Neuropathy Hope - Western Neuropathy Association

 Neuropathy Hope
Hope through caring, support, research, education, and empowerment
A newsletter for members of the
Pacific Chapter of The Neuropathy Association (PCNA)
January 2013
Issue 1
Volume 11
The Link Between
Neuropathy and
Shingles
Vitamin B12
PCNA Support
Groups
President’s
Message
Drug Offers New
Pain Management
Therapy For
Diabetes
PN Literature
Review
Alpha Lipoic
Acid Good For
Neuropathy
A Surprising Cause
Of Neuropathy
PCNA Board of
Directors
Dec. 10, 2012
Meeting Update
Save These Dates
Pacific Chapter of The
Neuropathy Association
P.O. Box 276567
Sacramento, CA 95827-6567
877-622-6298
888-556-3356
[email protected]
www.pnhelp.org
THE LINK BETWEEN NEUROPATHY AND SHINGLES By Russell Chin, M.D.
Postherpetic neuralgia (PHN) is a painful condition
that often occurs as a result of shingles (also
known as herpes zoster). It is estimated that about
10-15% of people with shingles will develop PHN.
The risk for developing PHN also increases with
age—especially in people over 60—and those
who are immunocompromised. Anyone who
once had chickenpox is at risk of shingles since
the virus may become reactivated years after the
initial infection.
The varicella zoster virus—which causes chicken
pox during childhood and sometimes adulthood—
enters the nervous system where it remains
dormant for many years. Normally, the body’s
immune system stops the virus from becoming
active; however, with advancing age or an
immunocompromised state, the virus reactivates
causing shingles. Shingles is an infection of a
nerve and the area of skin around it. Typically, the
nerves of the chest and abdomen on one side
of the body are affected. Even after the shingles
rash subsides the pain can persist or recur in the
shingles-affected area and is called PHN.
PHN symptoms are usually restricted to the area
of skin where the shingles outbreak first occurred.
Symptoms include: occasional sharp burning,
shooting pains; increased sensitivity to touch
and temperature changes; itchiness; and, rarely
muscle weakness or paralysis. People suffering
from PHN may also develop anxiety, depression,
and sleeping difficulties resulting from chronic pain.
There are a variety of therapies available to
manage the pain associated with PHN. A 2004
practice parameter of the American Academy of
Neurology recommends tricyclic antidepressants
(amitriptyline, nortriptyline, desipramine, and
maprotiline), antiseizure drugs (gabapentin,
pregabalin), opioids, topical lidocaine, and
capsaicin to treat PHN. (Amitriptyline is noted
to have significant cardiac effects in the elderly
compared with nortriptyline and desipramine.¹)
A high-dose capsaicin patch (Qutenza®) and a
once-a-day prescription of gabapentin (Gralise™)
offering 24-hour pain control for people with aftershingles pain has recently become available in the
U.S. for PHN. Therapy should be individualized
and patients should work closely with their doctors
to determine which medication or combination of
medications can provide maximum pain relief with
no or minimal side effects.
Russell L. Chin, M.D. is assistant professor of
Neurology at Weill Cornel Medical College. He
is an assistant attending neurologist at New
York Presbyterian Hospital and at the Peripheral
Neuropathy Center at Weill Cornel Medical College,
which is a Neuropathy Association-Designated
Center of Excellence. Used by permission of The
Neuropathy Association.
VITAMIN B12
One of the known causes of peripheral neuropathy
is low B12. This information is a service to you to
more fully understand what it is and what foods
contain it so you can plan your diet to include some
of these. B12 level is something your doctor should
include in blood work periodically. Your doctor may
encourage supplements as well. However, don’t
start taking B12 without consulting your doctor.
Some people have a high level of B12 and don’t
need supplementation. Check with your doctor on
any supplement you think you might like to try. It may
conflict with other medications you take or not be
recommended because of other physical conditions
you may have, Be sure to include all supplements on
your medication list you carry with you.
