Quote:
Originally Posted by AnnieB3
This is sort of on-topic, Abby, so please indulge me. I did some research at the local university after my B12 deficiency. I found unbelievable amounts of detailed "doctoring" a century ago. People like Addison, who truly looked at every angle of a disease and documented it. I agree with Alice. There is not as much looking and thinking now days. And putting pieces together. Dr. Andrew Weil said in a lecture I saw over a decade ago that pathophysiology is not even taught in medical school anymore. There's no time for it. How sad.
Sure seems like a lot of us here are - as Alice has said - zebras.
Annie
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Annie,
(forgive me if this is a bit off-topic).
B12 deficiency was sort of my first clue to understanding my illness.
No, I do not personally have B12 deficiency. But, quite a few years ago (shortly after I finished my fellowship in hematology), I was called in the middle of the night to see a patient who the resident thought had leukemia.
On first seeing her this is what I thought too. she was very pale, slightly jaundiced, with an enlarged spleen. All her blood counts were at ground level and she looked very ill.
On first site her bone-marrow also looked as if she had leukemia, but the more I looked at it, the more I realized that this was not what she had. It looked more and more like she had severe B12 deficiency such as I have never seen before. ( I had to open all the atlases and text-books to find similar BM findings, and be convinced in what I thought).
It turned out that she was not only a vegetarian, but also never went to see her physicians. She did feel a bit tired, but only when she started to have bruising and collapsed was she brought into the hospital by her family.
I realized that I was seeing the natural history of an illness that should no longer have a natural history. I also realized why it is called "pernicious anemia". Until the discovery of vitamin B12 it was a fatal illness, just like leukemia. I knew this theoretically, but now saw it in front of my own eyes.
Within a few months of receiving treatment with B12 she fully recovered, and even her liver and spleen went back to normal size. I went back to the original descriptions of pernicious anemia and found it all described.
I wrote a case report about it-Pernicious anemia-revisited (as I thought it is important that other physicians will know how to recognize it), but it was not accepted.
When I was nearly bed-ridden and required nearly constant respiratory support, I started thinking why so many neurologists told me that my symptoms were "impossible" and that they have never seen something like that. And I thought to myself that maybe (just like me with the patient who had pernicious anemia), they are seeing the natural history of an illness that rarely has a natural history nowadays.
So, I asked my husband to find me everything that was written about myasthenia before there was effective immunomodulatory treatment.
This is how I got to Osserman, Mary Walker etc. Who have indeed describe each and every one of my "impossible" symptoms.
In fact I recently came across a paper (and found it quite amusing) that one of my "impossible" symptoms was called the "Mary Walker Phenomenon". This phenomenon was required (then) in order to confidently make the diagnosis of MG. It is probably not seen much now, because patients receive effective treatment long before they reach this state. And also because physicians are many times much less observant and meticulous in their examination than when they had very limited tools other then their own clinical skills, so probably wouldn't even notice it, if patients did have it.
I was thinking if I should send this paper to the neurologist who told me it is "impossible" but then decided not to.
So, in a way you can say that B12 deficiency probably saved my life.