Re: B-12 Deficiency

Posted By Deb on April 03, 1999 at 21:03:53:

In Reply to: Re: B-12 Deficiency posted by CCF Neuro[P] MD, RPS on March 31, 1999 at 08:36:45:






: : : : i am a 42 year old female who has just been diagnosed with a vitamin b12 deficiency. symptoms started 18 months ago with pain starting in my neck and radiating down in my left arm, weakness and numbness in my left hand and then numbness in my right leg. previous tests included carpal tunnel,  x-ray, mri, cat scan, and mylogram. a "spot" was found on my spine at the 6th & 7th vertibrae which was determined by the mylogram to be a pocket of blood vessels that had probably been there since birth.this physician recommended steriod injections as my next resort. i opted to do nothing at that time (Jan. 1998). afterwards i underwent 12 sessions of physical therapy with no improvement. Approx. 3 months ago i started having weakness and numbness in my right arm and hand also and found that when walking for exercise - both legs went numb. i brought this to my current doctor's attention and he ordered blood work - which showed the b12 deficiency. i have just finished daily injections of b12 and now will administer weekly for 4 weeks and then monthly for life. cause of b12 deficiency is unknown - anemia was not present. doctor is also trying daily doses of "Celebrex" 100 mg, twice daily. he wishes to order steriod injections if no results are seen. after 9 days, there is no improvement.
: : : : also i need to make a note that in dec. 94 i had a partial hysterectomy.
: : : : my questions are:
: : : : could the hysterectomy be the cause of non-absortion of B12? (B-12# was 26 in blood work - no signs of diabetes or thyroid problems)
: : : : do i possibly have neurological damage that can be reversed? would steriod injections have any effect on the numbness,weakness and pain?
: : : : i am seeing a general physician- specialists are 2-3 hours away.any advice or knowledge you could share would be appreciated. i have done some research and know that this is rare for someone my age. i am in general good health except for a history of migraines since age 18. they improved in 1995, but have increased since late 1998. (but i also changed jobs at that time???)
: : : : also - can you give methe good and bad of steriod injections if it is a possible solution? i have been unable to find anything on the internet.
: : : : thank you very much for your time.
:



: Dear Donna:
: Sorry to hear about all your problems.  Your hysterectomy is not the source of your B12 deficiency.  Most of the time it is due to diet that is deficient in B12, but sometimes there is a malabsorption in the B12 at the end of the iliem (where the body absorbs B12 from).  A schillings test can be done to show if this is your problem.  You may suffer from a malabsorption disorder, diverticula, or be a lactovegetarian.  You will have to discuss these issues with your physician.
: The treatment of vitamin B12 deficiency is vitamin B12.  I would be hesitant to use steriods or anti-inflammatory medications as this process is usually not due to an inflammatory process.  The most important factor influencing the response to treatment is the duration of symptoms before treatment is bugun.  All neurological symptoms and signs may (MAY) improve with time, mostly in the first 3 to 6 months and then steadily progress at a slower rate during the ensuing year or longer.  Each patient is alttle different so it is difficult to tell you how much you will improve, but you will improve.
: Best of luck,
: Sincerely,
: CCF Neuro[P] MD

: :



Dear HEDA:
Thanks for the info.
CCF Neuro[P] MD

:



thank you for the information and thank you HEDA for your response- it is good to know that i am not the only "young" person with B12 deficiency. i guess i just have so many questions-
1. since i am NOT PA will the Schillings test show what caused the deficiency?
2. do only those with PA need to watch for stomach cancer?
3. do i need to have xrays or mri to look for spinal lesions or degenerative problems?
4. has the amount of time since my neurological problems started (18 months) been too long without treatment to expect any results or will this cause the results to not be 100%
maybe that is all for now - i plan to take all of this to my dr. to ask for help in determining my future treatment plan. thanks again - i think it is really great that you offer this service. :)




Dear Donna:
The Schillings test will only examine one possibility of B-12 malabsorption.  As stated in the previous posting, there are multiple ways that malabsorption can occur.  This is only one of the tests that your physician will run.
Malabsorption can result from gastritis.  The inflammation lowers the production of the intrinsic factor needed to carry the B-12 to the terminal ilieum to be absorbed.  Without symptoms of gastritis, I would let your physician decide if you need to have your stomach scoped.  Gastric cancer may be a cause of intrinsic factor problems but you do not describe any symptoms of this entity.
As you have just had a recent MRI, I would not suggest another MRI.  X-rays are good for gross boney structures but are not the method of choice to look for degeneration unless an MRI can not be performed.
As previously stated, the longer until therapy the less of a recovery a patient will have.  Now that is a general statement.  It depends on the symptoms that the patient is having.  Since I have not examined you, it is impossible for me to tell you the recovery.  Your physician should have a good feel for what he/she expects.
Good luck.
Sincerely,
CCF Neuro MD




My daughter has been having alot of the same symptoms numbness is left
shoulder, loss of muscle and nerve in right leg. Has had MRI, myleogram
(nerve and muscle tests, Her sciatic nerve is involved althought she
has not been diagnosed yet recent blood test show her MCV at 97.9
and MCH at 33.6.  We do not know what these are or what it means.
She had surgery on her feet 18 mos ago,  soon after started having
stomach problems and was treated for ulcers. She is scheduled for
more tests MRI on sciatic. Would appreciate if anyone knows what MCV
or MCH is or means would email us or reply here.  Thank you Deb