What is the optimal B12 injection dose for low-range B12 with many neurological/psychiatric sx?

I'm in the early phase of FINALLY getting good hypo tx from my new endo after several years of mismanagement by my (ex) PCP. He has already made positive changes re adding T3 and Rx weekly VitD which have started to help. I also believe my B12 is too low for me to feel well.I have quite a few neuro sx and anxiety, depression which is really causing me distress. I'm a retired nurse and I know these sx could have other causes but from what I've learned here I believe that many problems that have in the past been attributed to other causes are, in fact, related to mismanaged hypothyroidism. My 2nd visit is in early June , my labs have been posted here and I have my 'treatment plan' questions ready. My b12 in early April was 452 (range (US) 232-1245.) What I want him to do is allow me to take B12 injections to see if my sx will improve. I want to be prepared for the possible response "your b12 is in range and is fine." I believe 452 is very 'not optimal' for me and want to try and improve my neuro sx-brain fog, pins and needles, bad anxiety, inability to cope etc. I believe if I could have a trial of b12 injections I will know if my sx are caused by this deficiency. I am prepared to practically BEG him to give me a Rx for my 'trial'. And if he does how often can I take them? Seems to me weekly is better than monthly right now. And if he won't order the Rx what can I buy OTC to raise my level and alleviate sx? I know the added t3, Vit D will help but want to be prepared for a possible B12 'skirmish'. I just want to try and relieve sx asap. I believe B12 is a major factor re my psych sx and don't want to waste any more time trying to get appropriate tx. I am hopeful re this new endo but want sx relief without wasting any more years on inadequate tx of my thyroid sx. Just trying to think ahead and have a game plan to cover all my bases. I'm 74 and these little neuro probs-forgetfulness, brain fog etc. cause me to worry about dementia. I want him to understand that trying the B12 is a simple firstline approach to see if sx can be helped without a big (read expensive, unnecessary, time-wasting) neuro workup and help me avoid the 'cutting off my nose because I have a cold" medical approach. This post is disorganized but I feel disorganized and want help re asking for the proper med, the proper dose, and proper OTC approach if he turns me down. I am so tired of feeling bad, being blown off re my suggestions, and most of all becoming another elderly statistic who is shelved in a nursing home for mental sx that could have been easily remedied if the medical profession had listened. Thank you to all who respond. PS I REALLY want to go back to renting my own apartment that is not part of an independent senior living environment and I know I need to be in good mental shape to get off of the US 'senior living>assisted living>nursing home merry-go-round.' Thanks, irina1975 PS I was on antidepressants for years-never much help (Prozac😡😠) got myself off them several years ago and am not prepared to go that route again as I don't feel that is the solution.

[Hillwoman]

Hi Irina. I think your reasons for wishing to try B12 injections are eminently sensible. State your case to your new doctor in the terms you've used in your post. If he says 'No', then try high dose (5000 mcg) sublingual methylcobalamin tablets to see if they help. If they even help a little bit, go back to the doc and try again.

Many people with B12 deficiency caused by PA, or autoimmune gastritis, and similar conditions, are dependant on injections to make real headway with symptom control, so do be persistent. Absorption of B12 declines with age too, so that's something else for your doc to consider. I suggest reading Sally Pacholok's book, Could It Be B12? Good luck!

[Hillwoman in reply to Hillwoman]

Sorry, I've just re-read your post title and realised I'd forgotten to address injection dosage. I'm not sure about the US, but in the UK, the recommendation is to start a loading dose regime for PA and/or severe deficiency of 1000 mcg hydroxocobalamin on alternate days, until there is no further improvement in symptoms. Thereafter, if memory serves, you get the jab once every three months for PA. I can't remember the details, because I self-treat my PA and I left the HU-PAS forum over a year ago. The forum has pinned posts which non-members can read, with useful info.

[Hidden in reply to Hillwoman]

Will do. Using all your suggestions. I know there will be trial and error time finding my optimum dose. Everything is a process. Just wish we could buy B12 injection without a script. xx

[Hidden in reply to Hillwoman]

Thank you so much, Hillwoman. 🐱 This is very helpful and exactly what I was looking for. I approach my dr visits with a tentative 'treatment plan' in place. My docs, esp my a-fib Electrophysiologist loves this. The only doc that never liked this was my PCP/GP but she's 'gone with the wind' now from my med care. In fact I saw my EP Mon just to get clearance for having my tsh to go as low as necessary for symptom relief. This is possible for me a-fib- wise because I have a pacemaker and am well managed and stable (also had ablation). My EP has even documented in my online chart that my AF is not a concern now re thyroid treatment. I did this to take pressure off the endo and not influence my tx. Again, thank you so much. I already am impressed with this endo who, btw, was recommended by my EP and feel I'm finally on the right tx path. I just believe in having my 'ducks in a row.' 😊 Take care. xx irina

[Hidden in reply to Hidden]

PS I am happy to self-treat (will give my own injections, monitor my progress, etc.) The hurdle is getting the prescription. 'Plan B' is hitting him over the head with my cane-LOL!!!!

[Hillwoman in reply to Hidden]

I have a cane too (PA permanently affected my balance, among other things) and sometimes I picture a medical consultation where it suddenly transforms into one of those old-fashioned sword sticks...

I like to get all my ducks in a row too, but few NHS doctors welcome a patient's treatment plan, or will even discuss it. It sounds as though you've finally found a sensible, cooperative endo for hypo treatment - what a relief that must be!

[Hidden in reply to Hillwoman]

it's a big relief! Good, caring docs are out there but you gotta kiss a lot of frogs first.....😡😡😡😡😡😡😡😡😡😀

[Hidden in reply to Hillwoman]

Or, if you saw the OLD movie "The Ten Commandments" with Charleton Heston (Moses) in a scene with Yul Brynner (Pharoah) where he throws his walking stick down in front of Pharoah and God turns it into a snake. As I recall his request about the Israelites was immediately granted. LOL. I guess snakes can be quite a motivator to help one see things our way!!! Just a thought. 🐱

[Hillwoman in reply to Hidden]

I'll see that film in a new light now.

[Jazzw]

Hi Irina - not sure if you’re aware that there’s a pernicious anaemia society forum here at HU?

Worth a read and maybe post there too?

healthunlocked.com/pasoc

[Hidden in reply to Jazzw]

Thanks. Plan to look it up. Today was Jacob's birthday so we were out and about eating good food!. xx