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Feeling insomnia, weakness, indigestion, bloating and suicidal thoughts. Remedy?

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General & Family Physician
Practicing since : 2008
Answered : 3512 Questions
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Hello Doctor,

I have been suffering with this health condition for the past two years. I have consulted many doctors, specialists and have been taking various medications for over two years and nothing seems to be helping beyond a point of recovery. I am a software engineer. I was living in the US (New York) starting March 2010. Let me explain my health problem with proper timelines:

XXXXXXX 2011
---------------

In XXXXXXX 2011, I got some feeling of dizziness while I was roaming out on a hot day. The same dizziness happened couple of times on the days that followed, especially after I had taken lunch in the afternoon. i.e the dizziness happened immediately after I ate my lunch.

Tests run by my Urine showed the following abnormalities:

Cholesterol (High) 255 mg/dL Reference Range 100-199

Triglycerides (High) 168 mg/dL Reference Range 0-149

LDL Cholestral (High) 166 mg/dL Reference Range 0-99

Vitamin D, 25-Hydroxy (Low) 6.7 ng/mL Reference Range 32 - 100

Vitamin B12 (In the Borderline) 224 pg/mL Reference Range 211-946.

Methylmalonic Acid in Serum (High) 965 nmol/L Reference Range - 73-376.

My doctor told me I had high deficiency of Vitamin D3 and Vitamin B12. She gave me a Vitamin B12 shot (1000 mcg, methycobalamin) & started me on the following tablets

0000IU Vitamin D2 weekly tablets

1000mcg Cynacobalamin daily tables

The doctor referred me to a Cardiologist who ruled out all sorts of illness in cardiovascular system (Tests taken - ECG, Echo, Tread mill test, primary care physician concluded it was just too much of stress and some vitamin deficiency. I continued with the medication for another 3 months.

October 2011
------------------
I was given Flu vaccination by my employer (In the US, people are given flu vaccinations before the onset of winter). I fall sick within few hours of taking the Flu shot. I developed fever which subsided the same night. In the meantime, the work pressure and stress was tremendous. I kept working for 14 hours a day for almost 5 months continuously. I started feeling tired, burnt out every day. But thought it was just the work pressure as I felt great on Mondays after relaxing weekends. I develop insomnia and body/back pain. I took couple of days rest. The body/back pain went away but the sleep problems remained.


February 2012
-------------------
Hell broke loose into my life. I developed severe back pain, insomnia, severe indigestion. Within a week’s time I fall extremely sick:

i) I was barely able to walk

ii) The food I ate did not get digested. I completely lose my appetite.

iii) I am not able to sleep for days in a row (like 72 hours continuous)

iv) My mind becomes too foggy, I was not able to think clearly & make any decisions.

v) I develop severe pain in the spinal cord, knees, feet etc

My new primary care physician runs blood tests, urine tests. The results came up with the following abnormalities:

Vitamin D, 25-Hydroxy (Low) 11 ng/mL Reference Range 32 - 100

Vitamin B12 (In the Borderline) 236 pg/mL Reference Range 211-946.

Blood trace found in urine (Only RBCs, No WBCs, No Puss cells)

My doctor concluded that I have severe depression, vitamin D, Vitamin B12 deficiency and Urinary Tract Infection. She gave me a vitamin b12 shot, again starts me in 0000IU per week vitamin D2. Also, she gave me Bactrim Ds tablets for the UTI.

My doctor refers me to a orthopaedician for my back, knee pains. The orthopedician ran Xrays and concludes that my back pain was due to thoracic scoliosis and injected hydrocortisone steroid along my spine for pain management. The steroid did not alleviate pain. And later I find that the entire diagnosis was wrong.

I spent almost 3 weeks in bed. Unable to manage my health condition in the US, I returned to India in March 2012.

March 2012
---------------
I visit XXXXXXX Hirudayala, Bangalore and consult Oncologists, gastroenterologist, Orthopaedician, Urologist. The doctors rule out all types of Cancer & major diseases. They concluded I was under severe depression. They gastroenterologist diagnosed acid pepsis and gave me 3 weeks course for the digestion problem. All other doctors rule that my health will improve with time and I don’t need any medication other than good food & sleep. I take rest for another 4 months. Nothing improves.


November 2012
---------------------
My health condition kept deteriorating (Insomnia, Weakness, Indigestion, Bloating, Suicidal Thoughts).