Dietary Supplement Fact Sheet: Vitamin B12
Introduction
Vitamin B12 is a water-soluble vitamin that is
naturally present in some foods, added to others,
and available as a dietary supplement and a
prescription medication. Vitamin B12 exists in
several forms and contains the mineral cobalt, so
compounds with vitamin B12 activity are collectively
called “cobalamins”. Methylcobalamin and
5-deoxyadenosylcobalamin are the forms of vitamin
B12 that are active in human metabolism].
Vitamin B12 is required for proper red blood
cell formation, neurological function, and DNA
– Continued on page 5
Roster of Our PCNA Information and Support Groups
2012
PCNA Board
of Directors
CALIFORNIA
Alturas
Bev Anderson
Antioch-Brentwood
President
Karen Polastri
Vice President
Pam Hart
Secretary
Wayne Hewlett
Treasurer
Sandra Grafrath
Director
Michael Green
Director Emeritus
Arvin Magusara
Director Emeritus
Casimir Sammanasu
Director Emeritus
Sandra Vinson
Director Emeritus
Dick Ward
Director Emeritus
For information call:
Bev Anderson (877) 622-6298
3rd Wednesday, 2PM
Sand Creek,1D Kaiser-Permanente
4501 Sand Creek Rd. Antioch
L.D. Wright (925) 684-7548
Auburn
1st Monday, 1:30 PM
Woodside Village MH Park
12155 Luther Road
Sharlene McCord (530) 878-8392
Bakersfield
3rd Wednesday, 1:30 PM
Stockdale Moose Lodge
905 S. Stine Rd.
David Wollard (661) 663-9406
Editor
Newsletter Design by
Diane Blakley
Designs
Page 2
Fresno
Placerville
3 Tuesday, 11:00 AM
Carrows
4280 N. Blackstone
Marvin Arnold (559) 226-9466
rd
Redwood City
2nd Monday, 1:30 PM
GV United Methodist Church
236 S. Church Street
Salli Hearn (530) 268-1017
Jackson
Carmichael
2nd Monday, 10:30AM
Lakeport Senior Center
507 Konocti Avenue
Grace Gault (707) 274-9999
2nd Tuesday, 1:30 PM
Eskaton
3939 Walnut Ave.
Karen Robison (916) 972-1632
Call Karen before coming as it is a
gated community and sometimes
the day/time changes.
Lincoln
2 Wednesday, 1:30 PM
First Presbyterian Church
2490 Grove Way (next to Trader Joe)
Judson Leong (510) 581-6697
Madera
For information, call
Barbara Dryden at (707) 994-0734
Concord
3rd Thursday, 1:30 PM
First Christian Church
3039 Willow Pass Road
Bev Anderson (877) 622-6298
Call Bev Anderson for
information (877) 622-6298
Livermore
4th Tuesday, 10 AM
Heritage Estates
900 E. Stanley Blvd.
Sandra Grafrath (925) 443-6655
For information call
Leo Trzepowski (559) 673-4388
Merced
2nd Thursday, 1 PM
Central Presbyterian Church
1920 Canal Street
(The Hoffmeiser Center across
the street from the church)
Larry Frice (209) 358-2045
Modesto
Crescent City
3rd Monday, 10:30 AM
Trinity United Presbyterian Church
1600 Carver Rd., Rm. 503
Monte Schrader (209) 531-3838
Davis
Monterey
Call Bev Anderson for
information (877) 622-6298
Elk Grove
2nd Tuesday, 2 PM
Elk Grove Senior Center
8830 Sharkey Avenue
Michael Colozzi (916) 421-8103
Eureka
For information call:
Earlene (707) 496-3625
Folsom
Call Bev Anderson for
information (877) 622-6298
Redding
Grass Valley
For information call:
Bev Anderson (877) 622-6298
Lakeport
Clearlake
Call Bev Anderson for info
(877) 622-6298
2nd Wednesday, 1:30 PM
Neighborhood Church of Redding
777 Loma Vista
John Wright (530) 222-6570`
3rd Wednesday, 3 PM
N Berkeley Senior Ctr
1901 Hearst Ave. (corner of MLK)
Johnetta Smallwood (510) 841-0239
Castro Valley
For information call:
Kathleen Denson (805) 746-8090
Garberville
Berkeley
2nd Tuesday 3:30-5:00 PM
Davis Senior Center
646 A Street
Mary Sprifke (530) 756-5102
Bev Anderson
Oxnard
For information call:
Betty Adams (707) 964-3327
For information call:
Bev Anderson (877) 622-6298
nd
Please contact
your group leader
or check your
local paper to
find out about
the topic/speaker
for the upcoming
meeting.
