Ladies Entering Chemo, Get Your Vitamin B-12 Level Checked

oldbeauty

Just returned from visit with endocrinologist who evaluated my post-chemo neuropathy.  She lamented that I did not have my Vitamin B-12 level checked before chemo because it was found to be low after chemo and it likely was low before I started.  Low B-12 is a cause of neuropathy on its own and chemo certainly didn't help.  She said it's possible I would not have been affected, or affected to a lesser extent than I am now, if I'd had the B-12 injections before, during and after treatment rather than later after the damage had been done.

My gyn oncologist never included B-12 as part of my labs.  His nurse only recommended B-6 50 mg tablets after the onset of neuropathy.  So, again, it pays to be pro-active.  Insist that your B-12 level is added to the labs they will do before you start chemo.  Better, insist it be checked prior to surgery so you can get a head start on injections, if B-12 is low, before you start chemo.  Low B-12 should be corrected even if you don't have chemo after surgery. Low Vitamin B-12 is common in older women.

Best wishes, Oldbeauty

MAbound

B12 & Blood Sugars

I've posted on this a number of times in the past, but Old Beauty is right on the money about B12 except for one issue.

Your B12 level can be low even if the lab work shows that you are in the normal range because the lab test doesn't distinguish between B12's active and inactive forms. Cancer and chemo converts almost 80% of you're B12 into it's inactive form, so normal levels don't necessarily mean a thing. There is a lab test that distinguishes between the two, but it's so new that few labs offer it and it's unlikely that insurance covers it.

If you are over age 50, if you are taking Metformin, if you have Cancer and/or are getting chemo, you are very likely to be B12 deficient going into chemo. Doctor's will probably blow you off when you lab levels are normal, so at least take the sublingual form if you can't get the shots prescribed. I had both monthly shots during chemo and took 3000 mcg. sublingqual (and I'm still taking it). It really does help with the Chemo Induced Peripheral Neuropathy, although it is very slow acting (like months before you notice). Prevention by starting before chemo is really a good idea.

Be careful about taking B-Complex supplements. Both B-6 and folate have upper tolerable limits and can actually cause neuropathy when taken in greater than recommended amounts. You need to count what you get from fortified foods and multivitamins into the daily amount you take and most supplements contain way too much on top of what you get from those sources. It's one thing if your not eating, but something to take into account when you are. B12 is much safer and plenty effective to take by itself.

If you are pre-diabetic or diabetic, you also really want to have your blood sugars under really good control because the steroids are going to shoot them up dramatically when you take them and also because poorly controlled diabetes is going to put you at greater risk for neuropathy. This is a must! Peripheral Neuropathy is awful...it may be temporary but it can be permanent. 

There's also L-glutamine (do I have that right?) supplements, but some eschew that because of the question about it probably feeding the cancer, but it has a protective effect on the myeline sheath that covers nerves and can help prevent neuropathy during chemo. Get it cleared with your oncologist before trying it. As far as it feeding cancer, chemo goes after cancer cells at their most active, so that may actually help the chemo.

If you have time and the wherewithall to look into and purchase hypothermia slippers and mittens, I highly recommend them over ice caps. Hair loss is temporary, but neuropathy is burning pain that never lets up for a second. Since hypothermia options are each very expensive, I'd give priority to the slippers if you can't afford it all and have to pick and choose. Those slippers also help between treatments for pain relief without drugs if neuropathy does still develop. They are a major pain to schlep to chemo and make changes during it, so hopefully you'd have someone to help you with all of that. Compared to neuropathy pain, though, they are worth the expense and extra effort to use. I don't know how I would have gotten through chemo and afterward without them. I still have some residual neuropathy, but it's nothing compared to what it was after my first infusion before I learned about all of these options for keeping from getting worse and getting it to abate.