I developed burning sensation, pins & needles in the back, numbness in the back, shooting pain in the feet & knees, extreme weakness.

I felt like it was better to die rather than living a life where I was not able to eat, digest & sleep.

I finally XXXXXXX a psychiatrist. She diagnosed depression and put me on anti-depressant for a month. Endoscopy was done by another gastroenterologist and it came back normal. A spine MRI was done for the back pain and everything came back normal.

My family doctor in India runs tests like ASO, Blood, Urine. The blood test comes out normal. Urine had blood trace and the doctor says it was because of heat.

The doctor gave me lot of enzymes and flushes the digestive system over a period of two days. Finally, I was able to eat and digest the food too. But still my appetite was almost lost.

My health seemed to improve a bit after the cleaning of my digestive tract.


February 2013
------------------
My health deteriorates further (severe back pain, tingling, numbness, insomnia, indigestion). This time, I consult a new orthopaedic surgeon in Chennai. The doctor runs spine MRI, blood, urine tests. He concluded it was all the vitamin B12 deficiency and depression. The new doctor concludes it was all Neuropathic pain due to vitamin B12 deficiency.

He immediately starts me on Vitamin B12 (Methycobal 500 mcg) per day, every day for a week, then 2 injections a week after that.

My health improved to a large extent (Burning in the back reduces, digestion improves, sleep patterns improves). But the health improvement reaches a saturation point in a months time and all the symptoms return in April 2013.


May 2013 (Right Now)
--------------------------

The burning sensation, pins-needles, foot pain, knee pain, back pain is between moderate and severe. Appetite has gone down. Sleep patterns are OK.

Doctor,
Do you think there could be something else than the vitamin B12 deficiency?
How long will it take to recover from vitamin b12 deficiency?

Is there any other test I should be taking to diagnose the problem further?

Is there any other specialist doctor I should be consulting with regarding this health condition?

What is the best course of treatment to get out of vitamin B12 deficiency?

What could be the root cause of this vitamin B12 deficiency? I am a non-vegetarian. I regularly eat eggs, milk etc.

Do you think something could be broken in my B12 absorption or metabolism mechanism? How to test and diagnose any such conditions?

Currently I am on Neurobion Forte (1000mcg mecobalamin) thrice a week.

I look forward to your reply.

Best Regards,

XXXXXX.
Posted Sat, 15 Jun 2013 in General Health
 
 
Answered by Dr. Raju A.T 17 hours later
Hi XXXXXX,

Thanks for your query.

First, I would like to appreciate you for the easily understandable and informative way of presenting your history.

Based on the same, I would believe that you have been through lot of misery. I do feel your concern.

Let me address your queries in sequence.

1) Do you think there could be something else than the vitamin B12 deficiency?

The symptom presentation and the lab reports do make me to consider Vitamin B12 deficiency induced neuropathic pain to be the cause here. Most of the other causes for such symptoms has been ruled with the investigations.

2) How long will it take to recover from vitamin b12 deficiency?

The duration depends on the type of deficiency. If it is due to storage defect then you may have to be taking it lifelong. If problem is with absorption or metabolism then treatment in cycles would suffice.

3) Is there any other test I should be taking to diagnose the problem further?

Yes, Methylmalonic Acid in Serum test done in you which shows high titres indicate that the deficiency could be due to absorption defect.

To confirm the same there are tests like determination of intrinsic factor antibody titres and a Schilling test which determines antiparietal cell and intrinsic factor antibodies.

4) Is there any other specialist doctor I should be consulting with regarding this health condition?

An integrated approach by a Gastroentrologist and a Neurologist would suffice to treat the condition well.

5) What is the best course of treatment to get out of vitamin B12 deficiency?

Neurobion Forte (1000mcg mecobalamin) thrice a week is recommended dosage, the course may have to be decided depending on the type of deficiency as I mentioned before.

6) What could be the root cause of this vitamin B12 deficiency?

Based on some of the investigations I would suspect absorption defect to be the cause for the deficiency in you.

7) Do you think something could be broken in my B12 absorption or metabolism mechanism? How to test and diagnose any such conditions?

Yes, I think it could be a defect in absorption. I have mentioned tests to confirm the same.

Hope I answered your query.