Fort Bragg
3rd Wed.,10:30 AM–odd numbered months
First Presbyterian Church
501 El Dorado Street
Don & Ann Trout (831) 372-6959
Napa
1st Thursday, 2 PM
Napa Senior Center
1500 Jefferson Street
Ron Patrick (707) 257-2343
[email protected]
Oakland
1st Thursday, 1 PM
Grand Ave. 7th Adventist Church
278 Grand Ave.
Kathleen Nagel (510) 653-8625
4th Tuesday, 1 PM
Sequoia Hospital Health and
Wellness Center
749 Brewster Avenue
Stan Paschote (510) 490-4456
Roseville
2nd Tuesday, 1 PM
Sierra Point Sr. Res.
5161 Foothills Blvd.
Bev Anderson (877) 622-6298
Sacramento
3rd Tuesday, 1:30 PM
Northminster Presby. Church
3235 Pope Street
Charles Moore (916) 485-7723
Salinas
For information call
Bill Donovan, M.D. (831) 625-3407
San Francisco
4th Thursday, 10 AM
UC-San Francisco Med Ctr.
400 Parnassus Avenue
Amb. Care Ctr. 8th Flr., Rm A888
Y-Nhy (e nee) Duong (415) 353-3667
San Jose
3rd Saturday, 10:30 AM
O’Conner Hospital
2105 Forest Avenue
SJ DePaul Conf. Rm.
Stan Pashote (510) 490-4456
San Rafael
3rd Wednesday, 1 PM
Lutheran Church of the Resurrection
1100 Las Galinas Avenue
Scott Stokes (415) 246-9156
Santa Barbara
4th Saturday, 10 AM
First Presbyterian Church 21 E. Constance St.
Shirley Hopper (805) 689-5939
Santa Cruz
3rd Wednesday, 1PM
Odd numbered months
Trinity Presbyterian Church
420 Melrose Avenue
Mary Ann Leer (831) 477-1239
[email protected]
Santa Maria
2nd Tuesday, 12:00 Noon
Elwin Mussel Senior Center
510 Park Street
Wanda (805) 938-1086
Mary (805) 344-6845
– Continued on page 3
President’s Message By Bev Anderson
2013 is here already. It is full of promise and probable problems, but it also is a clean
slate to write a new chapter of our lives on. Thirteen has been a special number for
me so I have great hope that this will be a banner year for me and for you.
If you are like me, one of the first things you think about is that it is time to
prepare income taxes again. A member called me recently as she was getting
her documents ready for her taxes. She will likely be ready to file in very early
January. She wanted to know if dues and contributions were tax deductible. I
assured her that they were. PCNA is a 501 (c) (3) charitable organization. I didn’t
tell her, but I was in total awe of someone that was working on their 2013 taxes before the 15th of December.
Maybe some of you are already preparing too.
At the beginning of a new year, there are lots of things that could be said. I’d like to give you several pieces
of information that could help you and/or your neuropathy this year.
