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Hey guys,

I am dealing with some of the side effects of a b12 deficiency. I am still awaiting the results from a blood test, testing for intrinsic factor. Most of my symptoms have improved a lot but I am left with a burning pain all down my leg, off balance and most importantly speech difficulty.

Some of my words are all mumbled into one and I feel like the words I am speaking are slightly slurred. I have read multiple articles and looked on different websites but cant really find anything that expands on it. Has anyone else experienced this and if so, I would love to hear how its going for you.

Thanks for recent support within the community, wishing good health for all :)

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9 Replies
wedgewood profile image
wedgewood

You don’t say if you are receiving treatment i.e. B12 injections .But you say that you have improved . Yes , what you describe can be symptoms of B12 deficiency .

I would want B12 injections every other day until there was no improvement . for such neurological symptoms that you have.

It’s a fact that the Intrinsic Factor Antibody test gives a negative result for about 50% of P.A patients , so cannot be relied upon .

Best wishes

in reply towedgewood

thanks for the info, I finished my loading doses 1 month ago and this symptom appeared a week into treatment, but it comes and goes. I will bear that in mind when I get results back

Sleepybunny profile image
Sleepybunny

Hi,

Hope you soon see lots of improvement.

I had some speech difficulties, these included

1) slurred speech

I think this was caused by extreme fatigue in some of the muscles around my mouth. I still have some mild weakness on one side and wonder if it's possible I had a TIA (Transient ischaemic attack) also known as a mini stroke.

Were you checked for signs of a stroke?

B12 deficiency can lead to high levels of homocysteine in the blood and high homocysteine has been associated with increased risk of stroke.

Any signs of stroke is an emergency situation. In UK ring 999 .

NHS link about Stroke Symptoms

nhs.uk/conditions/stroke/sy...

2) couldn't get the right word out

The medical term for this is nominal aphasia.

NHS links about Aphasia

nhs.uk/conditions/aphasia/

3) I would go blank in the middle of a sentence

I had severe cognitive issues and think the severe B12 deficiency I had affected my brain.

4) One neurologist, the only one I felt was competent, thought I had low levels of dopamine (a neuro transmitter).

B12 deficiency can affect levels of neurotransmitters eg dopamine, serotonin etc.

You may want to look into how low levels of neuro transmitters affects language.

Symptoms of B12 Deficiency (folate deficiency also mentioned)

pernicious-anaemia-society....

b12deficiency.info/signs-an...

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

b12-institute.nl/en/symptom... (B12 Institute Netherlands)

Do you mind me asking which country you are in?

The reason I'm asking is that patterns of treatment vary between countries and type of B12 used in treatment can vary.

Knowing which country you are in may help people to post the most relevant info.

A few B12 links

Two useful B12 books

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

Martyn Hooper founded PAS (Pernicious Anaemia Society).

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

Very comprehensive with lots of case studies.

PAS (Pernicious Anaemia Society)

pernicious-anaemia-society....

Based in Wales, UK but has some overseas members.

PAS membership is separate to membership of this forum.

B12 Deficiency Info

b12deficiency.info/

B12 Awareness (US website)

b12awareness.org/

Stitchting B12 Tekort

Dutch B12 website with English articles

stichtingb12tekort.nl/our-e...

B12 Institute - Netherlands

Has useful lists of symptoms and causes

b12-institute.nl/en/home-2/

Misconceptions

Some doctors have 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.

If you're in UK, there's a lot more info I can post.

in reply toSleepybunny

wow thank you for all this information. I am in the UK. I have a few tests waiting to come back and have described my symptoms to my doctor. they didnt really say anything but have noted it. I think it is something similar to your symptoms, my muscles from my cheekbones down feel stiff. Still recovering from a newly diagnosed deficiency. My twitching has mostly stopped, I'm just left with stiffness in my face. I really appreciate all of the information you provided and I'm going to look through all of it now. Thank you so much!

Sleepybunny profile image
Sleepybunny in reply to

One thing I usually urge UK forum members to do is to track down the local B12 deficiency guidelines for their ICB (Integrated Care Board) in England or Health Board in rest of UK.

List of ICBs in England

nhs.uk/nhs-services/find-yo...

Read this blog post if you want to know why I suggest this.

b12deficiency.info/gloucest...

To find local guidelines, try a search of forum posts, an online search or submit a FOI (Freedom of Information) request to your ICB or Health Board website asking what B12 deficiency guidelines they use locally.

I also suggest comparing the local guidelines with UK national guidance on B12 deficiency. See links below.

Some UK B12 documents

BSH Cobalamin and Folate Guidelines

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 below 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...

Check your GP has put you on the treatment pattern for those with "neurological involvement".

This is a B12 loading injection every other day for as long as symptoms continue to improve then a maintenance B12 injection every 2 months.

There is no set time limit as to how long the every other day loading injections can continue for if neuro symptoms present.

Your GP can find the info on treating B12 deficiency with neuro symptoms in their BNF book Chapter 9 Section 1.2

How many loading injections did you have?

How often are you going to get maintenance injections?

Unhappy with Treatment (UK info)?

Letters to GPs about B12 deficiency

b12deficiency.info/b12-writ...

Point 1 in above link is about under treatment of B12 deficiency with neuro symptoms present.

