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AACL 2012 Speaker

Sally PacholokSally M. Pacholok RN BSN

Co-Author of Could It Be B12? An Epidemic of Misdiagnoses

Sally Pacholok, R.N., B.S.N, an emergency room nurse with 24 years of experience, received her bachelor’s degree in nursing from Wayne State University in Detroit, Mich. Prior to entering the field of nursing, she received an Associate’s Degree of Applied Science with magna cum laude honors. She was also an Advanced Emergency Medical Technician (A-EMT), and worked as a paramedic prior to and during nursing school. She has worked in health care for a total of 32 years, and has cared for thousands of patients. In addition, she is an Advanced Cardiac Life Support (ACLS) provider, and has assisted instructors at a local community college in training paramedics in ACLS. She is a Trauma Nursing Core Course (TNCC) Provider, an Emergency Nurse Pediatric Course (ENPC) Provider and a member of the Emergency Nurses Association (ENA).

In 1985, Pacholok diagnosed herself with vitamin B12 deficiency, after her doctors had failed to identify her condition. As a result, she is passionate about the need to educate the public about the dangerous consequences of this hidden and all-too-common disease.

In 2009, Pacholok and her co-author, Jeffrey J. Stuart, started B12 Awareness, an organization to educate the health-care community and the public to the dangers of B12 deficiency. B12 Awareness has declared the last week in September to be B12 Awareness Week and are working to get legislation passed to officially recognize B12 Awareness Week annually. Visit B12 Awareness on the Web at B12Awareness.org.

Pacholok is a passionate crusader in the cause of educating the public, health-care professionals and health-care policy leaders about vitamin B12 deficiency and treatment. Says Pacholok, “We cannot rest until this disorder gets the attention it deserves and we stop needless injury, suffering and poor outcomes. The only way to solve this epidemic is to educate others to what is going on behind closed doors. There is a simple solution: Education, Awareness, Advocacy, Responsibility and Prevention.”

 

2012 - The Consequences of Undiagnosed Vitamin B12 Deficiency Is It Aging—or Is It B12 Deficiency?

Vitamin B12 deficiency is a world-wide problem and a hidden epidemic in the United States.  Masked behind misdiagnoses, vitamin B12 deficiency has slowly grown to become the most untreated and unrecognized nutritional disorder causing injury in the United States.  B12 deficiency causes symptoms such as weakness, dizziness, paresthesias, dementia, mental illness, tremor, and difficulty walking.  It is commonly misdiagnosed as Alzheimer’s disease, depression, diabetic neuropathy, vertigo, mini-strokes, and early Parkinson’s disease. Major medical journals report that vitamin B12 deficiency occurs in up to 15% of the elderly—approximately 5.9 million seniors.  Other studies report the prevalence to be 15% to 25%.
What’s more, these numbers only relate to persons 65 and older. They don’t include the vast numbers of Americans under the age of 65—some of them infants and children, and millions of them middle-aged adults—who become B12 deficient for a variety of reasons. 
B12 deficiency can mimic multiple sclerosis, chronic fatigue syndrome, and post-partum depression/psychosis.  It can make men or women infertile and cause developmental disabilities or autistic-like symptoms in children. Other groups of people at high risk for B12 deficiency include vegans, vegetarians, alcoholics, and people with celiac disease, Crohn’s disease, autoimmune diseases, AIDS, and those who have had gastric bypass surgery.  The use of certain drugs such as proton-pump inhibitors, metformin, H-2 blockers, and nitrous oxide can also cause B12 deficiency.
Untreated B12 deficiency increases a patient’s risk of vascular diseases including stroke, heart attack, pulmonary embolism, and deep vein thrombosis because it causes hyperhomocystinemia.  B12 deficiency causes a suppressed immune system which affects wound healing, antibody production from vaccines, and defense against bacteria and viruses. 
The problems that exist or contribute to undiagnosed vitamin B12 deficiency are as follows:

  1. Knowledge deficit amongst physicians and other health care providers. 
  2. Poor or absent screening in symptomatic and at-risk patients.
  3. Lack of use of other useful tests to aid in diagnosis when indicated. 
  4. Current range for “normal” serum B12 extends too low.
  5. Failure to understand that B12 deficiency mimics other disorders.
  6. Clinicians wait for macrocytic anemia to be present before contemplating B12 deficiency.
  7. Older adults are frequently misdiagnosed due to increased incidence of preexisting diseases and

co-morbid conditions.   

  1. B12 screening is not included in older adults who fall or are at risk for falling.
  2. B12 screening is not included in work up or medical clearance of psychiatric patients.
  3. B12 screening is not included in women during preconception, pregnancy or breastfeeding.
  4. B12 screening is not included in infants and young children with developmental delay or in children diagnosed on the autism spectrum.
  5. Lack of a universally accepted screening protocol as well as outdated treatment protocols.

This presentation will raise awareness to the dangers of vitamin B12 deficiency and how the medical community is failing to diagnose this common disorder.  The lecture will educate participants about the critical role vitamin B12 plays in the normal health in adults.  Participants will learn how to recognize, diagnose, and treat B12 deficiency as well as understand subclinical B12 deficiency.  The groups at greatest risk for misdiagnosis and the cost-effectiveness of early diagnosis and proper treatment will be reviewed.  Cases of misdiagnosis from journals as well as in my own practice and Dr. Jeffrey Stuart’s will be presented.   Billions of health care dollars are being misspent on misdiagnosed B12 deficiency and will be explored.  Lastly, to combat this epidemic reeducation, advocacy, and a standard of care change will be discussed. 

As health care providers, it is our ethical duty to protect patients, report unsafe care, and report poor health care practices. Diagnosing B12 deficiency is simple and inexpensive.  Treating it costs only a few dollars per month.  Failure to understand and treat this disorder contributes to poor health, cognitive decline, fall-related trauma, neurologic injury, disability, poor outcomes, and premature death.  The hidden epidemic of B12 deficiency can be stopped in its tracks by reeducating the health care community and educating the public. This is one of the most preventable, and most curable, of all medical scourges, but only if we choose to act. 

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