Some people seem to think that only those with diabetes have to be careful about their feet and check them
daily. I don’t have diabetes. I’ve told my story a number of times in support group meetings, but you may
not have heard. I woke up in the night and made the required trip. I stepped on one of those long straight
pins that used to come in clothes sent via mail order. It went into my foot – to the bone I later found out. It
hurt a little but not hugely. I pulled it out, put some peroxide on it, and went back to bed. It twinged in the
morning somewhat but I ignored it. Numb feet can sometimes be an advantage.
Some weeks later, I noticed a black spot on the bottom of my foot. It got larger and darker. I showed it to
my doctor. He sent me to my podiatrist. It was an abscess. He drained it down to the bone with my barely
feeling anything thanks to neuropathy and had it x-rayed. It proved to have osteomyelitis which could soon
have taken my foot or my life. They put me in the hospital for a week with several bags of antibiotics hung
and dripped the medicine through my IV constantly. I was sent home with a pic line (home operated IV) that
failed so I was put on major amounts of one antibiotic for 7-1/2 weeks. Rather soon, the metatarsal bone
had to be removed as that was what the pin hit. I’ve had no further problem with it for which I am glad.
Please don’t go barefoot or even stocking footed. It is too risky for people with neuropathy.
– Continued on page 7
PCNA Information and Support Groups – continued from page 2
Santa Rosa
1st Thursday, 10:30 AM
Santa Rosa Senior Center
704 Bennett Valley Road
Willie Quarante (707) 544-3236
Sonoma
1st Friday, 10:30 AM
Vintage House
264 1st Street
Joann Bertolucci (707) 996-8336
Sonora
For information call
Bev Anderson (877) 622-6298
Stockton
3rd Tuesday, 1 PM
St. Andrew Lutheran Church
4210 Claremont Avenue
(at March Lane)
Jerry Elliot (209) 447-1242
Susanville
For information call:
Bev Anderson (877) 622-6298
Truckee
For information call:
Bev Anderson (877) 622-6298
Tulare-Visalia
3rd Tuesday, 2 PM
Alternates between Tulare & Visalia
Call for location:
Cathy Moriarity (559) 686-2351
Esther Hoover (559) 799-2143
Turlock
3rd Monday, 1 PM
Covenant Village Adm. Bldg. Classroom
2125 N. Olive Street
Dee Muhlenbruch (209) 667-0042
Ukiah
Last Thursday, 5:30 PM
Selzer Realty Conf. Room
551 S. Orchard, Ukiah
Shirley Blattner (707) 621-0208
Carole Hester (707) 972-2795
Walnut Creek
4th Friday, 10 AM
Rossmoor, Hillside Clubhouse
Las Trampas Room
Carolyn Cash (925) 254-8195
West Sacramento
No meeting until new leader is found
Sandra Vinson (916) 372-6093
[email protected]
Woodland
3rd Monday, 1:30 PM
Woodland Comm. & Senior Center
2001 East Street
Beverley Matteoli (530) 662-7631
Yreka
For information call
Bev Anderson (877) 622-6298
Yuba City-Marysville
2nd Tuesday, 10:30AM
St. Andrew Presbyterian Church
1390 Franklin Rd.
(next to Winco Shopping Center)
Ken Lux (530) 673-3479
NEVADA
Reno-Sparks
For information call
Bev Anderson (877) 622-6298
OREGON
Salem
4th Monday, 6:30 PM
Community Health Education Center
Salem Hospital Campus, Bldg. D
890 Oak Street SE
Michael Siebler (503) 857-3508
[email protected]
Brookings
For information, call
Robert Levine (541) 469-4075
Start a support group in your area:
Contact Bev Anderson at (877) 622-6298 or [email protected]
INDEX
TOP
Help With Health
Care Challenges
If the number is not in
your area, call the one
listed and ask for the
right number.
Medicare
www.Medicare.gov
•••
The Affordable
Health Care Act
For current
information go to
www.HealthCare.gov
•••
HICAP
Health Insurance
Counseling
for seniors and people
with disabilities.
www.cahealthadvocates.org
/HICAP/
Call (800) 434-0222 to
ask a question or to
make an appointment.