Keep letters short and always keep a copy.

It's vital to get adequate treatment. Inadequate treatment increases the risk of developing permanent neurological damage including damage to spinal cord.

NHS Complaints

patients-association.org.uk...

Care Opinion website

Patients can leave reviews of their experiences.

careopinion.org.uk/

Local MP may be worth talking to if struggling to get adequate treatment

More about neuro symptoms

My twitching

burning pain all down my leg

off balance

speech difficulty

words are all mumbled into one

words I am speaking are slightly slurred

I'm not a health professional but the above symptoms seem suggestive of neurological problems to me.

Have a look at the symptoms lists below and make sure your GP has a list of all your symptoms, especially every neurological symptom and definitely any affecting your spinal area.

Symptoms of B12 Deficiency (folate deficiency also mentioned)

pernicious-anaemia-society....

b12deficiency.info/signs-an...

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

b12-institute.nl/en/symptom... (from B12 Institute Netherlands)

Symptoms of Peripheral Neuropathy (damage to peripheral nerves)

nhs.uk/conditions/periphera...

Peripheral neuropathy can be associated with B12 deficiency and sometimes with folate deficiency.

PAS article about SACD, sub acute combined degeneration of the spinal cord

pernicious-anaemia-society....

Blog post from Martyn Hooper's blog about PA and B12 deficiency, mentions SACD

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

It's still relevant to in my opinion to mention any neuro symptoms that have disappeared since treatment started.

Referrals

NICE guidance Suspected Neurological Conditions

nice.org.uk/guidance/ng127

NICE when to refer B12 deficient patient to neurologist/haematologist/gastro-enterologist

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

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 (lots of pages).

Links to forum threads where I left very detailed replies with lots of B12 deficiency info eg causes and symptoms, more UK B12 documents, B12 books, B12 websites and B12 articles and a few hints on dealing with unhelpful GPs.

Some links may have details that could be upsetting.

Some of the info will be specific to UK.

healthunlocked.com/pasoc/po...

healthunlocked.com/pasoc/po...

healthunlocked.com/pasoc/po...

in reply toSleepybunny

I did develop a pain in lower back but it has passed. I had 6 loading injections and am scheduled to have them every 3 months now. I will mention all of this when I see a doctor next. Thank you so much for these resources.

Sleepybunny profile image
Sleepybunny in reply to

"I had 6 loading injections and am scheduled to have them every 3 months now."

That's a treatment pattern recommended for those without neuro symptoms.

Take a copy of BNF hydroxocobalamin info with you to next appointment or ask GP to look at Chapter 9 Section 1 sub section 2 in their BNF book at the pattern for those with neurological involvement.

Both patterns of treatment in BNF allow for maintenance injections every 2 months.

Your GP may not be aware of this as BNF treatment changed a few years ago.

You could also show them page below from NICE CKS (CLinical Knowledge Summary) on treatment for B12 deficiency

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

You could give your GP a copy of this PAS fact sheet on treatment of PA

(Info is applicable to B12 deficiency from other causes)

pernicious-anaemia-society....

Have you been tested for coeliac disease?

PA and coeliac disease are both auto-immune conditions that can lead to B12 deficiency.

NICE guidelines Coeliac disease suggest that anyone with unexplained B12, folate or iron deficiency should be tested for coeliac.

nice.org.uk/guidance/ng20

If you were tested in past and had a negative result, check the guidelines to see if GP followed the recommended diagnostic process....some don't.

A person with coeliac disease may get a negative result in coeliac test if

1) they have IgA deficiency

2) they were not eating enough gluten before blood tested

Have you got recent results for folate, ferritin (and any other iron tests) and Vitamin D?

Forum members often report deficiencies in these as well as B12.

Thyroid

It's quite common for forum members to also have thyroid issues.

I suggest you put any thyroid results on Thyroid UK forum on Health Unlocked along with an outline of your story.

In UK, GPs often only test TSH and it's possible to have thyroid issues with a normal range TSH. There are other thyroid tests your GP or a specialist can order.

thyroiduk.org/thyroid-funct...

GP/patient relationship

Sometimes being an assertive patient can put a strain on relationship with GP.

I always tried to be polite but in the end gave up worrying that I might upset my GP by challenging them when I realised I was headed for permanent dementia and spinal cord damage if I didn't get treatment.

Some forum members resort to treating themselves if NHS treatment is not enough for them, I see this as a last resort.

I think putting queries about treatment/diagnosis/referrals into letters to GP is likely to be more effective.

in reply toSleepybunny

I got tested for coeliac disease, still waiting on the results, I will print out the related articles and persevere with trying to get this sorted. Thank you so much, you have been very helpful :)

Sleepybunny profile image
Sleepybunny in reply toSleepybunny

"I am still awaiting the results from a blood test, testing for intrinsic factor."

Testing for PA

pernicious-anaemia-society....

I've also read that a pepsinogen test may be helpful.

A negative result in Intrinsic Factor Antibody (IFA) test does not rule out PA.

It's possible to have Antibody Negative PA but your GP may not be aware of this.

See diagnostic flowchart in one of my other replies.

PAS website has lots of useful leaflets/articles and a page for health professionals that I suggest you point out to your GP as they may find it helpful.

pernicious-anaemia-society....

pernicious-anaemia-society....

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