#Middlebury #Health
DEAR DR. ROACH: Two years ago at my yearly physical, my doctor said I was low on vitamin B-12 and that the only way to increase it was through a shot in the arm. I received my first shot that day, and my arm was paralyzed for four days. I went in a week later for my second shot, only to have the same thing happen again. I didn’t get any more shots. It still hurts to this day, even though an MRI shows nothing wrong. The specialist says it was just coincidence. I cannot hold my arm over my head or stretch it out. What’s your take? – D.R.
ANSWER: Well, I don’t believe it was just coincidence. Nerve damage following injection is extremely rare, but it sounds like what you are describing. This can be due to direct trauma to the nerve by the needle, or by an inflammatory reaction. The treatment is physical therapy, but unfortunately for you, it works best if begun right away. I still think it is worth your while, however.
Also, vitamin B-12 deficiency absolutely can be treated with oral vitamin B-12. Although pernicious anemia, the most common form of vitamin B-12 deficiency, is due to poor B-12 absorption, this can be overcome simply by giving much more B-12 than the body usually needs. A dose of 1 mg daily by mouth is a safe, inexpensive and effective treatment for vitamin B-12 deficiency. Many of my patients still want the injection, however, even though it seems inexplicable to me.
DEAR DR. ROACH: Yesterday, while walking barefoot in my back yard, I stepped on a bee. This has happened to me before, and it seems that each time the results are a little worse. After I removed the stinger from the underside of one of my toes, I put ice on the sting and took a Benadryl. Since this happened in the evening, I was able to elevate my leg for the rest of the night. In the morning, the area was swollen, red, hot and painful. Now, after my usual three-mile morning power walk, the swelling and soreness is spreading up my foot.
I am notorious for going barefoot and stepping on bees. I just know this will happen again. Do you have any suggestions for what might help prevent a bee sting from going “viral”?
ANSWER: Your best bet is not to get stung in the first place, which for you means not stepping barefoot where bees might be. It’s particularly important for you, as local reactions to bee stings do tend to get worse over time. Fortunately, they do not usually predict the life-threatening anaphylactic reaction.
Once stung by a bee, remove the stinger, within seconds if possible, since the venom can continue to be released for several seconds. The local reaction usually lasts less than a day in most people, but it can last up to five days.
The reason the swelling and soreness spread after your walk is that the exercise and increased blood flow to the area allowed the venom to move to different areas, and the inflammatory response also progressed. I would recommend that you continue cold compresses and avoid your power walks for at least another day or two after a sting.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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