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Medical Forum / Diseases and Disorders / Cancer / April 2005B12 Further comments
Mny thks J and apologies for this long screed. No answer yet from family doc. I faxed him a copy of the vitimin B12 reading of Nov 04 this morning as his receptionist requested. I guess they expect me to telephone tomorrow as there were no recorded messages. I just got back from the hospital I took my wife into this early pm for a mastectomy which went very well so far after being with her for 8 hours. T.G. so far. Re the B12 reading of 111 in this same report of Nov 2004 I note the following also appeared WBC 3.9 x 10/9/L NORMAL RANGE (4 -10) RBC 4.22 x 10/12/L DO (450- 650) Hb 13.3 gr/dL DO (13.5 - 17.5) Now my family doctor is a sole practitioner and a good guy normally but is firstly ill himself, late middle aged and secondly somewhat overcome with government NHS beaurocracy. The latter probably caused the illness. He allocates some 7/10 minutes per person and at my age of 75 with multiple problems I guess he is not that keen to waste too much time on delving as palliative treatment seems to be the name of the game. I am a persistent sod however and will keep chasing for answers so I can get ammunition to arm myself with to encourage a meaningful conversation with this family doctor.( Dare I say even if it kills me without tempting the fates) I could of course change family doctors but my guess is this would be a bad time for my wife and myself and the devil I know may be the best I can get at this time. Obviously I have to do something. Hence this second note to you. I understand that what you say is without responsibility and I will not quote you as a person in any way nor my source of information. Plse forgive my lengthy note. I will down load the web site in your second posting as I have the sites in the first one. They are a bit over my head but I will try to understand them. My question now is does the Vit B12 deficiency on its own have significance. I am or was an accountant running my own electronics company before I retired in 1966. I was a good marketing man worldwide but egg head I was not. I employed PhDs to do the brain work! My $64,000 question however is with the Nov 04 red white and haemoglobin readings as above, does the B12 reading noted mean I have anaemia? The family doc when we touched on the subject said only that I was slightly anaemic. My constant tiredness has caused me to get copies of blood reports and this is the first chance I have had to get to ask him since I got copies. He may not even have seen the reports of Nov 04 done when I was seeing a Liverpool consultant endocrinologist at my request to the same family doctor to see if I had hypothyroidism as that seemed an easy thing to cure.( You got to be lucky sometime!) I am assured by the endocrinologist that I do not have this. However he did find evidence of several small strokes after a TIA in Sept 03 which I knew about and that my mitral valve has mild to moderate stenosis which I did not know about as well as my aortic valve which has mild stenosis. which I did know about. My Family doctor was on holiday in March 05 and a locum who operated the sole doctor practice in his absence ordered a blood test as he could see how fatigued I was. This March 05 therefore one was done at another hospital in Llandudno N Wales. The Nov 04 one was done in Liverpool. In the March 05 one there is no mention of B12 I am afraid. I guess this report is what the family doctor based the slight anaemia on saying nothing needed to be done until I see the haematologist in July. The March 05 out of tolerances follow:- The WBC is 3.2 x10/9/L (normal 4 - 1 alongside the WBC appears Myelo 0.06 x 10/9/L RBC no comments 3.54 10/12/L HGB 11.2g/dl normal ( 13 -17) PLT 103 x10/9/L do ( 150 - 140 ) Any comments gratefully received. This is one time ignorance is not bliss. Thks again Bst rgds Ron and Jane Koffler Tel + 44 (0)1492 515580 just in case and I will phone you back. > No answer yet from family doc. I faxed him a copy of the vitimin > B12 reading of Nov 04 this morning as his receptionist requested. I guess [quoted text clipped - 66 lines] > > Thks again Bst rgds Ron and Jane Koffler vitamin B12 is needed to make red blood cells and is usually obtained in a healthy diet. People who can't absorb B12 get pernicious anaemia where you may have a normal but probably reduced red blood cell count with a normal haemaglobon (hb) content. Eventually the cells become so deformed they can't multiply. Added to this there are toxic effects which lead to increased lactate levels all of which means you become very ill if left untreated. If you are feeling reasonably well you probably don't have any reason to worry. If you begin to feel excesively tired that is a sign to have things checked out. MIKE MIKE > > No answer yet from family doc. I faxed him a copy of the vitimin > > B12 reading of Nov 04 this morning as his receptionist requested. I guess [quoted text clipped - 74 lines] > effects which lead to increased lactate levels all of which means you become > very ill if left untreated. Mike, Vit B12 absorption decreases with aging. Worsened by acid lowering medications. Important for you to know for your patients. http://www.nlm.nih.gov/medlineplus/ency/article/000574.htm > If you are feeling reasonably well you probably don't have any reason to > worry. If you begin to feel excesively tired that is a sign to have things > checked out. Did you miss his first post? He is very tired. That's why he posted here to begin with. His B12 levels are below the normal range. He also has "asymptomatic myeloma" and the heart troubles. J > Mike, Vit B12 absorption decreases with aging. > Worsened by acid lowering medications. > Important for you to know for your patients. > http://www.nlm.nih.gov/medlineplus/ency/article/000574.htm That one showed the signs and symptoms http://www.postgradmed.com/issues/2001/07_01/dharmarajan.htm Preview: Vitamin B12 deficiency is a common problem that affects the general population and the elderly in particular. Persons with the deficiency may be asymptomatic or may have hematologic or neuropsychiatric signs and symptoms. If the disorder is untreated, complications may cause significant morbidity. Vitamin B12, also known as cobalamin, was first isolated in 1948 and immediately shown to be effective in the treatment of pernicious anemia (1). Recently, interest in the vitamin has been renewed because of the recognition that cobalamin deficiency occurs in 3% to 40% of the general population (2-7). Our own studies of community, hospital, and nursing home subjects (3,7) found the prevalence to be 15% to 25%. The most recent Food Guide Pyramid for persons over age 70 features a flag to emphasize the importance of adequate daily B12 intake (8). Table 1 summarizes several conditions and mechanisms that affect absorption of vitamin B12 from the intestine (4,12). Pernicious anemia, once believed to be the most common cause of vitamin B12 deficiency (15), may account for only a small percentage of cases (4). Deficiency most often results from food-cobalamin malabsorption due to gastric dysfunction that may be exacerbated by the use of acid-lowering agents (eg, proton pump inhibitors, histamine2 receptor antagonists) (16,17).Certain other drugs (eg, cholestyramine [LoCHOLEST, Prevalite, Questran], p-aminosalicylate, metformin hydrochloride [Glucophage], colchicine) cause malabsorption through effects on the ileal mucosa or membrane receptors or by other means (10). Hematologic and neuropsychiatric manifestations can occur simultaneously, in sequence, or independently (tables 2 and 3). They may resemble typical complaints of aging, such as fatigue, weakness, loss of memory, and depression. When these symptoms occur in the elderly, vitamin B12 deficiency should be ruled out. Complications typically develop over time and can be severe or even life-threatening. However, a rapid-onset, postoperative myeloneuropathy due to nitrous oxide anesthesia that inactivates marginal B12 stores has been described (18). Shooting pains in the extremities (Lhermitte's sign) indicate spinal cord involvement, root involvement, or both, but are not specific for vitamin B12 deficiency. The presence of ataxia, altered tendon reflexes, Romberg's sign, and extensor plantar reflexes suggests subacute combined degeneration (ie, involvement of posterior or lateral columns of the spinal cord, or both). Neurologic features may improve rapidly with therapy, and damaged axons may regenerate (10,19). The window of opportunity to initiate treatment to reverse or minimize complications is narrow. Vitamin B12 deficiency should be considered in the initial workup of patients with dementia and psychiatric disorders (20,21). J-archiving very ill if left untreated. > Mike, Vit B12 absorption decreases with aging. > Worsened by acid lowering medications. [quoted text clipped - 13 lines] > > J I did miss the first post but I would suggest his blood count is not unreasonable for someone with myeloma and as long as he is getting regular reviews by his haematologist I doubt there is much to get worried about. A certain amount of fatigue would be expected, I think. If he is fatigued to the point of becoming breathless on minimal exertion this would be a reason to push for earlier r/v but his gp, hopefully, knows him well enough. Your body can accommodate a wild abnormality in many 'normal' blood values. I have had patients with Hb down to 4 or 5 and showing only mild breathlessness and moderate fatigue. This happens over a period of time and the body adjusts. If you lost that amount of Hb quickly you would probably be dead. MIKE > very ill if left untreated. > > [quoted text clipped - 28 lines] > be dead. > MIKE Hi Mike, I reread the posts. To be honest, it sounds like he hasn't even seen a hematologist yet and I did see clinical trials of B12 to see if it could ameliorate myeloma. Did the posted labwork confirm myeloma? I imagine his heart troubles would contribute to fatigue also. I hear what you're saying but I think that B12 has to drummed home to many doctors, who are not aware of it. Mine wasn't or didn't clue in that I was low. His nurse later told me she does the injections, so I guess he forgot. My concern is that people could end up being dx'd with senility and abandoned in nursing homes, where all they need is proper monitoring and boosting of B12. I'm sure that's happened. It's insidious and if not tested for, as you say, very ill and at some point, irreversible or so that web site said. And in this UK/Canada "doctor" environment, where doctors have little time, it's best to drum it home to the doctors. In any event, if he follows my instructions, the hematologist will guide him on what to do. Thanks J > No answer yet from family doc. I faxed him a copy of the vitimin > B12 reading of Nov 04 this morning as his receptionist requested. [quoted text clipped - 17 lines] > HGB 11.2g/dl normal ( 13 -17) > PLT 103 x10/9/L do ( 150 - 140 ) My good man, As Mike stated Vit B12 is reguired to make red blood cells (RBC's) . Your WBC's (white blood cells, hemoglobin (HGB) and platelets (PLT) are all out of range (too low) in the first lab test results and continue to lower in the second lab test result. Your RBC's (red blood cells) have also lowered. I do not know what "DO" means. As I said, I'm not a doctor and not qualified to interpret lab tests. I cannot telephone because I'm poor as a church mouse. I'm in Canada. Nor would I because I'm not a doctor. If I were you, I would fax or take copies of the results of all your lab test results to the hematologost, with an "Urgent" request to prescribe you cobalamin (10,000 units - it is fairly inexpensive) and one repeat prescription. Supply him the name and fax/phone number of your drugstore. That puts the onus and responsibility on him. If he sees a problem with your boosting your B12, he would not prescribe the cobalamin. Follow up with his office within a week of faxing the paperwork and confirm that he's seen it and ask if the prescription has been sent to your drugstore. If yes, go get it and ask the nurse at your doctor's office for the injection. Sometimes receptionists are nurses also. If not, arrange for your doctor to give the injection; ask him to instruct you how to inject yourself. Our health system is similar to yours. Many of us cannot even find family doctors, much less change doctors. Some breast cancers are curative with surgery. Depending on the pathology report, sometimes adjuvant therapy (medicines) are recommended. There's several ladies from the UK on alt.support.cancer.breast Once you have the pathology report, post there and Mary (or one of the others) will no doubt be very helpful to you and your wife. Best wishes, J |
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