Private GP visit: I saw I private GP... - Pernicious Anaemi...

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Private GP visit

Chickens44 profile image
15 Replies

I saw I private GP today as I felt with more time to go through my symptoms and tests I might get somewhere. But she is of the opinion that my B12, ferritin and folate levels were all fine and nothing to worry about. They are within range. I asked about my symptoms, but she didn’t feel they warranted being able to get B12 injections. So no further forward, and just keep taking the oral supplements.

I mentioned the NICE guidelines and also that the B12 tests are not always accurate. And also the malabsorption issues. She was very nice about it, but really didn’t feel I have pernicious anaemia.

She did agree that both pregabalin and omeprazole can mess with the body and that I was right to stop both of them.

So a little frustrated. She did suggest I stop taking statins for a month to see if that helps with the fatigue.

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Chickens44
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15 Replies
charks profile image
charks

Going private is no guarantee of better treatment. My partner once had a private consultation and the consultant ate his sandwiches during it. And he was totally useless as well.

I think many people on this forum have done the same as you and been sadly disappointed. The problem is that all GP's get hardly ( if any ) training in nutrition. And until they do we will continue having problems getting the right treatment.

FlipperTD profile image
FlipperTD in reply to charks

Going private is often a way of getting to see someone sooner. They're still the same person as you'd see on the NHS however. Despite being fully committed to the NHS, I still opted for private treatment on several occasions, and I was happy that I did. My first was a hernia repair. GP said 'I don't know how long the waiting list will be' to which I said 'I'll go private' and everything changed. Saw the consultant within three days, and we agreed when he would do it. Three days later, on a Bank Holiday morning. Result? Complete satisfaction. Then another hernia on the other side, a few years later. Same approach. And then, a suspicious mole on my back. Private appointment and the mole [malignant] was removed the same evening. None of these appointments took priority over NHS appointments; they were effectively 'Overtime'for the consultants involved, and done 'Off site' in Private hospitals. They each reduced the load on the NHS.

I am fortunate that I could afford the option each time, and we really ought to be able to do better for us all with the NHS.

Wheat profile image
Wheat

hello Chickens44, so sorry you had such a useless experience.

I have heard that Private practitioners can be as disappointing as nhs.

Symptoms are ignored so are abnormal blood results, and ranges are lowered so all appears normal. It is not just ignorance, its deliberate. Sorry I did not mean to get on my soap box.

Have you had blood serum B12 and folate and full blood tests. If so obtain results. Are you able to self inject, many of us have to resort to this to get the frequency/treatment we need.

An Active B12 test is very useful, it should at least be 70. I used Medichecks but many others too.

Best wishes.

Chickens44 profile image
Chickens44 in reply to Wheat

I did a Medichecks test recently and it came back as borderline. But the GP still felt as it was within range it wasn’t a problem. It is so frustrating as I wanted to get cross, but I knew it wouldn’t get me anywhere. She is going to write to me following our meeting and I will ask her to read some of the documentation issues by the PAS.

Wheat profile image
Wheat in reply to Chickens44

Medichecks borderline measurement for Active B12 is 37.5 but it should be at least 70, mine was 150.

Do they do a Blood serum B12 ? The range for these tests is set too low.

My gps didn't consider symptoms, or consult NICE guidelines. If unsuccessful in obtaining treatment you need I can only suggest trying another gp, complaining or s.i. I wish you the best of luck x

Chickens44 profile image
Chickens44 in reply to Wheat

Last active B12 was 48.3. Which I showed the Private GP, but she still felt it was normal.

Wheat profile image
Wheat in reply to Chickens44

Yes very hard to get them to understand its symptoms they should consider first. Not one rule suits all. I Wouldn't bother with the Private gp again.

Best wishes x

FlipperTD profile image
FlipperTD in reply to Wheat

Reference ranges for tests are a constant theme!

There is no 'right answer' and no such thing as a normal range, despite us using that term.

The standard approach is to measure lots of samples from healthy individuals, and then do some magic on the numbers. Typically, we would calculate the arithmetic mean [average] and compute the Standard Deviation [SD] of the results. The mean value plus 2x SD = upper bound of the reference range, and mean minus 2x SD = lower bound of the range. This simply gives us a range that describes 95% of the population that we sampled. So, 5% of the population [1 in 20] will lie outside that range whilst still being 'normal'. Widening the range to 3 SD captures 99.7% of the population, but that still means that 3 in a thousand can lie outside the range whilst still being 'normal'. It's important to note that this is about numbers, not people!

You could ask 'where do you get all these healthy individuals from?' and in the words of Eric Morecambe, 'there's no answer to that!' Once upon a time, 'volunteers' were invited; typically medical students and colleagues. Of course this doesn't describe the general population, as we would be selecting a group of well-nourished, younger professional folks.

An alternative approach could be to simply run the test as an extra, having anonymised patient samples, and do 'the numbers' on that set of results. It's worth mentioning that the (Mean +/- 2SD) is only valid for results that are 'normally distributed', where the Mean, Median and Mode are [more or less] the same. Would that is was that simple. Skewed distributions are much more common.

Here endeth the lesson, apart from 'TREAT THE PATIENT, NOT THE NUMBERS'.

helvella profile image
helvella in reply to FlipperTD

This is a link to a very good article in the British Medical Journal discussing what the 'normal range' really is. Very readable.

The normal range: it is not normal and it is not a range

helvella.blogspot.com/p/the...

(The word 'normal' also rather implies a Gaussian distribution to anyone with a passing awareness of statistics. And all too many medical distributions give a passing imitation of being Gaussian but in reality are far from that.)

FlipperTD profile image
FlipperTD in reply to helvella

Couldn't have put it better myself. Thank you.

Susanleanne profile image
Susanleanne in reply to FlipperTD

You lost me at the start of the 4th sentence lol. I was never any good at maths or even arithmetic and now I remember why.I really admire you being able to work all that out x

TheLabSquad profile image
TheLabSquad

hi, I went to my GP initially, b12 normal, had a private GP appointment also said B12 normal - my results showed JUST within normal range and I had all the symptoms of low B12. Made an appointment with the Cambridge iron clinic - this is an extract from my clinic letter:

‘Your Ferritin is 35 which is low, ideally we want your Ferritin to be > 50. We discussed and you agreed to have an iron infusion. Your B12 was also low at 219 – I normally suggest treatment with B12 injections when B12 < 300 with symptoms which we discussed and you agreed. Your Folate is 14.5 which is good, we want it to be 15-20. Your haemoglobin is 132 so you are not anaemic, your red blood cells are enlarged, MCV 95 – which is macrocytosis and consistent with long-term B12 deficiency’

I’m afraid you might have to keep pushing…

Wishing you luck

Jo5454 profile image
Jo5454 in reply to TheLabSquad

Wow,that's more like the kind of reassuring words we'd like to hear. I've had ferritin of 15 and been told that's adequate over the years,won't go into the rest! That's a few times recently I've read MCV in higher 90's means macrocytosis. My MCV was 97 recently,but told its in range (under100) and ok. I noticed MCH over range. Is that a different range used by Cambridge please?

Sleepybunny profile image
Sleepybunny

Hi,

I left a detailed reply in this thread which might be useful.

Help Needed! Have I got Pernicious Anaemia?

healthunlocked.com/pasoc/po...

Sorry for brief reply, I've injured my arm so have to limit typing.

Chickens44 profile image
Chickens44

I have just contacted Dr Klein, and he has agreed to read through my copious notes and see if he can help.

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