This topic is about understanding the need for vitamin B12 after having a panproctocolectomy and ileostomy. The person sharing their experience has been feeling unusually tired and is curious if B12 injections might help, even though they believe most of their ileum is still intact. They are seeking advice from others who have had similar experiences.

Here are some helpful insights and advice shared by others:

1. B12 Deficiency Is Common Post-Ileostomy
- Many people with ileostomies, even with an intact ileum, need B12 injections every few weeks or months.
- Some prefer sublingual or liquid B12, which is placed under the tongue, as an alternative to injections.
- Symptoms of B12 deficiency can include extreme fatigue, excessive sleep, anemia, tingling in extremities, and potential memory or neurological issues.

2. Not Everyone Needs B12
- Some individuals do not require B12 supplementation. It's important to determine this need through blood tests.

3. Monitoring & Testing
- It's recommended to have comprehensive blood work every six months, checking levels of hemoglobin, ferritin, iron, B12, B1, B6, magnesium, and vitamin D.
- Deficiencies in nutrients other than B12, like iron or magnesium, can also cause fatigue.

4. Iron & Other Nutrients
- Some people receive regular iron infusions or take high-dose oral iron, though pills can sometimes cause issues like constipation.
- Cooking with cast-iron cookware can naturally increase iron intake.
- Magnesium injections are an option for those with consistently low levels.

5. Practical Tips
- Keep copies of your lab reports and learn to understand them to better discuss your health with doctors.
- Surgery and anesthesia can affect energy levels for a long time, but persistent fatigue should be investigated.
- High medication tolerances are common, and malabsorption may require larger or more frequent doses.
- Chew nuts thoroughly to avoid blockages, and remember that gas is common—vent and wait it out.

6. Products & Medications Mentioned
- Liquid or sublingual vitamin B12, B12 injectable ampoules, iron tablets, iron infusions, magnesium injections, Remicade infusions for Crohn’s disease, Proctofoam-HC for rectal pain, and cast-iron cookware.

7. Key Take-away
- Persistent fatigue after an ileostomy should be evaluated with lab tests. B12 shots or sublingual forms can quickly restore energy if there's a deficiency, but it's also important to check levels of iron, magnesium, vitamin D, and other B-vitamins. Be persistent in seeking answers from healthcare providers.