•••
Health Rights Hotline
Serving Placer, El
Dorado, Yolo, &
Sacramento Counties,
regardless where you
receive your health
coverage.
Tollfree (888) 354-4474
or TDD (916) 551-2180.
In Sacramento,
(916) 551-2100.
www.hrh.org.
•••
HMO Help Center
Assistance
24 hours a day, seven
days a week.
(888) HMO-2219
or (877) 688-9891 TDD
•••
DRA’s Health
Access Project Free
publications about the
health care, insurance
rights and concerns of
people with disabilities
and serious health
conditions. For more
information, go to
http://dralegal.org/ and
click on “Projects”.
Page 3
DISCOUNTS FOR
PCNA MEMBERS
The following companies
or individuals have agreed
to give PCNA a discount
to PCNA members. Give
them a call or visit. If you
choose to purchase the
service or wares of any
on this list, pull out your
PCNA Membership Card
and claim the discount.
Anodyne Therapy
Infrared Light Therapy
equipment - $50 off Model
Freedom 300 (single
leg at a time) and $50
discount on Model 120
that does both legs at the
same time.
Contact: 800-521-6664 or
www.anodynetherapy.com
HealthLight
Infrared Light Therapy
equipment - 10% off
Single Boot System
$999 and Dual boot
system $1759
Contact: 888-395-3040
or www.healthlight.us
Auburn
The Footpath
825 Lincoln Way
Auburn, CA 95603
(530) 885-2091
www.footpathshoes.com
PCNA Discount:
10% off the regular
price shoes.
Elk Grove
Shoes That Fit
8649 Elk Grove Blvd.
Elk Grove, CA
(916) 686-1050
PCNA Discount:
20% off the regular
price shoes.
Fortuna
Strehl’s Family
Shoes & Repair
Corner of 12th & Main
1155 Main Street
Fortuna, CA 95540
(707) 725-2610
Marilyn Strehl, C.PED
is a Certified Pedorthic
PCNA Discount:
10% off the regular
price shoes.
– Continued on page 5
Page 4
DRUG OFFERS NEW PAIN MANAGEMENT THERAPY FOR DIABETES
A study from the University of Calgary’s Hotchkiss
Brain Institute shows there is evidence to support
a new drug therapy called nabilone to treat
diabetic neuropathy, or nerve pain. Researchers
enrolled 60 patients with diabetic neuropathy in a
12-week placebo controlled clinical study. At the
end of the study, patients reported less pain and
an improvement in sleep and anxiety when taking
nabilone as compared to the placebo.
“This is a good option to help treat nerve pain
due to diabetes, with very few side effects,” says
Dr. Cory Toth, a neurologist and the study’s lead
researcher. Toth is a member of the University of
Calgary’s Hotchkiss Brain Institute, Department of
Clinical Neurosciences and is the research director
of the Calgary Chronic Pain Centre Clinic.
The medication used in the study has the generic
name nabilone, and is currently used in Canada
to treat nausea in chemotherapy patients. This
study gives doctors more evidence to support
its prescription for treating neuropathy pain in
diabetics. Nabilone is a synthetic cannabinoid,
which mimics some of the chemical compounds
of cannabis, or marijuana. It is approved for use
by Health Canada and the FDA.
“This study is further demonstration of the potential
medical benefits of cannabinoids in a difficult pain
condition. Dr. Toth and his team have conducted
a solid trial which, although small, validates our
clinical experience. This study gives physicians
support to consider further options in treating
this devastating chronic pain disorder,” says Dr.
Mark Ware, Association Professor at the McGill
University Health Centre.
Type 2 diabetes is exploding at epidemic rates
all over the world, and Canada is no exception.
Recent studies show that type 2 diabetes is
present in close to 10 percent of Canadian adults
and growing at faster than predicted rates.
