When I needed an expert witness, during the time I thought I could successfully sue the hospital for failing to tell me I had Profound B12 Deficiency, I wrote to Dr. Stabler.
I later called her and she kindly talked to me for over half an hour. She said, however, that the one time she had tried to act as an expert witness it had not turned out well and had made her anxious with the conclusion she was not suited to being an expert witness.
She also said I didn’t sound as if I had a mental disability, which I get a lot when I prepare for a conversation or write. The fact is, however, that my ability to think, in terms of processing speed and working memory, have been severely curtailed. I am lucky in that prior to the problem I was relatively gifted, so after the problem I still display my gift, though it is much more difficult to write or talk.
December 19, 2002
S. P. Stabler
University of Colorado Health Sciences Center
Denver, CO 80220Dear Dr. Stabler,
I have read three of your articles:
1.) Cobalamin Deficiency in White and African American Elderly Women, 1999,
2.) Metabolic evidence that deficiencies of vitamin B-12 (cobalamin), folate, and vitamin B-6 occur commonly in elderly people, 1993, and
3.) Cerebrospinal fluid methylmalonic acid levels in normal subjects and patients with cobalamin deficiency, 1991.
I saw that you worked with D.G. Savage and J. Lindenbaum on Cerebrospinal fluid methylmalonic acid levels, and was particularly interested in that, since I am finding their Neurologic aspects of cobalamin deficiency to be highly useful in preparing my malpractice case against doctors who failed to diagnose my pernicious anemia.
My reason for bringing the action, is to raise awareness of B12, which is much more easily administered, than the effects of its deficiency are cured, once they have persisted for some time.
In my case, when I was taken to hospital, May 1997, as a result of a suicide attempt (Dalmane and carbon monoxide), my B12 tested at 141. The physician diagnosed “profound anemia” and “personality disorder,” the later apparently on the basis of my suicide letter, which talked about IRS abuse I had suffered. (U.S. News & World Report used some of my experiences in an article published April, 1996.)
I was given a shot of B12, which I don’t remember because of all the Dalmane. During the following months, despite telling my doctor that my mother has pernicious anemia, I was told only that my B12 had been low. I bought B-Complex tablets and took them by the bottle, ate liver (but not a pound a day) and had no increase in my B12 level. Over two years, I had a few more B12 shots, but mostly I had to beg for them, since my level reached 241.
On Christmas Eve, December 24, 1998, a different doctor diagnosed pernicious anemia and had a nurse show me how to give myself shots.
With a shot a month, I began to improve so that I was able to take a job, just a desk clerk job, whereas I had been a successful Realtor, but still it was a major step. However, I couldn’t hold the job because I could not remember room numbers I had just assigned: so, keys I made didn’t match, and I entered wrong numbers into the phone machine. The more stressed I became, the worse I did, till I was fired.
Luckily, I was in Chapter 11 and had an adversary proceeding re violating the automatic stay, so I had to get an expert witness, which led me to Dr. Michael Baten, a neurologist. I am ever grateful to the opposing attorneys, because Dr. Baten suggested I take more B12, especially when I was under stress. Also, he had me keep a timeline, showing my B12 shots, symptoms, B12 test results, etc.
I had been unable to go to three places, like the grocery, Kinko’s and the post office on one trip, because I could not remember all of that, which was distressing. But, taking more B12, I was able one day, to think while I drove of someplace else I wanted to go and plan the route, and go both places. It was like Christmas, a gift, exciting and wonderful: I was suddenly younger. Up until then,one of my main occupations was to remain calm when I was confused. I would constantly reassure myself, “It doesn’t matter. If you do one thing in a day, that’s fine.”
Also, my legs used to jump at night, waking me, and they hurt. After quite a lot of B12, that stopped. But an odd sensation persisted, so that I feared it would not go away: it was a feeling in my legs and thighs as if a small animal were inside, trying to get out, it was less painful than it sounds, but was major disturbing. And, I often had a feeling of something crawling on my legs and arms. I would think there was a spider, jump, and brush it away, though really there was nothing there.
Both of these sensations mostly went away, for which I am grateful.
But problems remain: my toes are numb, my right thigh is often numb, which I only know if I touch it, but can’t feel my touch — I’ve fallen when a cord was around my right leg, and I didn’t feel it — recently, my feet go numb, so that I feel as if I’m falling — I have fallen, but did not get badly hurt, like the time with the cord, and there are my memory and cognitive skills which are impaired: not long ago I spent a day reading about certain Constitutional amendments, next dayI couldn’t remember which ones. Mostly, I have to write things down, then hope that I can find the notes when I want to use them. Sometimes I don’t remember there’s something I want to use.
I think the opposing attorneys, seeing me as too ineffective/forgetful to win, advised their clients not to settle when I offered to settle for $30,000 ($5,000 from each defendant) and an agreement that they would promote B12 education in the community, which I thought they could easily do by asking the television stations to participate, newspapers, etc.
However, I did do my Chapter 11, (1997-2000) where I was allowed to read what I wanted to say. And, I can copy things, and put them together in a compelling way, given the time.
So, if you were to agree to be an expert witness for me, I don’t think you would be embarrassed in court. (I imagine that might be a fear, given that I’m pro se.)
In terms of paying you, I believe that I will be able to do an equity loan in February. Right now I’m low on cash resources because while I was less mentally functional, a very clever man was able to take several thousand dollars from me. Luckily, I was able to stop him from taking my home.
