After the ulcer - what then?

Digestive health
1

I had a perorated peptic ulcer at the age of 17 way back in 1959.

At first no-one would believe it was an ulcer although I'd been in considerable pain on and off for three months and got through a lot of Rennies.

The ulcer burst whilst I was at work as an apprentice electrician on the "Big Top" site in the middle of Birminhgham, I was taken to the General Hospital, accused of eating beetroot (for breakfast?) and sent home wiith a letter to my doctor.

I continued losing blood (from both ends) before being rushed across the city to the Dudley Road Hospital where I was put in a medical ward and fed on Horlicks tablets and blood drips - if they could find any veins.

Sunday afternoon visiting time came and I vomitted another kidney bowl full of blood and a surgeon was called who simply said "I'm going in" and in he went removing two thirds of my stomach.

Being so young and otherwise very fit I made a very quick recovery and was discharged from hospital after only nine days and the only advice given me by the surgeon was to give up my job and find "a sedentary job" - whatever one of those were.

Being so young - and foolish - I continued and finished my apprenticeship and qualified as an electrician but I was beginning to notice that I did not have as much energy as previously and my general health began to decline so I remembered the surgeons advice and took a less strenuous job as a buyer for an electrical wholesaler in 1962 - three years after the surgery.

In 1965 I got married but unfortunately my wife was taken seriously ill with heart problems in early 1966 and was hospitalized for several weeks the worry about which dragged my health down even more, I caught 'flu, was off work for four weeks and lost my job.

By now, in 1967 and unbeknown to me, I started to exhibit neurological symptoms of Vitamin B12 deficiency and in 1968 was sent for a "Schilling Test" which proved inconclusive.

Still my health declined and I was fed a cocktail of Librium, Valium and Tofranil for depression until I was a walking Zombie.

In 1972, thirteen years after the gastric surgery my doctor in one last desperate attempt to "sort me out" sent me for a second "unheard of" Schilling Test which this time proved positive for Pernicious Anaemia.

I was offered the choice of eating raw liver three times a day or having injections of cyanocobalamin B12 every four weeks for the rest of my life.

I've used the words "unbeknown to me" and it is about this ignorance that I have gone through that this post is about and believe me this ignorance is not bliss.

I have lived for nearly 45 years not understanding why I have pernicious anaemia.  In all that time I never knew anyone else with it and neither nurses (whom I saw every four weeks for the injections) or doctors ever asked me how I was coping.

In recent years however I've noticed a return of some of the symptoms in the run up to my next injection and that prompted me to find out more about P.A. by joining the Pernicious Anaemia Society and what I know now should have been made known to me fifty seven years ago and that is that gastric surgery makes it virtually impossible to absorb Vitamin B12 from food via the stomach.

A "normal" person has several years "store" of B12 in their liver but gastric surgery prevents this being replenished so after the 13 years gap between surgery and diagnosis and treatment I was probably running on "empty".

There are many other causes of Vitamin B12 Deficiency/P.A including diet, medications, other autoimmune diseases, family history, and surgery involving nitroud oxide etc etc  but my purpse on this forum is to advise those who have suffered gastric surgery to be aware of the danger of becoming B12 Deficient - also known as "The silent killer".

2

That was a most intresting and well written post. I'm glad that you are still alive and fighting.

I did not know that we have such a store of of B12.

3

Thank you....I self inject...

4

Thank you.  Sadly many doctors don't consider vitamin deficiencies when tring to arrive at a diagnosis of their patient's symptoms.

Often B12D is misdiagnosed as ME/CFS, Alzheimer’s, dementia, cognitive decline and memory loss (collectively referred to as “ageing”) 

Multiple sclerosis (MS) and other neurological disorders

Mental illness (depression, anxiety, bipolar disorder, psychosis) 

Cardiovascular disease

Learning or developmental disorders in kids

Autism spectrum disorder.

Cancer

Male and female infertility.

The symptoms of the above can all mimic the signs and symptoms of vitamin B12 deficiency which can be detected by a simple blood test and treated by injections costing only a few pennies a shot - and yes! I'm still "clivealive" at 75. 

5

I'm glad that you do - but would not your GP prescribe them for you?

6

He prescribes the B12....I inject because it is a hassle to get up and go to the doctor just for an injection I can give to my self.

7

Well done for doing that from your own choice.  So many people can't get their doctors to treat them.

Do you know what your Folate level is as this is essential to process the B12?

8

I do not,,,but now I will ask...hug

9

What a great and interesting post! I've heard the B vits are good - I've had terrible anxiety due to stomach issues recently. Mine kicked off after 2 rounds of antibiotics in short succession - but the anxiety I'm experiencing just now is disproportionate and terrifying. I'll give B12 a go! Tonight!

10

Sadly antibiotics can kill off the good bits as well as the bad bits and also affect absorption of Vitamin B12.

Before you start supplementing get your serum B12 and serum Folate levels checked as supplementing wil,"skew" the results.  If they are "a bit low" or  "normal" your doctor may well try to shrug you off but this is wrong if you are having neuropathy symptoms.

If you are diagnosed with Vitamin B12 Deficiency then your doctor should treat you inaccordance with the BNF Guidelines as follows:

Treatment of cobalamin deficiency

"Current clinical practice within the U.K is to treat cobalamin deficiency with hydroxocobalamin in the intramuscular form outlined in the British National Formulary, BNF, 

Standard initial therapy for patients without neurological involvement is 1000 μg intramuscularly (i.m.) three times a week for two weeks, then every three months. 

The BNF advises that for Pernicious anaemia and other macrocytic anaemias patients presenting with neurological symptoms should receive 1000 μg i.m. on alternative days until there is no further improvement, then 1 mg every 2 months.

However, the GWG recommends a pragmatic approach in patients with neurological symptoms by reviewing the need for continuation of alternative day therapy after three weeks of treatment"

If your doctor prescribes B12 injections, then, depending on your Folate level he may also prescribe Folic Acid as this is essential to process the B12.Vitamin B12, one of eight B vitamins, is essential to blood formation, regeneration of vitamin B9 (or folic acid) DNA synthesis and the proper function of the brain and nervous system.

B12 is an essential vitamin. Essential nutrients are molecules the body cannot produce on its own. So they must be supplied in the diet. Even just a small deficiency of vitamin B12 can have drastic effects on mood.

Symptoms of a small vitamin B12 deficiency include anxiety, stress, irritability, depression, fatigue and mental confusion.

Vitamin B12 helps generate the fatty layer of the nerve endings, also known as myelin. The myelin layer must be intact for neuron signals to transmit properly. A vitamin B12 deficiency may impair the myelin layer and prevent proper signal transmission.

If you have an absorption problem for whatever reason you will not be able to obtailn B12 from your diet and here is a list of people who will be likely to become deficient.

"Vegetarians, vegans and people eating macrobiotic diets.

People aged sixty and over

People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (Gastric bypass).

People who regularly use proton-pump- inhibitors. H2 blockers, antacids, Metformin, and related diabetes drugs, or other medications that can interfere with B12 absorption.

People who undergo surgeries or dental procedures involving nitrous oxide, or who use the drug recreationally.

People with a history of eating disorders (anorexia or bulimia).

People with a history of alcoholism.

People with a family history of pernicious anaemia.

People diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia and thalassaemia).

People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), or any other disease that cause malabsorption of nutrients.

People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Grave’s disease) Type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders.

Women with a history of infertility or multiple miscarriages."