Diabetic neuropathy is damage caused to the
nerves, which results in numbness, tingling,
burning and pain. About half of all diabetics
suffer from diabetic neuropathy, and about half
of the group experiences extreme pain, sleep
disturbances, and difficulties walking.
Leslie knows firsthand the pain associated with
diabetic neuropathy. She was diagnosed with type
2 diabetes five years ago. Having participated in
the study, she experienced positive results. “My
pain was so severe that I could barely walk a
block. After taking nabilone, I can manage my
pain and I can function day to day,” she says.
(Used from a public domain news release)
PERIPHERAL NEUROPATHY LITERATURE REVIEW By William B. Donovan, M.D.
We can access the National Library of Medicine
(NLM) to obtain information on peripheral
neuropathy (PN). There are over 100 medical articles
a month written on PN.
I review these references and select articles
that would appear to be most interesting to us
neuropathy sufferers. This is the link to PubMed
that will take us to the
NLM: www.ncbi.nlm.nih.gov/sites/entrez
If you are reading this article on the computer, just
click on the above link to go there. If you are reading
the print edition of the newsletter, type this link into
the address bar of the browser on a computer. If you
don’t know how, get a librarian or friend to help you.
After you get to PubMed, you will see a line that
says “Search _PubMed” followed by “for” and a
space. Every article in the NLM is given a PMID, an
eight digit identification number. I will give you PMID
numbers of the selected articles. Type the PMID
into the space after the “for” and click on “Go” at
the end of the space, or press the ENTER key on
your keyboard. You will then see a one paragraph
abstract of the article appear, as well as links to
related articles.
INDEX
This month’s PMIDs:
•21775755 This is the four- year, multicenter,
randomized, controlled, Nathan I study of
alpha lipoic acid in chronic, mild to moderate,
diabetic, distal, symmetric, sensorimotor
polyneuropathy. Nathan I demonstrated
clinically meaningful decrease in the
progression of neuropathic symptoms.
•21807565 A French study demonstrating
that rTMS (repetitive transcranial magnetic
stimulation) significantly reduces neuropathic
pain in 79% of peripheral neuropathy patients.
•21998121 This is a randomized, controlled
study of patients with acute sciatica. In
the group treated with two subcutaneous
injections of adalimubab (a tumor necrosis
factor, alpha), 28% required surgery within
three years, whereas 56% of the control group
required surgery.
•22050401 This Kuwaiti study found that those
Type 2 diabetics with peripheral neuropathy
had significantly lower vitamin D levels than
those without. Further study assessing
TOP vitamin D as a preventive is suggested.
ALPHA LIPOIC ACID GOOD FOR NEUROPATHY
I have been reminded recently that I’ve not
mentioned Alpha Lipoic Acid in the newsletter
recently. I have taken it for several years and
can testify that for me it has been a wonderful
help. If you are diagnosed in Europe, especially
Germany, Alpha Lipoic Acid is the first thing that
you are requested to take.
Alpha Lipoic Acid is a universal anti-oxidant.
It works in all types of cells to put down free
radicals. It also helps to refresh other antioxidants like Vitamin E and C, CoQ10, and
glutathione. It has been found effective with a
variety of types of neuropathy especially diabetic
neuropathy as it helps to stabilize blood sugars.
The recommended dosage is 600 mg a day - 300
in the morning and 300 at night. It is taken with
food. You want to find a 300 mg capsule or pill
rather than taking multiples of other sizes.
In Europe and in some places in the United
States, it is given by injection or by infusion
rather than taking it as a daily medication. It is
reported be very effective in reducing the pain
and disability of neuropathy.
Here is what it says about obtaining it in our listing
of Complementary and Alternative Treatments
for Neuropathy publication.
Alpha Lipoic Acid can be obtained in pharmacies
and health food stores but possibly at a lower
cost via mail order. Here are two examples, but
there are other mail order sites that carry it as well.
