Guest guest Posted January 30, 2010 Report Share Posted January 30, 2010 How about nasal B12 - Nascobal? It is prescription and often needs prior auth (pricey if no insurance) but patients love it. I have not used patch.Palm Desert, CASent from my Verizon Wireless BlackBerryDate: Fri, 29 Jan 2010 19:56:53 -0700To: Clinical Procedures; practiceimprovement1< >Subject: B12 Patches Anyone with experience with B12 patches. I have a patient with low normal Vitamin B12 who I want to boost levels to high side of normal. Had her on 1,000mcg B12 orally for several months and barely budged her levels. I'm planning to do a trial of B12 injections and recheck levels to see if this will get her to high normal. Did see the B12 patch on the web. http://www.vermontcountrystore.com/browse/Home/Apothecary/Medicine-Cabinet/Vitamin-B-12-Patches-Box-of-4-Patches/D/30100/P/1:100:1000:10130/I/f12797?searchid=7LA1SRCH & feedid=yahoononbrand Haven't heard of that?Are they legit?Seem kind of expensive for what I'm trying to do. Any other thoughts? I'm pretty sure she has been taking the high dose oral B12 -- so a little surprised she didn't improve her B12 much. Locke, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2010 Report Share Posted January 31, 2010 - To ask the obvious - are you sure she does not actually have true pernicious anemia (with lack of intrinsic factor and hence inability to absorb B12 in any enteral form)? Worth knowing about to give her the guidance she'll need long-term. I have used nascobal for pernicious anemia, but know nothing of a patch... Steve Hersch Ashland, OR Locke wrote: Anyone with experience with B12 patches. I have a patient with low normal Vitamin B12 who I want to boost levels to high side of normal. Had her on 1,000mcg B12 orally for several months and barely budged her levels. I'm planning to do a trial of B12 injections and recheck levels to see if this will get her to high normal. Did see the B12 patch on the web. http://www.vermontcountrystore.com/browse/Home/Apothecary/Medicine-Cabinet/Vitamin-B-12-Patches-Box-of-4-Patches/D/30100/P/1:100:1000:10130/I/f12797?searchid=7LA1SRCH & feedid=yahoononbrand Haven't heard of that? Are they legit? Seem kind of expensive for what I'm trying to do. Any other thoughts? I'm pretty sure she has been taking the high dose oral B12 -- so a little surprised she didn't improve her B12 much. Locke, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2010 Report Share Posted February 4, 2010 --- It's a lot easer to diagnose true B12 deficiency and the causes then it used to be(no more Schilling test). Order: 1)methylmelonic acid and homocysteine --both will be low if true B12 deficiency. Does pt have achlorhydria? A blind loop syndrome? A loss of duodenum where B12 is absorbed? 2)anti-intrinsic factor antibodies and anti-parietal cell antibodies--if + = pernicious anemia and pt needs B12 injections for the rest of her life. A certain % of pts are neg to one Ab but together, you can identify more pts. I don;t know anything about the patches but without IF, B12 will not be absorbed by the gut which is why giving B12 pills is useless(pure placebo effect when people say it makes them feel better). Rx: B12 1,000 u/wk x 4 wks, then 1,000 u month x3, then 1,000 u/3 months. Re-check B12 levels after the first 4 mos. The textbooks have it wrong. I worked with one of the world's experts in B12 deficiency at Columbia Presbytarian. We had data from years of treating people at Harlem Hospital that q3mos is adequate for long term Rx. It takes 4 mos to deplete B12 stores. Ellen IM/Heme Portland, OR Jill and Steve Hersch wrote: > > - > > To ask the obvious - are you sure she does not actually have true > pernicious anemia (with lack of intrinsic factor and hence inability > to absorb B12 in any enteral form)? Worth knowing about to give her > the guidance she'll need long-term. I have used nascobal for > pernicious anemia, but know nothing of a patch... > > Steve Hersch > Ashland, OR > > Locke wrote: > >> Anyone with experience with B12 patches. >> I have a patient with low normal Vitamin B12 who I want to boost >> levels to high side of normal. >> Had her on 1,000mcg B12 orally for several months and barely budged >> her levels. >> I'm planning to do a trial of B12 injections and recheck levels to >> see if this will get her to high normal. >> Did see the B12 patch on the web. >> http://www.vermontcountrystore.com/browse/Home/Apothecary/Medicine-Cabinet/Vitam\ in-B-12-Patches-Box-of-4-Patches/D/30100/P/1:100:1000:10130/I/f12797?searchid=7L\ A1SRCH & feedid=yahoononbrand >> <http://www.vermontcountrystore.com/browse/Home/Apothecary/Medicine-Cabinet/Vita\ min-B-12-Patches-Box-of-4-Patches/D/30100/P/1:100:1000:10130/I/f12797?searchid=7\ LA1SRCH & feedid=yahoononbrand> >> Haven't heard of that? >> Are they legit? >> Seem kind of expensive for what I'm trying to do. >> Any other thoughts? >> I'm pretty sure she has been taking the high dose oral B12 -- so a >> little surprised she didn't improve her B12 much. >> Locke, MD > Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
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