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Old 10-03-2006, 02:42 PM
rose rose is offline
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Join Date: Oct 2006
Location: Northern California
Posts: 338
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If the B-12 test result is clearly deficient, B-12 therapy should be given immediately and follow up tests should be scheduled within a month or so. B-12 treatment should be continued, because most people who malabsorb continue to do so for life.

Please obtain copes of your B-12 and other lab results. Hearing "It's normal" or "everything is fine" from most doctors is meaningless, because they don't know how to diagnose deficiency. In addition, it is surprising how often out-of-range results, along with other clues, are ignored.

Many doctors think that a B12 serum result within "normal" range rules out deficiency----it clearly does not, especially in a patient with neurological symptoms.
Many doctors think that ruling out anemia eliminates the possibility of B-12 deficiency--on the contrary, people low in B-12 who do not become anemic are more at risk for severe neurologic damage.

Many patients are damaged, even disabled while testing well into normal. Rare patients are deficient even when blood levels are high, because B-12 does not work in the blood; it works in the tissues. Some people can absorb B-12, but they cannot deliver it from blood to tissues.

If the B-12 result is not clearly deficient, the patient with neurologic symptoms should have follow up tests: methylmalonic acid and homocysteine. The two follow-up tests have a good, but not perfect, record for exposing deficiency. In case you are one of the few who test "normal" all round but still need B12, it is a good idea to take at least 1000 mcg B-12 per day to cover the possibility that you are in that minority. In that case, one can only hope.

If follow-up testing cannot be obtained right away, the patient should consider taking at least 1000 mcg of B-12 per day on the chance that it is needed. If deficiency is causing the damage, sufficient doses of B-12 will stop the damage and eventually allow some degree (sometimes 100%) of recovery over time. If testing is done after B12 has been taken, the results will probably be normal; that does NOT mean that the person was not deficient prior to taking the vitamin or will not become deficient again if it is stopped.

B12 is safe and inexpensive. Too little of it is very dangerous.
A more detailed description of diagnostic procedures for your doctor is available in current medical textbooks, such as Goldman: Cecil Textbook of Medicine, 21st Ed., Copyright © 2000 (or 2004) W. B. Saunders Company.

Once the damage has been stopped, it is time to look for the cause of malabsorption or failure to convert, transport or store B12 normally. Unfortunately, most doctors will not be interested in finding the reason. And worse yet for some people, many assume that if B12 deficiency did the damage, all problems will immediately disappear as soon as the B12 level is up. Good grief.


Last edited by rose; 10-03-2006 at 08:29 PM.
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