This topic is about the challenges some people face in maintaining adequate vitamin B12 levels after ostomy surgery, particularly when the terminal ileum, which is crucial for B12 absorption, is removed. Here are some helpful insights and advice shared by others:

1. Many people who have had their terminal ileum removed receive monthly vitamin B12 injections, which effectively keep their B12 levels normal.

2. If injectable B12 is not available, some individuals manage to maintain good B12 levels with high-dose oral tablets, such as 1,000 micrograms per day, even if they no longer have a colon.

3. Sublingual B12, which comes in liquid drops or tablets that dissolve under the tongue, is another option. These are available in pharmacies and health-food stores and have helped some people maintain normal blood levels.

4. Some individuals have not noticed an improvement in energy levels with sublingual B12 and are considering switching to injections. There is a question about whether these injections are covered by provincial health insurance in Ontario.

5. Regular blood tests, including checks for hemoglobin, hematocrit, liver enzymes, and glucose, can help monitor overall health. Any abnormalities might suggest the need to evaluate B12 and other nutrient levels.

6. In addition to B12, some people also take other supplements, such as ferrous sulphate, to help with iron levels.