Thursday 18th February 2010
Gestation: 20 weeks, 6 days
One year ago.
I tear at the edge of the envelope, and pull out the piece of paper.
I look at the piece of paper.
Suse enters, placing an earring in her lobe, and walks across the room.
We both stare at the piece of paper.
“Five hundred and thirty?”
“What’s the normal range?”
“Thirty-five to one hundred and ten.”
“So my level is…”
“…More than five times the upper limit of normal.”
We both look back at the pathology result again.
“How could that be?”
“I don’t know.”
“Could that be the cause of the pins and needles?”
“It’s not something I’m aware of.”
“But could it be?”
“Anything’s possible, I guess.” I walk over and pick up the phone. “And I know one way to find out.”
* * * * *
“Hi Terry, it’s Mark Nethercote here.”
“Oh, Hi, Mark,” he says, a little awkwardly.
“We’ve had an interesting result come back.”
“The B6 level.” I wait for a response. “Susan’s pyridoxine level?”
“Was five hundred and thirty.” Again, I wait for a response.
“The quoted range is thirty-five to one hundred and ten, so her level is…”
“…More than five times the upper limit of normal.” There is another pause. “That is very interesting.”
“Have you seen this before?”
He takes a moment.
“I’ve only had one other patient with B6 toxicity leading to peripheral neuropathy. Many years ago. But she was on very high doses. How much does Susan take?”
“We just checked that. 50mg per day in her pregnancy vitamins.”
“Well, I’ve seen toxicity when it’s taken at more than 200mg per day, certainly above 400mg a day, but there’s not great data on all of this. At 50mg, that doesn’t make a lot of sense.”
“There’s not a lot that has about this whole thing, Terry.”
“Mmmm. The other problem is that the assay isn’t designed to look for high levels. It’s designed to look for low levels of B6.”
“Because low B6 is a cause of peripheral neuropathy.”
“Exactly. It’s hard to know the accuracy of the test in the upper range. But all the same, it is a very interesting turn of events.”
“It certainly is.”
“I must admit, I don’t usually check for B6 levels. I might have to start including it on my routine bloods for peripheral neuropathy from now on.” “Excellent.”
There is another pause.
“I should also add,” he continues, “that one other patient I had with high B6 levels got better in a few weeks.”
Well it’s certainly brightened up our day,” I add. “It’s nice to have something tangible, Terry.” I stop for a moment. “But it doesn’t really make sense, does it? Isn’t B6 water-soluble? Shouldn’t she just wee it out?”
“At those levels, you’d think so.”
“But, as we said, Susan doesn’t always make sense.”
* * * * *
I exit the study. Before I can open my mouth, Suse walks over, holding her laptop.
“I’ve just been on the internet, and found a whole forum of women – all on pre-pregnancy vitamins, all with similar symptoms, all attributed to B6.”
“Everyone says it is a little known entity. They all said their neurologists didn’t check for it, even when pressed, and all had peripheral neuropathy. A couple were even treated with B6 before it worsened, and only then was it tested and recognised. This lead to prolonged numbness in one woman, and inability to walk for months in another.”
“Lucky we had Terry.”
“Lucky we had Terry,” she echoes. “So, what did he say?”
“He was a little puzzled, but agreed that it could all be due to B6. It doesn’t make a lot of sense, as the doses were so low, but maybe there’s an issue with your B6 metabolism. Hopefully that’s our answer.”
I take her in my arms, and hug her close. But she remains stiff.
“What is it, love?”
“Would you still marry me today?”
“If you weren’t married to me already?”
“Even after everything that’s happened?”
“Are you just saying that to be nice?”
“Even if I can’t metabolise B6 like a normal person?”
“Especially if you can’t metabolise B6 like a normal person.”
* * * * *