Help with lab results. Please!!!

After, many headaches, I was finally able to get a copy of my lab reports.  Everything seems to look good except my B12 and Vitamin D. 

Vitamin B12, serum = 290 (within the normal range of 200-1100, but I know ours are supposed to be higher)

Vitamin D-OH, Total = 33 (again normal in the range of 30-100, but ours should be higher)

So I need advice about how much to supplement to get these levels up before my next labs at the begining of August.  Any help or suggestions would be appreciated.  THANK YOU IN ADVANCE!!

Oh, man, your B12 is HORRIBLE.  It's not just that ours is supposed to be higher, really everyone's needs to be higher, RNY or not.

Below 400, people can get permanent nerve damage in hands and feet.  You getting numbness or tingling in your hand or feet yet?

That low, I personally would start B12 shots ASAP.  The dose recommended by the ASMBS if your B12 level is good (meaning at LEAST above 550 - below 550, people tend to get tired and depressed) is 1000 mcg once a month.  Since yours is so low, I would personally do shots weekly for a while.

As far as vitamin D, that's bad too.  And again, it's not just that ours should be higher, everyone, RNY or not, is at increased risk for stuff like osteoporosis, heart disease and some kinds of cancer if their D level is below 80.

For that, I would order 50,000 IU dry D3 from vitalady.com and take one a day for a couple months, then get tested again.

Yes, I actually have been experiencing some tingling in my hands, but I didn't know why.  How would I go about setting up B12 shots?  Should I go through my PCP?  What if I upped the sublingual B12 that I have been taking?  How much would I have to take?

Upping the sublingual would probably work.  I just think shots work faster and if my B12 was that terribly low, I'd do shots.

How much of the sublingual do you do now?

You can actually go see your PCP every week for a shot, but you can get a prescription for the needles and B12 and get them at any pharmacy and give yourself the shots.  That's what I do.  Well, actually, I have my partner give them to me because I don't like to stick myself.  It's really easy, though.  I specifically asked my PCP for really skinny needles and I think mine are a size 27 and most of the  time I don't even feel the stick.  Like, not at all.

Some people think B12 shots should be done in the muscle (IM) while others think they can be done done subcutaneously (under the skin).  I asked my PCP and she said she always prescribes them sub-q and so that's what I do.  If you do them IM, you gotta get bigger needles and you'll feel it.  Shouldn't be terribly painful or anything, but you'll feel it.

Your PCP can show you how to do the shot the first time if you want.  I just discussed it briefly with mine to make sure I knew how but she didn't actually show me.

But whatever way you decide to go, shots or upping the sublingual, do it ASAP.  If you get your B12 up fast enough, the damage may not be permanent.  But you may end up with tingling in your hands for the rest of your life.  And the longer you go with your B12 that low, the worse it will get.

Oh, there is also a nasal spray for B12 you can get by prescription.

I just started 2500mcg sublingual 2x per week.  Should I up that to everyday or even twice a day?  I'm a little squemish about shots so I would rather use that as a last resort.

I'd do the sublingual once a day for a while, then.  Get it checked again in a couple months.  It's hard to take too much B12 so you don't need to worry about that - with B vitamins, we just pee out whatever we don't need.  Anyway, you need a lot right now.

If the tingling goes away, that probably means your level is going up nicely, but don't count on that to tell you.  Get retested in a couple months.

Thanks, Kelly.  I appreciate it.  I guess I will call my PCP this morning and see if shots are an option.  I guess I will have to get over my needle phobia for the sake of my health.  :)

Thanks again for all your help.  I have labs scheduled in about 6 weeks, so I will see if there is a difference then.

I've you're really squeamish about the shots, try the sublingual every day.

I'm still pre-op, but have deficiencies in both Vitamin B12 and D.  Was getting the shots monthly at my PCP's office, but $60 just to walk in the door was starting to get old (along with all the other assorted dr bills).  He gave me a 3 month prescription that cost all of $2.95 after insurance (Medco), the needles I already had (shorts) for my insulin and the syringes were only $2.50 at CVS.  The shots can be taken in the stomach now, so it's much easier than I expected.  As for D he told me to take D3 2000mg a day and that was just over the counter vitamins.   Am hoping in another month my labs inprove and my A1C has dropped enough to schedule my surgery.  Good Luck!