Continue with monthly injection? - Pernicious Anaemi...

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Continue with monthly injection?

Sotired3 profile image
20 Replies

Hello everybody, my B12 was 218 (range 206-1000) now 2000 after two injections, one per month.Ferritin was 19.9 (range 23-393) now 25.2 after two months of one daily tablet of 305mg ferrous fumarate.

Folate was 3.4 (range 4.5-20) now 4.1 after two months of daily of one 0.4mg folic acid.

Thankfully as you can see my B12 levels have shot up, and slight improvement in the other two . I am feeling alot better.

My question to you all is should I ask/request that my B12 injections continue monthly or should I leave it for a few months?

Thank you

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Sotired3
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20 Replies
Nackapan profile image
Nackapan

Not sure what country you are in.Did you get the 6 loading doses ?

Definitely do not leave it for a few months ,otherwise you will be back to square one.

It's worked very quickly for you and I'm sure you want to kerp thr improvements

If the cause is not dietary

You will need to continue with a regular frequency that suits you.

Looks like you need a short term higher dose of folic acid.

Also keep up the iron.

Vitamin D worth testing too.

Sotired3 profile image
Sotired3 in reply to Nackapan

Thank you for replying and for the advice. I am in Ireland, I received my first dose in September and then one in October. I had read about loading doses in other countries, but I wasn't offered this and maybe that's because I wasn't low enough or they don't do it, either way I am glad my symptoms have improved and levels, hopefully my doctor will agree to keep going with them because as you said I don't want to go back to square one! Thanks again.

Wheat profile image
Wheat

Hello, I agree with Nackapan. Keep on with everything.

The B12 is high, but that is the amount in the blood, not the actual 'active' amount actually used at cellular level. As a guide 80/20 divide so 400 is still quite low when 500 to 1000 is optimum level .

Best wishes

Sotired3 profile image
Sotired3 in reply to Wheat

Thank you.

Narwhal10 profile image
Narwhal10

Hi Sotired3,

Please inform your GP that they have wasted money on :-

1) Re-ordering of a pointless blood test.

2) The cost of engaging with you prior to said blood test. Whether that was a phone call or face to face appointment to decide to re-order said blood test ? That is another cost.

3) The cost of a phlebotomist appointment to take blood.

4) The cost of the serum tube.

5) The cost of a delivery person to pick it up and transfer it to the laboratory.

6) The laboratory’s cost to use their equipment and the person(s) undertaking the analysis ?

7) May I ask how did you receive your results ? Were you able to access them on-line ?

Your GP is not working SMART (Specific, Measurable, Achievable, Realistic, Time-Bound) and are not allocating their BUDGET effectively.

Your blood results are meagre numbers. They are not signs nor symptoms. You are not a robot, you are a human being. Human beings program computers using extremely lengthy mathematical algorithms. Guess what ? We use numbers. 🙀

The police drag people and their cars out of rivers. They often hear,

‘My SatNav told me to go this way.’

People really are starting to loose their skills, common sense and lives because of technology. A witness statement can read, ‘They were looking at their phone and had headphones on. I waved at them to alert them to danger but the bus could not brake fast enough in time. Their body flew across the road.’

So, the police, the paramedics and the hospitals have more work AGAIN. Lots of Health Professionals know each other. So, your GP can have a nice ‘catch up’ with the ED doctor who looked after the person who just had no idea how to cross a road safely.

I agree with Nackapan and Wheat regarding your B12 treatment. May I ask if you receive NHS or private care ? Ireland offers both.

😘

Sotired3 profile image
Sotired3 in reply to Narwhal10

Thank you.

MorningMist profile image
MorningMist in reply to Narwhal10

- it’s not just the public who are losing their ability to think because of technology. It must affect the reasoning and judgement of . doctors too.

Narwhal10 profile image
Narwhal10 in reply to MorningMist

My friends and family members are doctors. They went on strike this year in the U.K. It was not just about pay, it is the conditions as well. Ridiculous targets, poor staffing, lack of equipment, computers not working. Too many managers. My sister once worked 31 hours straight which is unsafe.

Often she gets upset at work, she is in paediatrics. How she cannot change careers because she is not trained to do anything else. I know Emergency Department consultants who have just walked out. Midwives from other countries who refuse to work for the NHS so move country or back home.

Nobody on here, realises just how a doctor feels when they and a team have done absolutely everything for a child or a person but they are not going home. They will never see another Bonfire night, Halloween, Thanksgiving, Eid or celebration. When we break the news to parents, families, we shatter people’s lives. We are not robots and we do get upset. We allow ourselves 2 minutes if that then compose ourselves before getting on with our jobs. It is called professionalism. We put on masks to deal with patient after patient.

On a personal note, many years ago, I walked into ITU and a handsome younger man, a doctor, came up to me. He had ‘the look’ on his face. I touched his arm, that he need not explain and I was a midwife. I thanked him and asked what medication he was on. I told him to look after his other patients. I knew I was very fortunate to make it to the hospital. My second sentence to the doctor was, I know I am here to say Goodbye.

In my haste to get to the hospital in central London, I had got lost. So, made a wrong decision driving my car. I was pulled by the police and breathalysed. It was approximately 2.15 a.m. I explained the situation and asked for directions to that particular hospital. They were brusque and disinterested, they just told me to drive more carefully.

