If you start the B12 and Cymbalta together, and start to feel better, you won't subjectively know which is doing the job.

But if you are so uncomfortable, and miserable not starting the Cymbalta is only prolonging that.

It will take a month or more on B12 to see if there is any difference.

But I certainly wouldn't add in other supplements with either of these two things, yet.

You are already on gabapentin, and know how much that is working, right? (or not)

Not everyone who comes here has a definite low B12 test result already in hand.
All I am suggesting is that the low B12 when corrected may help alot.

Cymbalta does not work for everyone...and it remains the only antidepressant with potential toxic liver reactions. So considerations about that need to be considered. (benefit vs. risk).

If your gabapentin is working for you, you don't need to change it at this time. But this drug also is not reliable, and new studies show only about 30% of patients find it works for them.

Hi Doc. Thanks for your advice. I did talk to my doctor at length and he thinks, based on my history, symptoms, etc., that Cymbalta will help with both pain and depression. So I've started on 30mg a day, while I wean off the gabapentin (down from 900mg to 600mg so far).

I am taking B-12 daily, as my number was quite low (270), though my doc says I shouldn't take more than 1000mcg for now.

Thanks again for your input.

Be well,
APJH

Hi mrsD. My B12 number is 270--according to my doc, that's the very low end of the normal range. So he thinks 1000mcg a day is enough for me.

My doc requested more blood tests, specifically to look for other vitamin deficiencies that my neuro didn't test for, including vit D.

Thanks for your input!

Be well,
APJH

Hi again. Gabapentin really has not worked for me, even after increasing the dose from 300mg to 1200mg. I don't want to take more because of how drowsy and foggy it makes me--it's hard to work while taking it.

So, I've decided to start Cymbalta 30mg, along with B12, while weaning off the gabapentin (down to 600mg now).

We'll see how this goes.

Thanks for your input and be well!
APJH

So then expect a long wait to raise your levels and then see results. I hope you are using the active methyl form of B12 and not the cyano. Some people cannot methylate cyano version to its active form so it will work.
You must take it on an empty stomach, as presence of food impairs passive absorption in the intestine.
The new cutoff for "normal" now is recognized as 400. So you are well below that.

Only about 10mcg will be optimally absorbed orally from 1000mcg oral. There is a study that measured this:

http://www.ncbi.nlm.nih.gov/pmc/arti...able/T1/#TF1-4

For people with long term low B12, faster treatment makes more sense. You don't just need to bring up a level, you need to replenish all your tissues.

But it is your decision in the end.

IOW, he scoffed. I had a professor once who used to say, "If you can't get in the front door, try the back door, or a window." The big question is, does he have any objections to your trying the supplements recommended? If not, wait until the Cymbalta has settled in (I'm not conversant with Cymbalta off the top of my head, so however long that is) and you've established a baseline (normalized how you feel) and try adding in one supplement at a time for a month, then add or try another. Eventually, you'll find what works for you and what doesn't, and hopefully be on the road to improvement, and may be able to wean off the Cymbalta. Cymbalta may treat symptoms, but won't halt or improve the nerve damage.

In the meantime, research Cymbalta (if you haven't already - it can be funky stuff) and keep reading up on what ails you. We have to become our own advocates.

Doc

Saw my doctor last week and he told me to be on the lookout for flaky skin or redness on my feet and ankles, where the worst of my neuropathy is.

Since then, I've noticed the skin on my feet has become quite flaky. Does anyone know how this relates to SFN and if I need to do anything about it?

Thanks and be well,
APJH

He may be concerned about RSD/CRPS - or not.

If it were me, I might give him a call and let him know, and ask why he said that.

Doc

There are other causes of extremely dry skin...flaking.

1) low intake of Essential fatty acids is one common cause.

This would be flax oil and fish oil. You could start orally at 1 gram of flax and 3 grams of fish oil to start. (you can also use Krill oil, instead of fish oil...it is more potent so 2 of them a day should be enough.)

2)If your circulation to the feet is impaired then nutrients cannot get down there. If you soak in epsom salts daily, the skin will soften and the dryness will improve. Magnesium may not get to your feet for the same reason I gave above. People who take baths tend to have softer skin than people who shower. Soaking in a tub tends to hydrate the skin much better. You can also put epsom salts in the bath tub...but be careful getting out, as it can be slippery.
6-8 oz in of salts in a bathtub of lukewarm water is often sufficient. Soak at least 1/2 hr or so.

3) you could try high dose Biotin, 5 or 10mg a day to improve skin tone.

4) There are magnesium lotions and creams you can put on your feet. Epsom-It and Kirkman magnesium cream are two good ones. Available on the net easily.

Susanne C: I've been on Crestor and Lovesa for triglycerides and cholesterol for years. Crestor brought my LDLs down some and my HDLs were ok but my triglycerides were extremely high. So I got Rx for Lovesa. Next blood test showed all readings to be great. LDL low HDL high and Triglycerides normal. All good stuff. But I have never heard about balance issues associated with these drugs. I can walk ok but I hope the cops never pull me over and do a "walk the line" test. I'd flunk and be in the drunk tank in no time. When I walk down the hall in my house, I use my hands to keep from bumping into the walls. I have trip over the smallest imperfections in a sidewalk. I fear walking at night in a poorly lite area because I can't see the walk or my feet. So my question is, what are the alternatives? I am finally in good shape lipids wise after 40 years of bad triglycerides. But I may be getting osteoporosis (probably from some other drug I'm taking) and tripping and breaking something is now my worst fear.