Dear Dr. Roach: I had a vagotomy and antrectomy in 1980. I鈥檓 76 now and for the past few years have been anemic. My doctor gave me five B-12 shots, and I have been taking B-12 pills for the past 18 months. I also needed iron infusions. The surgeon says because I鈥檝e had an antrectomy and vagotomy, my body can鈥檛 absorb vitamin B-12 pills. My family doctor says that鈥檚 not true. The surgeon, in whom I have total faith, suggests I have B-12 shots every three months. Whom do I believe? What should I do?
S.D.
The anterior part of the stomach makes gastrin, a hormone that helps the body absorb iron. This explains why you needed the iron infusions. But vagotomy and antrectomy together may reduce the stomach鈥檚 ability to make a protein called intrinsic factor that helps absorb vitamin B-12. Your surgeon is right 鈥� it鈥檚 much harder to absorb vitamin B-12 without intrinsic factor, and many people in your situation are treated with B-12 injections.
Your family doctor is right, too. With enough vitamin B-12, 1,000 times more than you would need if everything worked perfectly, your body can absorb all the vitamin B-12 you need. In a study that compared injection with high-dose oral B-12 in people with deficiency and difficulty absorbing, both worked very well. I recommend oral vitamin B-12. Some people are very happy getting their injections (usually monthly) and don鈥檛 want to switch.
听
Dear Dr. Roach: Are Paget鈥檚 disease and multiple myeloma the same disease?
D.I.
They are not the same. Paget鈥檚 disease of the bone causes 鈥渉oles鈥� in the bone that can lead to pain, de-formities or fractures. No one knows why the cells that break down bone are activated in Paget鈥檚 disease. A virus has long been suspected but never proven.
Multiple myeloma is a cancer of plasma cells, which normally live in the bone marrow and make antibodies. These also cause 鈥渉oles鈥� in the bones that can lead to fracture.
Paget鈥檚 disease, if caught early, can be treated effectively with medication, usually the same ones used for osteoporosis. Multiple myeloma is much more difficult to treat, but cancer experts are devising ever more effective treatments for it.
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Dear Dr. Roach: It has been half a century since I was an intern and had the opportunity to give a local nerve block for a fractured rib. Even the intern could put the needle above the rib, make sure it was not in a vessel and inject Novocaine (that鈥檚 what we had back then). It puzzles me that doctors are no longer using that simple technique to relieve pain. It seems this is not the only effective therapy that has withered over time.
Dr. J.M.
It鈥檚 an interesting question. My first thought is the duration of action. Novocaine lasts minutes to hours, and the pain of a fractured rib persists up to six weeks. Newer agents, such as bupivacaine, can last for days. Still, that would be a lot of injections, each with a small chance of a side effect.
You are probably right that there are some effective treatments that we no longer use. Colleagues who have trained in other countries have shared much knowledge not taught 鈥� at any rate not to me 鈥� in medical school.
听
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
