Vitamin B12 Deficiency Missed for Two Months by Three Doctors

The Second of Three Missed Deficiencies in the Same Patient

By G. Douglas Andersen, DC, DACBSP, CCN

In the previous article [April 9 DC], I discussed the case of a 22-year-old woman, "M," who entered my office just after the new year. The complaints she noted on the intake form included pain in her neck, upper back, middle back, lower back, arms and legs. She also had headaches, dizziness and burning feet, especially at night. M denied any trauma and said the problems had started two months ago. Additional questioning revealed her complaints and a host of other problems had been building up long before things reached the breaking point.

After a negative blood test, her primary care doctor thought she had a nerve problem and sent her to a neurologist. After unremarkable MRI studies of her brain, neck and back, along with a negative EMG on her legs, the neurologist thought M had a muscle problem and sent her to a rheumatologist. The rheumatologist diagnosed fibromyalgia and had been trying various types of medications unsuccessfully.

I took her history; there was no question she had an iron deficiency, even though the primary physician had told her that her iron was fine. (See part 1 of this series, "Subclinical Iron Deficiency Missed for Two Months by Three Doctors," in the April 9 issue.) I thought something was clearly wrong with her nervous system and didn't feel right about the fibromyalgia diagnosis. I had to convince her to try iron. (She had never been to a DC, but assumed she was going to get everything cracked, and did not expect to be told she had a nutritional problem.) She was also surprised at both the examination and the number of questions I asked.

Her skepticism was gone when she returned for her first treatment. She was still in a world of hurt, but stated that her energy was better than it had been in two months. I elected to use some muscle stim on her very painful back. Once the electrodes were in the right location and the intensity was at the right level, she couldn't believe how great it felt. Her reaction was nothing short of amazing, and this happened during the treatment. I had never seen anything like it. She said it was the first time in four months that her back didn't hurt.

After the time was up, I decided to quit while we were ahead and not manipulate. Little did I know how wise that decision was. When she returned for her next visit after the weekend, she said, "I had no back pain for about 6 hours. Then it returned and was worse all weekend. My arms and legs were also bad." This convinced me something was affecting her nervous system, even though her neurologist had told her there was nothing wrong with her nerves.

I iced her back and neck (which helped a lot) and again decided not to manipulate, although I did find segmental dysfunction at L-4 / L-5. I started her on 3,000 mcg/day of B12 even though her B12 wasn't low on the blood test. I did this because 1) she'd only had a serum B12 test, rather than methylmalonic acid which is much more accurate; 2) a diet that is low in iron is often low in B12; 3) her symptoms of a polyneuropathy with the absence of pathology following multiple scans and exams by a neurologist (which is where I would have sent her had she walked in off the street); 4) B12 is nontoxic; and 5) the iron supplement I gave her had plenty of folic acid (which can mimic a B12 problem).

Please note that at the same time she had the bad reaction to the electric stimulation, many of her other symptoms were improving daily. After a week of iron, her energy went from a 1 to a 5-6 on a 1-10 scale. Her hair stopped falling out, her hands and feet were no longer cold, her headaches were much less intense and the brain fog was gone. She was beyond happy even though her polyneuropathy was only slightly improved and her myalgia, arthralgia and burning feet were unchanged.

I called her when she missed her next appointment due to insurance problems. (Her insurance company initially told her she did not have chiropractic. My staff double checked and found out she had coverage, but then someone else again told her she wasn't covered during a conversation about benefits for another provider.) She said the burning was slightly better, but wasn't sure if it was the ice she was using on her back. I doubled the B12 to 6,000 mcg/day.

Four days later, I called again. This time she definitely felt a difference and was pleased to say she did have chiropractic coverage. She had an appointment with her primary HMO doctor on the following day, so I told her to ask for a B12 shot and another blood test for iron, B12 and vitamin D deficiencies.

Two days later she returned and was not happy: "I told her my chiropractor suggested a B12 shot and before I could say anything else ,she cut me off and said I had plenty of B12. She would not give me a shot and I was so surprised my mind went blank. It took everything not to cry. I didn't tell her about the iron, either. I have no idea what else she said to me because I just felt numb. I am supposed to see another doctor next week, but I don't want to go."

I calmed her down and rehearsed how she would handle the next doctor. In the meantime, the B12 was working and she was able to tolerate light massage and manipulation to both L-4 / L-5 and new dysfunctions that were now presenting at T-1/2/3.

M called the day after her medical appointment, which turned out to be with the rheumatologist. After she'd told him everything that had happened she was again caught off-guard. But this time it was a pleasant surprise. Without saying a word, the doctor called his nurse and ordered a B12 shot and a blood test for vitamin D. (M forgot I also wanted more labs on the iron and B12.) He then told M to keep doing what the chiropractor said.

When I asked her if she'd noticed any effect from the shot, she was ecstatic. "The shot made a huge difference! Since I started the pills (B12), I have been feeling a little better each day. After the shot, it was a lot better. My arms don't tingle at all and my feet have stopped burning. My legs still tingle a little, but it's nothing like it was. Even my energy is better. It feels like the improvement I had when I started the iron."

Next time we will conclude this case with the results of M's vitamin D blood test, which – you guessed it – showed a big problem.

Click here for previous articles by G. Douglas Andersen, DC, DACBSP, CCN.

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