The following is a guest opinion article from Doc Martyn. His opinions and advice are entirely his own and may not necessarily be those of The Pattaya News Company Limited. His contact information can be found at the end of the article.
- For those not living in Pattaya, I provide medical opinions via telephone consultations.
- Recently, Am’s husband contacted me about Am’s systemic pain and the paraesthesia, numbness, in her legs. She also suffered troublesome epigastric pain and intermittent pain in her right iliac fossa.
Am is a 45 years old, Thai national. She is 144cm tall and weighs 40kg.
Her past medical history included; a difficult appendectomy as a youth, and a hysterectomy, for profound uterine bleeding, following the birth of her first child.
She did not smoke or drink.
Her medications included Celebrex 200mg bd (twice a day), Lyrica 75mg bd, omeprazole 20mg daily prn (as required), Tramadol 50mg prn.
- In addition to her fatigue, loss of energy, and slightly dysfunctional mood, the distribution of herparaesthesia suggested a Vitamin B12 deficiency.
- The absorption of Vitamin B12 is complicated. When ingested, Vitamin B12 combines with an intrinsic factor, a glycoprotein released by the parietal cells in the stomach. The intrinsic factor/B12 complex then travels through the length of the small bowel to the terminal ileum (TI), the end of the small intestine, see photo 1. At the terminal ileum, the Vitamin B12 is absorbed into the blood. Its final destination; the liver.
- I suspected her B12 deficiency was a consequence of her appendectomy and hysterectomy. Her terminal ileum had been damaged during these difficult operations, rendering her unable to absorb Vitamin B12. This was confirmed by her pathology tests which indicated that she had a megaloblastic anaemia, typically found in Vitamin B12 deficiency, see photo 2: She was borderline anaemic, Hb 12.9g/dl, but her red blood cells were large MCV (Mean Corpuscular Volume) 97 and her MCH (Mean Corpuscular Haemoglobin) was elevated 32.6g/dl.
Without appropriate treatment, her progressive physical and neurological deterioration was inevitable.
- The Buriram Public Hospital, who was responsible for her care, refused to perform a Vitamin B12 blood level on Am, because, in their mind, her haematology was within normal limits, the test was expensive, THB800, and the results would take 6 weeks.
- I commenced therapy for her using Vitamin B1/B6/B12 parenteral, injection, therapy on alternate days for 3 weeks. She was then transferred to monthly injections, which she would require for the rest of her life.
- The most serious consequence of Vitamin B12 deficiency is a syndrome called Sub-acute Combined Degeneration of the Spinal Cord, aka Lichtheim’s Disease. This is a progressive degenerative disease that damages the posterior and lateral tracts in the spinal cord, see photo 3, the gray shaded areas. The degeneration results in bilateral spastic paresis with a loss of vibration, balance, and the sense of touch. With monthly injections, her degenerative neurological disease will cease and heal.
She will not progress to paralysis.
“THB300 well spentâ€.
Addendum: Over the past 6 years, as a retired medic living in Buriram I offered second opinions on any medical issue. I recently moved to Pattaya. As in this case, if you reside outside of Pattaya, telephone consultations are provided. For assistance; please contact me, Doc Martyn, on Facebook or call Dao on 095 414 8145.
