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What Causes Heart Palpitations, Shoulder Pain, Shortness Of Breath And Dizziness?

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Posted on Mon, 30 May 2016
Question: Hi , First of all may I ask that you please only answer if you have some relevant information regarding my query and if you are well informed in the matter of b12 deficiency and electrolyte levels etc. I have recently been diagnosed with b12 deficiency (level 70) however the consultant from the hospital who diagnosed me and my g.p are disagreeing , the consultant recommended a b12 shot every second day for two weeks , one a week for a month and one every three months for life , however my doctor says that i do not have pernicious anaemia as my blood test shows that i still have intrinsic factor ,and so only gave me 5 shots in a row over five day s and now wants to leave it for three months , he is difficult to approach about anything as he puts everything with me down to anxiety because of my history and the fact that anxiety /panic attacks etc run in the family (my mother and brother both have a history of this aswell) I have been having odd reactions to the b12 shots and am afraid to approach him about it because i know what he will say but i am genuinely concerned as i know by now the difference between something which is anxiety driven and something real ,so here is the history including anything i feel is relevant to this case. I am male ,44 years old 18 stone,
I have been having symptoms for a good number of years (7+) starting with anxiety and panic attacks around 7 years ago which lasted around a year and then disappeared , at this point I was very fit and healthy and was eating a very healthy diet with fresh fruit and vegetables , juicing etc ,doing a lot of running ,did a marathon in 2010 , I then left my wife as things had been bad for many years and the last five years have been unbelievably stressful to say the least , I have been under very very severe stress for the past five years from many sources , including my ex wife , my new partner not turning out to be as she had initially represented herself , my father had a stroke and i am looking after him , my diet and exersize has suffered , i have gained 3 stone in weight , I also have been in the habit of performing water enemas from an online kit for the past seven years , also wheatgrass ones and which i had believed to be good for me but now realise probably contributed to my problems . For the past two years i have been suffering from the symptoms of gastritis/gerd / stomach problems where i get pains to the left of my stomach which i initially mistook for muscular ( not all the time every few weeks) these would be accompanied by the following not nessesarialy all at once 1. heart palpitations , pains in my shoulder and right across my shoulder blades and upper back . shortness of breath , brain fogginess , a red rash in the morning mostly around my neck ,but also arms and legs , which would disappear shortly after showering , also i suppose it goes without saying that my energy levels have been through the floor. So now my doctor has given me the 5 b12 injections , I was fine after the first which i was given in the hospital after diagnosis ,but after the subsequent ones I felt nauseous and had the pains in my shoulders and dizziness etc , i wondered about potassium etc in this regard , I would also point out that two years ago my current partner had low b12 and was treated successfully , but when describing the tiredness etc i thought i might have the same thing , so i went to my doctor who tested me at that time , and i was 130 , he said this was perfectly normal , but i now believe from what i read that 130 is very low and he should have addressed it at the time , I haven't said this to him at all , he has tested me (awaiting results) for celiac disease
and h pylori , I really feel he is not very knowledgeable on this subject however i live in a very remote country area of XXXXXXX and he is my only option ( as i said already , please only answer if you can help, not just say go see your doctor or something , i need solutions and proper guidance with this not lip service, thank you for understanding)
doctor
Answered by Kathy Shattler (5 hours later)
Brief Answer:
Welcome and sorry for the delay

Detailed Answer:
I see that it took the company 4 hours to get this query to me, thus delaying your answer. I am in US and we may, of course, have different time zones, but I attempt to read your question completely. I am very knowledgeable in B12 deficiency, but your troubles are quite lengthy and I am timed, so if I don't answer everything, please follow-up with me.

In following your history, just before the symptoms started it appeared that you ate little to no meat. Correct? If so, for how long had you been eating like this?Vegetarianism is a cause for pernicious anemia.Plasma B12 is reflective of the most recent levels and not bodily stores.If you want to get a better idea on how long you have been vitamin B12 deficient at the cellular level, measure urinary methylmalonic acid (MMA)/creatine ratios.

To determine anemia from inadequate intake or malabsorption may use Schillings test but etiology must be determined before treatment begins because it is the etiology that drives the treatment modality.

