Bethan is eighty three years old. When she was forty men were landed on the moon for the first time. Bethan was not really concerned or excited by the moon landing because she had more important things on her mind. She was having serious problems with her stomach and underwent stomach surgery that meant large parts of her small intestine were removed. The surgeon who removed her body parts was a Professor at the Bristol Royal Infirmary. He was a good man and told Bethan that she would have to have replacement B12 injections every month for life. The reason that Bethan had the operation to remove a large part of her stomach was because the digestive tract kept getting blocked, “part of it was too narrow” she told me yesterday, “the lifetime injections were a small price to pay for the relief I felt after the operation” she said.
Bethan is a frail 83year old. She describes herself as “having as much meat as a coat hanger”. It’s hard to disagree with her self-description. Bethan doesn’t have Pernicious Anaemia. Nor did she used to have Vitamin B12 Deficiency because of the monthly replacement therapy injections that she had received for the over thirty years. She is, however, a member of the Pernicious Anaemia Society. Bethan joined around three years ago and, after paying her lifetime membership telephoned me. She was lucid, was able to express herself clearly using complex phrases and words. She was also rightly worried.
“They’ve stopped my monthly injections” she told me – ‘They’ being her doctors. I asked why her monthly injections had been stopped.
“They say I can only have them every three months now. My old doctor has retired and the new one says I can’t have them more than every three months”. It seemed a cruel thing to do to an eighty year old who had lived a good life, had worked all her life, paid her taxes and was an active member of society – but it wasn’t the first time I had come across a case where elderly patients were having their treatment altered or stopped altogether. There was nothing I could do other than ask her to appeal to her doctor’s reason.
Just over a year ago Bethan called me again. “They’ve stopped them altogether now” she told me. Her voice was trembling and shaking. My heart sank as it always does when I hear of treatment being stopped – almost always the patient is elderly.
Bethan has no family alive. Two months ago I had a call from Bethan’s friend. “She’s been sectioned under the Mental Health Act” she told me.
“She’s been complaining about her neighbours and her doctor said she is imagining things”.
A few days later Bethan telephoned the office from the inside of a secure Psychiatric Unit. It was a heart-breaking call and I felt next to useless.
I started to research the links between B12 Deficiency and Psychosis. There is a very strong association between B12 Deficiency and all manner of mental health problems and there have been many papers published in respectable journals by highly respected clinicians.
Early in March Bethan telephoned the office. She was reasonable, calm and lucid. She told me that she was going to appeal against being detained and asked if I might be able to write a letter to the appeal tribunal. I promised that I would attend in person. The appeal took place last week and I had been in email correspondence with her solicitor who arranged to meet me for forty-five minutes before the start of the appeal. I told him of the link between B12 and mental health issues and he then introduced me to Bethan.
Bethan is a very frail 83 year old. She has Osteoporosis and various other ailments. When I entered her room I immediately became aware that there was nothing personal there. There were no flowers, no get-well cards. There was nothing personal there other than her handbag. She was writing when I first met her. “I’ve been writing my story to read out at the appeal” she said.I knew that she wouldn’t have the chance to do so because the appeal was to be in two parts. The first hour would listen to medical evidence. The second part would consider the legal factors associated with Bethan’s detention. The solicitor told me that I would be allowed to address the first part of the appeal.
The panel consisted of a Judge, a Lay-Member and a General Practitioner. Also in attendance, though not part of the panel was her Solicitor and her Psychiatrist.
I was asked to offer any comments and I informed the panel that once B12 injections are given then the serum B12 test is next to useless to further monitor the patient’s B12 status. I also made them aware that the British National Formulary states that the treatment for Pernicious Anaemia is “for life”.
The Psychiatrist, who appeared to be a genuinely amicable and caring professional, told the panel that Bethan’s serum B12 level was “over two thousand” and that the threshold for determining B12 Deficiency was around two hundred.