One of the most difficult things I have every had to do was when my step-mother heard my father’s breathing becoming more laboured. He was intubated, she thought he was regaining consciousness. I gently held her and said, ‘No, it is time.’

Doctors collaborate with religious people and have to appear in courts of law as well. 🐳

MorningMist profile image
MorningMist in reply to Narwhal10

Yes I have every sympathy and respect for people who endure working in the NHS. Is it really all down to political choice to let chaos develop or is it a combination of things beyond our control?

I did take in all of your reply!

Narwhal10 profile image
Narwhal10 in reply to MorningMist

Morningmist, I became a clinician later in life. Many people do not, they go in straight from school.

Me, I used to design whole systems. So when a manager in the NHS pulled me, via phone call, email or whatever. Meh, I’d shrug. I did not have time to build a quick ‘firewall’ but I would risk assess at the start of a shift.

Oh I’d fill in this FORM, took me 3 minutes. Not enough staff, fill in the FORM, not enough equipment, fill in this FORM, not enough nappies FILL in this FORM, bust my thumb fill in this FORM. Girls, none of you have had a break, please fill in one of these FORMS BEFORE you leave. I now have 4 FORMS. It is not just ME.

Each time, I filled out a form, I am telling them in very specific terms YOU HAVE TO DO SOMETHING. When you fail to do something that’s your problem NOT mine.

You see a Civil Servant covers a multitude of sins. You are using an electronic device to message me. Did you know that the atomic clocks to make things sort of accurate and a bit instantaneous are in Nevada ? 😉

There’s a lot of bullying in the NHS, senior executives can make doctors GPS, consultant’s working lives very difficult. They can threaten them with disciplinary action to have their own way. Doctors can feel very disillusioned and may resent going to work because of the culture.

Tanglewooddream profile image
Tanglewooddream in reply to Narwhal10

I think most of us can understand that some doctors, particularly in a hospital setting, are overworked, have lots of things to deal with etc. But, most people on here with a grievance have encountered dismissive and/or brusque/arrogant GPs (and consultants) who don't listen, won't think outside of the guidelines - many of whom have cost people their health and in some cases their lives. People also post on here when they have had a good experience with a GP or other clinician.

Narwhal10 profile image
Narwhal10 in reply to Tanglewooddream

oh yes Tanglewooddream,

It’s happened to me as a patient, rude, little arrogant men but you get those in every walk of life. Now, the way forward is not the Them and Us. Not the divide and conquer. The Napoleon person has totally forgotten about you. Meanwhilst you’re still aggrieved. Harbouring resentment.

Is that clever ? No - is the answer. Now, I do not stoop to their level. I stick to my moral code and ethics. The approach I take is, it reminds me not to behave like that. So, you plan an approach that is smarter and more eloquent than them. Because when you outshine them, you dazzle them, then you blind them.

🤓

am111 profile image
am111

You need to continue with the monthly injections, else symptoms will come back. What are your symptoms? Serum B12 levels after injections mean nothing. They are not an indication of how much you are getting into the cells. MMA or homocysteine can give a better picture of that.

Ferritin is still low with 2 months dosage. Should have been higher. You can either continue if you feel fine, or even increase a bit if you can tolerate. Note that alternate day dosage here results in more absorption with lesser side-effects.

0.4mg of folic acid is just maintenance dosage. Can be increased to at least double. Upto 5mg/day can be used till levels are in high ranges.

Being deficient in all these probably means that your thyroid is working sub-optimally. Have you got your thyroid tests done?

Good luck.

Sotired3 profile image
Sotired3 in reply to am111

Thyroid ok, thank you for the advice.

bookish profile image
bookish

I'm glad you are feeling better. Have you or your doctor considered why your B12 and folate have been low for 3 years+ ? Could be diet, could be medication, could be surgery, could be metabolism, could be autoimmune, and of course it could be more than one of those - vegans still get Pernicious Anaemia. But you'll have more reason to insist on continued regular injections if you know what is happening and why. Any family history of similar? Personally, I'd increase the folic (although I found methyltetrahydrofolate suited me much better) as still far too low, and try to get homocysteine, MMA, IF ab and GPC ab checked. If you have copies of your results, look for changes in your FBC - RDW, MCV, HB etc should be reflecting improved B12 levels if actually doing something. Cheers

Sotired3 profile image
Sotired3 in reply to bookish

Thank you for replying, yes there is a family history. I will ask about the blood tests you suggest.

Narwhal10 profile image
Narwhal10 in reply to Sotired3

A family history, very interesting. Three years ??? 🙀

Bellabab profile image
Bellabab

Your folate is far too low and you would probably benefit form increasing it. B9 & B12 go hand in hand so when you are using up one the other is being used as well. A month of 5 mg folic acid daily will fix it and I would then reduce it to one 5mg every other day.

Sotired3 profile image
Sotired3 in reply to Bellabab

Thank you for replying and your advice in relation to upping my folate dose.

bookish profile image
bookish in reply to Bellabab

I'd agree to more folate in a form that suits. A month of 5mg folic could leave some with unmetabolised high folic, not necessarily the answer for all of us.

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