At Vitacost: 1-800-793-2601 or www.Vitacost.
com. Two bottles of 120 (240 total) $12.69 each
plus $4.95 for shipping no matter the size of
your order is $30.33. The recommended choice
when asked is NSI Alpha Lipoic Acid, 300 mg.
- 120 caps. Swanson: 1-800-437-4148 Item
#D4SWU136. This is for bottles of 60 of the 300
mg. capsules. Each bottle is $9.89. You save
on shipping and handling by ordering more. So
it is $9.89 x 3 - $29.67 - $4.95 (S/H) - #$34.64
is the total. The Vitacost product is reported
to be a smaller, easier to swallow capsule. It is
important to take the capsules with food and best
to not lie down immediately after taking it. Like
other vitamins or supplements, you want to let it
begin digesting before changing its environment.
COSTCO is always a good place to check on the
price of medicine and over the counter items due
to their patient oriented drug pricing policies.
Vitamin B12 - Continued from page 1
synthesis. Vitamin B12 functions as a cofactor
for methionine synthase and L-methylmalonylCoA mutase. Methionine synthase catalyzes
the conversion of homocysteine to methionine.
Methionine is required for the formation of
S-adenosylmethionine, a universal methyl
donor for almost 100 different substrates,
including DNA, RNA, hormones, proteins,
and lipids. L-methylmalonyl-CoA mutase
converts L-methylmalonyl-CoA to succinylCoA in the degradation of propionate, an
essential biochemical reaction in fat and protein
metabolism. Succinyl-CoA is also required for
hemoglobin synthesis.
Vitamin B12, bound to protein in food, is released
by the activity of hydrochloric acid and gastric
protease in the stomach. When synthetic vitamin
B12 is added to fortified foods and dietary
supplements, it is already in free form and,
thus, does not require this separation step. Free
vitamin B12 then combines with intrinsic factor, a
glycoprotein secreted by the stomach’s parietal
cells, and the resulting complex undergoes
absorption within the distal ileum by receptormediated endocytosis. Approximately 56% of
a 1 mcg oral dose of vitamin B12 is absorbed,
but absorption decreases drastically when the
capacity of intrinsic factor is exceeded (at 1–2
mcg of vitamin B12).
Pernicious anemia is an autoimmune disease that
affects the gastric mucosa and results in gastric
atrophy. This leads to the destruction of parietal
cells, achlorhydria, and failure to produce intrinsic
factor, resulting in vitamin B12 malabsorption.
If pernicious anemia is left untreated, it causes
vitamin B12 deficiency, leading to megaloblastic
anemia and neurological disorders, even in the
presence of adequate dietary intake of vitamin
B12.
Vitamin B12 status is typically assessed via
serum or plasma vitamin B12 levels. Values
below approximately 170–250 pg/mL (120–180
picomol/L) for adults indicate a vitamin B12
deficiency. However, evidence suggests that
serum vitamin B12 concentrations might not
accurately reflect intracellular concentrations.
An elevated serum homocysteine level (values
>13 micromol/L) might also suggest a vitamin
B12 deficiency. However, this indicator has poor
– Continued on page 6
DISCOUNTS FOR
PCNA MEMBERS
Continued from page 4
Sacramento
Midtown
Comfort Shoes
3400 Folsom Blvd.
Sacramento, CA 95835
(916) 731-4400
PCNA discount: 15%
on the regular price.
West Sacramento
Beverly’s Never
Just Haircuts
and Lilly’ Nails
2007 W. Capitol Ave,
West Sacramento, CA
Hair–(916) 372-5606
Nails–(916) 346-8342
PCNA discount:
10% off the regular
price
Additional
Discounts
Do you know a
business that might
offer our members
a discount? Tell
them that they
will be listed each
month in our
newsletter and on
our website so our
members will know
of their generosity
and patronize their
business. Call (877)
622-6298 or e-mail
[email protected].
We ’ l l m a i l a n
agreement form to
the business, and
once we have it,
we’ll add them to
this list.