Oral B`12 pills are effective if the body is making enough intrinsic factor and the pH of the stomach is such that it can do its job, repletion can be done with orals. On the other hand, if the body is unable to produce enough intrinsic factor or maintain the right pH then treatment would involve B`12 nasal sprays (trim nasal hairs a bit), a B12 patch or monthly injections.

The tingling is from the neuropathy is seems like you might have developed from long term B12 deficiency. Please tell me the results of all the labs that were run on you normal or not. Your story is missing pieces, is related to stress, I feel you may have multiple deficiencies, but I need more information.

I am not familiar with "stone", please confirm your weight in pounds, height in inches, history of weight changes, any lab results, medical conditions, supplements currently, medications and how you are eating. I will try to tell you the exact tests I would order if you were my patient if you think that would help.

Empathetically, XXXXXXX J. Shattler, MS,RDN, Registered Dietitian Nutritionist, USA

Now, did the doctor also test folic acid? How is your diet now?
Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Kathy Shattler (5 hours later)
Hi thanks for your answer, I really with all due respect don't think you read my request very well as several of your questions are answered within, and at no point did i mention tingling as i don't have any tingling at all.My weight is 115 kilos,quite a bit overweight which i now intend to address, my diet most days is a smoothie for breakfast for example (milk kefir frozen fruit bee pollen banana honey raw cacao powder) maybe poached eggs a bit later , and dinner could be meat veg and potatoes, pasta and meat, cold meat salad , fish etc , my problem with food is the snacking and eating late at night junk food etc , i know this and am going to address it.
To answer your question about my diet up to five years ago, no not much meat but i had wheatgrass ,spirulina , fish and eggs, I also went grey (hair) quite young 35 onwards .
Regarding the intrinsic factor I did mention that my test for that was fine ,this is why my doctor disagreed with the consultant in the hospital about having the injections every three months for life , also i was told that all the rest of my blood tests were normal and the b12 was the only problem , I had a heart monitor for 24 hrs and a treadmill stress test which were all fine .
What i had asked was 1.Am i correct in saying my doctor was very wrong to say my b12 level of 130 tho years ago was normal.
2.my doctor has not done what the consultant recommended which was one shot every second day for two weeks , one shot a week for one months and one every three months for life , and has only given me 5 shots on five consecutive days , is this ok or is he wrong in your opinion and is it enough to bring the level to normal , bearing in mind that this man thinks 130 is normal.
3. the symptoms i have had since having the shots(not present all the time but intermittent) are shortness of breath , a panic attack type feeling , a feeling of mild drunkenness , and pains across my shoulder blades and in my right shoulder and arm (the arm thing has been present all along) but the others are new since the shots, and these symptoms seem to correspond with what others are saying on the net about their experiences with b12 shots , and they say it is due to the b12 entering the system using up potassium stores and causing a deficiency in it , I did make a smoothie today of bananas and raw chocolate both of which are high in potassium , but i am concerned as the symptoms of both low and high k seem to be similar and i don't want to do the wrong thing ( your thoughts on this please)
4. should i take sublingual b12 and if so do you recommend taking a potassium supplement as well or maybe a good multi mineral?
5. finally is it possible and likely that a combination of really severe stress levels coupled with panic attacks , and having daily enemas of water for some time ,plus the fact that over the last number of years i have been on various antidepressants from time to time (nothing for 18 months now) could be responsible for all this , thank you ,
doctor
Answered by Kathy Shattler (55 minutes later)
Brief Answer:
Hello, I am sorry you felt I did not read your query well

Detailed Answer:
I offer no excuses except that you have a lot going on and we are timed in our responses. Let me try to do better. I did notice you had gained weight, but I asked you to clarify any patterns of weight change.

Thank you for clarifying that you are not vegetarian and for giving me an idea of your eating patterns. You have done a good job at identifying problem areas.

Grey hair tends to be highly genetic to address your other issue.

I know you stated all the rest of your tests were normal, but do you know what was run because I don't and there are lab values that could help me answer some of your concerns that I don't have.