Some of the questions I have to address, are whether or not I have pernicious anemia, or some other malabsorption problem. I didn’t test right for Intrinsic Factor antibodies to show that I have PA. I read articles that said only about 60% of the tests are accurate for PA. But now there seems to be evidence that there are other causes for the symptoms of PA, than lack of intrinsic factor, and other names for the disorders.
Also, I don’t know if extended B12 deficiency causes PA, which some articles seem to indicate. If that were the case, then because I raised my B12 level, maybe the added B12 in my system fostered Intrinsic Factor. If my B12 level had again been 141, then would I have shown a lack of Intrinsic Factor?
Personally, I would like to see our national “low” for B12 raised to the low used in Japan and Europe, which I understand from www articles is 550. I know that when my level, which I try to keep high, drops to 550, I begin to have bleeding, more tingling, numbness, vision and memory problems, depression, and other symptoms.
I was sad to read that R. Carmel had said, “Extending suspicion of deficiency to persons with cobalamin concentrations of 140-258 pmol/L appears to provide more disadvantages than advantages.” Am J Clin Nutr 1999.
It seems to me that if work like yours shows that deficiency occurs commonly in elderly people, that raising the “low” level, would help catch the problem before irreversible damage is done.
I wrote to NBC, CBS, ABC, etc. trying to get their health experts to cover this subject, but I haven’t seen any such coverage come on the news. I also wrote to several news magazines, with similar results.
If my case goes to trial, and you were an expert for me, then maybe the case would spur media coverage, which would be good for B12 deficiency sufferers, known and unknown, if I won, which I would hope to do.
This is such a busy season to be asking for help. Plus, as an academic you may be on holiday, and not timely receive this. Thinking to speed up the process, I tried to e-mail you, but I received the response that you were not accepting mail from unknown origins, or something like that.
My e-mail address is [email protected]
Hoping to hear a favorable response from you, I remain,
Sincerely,
Karen M. Kline
Copy: R. Carmel
12/20/02 – I searched Gale for “Stabler”, rather than “cobalamin” and found many more articles, or perhaps more accurately, abstracts.
1.) Association of folate intake and serum homocysteine in elderly persons according to vitamin supplementation and alcohol use. 2001.
2.) Vitamin B12 deficiency and depression physically disabled older women: epidemiologic evidence from the Women’s Health and Aging Study. 2000.
(For several reasons, this interests me: “Conclusions: In community-dwelling older women, metabolically significant vitamin B (sub 12)
deficiency is associated with a twofold risk of severe depression.” When my doctor finally got me to agree to take a Prozac look-alike, Sarafem, of which she gave me several sample boxes, I had (about two months later) adverse reactions: bleeding gums, my period, shaky hands, incontinence (not fun), severely decreased memory, increased problems with mental organizing, my chest hurt, I felt nauseous, my feet wentmnumb: so I felt I was falling. Her strong interest in me taking it may have stemmed from the “personality disorder” diagnosis, 1997.)
3.) Effects of parenteral cysteine and glutathione feeding in a baboon model of severe prematurity. 2000.
4.) Racial differences in prevalence of cobalamin and folate deficiencies in disabled elderly women. 1999.
5.) Vitamin B12 deficiency in older people: improving diagnosis and preventing disability. 1998.
“Vitamin B12 deficiency may not be a reliable indicator of general health in older patients, as it is a common occurrence in the elderly.”
But, would general health in older patients improve, if the “low” for B12 were raised to 550, so that older patients, and others, were more likely to receive more?
6.) Vitamin B12 deficiency in the elderly: current dilemmas. 1997.
“Research efforts should be directed toward determining practical methods for diagnosing and treating vitamin B-12 deficiency in the millions of elderly subjects with undiagnosed deficiency.” I love this.
7.) AIDS-associated non-Hodgkin’s lymphomas as primary and secondary AIDS diagnoses in hemophiliacs. 1996.
8.) Relationship among homocyst(e)ine, vitamin B-12 and cardiac disease in the elderly: association between vitamin B-12 deficiency and decreased left ventricular ejection fraction. 1996.
“In conclusion, vitamin B-12-deficient patients had significantly lower leftventricular ejection fractions than nonvitamin B-12-deficient patients.”
I wonder if this is why my chest hurts when my B-12 is low.
9.) The use of homocysteine and other metabolites in the specific diagnosis of vitamin B-12 deficiency. 1996.
“In conclusion, elevations of methylmalonic acid and total homocysteine are very sensitive and specific in diagnosing vitamin B-12 deficiency and can be used to help differentiate vitamin B-12 deficiency from folate deficiency.”
Does this mean that once I had years of B-12 shots, that this test, which was then given to see whether or not I had PA, could no longer be
effective for that purpose?
10.) Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. 1996.
“In the 15 people who received treatment, elevated levels of methylmalonic acid and homocysteine decreased, confirming the diagnosis of vitamin B12 deficiency.”
So, this sounds like after years of treatment, these tests can’t then be used to determine whether or not B12 deficiency existed. Are they equally unsuitable for saying PA didn’t exist?
11.) Effects of vitamin B12, folate, and vitamin B6 supplements in elderly people with normal serum vitamin concentrations. 1995. (Whole article was given)
“Higher metabolite concentrations in the blood suggesting vitamin B deficiency in elderly people may normalize after vitamin supplementation.”
That’s it, then. So, from the perspective that I’m no longer vitamin B12 deficient, I am said to no longer have pernicious anemia, which is then transposed into saying I never had PA., according to the opposing attorneys. Is that what you say?
*** Since I can’t use any of this in court without the author to back it up, I really need you.