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So, if for example you experience worse fatigue after B12 injections, it might be a brief phase where your body is still using the unhealthy red blood cells

If the physician incurs no expense for the drug, as in the case of a sample or specialty pharmacy provision, no charge should be submitted for payment of the supply

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This may also be due to the autoimmune attack on the parietal cells of the stomach in pernicious anemia

At each follow-up appointment, your team will assess: Symptom burden: Whether you are experiencing heartburn, regurgitation, chest discomfort, or difficulty swallowing Nutritional status: Blood tests to check for deficiencies in iron, vitamin B12, folate, calcium, and vitamin D which can be compounded by long-term PPI use in line with BOMSS nutritional monitoring guidance Medication tolerance: Any side effects attributable to omeprazole, such as headaches, diarrhoea, or abdominal discomfort Magnesium levels: The MHRA advises considering magnesium monitoring before and periodically during prolonged PPI therapy, particularly if you are also taking digoxin, diuretics, or other medications that affect magnesium levels, or if you develop symptoms such as muscle cramps, fatigue, or palpitations Need for further investigation: If symptoms are poorly controlled, your team may recommend an upper gastrointestinal endoscopy to assess the oesophagus and gastric sleeve directly Your GP plays a central role in ongoing prescription management, particularly once you have been discharged from the specialist bariatric service