I realize that you said there was a difference of opionion between the doctors as one said you had intrinsic factor. Having it and having ENOUGH of it are two different agendas. Furthermor, I apologize for misunderstanding the value of 130.
You didn't use units of values and it didn't the usual serum values of vitamin B 12 are 180-914 ng/L. Again, since doctors don't normally run folate tests, your folate is unavailable until B12 is repleted and often folate deficiency coexists and could be reponsible for feeling ill after your first shot. Yes, your doctor was wrong when he said 130 was normal if the reference ranges were standardized and not they based on the population normal of the people that came through that particular lab.

On your issue 2, I did provide you with other options besides injections that you could use for repletion even without much of an intrinsic factor. As far as dosages, you are asking me if they are enough, yet you failed to tell me the dosage per shot on each schedule. Furthermore, what the consultant is recommending is based on the fact that you do not have adequate intrinsic factor which I thought had not been decided on. I also read closely enough to advise you to find out the etiology of the B12 deficiency to determine dosage. If you have enough intrinsic factor, why would you need injections the rest of your life unless your test for celiac disease/malabsorption becomes an issues? Injections have aluminum in them, which over time, is best avoided if possible.

3. again, I did answer this. I said you need to get an electrolyte panel done. Next, after you tested yourself with a high potassiium recipe, did it ease the symptoms?
4.My dear sir, never take a potassium supplement without the objective measurement of potassium level as you are messing with your heart.
5. I did already give you all the methods of B12 repletion available in my last answer, again, you need to know if you have sufficient levels of intrinisic factor or any malabsorption issues to issue the correct form of repletion and don't forget the folic acid that is trapped. Unless and until we clearly rule out the other unknown etiology it is inappropriate to name panic attacks or depression as the cause of your symptom.

If you have enough intrinsic factor you may use nasal B12 sprays, sublingual tablets, and if you do not have intrinsic factor, use the patch or an injection schedule as outlined by the consultant. You can choose another physician for a second opinion if you are thinking of switching primary physicians.

Also, you asked about the enemas. The answer is yes. Your bowel is most probably not healthy with all these enemas, you are possibly laxative dependent. Do you drink fluids and have a high fiber diet for this habit? If you were my patient, I would put you on gluten free active culture yogurt or kefir.

You may either want to get your vitamin D checked or supplement. I strongly suggest testing.

I hope I have answered your questions this time. I apologize if you were not completely satisfied the first time around, but I am in hopes this clears some things up.

If this is satisfactory, please close the query and rate it. If not, I am still here at your service. Regards, Kathrn Shattler, MS,RDN

Please do not underestimate my probing just because you may not understand why I ask for such information.

The more I know about you, the better I can answer your questions.

You asked about multi-vitamins. I don't see a problem with a good hypoallergenic multivitamin once your repletions are completed.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Kathy Shattler (6 hours later)
Hi and thank you , im sure you are very good at what you do i have no doubt , but you really must be restricted on the time you spend reading and answering these queries , im not going to go through all the examples in your latest answer where it is clear you have not read my reply , but i did tell you my i.f was normal , and kefir was listed as one of the things i already do consume , there are many more instances throughout , so i am going to leave this discussion and just put the 18 euros it cost me down to experience , if you have a conversation with someone in real life and they clearly dont listen , then you dont continue talking with them , and just to clarify what you said at the start of your last answer , that i felt you didnt read my request properly , i didnt feel that you didnt , you just didnt its there for anybody to see in black and white , not an opinion but a fact , i was just trying something out looking for some help in a difficult situation , and i did make myself clear from the start if you read that lip service was not what i was after here , im sorry if you find this harsh but before you answer , please if you can read back through the conversation and you will see what i mean .
doctor
Answered by Kathy Shattler (54 minutes later)
Brief Answer:
I am sorry you are disappointed

Detailed Answer:
From my point of view you said there was controversy between the doctors. Any doctor that would advise you to take B12 for the rest of your life if they are certain you have enough intrinsic factor I am in disagreement with and I completely do not understand the reasoning at all.

And, in taking enemas as frequently as you are, I am dubious as to whether your frozen kefir smoothie is enough to get your good bacteria back into balance since you have been doing the enemas for 7 years. I was also addressing your continual problem of gerd/gastritis that you expressed. My relevance to gerd earlier and pH had to do if you were pH unbalanced (remember that?) it might affect B12 absorption. I was curious as to if you were taking an acid reducer.

Sir, I went through each question by number and answered them. Even overemphasizing some things. I am at a loss for what you have asked that I didn't answer.

