25 Feb 2007
Dear Mary,
I am the person who wrote to you about the book Could It be B-12, an Epidemic of Misdiagnosis and feel compelled to clarify a matter. I think your response to my letter in a recent column reinforced an incorrect belief that all blood tests are reliable. According to the authors, the urinary test is highly accurate in the early stages of deficiency where the blood test is not. They also advise measuring blood homocysteine because elevated levels can be a sign of B-12 deficiency (as well as B-6 and folate). Readers need to be aware of this. Thank you for allowing me to clarify the details of my letter.
Dear Reader,
I contacted Dr. Sevil Yasar, Assistant Professor at Johns Hopkins School of Medicine Memory Clinic about this issue. She said protocol is to do the blood test for vitamin B-12 deficiency but not a urinary MMA test. When someone presents with moderate to severe dementia there is no way to know “that the only cause is B-12 deficiency and that any type of treatment would reverse this level of impairment.” In her seven years of experience she has seen only one case of mild cognitive impairment due to B-12 deficiency that improved with treatment.
You have made an important statement that caregivers must be assertive and request tests that are beyond the routine. In my experience working with older adults I have found that by the time they go to a memory clinic they are well into the stages of dementia so it is very important that initial testing be done at the primary care level when symptoms first appear - before it is too late. According to the Linus Pauling Institute at Oregon State University ( www.oregonstate.edu/infocenter/vitamins/vitaminB12/), symptoms may not be noticeable in mild B-12 deficiency but “…homocysteine and/or MMA blood levels may be elevated.” Here, again, it does not hurt to request the urine MMA just to be sure. Thank you for
Dear Mary,
My mother and I had a big break through yesterday. We live together and after many months of trying to get help for her she finally gave me the go ahead. I told her I did not know what I was going to do if "I" did not get some help. She asked me what was wrong and I explained that due to horrible back problems I am not able to do the grocery shopping anymore. To my surprise she said “well let’s get you some help.” From there the gate was open and I pushed for an aide to come in, too. I cannot believe she said yes, but I am taking the ball and running with it. I am so delighted I just had to share this with you.
Dear Reader,
The reverse psychology you employed worked wonders. Thanks taking the time to share and I hope others will learn from it.
Dear Mary,
My elderly Uncle cares for his wife who is in a nursing home with progressive dementia. He has received “advice” from friends about “hiding” his money so she can qualify for Medicaid. My Uncle is not a wealthy man but has enough assets and income to be comfortable and pay for her care. What do you think of this?
Dear Reader,
I think your Uncle needs to consult with an Elder Law Attorney. Long-Term Medical Assistance (Medicaid) has a five-year look-back and “hiding” money can get him into a lot of trouble with the Federal government.
Mary C. Fridley RN, BC
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