The judge sought clarification as to the problem of overdosing on B12 and I was able to say with certainty that there was no danger and that any excess is passed away in urine. He then asked the psychiatrist why he didn’t just give the injections anyway – as there was no problem of overdosing.
“The Primary Care Trust would take a very dim view of me prescribing an injection when there was no clinical need” was his reply.
I then explained about the Active and Inactive B12 test which interested the GP and Psychiatrist very much. “In around ten years we will probably be using that” said the Psychiatrist. I just sighed.
Bethan’s appeal was not successful and she is still in that clinically barren room. I have promised to visit her once a week. I don’t know what else I can do.
I visited Bethan yesterday and took her around ten Get Well cards from members of the PA Society from all corners of the earth. She told me that she had received an injection of B12 on Wednesday. This was confirmed by two of the nursing staff. She is also getting daily Folic Acid Tablets.
I visited Bethan yesterday and took two more cards and some flowers and chocolates. She told me that she had been ‘in the community’ on Wednesday . This meant that she wall allowed out of the hospital escorted by two nurses. She had visited the bank and Asda. She had even been able to go back to her house although for not as long as she would have liked. She is allowed up to two hours a day community visits but has to be escorted. Many of you have enquired about the hospital that she is at and I have to say that it is quite unlike any Psychiatric hospital that is usually imagined. Yes, she is on a secure ward but she has her own room with bathroom which is kept spotlessly clean as is the rest of the hospital. Bethan is still a long way from being released but is receiving excellent care. The problem is that she doesn’t agree that she is ill, which she most certainly is, and because of this she is very frustrated and can’t understand why she is not at home. I am sure that she will recover as the nursing staff are dedicated, kind and caring. But I don’t think she will be ready to go home for a while yet. I have written to her GP stating that her B12 should never have been stopped even though her serum B12 levels were high. I have yet to receive a reply. I promised Bethan that I would be at her Appeal which takes place on Thursday.
Thank you for all of your concerns and for enquiring about Bethan’s progress. The cards mean a great deal to her coming as they do from all corners of the earth.
Bethan had an appeal against her detention on Thursday (the 3rd) and I went along for moral support. The appeal was turned down but only after a panel of three peers carefully heard evidence from Bethan’s medical team and her solicitor. The whole proceeding took over an hour. But – it’s not all doom and gloom. I discovered that she is now on two weekly injections of B12 and this will carry on for three months. She is also being given 5mg of Folic Acid daily. Bethan has asked me to thank you all for your kindness and get well cards. I will keep you updated.
I visited Bethan yesterday. I haven’t been able to see her for two weeks but am please that another member paid her a visit. She seems much better and told me that her new doctor was an angel and that her medication had been changed. She seemed much calmer and we had a good hour long chat. I asked her if there was anything she needed and she asked if it was possible to bring her a packet of Walker’s Cheese and Onion Crisps which I will take to her next time I visit. She is allowed to go home for a few hours next Friday albeit under the supervision of two nurses. I’m sure this will help her improve further. The staff at the hospital are so accommodating that it hardly feels like a hospital at all. If anyone would like to write a letter to her or send her a card please send them to the PAS, Level 4 Brackla House, Brackla Street, Bridgend CF31 1BZ UK. The letters and cards mean so much to her. I will try to visit her next weekend and take with me any cards or letters and will keep you all updated.
I’m off to visit Bethan again and take her “Walkers Cheese and Onion Crisps” which she asked for last time. Thankfully one of our members called Emma is accompanying me so the four hours on the road won’t be so lonely.
I lefmy house at 8:30 – spent 45 minutes with Bethan and then drove back, dropping Emma off on the way. I arrived back at 6pm. The traffic was horendous – well it was a bank holiday!
Bethan is making good progress and staff have told her that she may be discharged next week. She will know the outcome of an assessment on Thursday evening.
Bethan telephone me yesterday morning (Friday 8th June) – she is going home on Tuesday morning. Thank you for all of your support.
Names have been changed to preserve anonymity.