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Feeling fatigued and pain in legs. Diagnosed with vitamin B12 deficiency. Prescribed methyl cobalmin injections. Suggest?

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I am a female with 38 years of age. Last year on 11/7/2012, after feeling extremely fatigued and excruciating pain in legs, I was diagnosed with vitamin B12 deficiency 154pg/ml (reference range 180-914). I was prescribed methyl cobalmin injections course for a year along with ultranuron tablet OD and folvite tab OD. I felt better but not fully better with the symptoms. My vitamin B12 touched normal levels in September. But I did not feel robust. I was prescribed coenzyme Q10 but it did not benefit much.
Again in the month of Feb. 2013, I got all test done. My CBC was normal, urine analysis was normal, lipid profile was normal, KFT, LFT was normal thyroid profile was normal, my glycosylated haemoglobin, EDTA whole blood, HBA1C-5% (non diabetic <5.7%) and mean plasma glucose 96.8 <116.0mg/dl, vitamin b12 was normal, vitamin D3 was insufficient for that I was prescribed Uprise capsule. I felt little better with the energy levels but still not upto the XXXXXXX
On 23-06-2013 I had a full blood test done, all test were normal, with normal total protein, urea, potassium, phosphorus, calcium total, haemoglobin. Chest xray was normal. And vitamin d3 was in normal range.
My concern is: My vitamin B12 injection course is ending this month, despite my blood profile is normal, my vitamin D3 is normal I am still not feeling upto the XXXXXXX My energy levels are not in proportion to my good diet. I feel fatigued, I have generalised pain in both my legs. Pain and energy levels don’t get better with rest or consuming more nutritious food. It is more of a muscular pain in legs. It is hindering my day to day activities. I am resting most of the time. Combiflame makes it slightly better. I wake up feeling tired in the morning. My left leg is slightly jerky at night. It was jerkier before I was diagnosed with vitamin b12 deficiency. I don’t know what to do. Two years ago I was rigorously gymming, now it’s painful to do even regular chores. I am not over weight. My MC is normal. Please advice.
Posted Sun, 25 Aug 2013 in General Health
Answered by Dr. Shruti Rijhwani 25 minutes later
Dear Madam,

Thank you for posting your query on XXXXXXX

Well looking into your problem with all available reports I see that all your tests have been normal . It is very difficult to point out a diagnosis just on the basis of history but still you can be suffering from a condition known as fibromyalgia . It is a condition in which the pain perception of patient is increased associated with fatigue , headaches , difficult sleep etc. still all the investigations are normal.

One important test for you would be CPK , S. aldolase , SGOT levels to rule out any myositis . I advise you to see a rheumatologist because physical examination is necessary in your case to localise the type , character of pain .

Hope it suffices.

Wish you good XXXXXXX

Take care.

Dr. Shruti
Above answer was peer-reviewed by
Follow-up: Feeling fatigued and pain in legs. Diagnosed with vitamin B12 deficiency. Prescribed methyl cobalmin injections. Suggest? 2 hours later
Thank for replying Dr. XXXXXXX

Except for muscular pain in both the legs i have no other associated symptoms of fibromyalgia. i have no head aches, no sleeping issues as informed above. infact i am sleeping a lot to relax my muscles. all these symptoms resemble my state before i was diagnosed with vit b12 deficiency. there are spells when i feel normal. but currently i am in a bad shape. i need to know who would be a best consultant : an orthopedic or a rheumatologist for muscular evaluation?

secondly is there a chance , i am approaching menopause? although i have regular MC right now. is there any test to confirm this? please advise.

thirdly though my Vit D levels have touched the normal range. i have taken it once a week for 4 months followed by once a month, for 2 months. i was advised to take once a month for 12 months . should i continue for next 10months or discontinue now?

Answered by Dr. Shruti Rijhwani 52 minutes later
Dear madam,

Thanks for getting back.

I just mentioned a few symptoms of this disease , actually it involves lot of functioning of body . There are tender points in body which need to be evaluated in examination for fibromyalgia thats why physical examination is necessary .

In my opinion consult a rheumatologist for your problem.

Yes you can take vitamin D for another 10 months once a month because that is maintainence therapy .

For your menopause related issue i dont think you are approaching menopause because you are just 38 years but still if you want you can consult a gynaecologist for hormonal evaluation.

Take care.

Dr. Shruti
Above answer was peer-reviewed by
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