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Pernicious anemia - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
User :   One year ago I finally went to my doctor for tingling/numbness in my hands and feet that I had experienced for a several years. Blood work showed very low B12 levels (170 pg/mL) and I have been treated with monthly B12 injections since then based on a diagnosis of pernicious anemia. Although the numbness has subsided, I recently began experiencing dizziness, sometimes accompanied by nausea, as well as a persistent mental "fog" so I visited my doctor again. He suspected a middle ear infection (although I had no ear pain) and did blood work again to check my thyroid. The results were normal except for large blood cells (MCV 101) so it was recommended that we up my B12 injections to twice monthly. The mental fog persists along with other symptoms: dropping objects suddenly, short term memory problems, sudden burning/pinprick sensations (like getting stung by an insect) and increasing difficulty with my handwriting (e.g. signing my name - I get "stuck" writing certain letters or words). I have a healthy diet (lots of dark greens/kale, beans, whole grains & veggies, daily multivitamin) and exercise fairly regularly. However, I do drink alcohol every day (from 1-3 glasses of wine) and have since I was 20, which I know can affect B12 levels. Another recent symptom has been gum infections (despite daily brushing/flossing). I've also struggled with an irregular heart beat or heart murmur for the last 15 years, with increasing symptoms over the last 5 years. I've had many tests to try and diagnose that (EKG, 24-hour heart monitor, etc.) all with normal results. I've been told that although it feels very uncomfortable and somewhat anxiety-inducing (like my heart stops for a beat) it's normal. I'm concerned that there is a larger issue causing these symptoms, and that it could lead to neurological problems, dementia or heart problems later on. I've wondered about
User :   checking my homocysteine levels based on articles I've read, but my doctor has not recommended those tests yet. He seems to be satisfied with the diagnosis of pernicious anemia (due to lack of intrinsic factor) as the root of the B12 deficiency, but I'm concerned that there may be more going on. Any advice or insight would be most appreciated. I don't want to be labeled a hypochondriac by my physician, but at the same time I don't want to ignore these nagging and somewhat concerning symptoms.
Doctor :   Hi
User :   hi there
Doctor :   Let me read it
User :   Will do, thanks
Doctor :   May I know your age now?
User :   35
Doctor :   All the symptoms that you have mentioned is
Doctor :   definitely attributable to Pernicious anemia & its sequel
Doctor :   Pernicious anemia affects the neurological system in the form of brain fog as you rihjtly mentioned,
Doctor :   tingling, weakness, clumsiness etc
User :   Forgot to mention that the latest blood work showed my B12 at 523 pg/mL
Doctor :   Anemia itself can lead to tachycardia(fast heart beat) & murmurs
Doctor :   May I know when the reading was 170 pg/mL? & have the mentioned their lab reference range for normal?
User :   That test was done in June 2009. Reference range is 180-914 pg/mL
Doctor :   Now we are sure that the B12 levels are indeed rising
Doctor :   Have you measured the levels anytime inbetween?
User :   Yes, last measured in Dec 2009
User :   Checking on the value, but within normal limits
Doctor :   What you have to understand now is that the Blood levels of B12 levels, though rising, it takes a much longer time for the Neurons to recover
Doctor :   from the damage it has suffered
User :   ok
Doctor :   Since some or more of your symptoms have disappeared
User :   should I be concerned about the relatively new/increased symptoms of dropping objects, handwriting problems and "pinprick" nerve pain?
Doctor :   in this time, we can take that as the sign of neurological recovery
User :   is there an estimated time frame for how long I should expect neurological recovery?
Doctor :   Yes dropping objects & handwriting problems are due to incoordination & weakness
Doctor :   due to
Doctor :   Vit B12 dif
User :   are there any other tests that I should ask my doctor to run?
Doctor :   May I know the tests that you have undergone?
User :   tested thyroid levels and B12 several times, basic metabolic panel, CBC with diff, comprehensive metabolic panel
User :   have not tested homocysteine levels, which was one I was curious about.
Doctor :   May I know what makes you curious to test homocysteine levels?
User :   just reading about B12 and folate deficiency as related to dementia
User :   I'm wanting to be sure of the cause of the B12 deficiency in the first place
User :   whether it's lack of intrinsic factor or something else
Doctor :   Ok, you are right about the link between B12 and folate
Doctor :   But homocysteine is nowhere linked
User :   ok
Doctor :   has Schillings test been done?
User :   no
User :   have read about that as well, however
User :   all B12 tests have been done without fasting, BTW - don't know if that's important
User :   I guess one other thought was if the B12 deficiency was related to long-term moderate-to-heavy drinking (e.g. liver problems) or lack of intrinsic factor (hereditary?)
Doctor :   I think the best option to put your doubts to rest is
Doctor :   by going for a second opinion from another Gastroenterologist
User :   ok. curious you mention gastroenterologist. the only thing I have seen one for is colonoscopies due to family history of colon cancer
Doctor :   Whom are you consulting now?
User :   family practitioner
User :   but I do have a gastroenterologist, just have never discussed these problems with him
Doctor :   Do dsiscuss
User :   ok, I will do that.
User :   one last question: does any of this predispose me to Alzheimer's later in life? or are the two unrelated?
Doctor :   Alzheimer's & Pernicious anemia are two distinct disorders
Doctor :   You are predisposed to Subacute combined degeneration of spinal cord
User :   ok, so next step is to see my gastroenterologist re: pernicious anemia/low B12 - correct?
Doctor :   Yes
User :   thank you VERY much! this is a great service. I appreciate the feedback and advice! :)
Doctor :   Thanks for consulting me. Bye for now. Please refer your friends to our service.
User :   Will do. Thanks again!
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