Assessing damage caused by B12 deficiency

[character28]

Hi, I would like to know what is the best way to assess the damage caused by B12 deficiency. I have suffered of it for a long time and the stupid doctors I've seen wouldn't find out... Now I'm probably f***ed up... Which test should I get to evaluate this? Thanks in advance

[Londres70]

"Now I wonder, if I've been taking this medicine for a month before checking my B12 level and still got a very low result, wouldn't that point to malabsorption? Or simply this medicine had very little B12?".....How often were you taking this medication with the 500 mcg of B12?  500 mcg of B12 isn't very much.  A  low B12 level doesn't resolve quickly for alot of patients......it takes time.  As long as your level is elevating and not staying the same or dropping I would be more apt to say your MIGHT NOT be dealing with a malabsorption problem, but I can't say that is 100% so.  

You are so welcome for the advice.  Glad to have helped some.

Just keep in mind medicine is like detective work; it may take some time to figure or find out the culprit.  

[character28]

Hi again Londres70,

I'm sorry to ask you so many questions, but actually if you ever want to see my previous posts, you'll see how many things I thought I had. Now that I found the problem, you're the only one who really knows and answers me about it. That's very kind of you.

Regarding the possible malabsorption, well, I did experience GI symptoms all this year. Consultations to GP didn't really improve the symptoms. It was only after I suffered a discoloration (after a day of overexcercising) and started having weird symptoms one week later that I started seeing many specialists. The bad thing is that since a purplish fingernail discoloration primarily suggests heart or lung problems, I didn't connect it with the GI symptoms (nor the doctors did), so between the specialists I had seen there were a pulmonologist, a cardiologist and then I was referred to a rheumatologist. After ruling out lupus, scleroderma, sjogren, MS, and other autoimmune, I stayed with this doctor and demanded him to test me for vitamin levels. Then I found out the cause to my suffering.

Now what is weird is that during this nightmare, I also happened to consult two different neurologists. The second one only said that I had upper cervical problems due to stress and should correct them with massage and heat, but the first one ordered a CT and since nothing came up from it, he immediately said that all the symptoms I had in that moment (lightheadedness, blurry vision, buzzing in ears, concentration problems and other things) were due to stress. He said that he could only prescribe an oral liquid medicine which would improve the nervous system. This medicine somewhat helped with the lightheadedness, so I allowed myself to relax a little bit. Then I found out that this medicine had 500mcg of cobalamin.

Now I wonder, if I've been taking this medicine for a month before checking my B12 level and still got a very low result, wouldn't that point to malabsorption? Or simply this medicine had very little B12?

This said, is it guaranteed that an IM B12 will be absorbed? Or should I insist on IV just to be sure? I ask this because my fasciculations don't seem to be stopping with the therapy. Maybe it's too soon, or I don't know...

Again, thank you very very much for your useful answers and advice, Londres. And I'm sure you understand why I'm being so inquisitive :)

[Londres70]

Oh, there are alot of questions here and will try to answer them.

"What other tests do you suggest me to take?".......The Hematologist has already ordered the B panel, however, he should be ordering an Iron panel as well UNLESS this has been done already and a vitamin D level as well.  The labs he has ordered are decent.  

Strange that you can't get a simple vitamin IV infusion in this Hematologist's office.  Totally agree it would be foolish to be going to the hospital for this infusion related to viruses, bacteria and plus the costs would NOT be cheap.  Well....at this point they aren't sure what this is so I would recommend you DO these injections and see what happens.  I nor anyone else at this point can say this is any "malabsorption" issue......could or could not be....that remains to be seen.  

When are you supposed to see this GI Specialist and get the Endoscopy done?  The condition that came to mind was Celiac's disease in regards to a vitamin malabsorption problem. It is possible to have Celiac's WITHOUT experiencing GI symptoms.

"Do you know what malabsorption of other vitamins are related to B12 malabsorption?".......this is usually other B vitamins and iron.  It really depends on the condition a patient has.  

"One last question, can all these vitamin deficiencies be related to overexercise and fingernail discoloration?"  Overexercise?  What kind of exercise regimen were you doing?  Well.......I wouldn't say "overexercising" can cause vitamin deficiencies per se.  I would say that if you aren't eating in balance in regards to your diet and overexercising then you MAY have deficiencies especially if you have other lifestyle patterns that aren't healthy as well.  Fingernail discoloration is associated with several different conditions and diseases and not only vitamin deficiencies.  With that being said, B12 deficiencies and anemia CAN cause abnormal changes with the nailsbeds or nails.  

There should be AT LEAST 2 weeks- 1month time frame BEFORE rechecking the B12 lab or the folate.  In other words, the level can be checked two weeks AFTER the therapy is started, however, checking after one month would be better.  

BTW:  There are really only 2 labs in the group of lab results you've mentioned that are of concern:  the folate and the B12.

Well... WOW....that was alot, so I hope I answered everything.  I think after you get all these deficiencies taken care of you will notice these symptoms subsiding.  

[character28]

By the way I checked out the tests he wants me to have on 31/10 and, I'm not sure I understand what he wrote, but it looks he requested CBC, A and B vitamin panels and complement C3 and C4. There's one more question I forgot to ask you, how much time does it have to pass since the last vitamin injection to get a more accurate result in the vitamin testing?

[character28]

The only nutrition tests I got so far are these:

Folic acid: 7.6 ng/ml
Vitamin B12: 12.35 pg/ml
Magnesium: 2.5 mg/dl
Sodium: 142 meq/l
Potasium: 4.0 meq/l

All these tests were taken before starting with B12 and going to the hematologist. What other tests do you suggest me to take? Also, I went to see a gastroenterologist who said that it's very probable that I suffer of malabsorption and appointed me for an endoscopy. I asked if there are other vitamin malabsorptions related to this one and he said that if there's some kind of problem which I don't remember in the GI tract, there is probably malabsorption of many other vitamins. Do you know what malabsorption of other vitamins are related to B12 malabsorption?
By the way, I asked the hematologist if the therapy could be intravenous instead of IM. He said that there is an option, but I would be hospitalized and there's no need for me to be exposed to viruses in the hospital. Ok, that makes sense. But I was wondering, is the IM therapy efficient? Is there a possibility that the vitamins are not being absorbed even via IM?
One last question, can all these vitamin deficiencies be related to overexercise and fingernail discoloration? Thank you very much for your answers!

[Londres70]

Ok, so this hgb is 14.1, which is decent.  What's your iron panel look like?  Just because the hgb is ok doesn't mean anemia can be ruled out.  

In my opinion, a low B12 would correlate with fatigue.  

BTW:  what was your folate level BEFORE he started pushing this folic acid therapy? Did he do a B vitamin panel on you checking all the major serum B vitamin levels?  Just not understanding where this "folate therapy" is fitting in.