Sally M. Pacholok - Could It Be B12? Pediatric Edition: What Every Parent Needs to Know

We would like to thank the many dedicated physicians, researchers, and other clinicians who have contributed a vast amount of medical documentation regarding the devastating effects of vitamin B12 deficiency in children and adults.

We are grateful to the Groovers, the Ryans, and other families who recognized the importance of sharing their stories about their childrens B12-deficiency-acquired injuries in order to educate others. Special thanks go to Tracey and Damian Witty in the United Kingdom, who teamed up with www.B12Awareness.org to educate more countries about the dangers of B12 deficiencythere is power in numbers.

We are truly blessed to have the opportunity to work with writer, producer, and film director Elissa Leonard, who shares our passion and joined our lifelong quest to raise public awareness and expose poor health-care practices through her movie Sally Pacholok.

A big thank you to Chris Kelley, president of Polestar Communications, who taught me the fundamentals of giving a great interview and writing pitches. His continued support, advice, and friendship are priceless. Thanks also to Ron Beckenfeld, Matthew Supkoff, Steve Downs, Greg Faull, and the rest of the team at Superior Source Vitamins for their past and continuing efforts on behalf of B12 awareness and educating the public. And finally a private thanks to my dear friends Tracy Weick, Karen ODonnell, and Dr. Richard Nimbachlife would not be the same without your kinship, laughter, and listening ears.

Team B12

The Groover Family

The Ryan Family

The Leone Family

Ron Beckenfeld

Jaguar Bennett

Alison Blake

David Carr, M.D.

Joseph Chandy, M.D.

Michelle J. Cheatley

Pauline Ciaffone

Jeffrey Dach, M.D.

John Dommisse, M.D.

Anna Dutko

Joseph Flynn, D.O.

Kelly and Jack Genzlinger

Susie Griffiths

Teddy Harasymiw

Suzie Henson-Amphlett

Martyn Hooper

Chris Kelly

Pat and Kim Kornic

Elissa Leonard

Priscilla Leone

Charles H. Liu, R.Ph.

Joshua Luckasavitch

Lulu Ann Mattocks

Kilmer McCully, M.D.

Glenn Medina

Hugo Miney, Ph.D.

Daria Mytyakynska

Richard Nimbach, D.O.

Eric Norman, Ph.D.

Karen and Mike ODonnell

David R. Pacholok

Anna Pijanowska

Patrick Prentice

Kathy Reichenbach, R.N.

George and Donna Rossetti

Larry and Justyna Slabosz

Rick Solecki

Kent Sorsky

Anand Sridhar, Ph.D.

Heather Stratton, D.D.S.

Sue and John Stuart

Matthew Supkoff

Paul Thomas, M.D.

Alice and Carl Vandemergle

Carmen Velazquez, M.D.

Margaret Venske

Patricia Waldo

Tracy and Edward Weick

Tracey and Damian Witty

Linda and Ken Woolcock

In Memory of B12 Angels

Dale and Charlene Back

Paul and Priscilla (Mickey) Bowman

Joannes Dutko, D.D.S.

Paul Fernhoff, M.D.

W. Michael Forgette, D.D.S.

Melinda Groover

Sue Harvey

John Hotchkiss, M.D.

Grace Izzi

Helen M. Kosy

Connie Lamb, R.N.

Matteo Leone

Brian Liska, D.O.

Milton and Jean Lute

Jim Mundy

Mary and Michael Nykiforuk

Andrew and Anna Pacholok

William and Nancy Pacholok

Samuel Radzik

Bernard Rimland, Ph.D.

Marie Rusconi

Mary and James Stuart

Edward Waldo

Daria Zakharko

COBALAMIN DEFICIENCY RISK (CDR SCORE)

1. I. NEUROLOGICAL MANIFESTATIONS (+2 EACH)

• Paresthesias
• Weakness of legs, arms, or trunk
• Unsteady gait, balance problems
• Ataxia
• Dizziness or lightheadedness
• Tremors
• Restless legs
• Lhermittes sign
• Rombergs sign
• Abnormal Babinski reflex
• Visual disturbances
• Forgetfulness, short-term memory loss, or dementia
• Mental status changes
• Impotence, erectile dysfunction
• Urinary or fecal incontinence
• Impaired vibration, position sense
• Abnormal reflexes
• Seizures
• Paralysis

1. II. NEUROPSYCHIATRIC MANIFESTATIONS (+2 EACH)

• Depression, suicidal ideations
• Diagnosis of mental illness or on psychiatric medications
• Postpartum depression or psychosis
• Anxiety
• Poor concentration or foggy thinking
• ADD/ADHD
• Personality changes
• Irritability
• Paranoia
• Mania
• Hallucinations
• Psychosis
• Violent behavior
• Homicidal ideations

1. III. HEMATOLOGIC MANIFESTATIONS (+2 EACH)

• Anemia
• Macrocytosis
• Hypersegmented neutrophils
• Anisocytosis
• Leukopenia
• Thrombocytopenia
• Pancytopenia

1. IV. GENERAL SIGNS/SYMPTOMS (+1 EACH)

• Generalized weakness or fatigue
• Shortness of breath
• Pallor or jaundice
• Frequent falls or near falls
• Loss of appetite/weight loss
• Frequent infections, poor wound healing
• Orthostatic hypotension
• Postural orthostatic tachycardia
• Occlusive vascular disorder or thrombotic events (e.g., PE, DVT, CVA, MI, portal vein thrombosis)
• Cervical dysplasia
• Intrauterine growth retardation
• Malnutrition
• Glossitis
• Tinnitus
• Skin hyperpigmentation or hypopigmentation
• Hepatomegaly or splenomegaly

1. V. GASTROINTESTINAL RISKS (+2 EACH)

• Decreased stomach acid or atrophic gastritis
• Gastroparesis
• Helicobacter pylori infection
• Giardiasis
• GERD or ulcer disease
• Gastrectomy (partial or complete), bariatric surgery
• Ileal resection (partial or complete)
• Malabsorption syndromes (e.g., Crohns disease, IBS, celiac disease)
• Pancreatitis, pancreatic exocrine insufficiency
• Small intestinal bacterial overgrowth
• Diphyllobothrium latum (fish tapeworm)
• Liver disease

1. VI. (a) POPULATION AT RISK (+2 EACH)

• Vegans, vegetarians, macrobiotic diets
• MTHFR gene mutation
• Nitrous oxide administration or abuse
• Eating disorders

1. (b) POPULATION AT RISK (+1 EACH)

• Age 50 or over
• Pregnancy
• Intrauterine growth retardation
• Autoimmune disorders (e.g., thyroid, IDDM, lupus)
• Family history of pernicious anemia
• Proton-pump inhibitor or H2-blocker use
• Metformin use
• Alcoholism
• Dialysis patients
• AIDS
• Chemo- or radiation therapy
• Phenylketonuria (PKU)
• Down syndrome

PEDIATRIC COBALAMIN DEFICIENCY RISK (PCDR SCORE)

1. I. NEUROLOGICAL MANIFESTATIONS (+2 EACH)

• Developmental delay or regression (motor, speech, language, or social)
• Hypotonia
• Poor suckling/swallowing
• Abnormal movements