Oh, and I apologize going back to the first question the doctors were not named and there was some confusion as to who was saying what. The doctor that said you had enough intrinsic factor and "however my doctor says that i do not have pernicious anaemia as my blood test shows that i still have intrinsic factor ,and so only gave me 5 shots in a row over five day s and now wants to leave it for three months" would have made sense than someone telling you you must take B12 for the rest of you life for no reason stated like low IF (which you don't have) or chronic malabsorptive problems which aren't answered yet since your celiac test did not come back.

I went through an entire "book" with your query and attempted to answer your questions the best I could without the actual information in front of me that you were trying to relay from your conflicting physicians that were never named and became difficult to discern who was disagreeing with whom.

And, I did not ignore the panic attacks, but a good mental health specialist is the best person to address your problems with that.

Yes, I see where I used "tingling" instead of referring to the pain, dizziness, nausea, and those issues you were referring to. Slip of the tongue, apologies.

Plain and simple I do not know why you would do something like give yourself wheat grass enemas for 7 years, but then ask me not to give you "lip" service and I truly was interested in trying to help you, that's all.

I know you said you wanted "solutions" but before an intervention plan can be developed there must be thorough assessment and I don't feel that has been done

And some of the questions like should you take a sublingual, I gave you many options, but dosage and form is still left up to your treating physician

I can tell you have been stressed out, hurting, angry and resentful, part of what I suspect may be responsible for the weight gain. Positive rechanneling of any negative emotions left over from breakups and heartaches can help free you from any need to use food to fulfill feelings of emptiness, which sometimes occurs in these situations.

You asked for someone who knew about B12 and electrolytes. Well, I can't tell you anything about your electrolytes without a lab which I requested. I told you how dangerous it was to take potassium on your own unmonitored. What was there left for me to do with regards to that area? I told you how to clear up any confusion between the doctors. I told you what was appropriate with and without IF. I explained how PH impacts on B12 absorption.

I truly send my best wishes for your recovery.

I gave you tons of information. I thought I answered your queries in good faith and once again I apologize if it was not what you were looking for. I am going to wish you the best of luck, truly, in finding your health and feeling better. XXXXXXX Shattler, MS,RDN
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
Kathy
Kathy Shattler

Dietitian & Nutritionist

Practicing since :1985

Answered : 903 Questions

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What Causes Heart Palpitations, Shoulder Pain, Shortness Of Breath And Dizziness?

Brief Answer: Welcome and sorry for the delay Detailed Answer: I see that it took the company 4 hours to get this query to me, thus delaying your answer. I am in US and we may, of course, have different time zones, but I attempt to read your question completely. I am very knowledgeable in B12 deficiency, but your troubles are quite lengthy and I am timed, so if I don't answer everything, please follow-up with me. In following your history, just before the symptoms started it appeared that you ate little to no meat. Correct? If so, for how long had you been eating like this?Vegetarianism is a cause for pernicious anemia.Plasma B12 is reflective of the most recent levels and not bodily stores.If you want to get a better idea on how long you have been vitamin B12 deficient at the cellular level, measure urinary methylmalonic acid (MMA)/creatine ratios. To determine anemia from inadequate intake or malabsorption may use Schillings test but etiology must be determined before treatment begins because it is the etiology that drives the treatment modality. Oral B`12 pills are effective if the body is making enough intrinsic factor and the pH of the stomach is such that it can do its job, repletion can be done with orals. On the other hand, if the body is unable to produce enough intrinsic factor or maintain the right pH then treatment would involve B`12 nasal sprays (trim nasal hairs a bit), a B12 patch or monthly injections. The tingling is from the neuropathy is seems like you might have developed from long term B12 deficiency. Please tell me the results of all the labs that were run on you normal or not. Your story is missing pieces, is related to stress, I feel you may have multiple deficiencies, but I need more information. I am not familiar with "stone", please confirm your weight in pounds, height in inches, history of weight changes, any lab results, medical conditions, supplements currently, medications and how you are eating. I will try to tell you the exact tests I would order if you were my patient if you think that would help. Empathetically, XXXXXXX J. Shattler, MS,RDN, Registered Dietitian Nutritionist, USA Now, did the doctor also test folic acid? How is your diet now?