Please let me know if there are any other concerns.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Feeling insomnia, weakness, indigestion, bloating and suicidal thoughts. Remedy? 1 hour later
Hello Doctor,

Thank you so much for your detailed reply. I have couple of questions:

1) Urine tests showed blood trace (Only RBC, No WBC, NO Pus Cells). Do you think B12 deficiency could have caused the blood in the urine? Or is it just just some Urinary Tract Infection? Do you think I need to run any specific tests regarding the Urinary tract, Kidneys?

2) Do you think demyelination (i.e degradation of the myelin sheath) could have happened in my nervous system because of the B12 deficiency? If so, how can I diagnose it? What are the tests that needs to be run for detecting demyelination or any nerve degeneration?

3) I was given a flu vaccination in October 2011. And I probably was B12 deficient at that time. I read in the internet that some vaccinations deplete the B12 stores in already B12 deficient patients. Do you think the flu shot that I was given could have caused / contributed to my B12 deficiency?

4) I was given nitrous oxide based anesthesia when my orthopaedician gave me hydrocorisone injection along my spine (for my back pain). I have read in a book that nitrous oxide based anestheisa depletes Vitamin B12. What are your thoughts on this? Do you think the anesthesia does I was given probably depleted my Vitamin B12 stores?

5) I was given an anti-depressant (Typlin OD) to be taken in the nights to get good sleep. I took it for like a month, but stopped as I thought I was getting to a point where I was not able to sleep without the pill. Do you think anti-depressants can have any effect on the production of intrinsic factor or the absorption of B12 and its metabolism?

6) I used to drink a lot of coffee (like 5 cups a day) when I was in the US. Do you think coffee intake to could either reduce intrinsic factor or play any adverse role in the vitamin B12 absorption or metabolism?

You have been really helpful. Thank you so much for your time & help again.

Best Regards,
XXXXXX
 
 
Answered by Dr. Raju A.T 2 hours later
Hi,

Thanks for writing back.

1) Urine tests showed blood trace (Only RBC, No WBC, NO Pus Cells). Do you think B12 deficiency could have caused the blood in the urine? Or is it just just some Urinary Tract Infection? Do you think I need to run any specific tests regarding the Urinary tract, Kidneys?

--No, It may not be related to the Vitamin deficiency. Yes, you have to get a repeat urine analysis and urine culture done to rule out infections.

2) Do you think demyelination (i.e degradation of the myelin sheath) could have happened in my nervous system because of the B12 deficiency? If so, how can I diagnose it? What are the tests that needs to be run for detecting demyelination or any nerve degeneration?
-- Yes, the numbness, pins and needles you have could be due to B12 deficient demyelination. Diagnosis is by Cerebrospinal fluid (CSF) examination and Nerve conduction studies.

3) I was given a flu vaccination in October 2011. And I probably was B12 deficient at that time. I read in the internet that some vaccinations deplete the B12 stores in already B12 deficient patients. Do you think the flu shot that I was given could have caused / contributed to my B12 deficiency?

--I do not think so.

4) I was given nitrous oxide based anesthesia when my orthopaedician gave me hydrocorisone injection along my spine (for my back pain). I have read in a book that nitrous oxide based anestheisa depletes Vitamin B12. What are your thoughts on this? Do you think the anesthesia does I was given probably depleted my Vitamin B12 stores?

-- Frequent use of Nitrous oxide can cause Vit B12 stores depletion. I do not think a single episode could have caused such a severe deficiency.

5) I was given an anti-depressant (Typlin OD) to be taken in the nights to get good sleep. I took it for like a month, but stopped as I thought I was getting to a point where I was not able to sleep without the pill. Do you think anti-depressants can have any effect on the production of intrinsic factor or the absorption of B12 and its metabolism?

--No.

6) I used to drink a lot of coffee (like 5 cups a day) when I was in the US. Do you think coffee intake to could either reduce intrinsic factor or play any adverse role in the vitamin B12 absorption or metabolism?

-- It could have aggravated the deficiency but not caused it.

Hope this helps.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Feeling insomnia, weakness, indigestion, bloating and suicidal thoughts. Remedy? 2 hours later
Hello Doctor,

Thank you so much for the quick turnaround.

If the demyelination has occurred due to vitamin b12 deficiency, is the condition irreversible and permanent?

Best Regards,
XXXXXX
 
 
Answered by Dr. Raju A.T 16 hours later
Hi,

Yes, it is reversible and this happens after treatment with Vitamin B12 for may be months depending on the severity.

Wish you good health.

Regards,
Above answer was peer-reviewed by
 
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