Page 5
Vitamin B12 - Continued from page 5
specificity because it is influenced by other factors, such as low
vitamin B6 or folate levels. Elevated methylmalonic acid levels
(values >0.4 micromol/L) might be a more reliable indicator of
vitamin B12 status because they indicate a metabolic change
that is highly specific to vitamin B12 deficiency.
Intake recommendations for vitamin B12 and other nutrients are
provided in the Dietary Reference Intakes (DRIs) developed by
the Food and Nutrition Board (FNB) at the Institute of Medicine
(IOM) of the National Academies (formerly National Academy of
Sciences). DRI is the general term for a set of reference values
used for planning and assessing nutrient intakes of healthy
people. These values, which vary by age and gender, include:
Recommended Dietary Intake
Recommended Dietary Allowance (RDA): average daily level of
intake sufficient to meet the nutrient requirements of nearly all
(97%–98%) healthy individuals.
• Adequate Intake (AI): established when evidence is insufficient
to develop an RDA and is set at a level assumed to ensure
nutritional adequacy.
• Tolerable Upper Intake Level (UL): maximum daily intake
unlikely to cause adverse health effects.
Sources of Vitamin B12
Food
Vitamin B12 is naturally found in animal products, including
fish, meat, poultry, eggs, milk, and milk products. Vitamin B12
is generally not present in plant foods, but fortified breakfast
cereals are a readily available source of vitamin B12 with high
bioavailability for vegetarians. Some nutritional yeast products
also contain vitamin B12. Fortified foods vary in formulation, so
it is important to read product labels to determine which added
nutrients they contain.
Several food sources of vitamin B12 are listed in Table 2.
Dietary supplements
In dietary supplements, vitamin B12 is usually present as
cyanocobalamin, a form that the body readily converts to the
active forms methylcobalamin and 5-deoxyadenosylcobalamin.
Dietary supplements can also contain methylcobalamin and
other forms of vitamin B12.
Existing evidence does not suggest any differences among forms
with respect to absorption or bioavailability. However the body’s
ability to absorb vitamin B12 from dietary supplements is largely
limited by the capacity of intrinsic factor. For example, only about
10 mcg of a 500 mcg oral supplement is actually absorbed in
healthy people. In addition to oral dietary supplements, vitamin
B12 is available in sublingual preparations as tablets or lozenges.
These preparations are frequently marketed as having superior
bioavailability, although evidence suggests no difference in
efficacy between oral and sublingual forms.
Prescription Medications
Vitamin B12, in the form of cyanocobalamin and occasionally
hydroxocobalamin, can be administered parenterally as
Page 6
TABLE 2: Selected Food Sources of Vitamin B12 Food
Micrograms Percent
(mcg)
DV.*
per serving
Clams, cooked, 3 ounces
84.1
Liver, beef, cooked, 3 ounces
70.7
Breakfast cereals, fortified with 100% of
the DV for vitamin B12, 1 serving
6.0
Trout, rainbow, wild, cooked, 3 ounces 5.4
Salmon, sockeye, cooked, 3 ounces
4.8
Trout, rainbow, farmed, cooked, 3 ounces 3.5
Tuna fish, light, canned in water, 3 ounces 2.5
Cheeseburger, double patty and bun,
1 sandwich
2.1
Haddock, cooked, 3 ounces
1.8
Breakfast cereals, fortified with 25% of
the DV for vitamin B12, 1 serving
1.5
Beef, top sirloin, broiled, 3 ounces
1.4
Milk, low-fat, 1 cup
1.2
Yogurt, fruit, low-fat, 8 ounces
1.1
Cheese, Swiss, 1 ounce
0.9
Beef taco, 1 soft taco
0.9
Ham, cured, roasted, 3 ounces
0.6
Egg, whole, hard boiled, 1 large
0.6
Chicken, breast meat, roasted, 3 ounces 0.3
1,402
1,178
100
90
80
58
42
35
30
25
23
18
18
15
15
10
10
5
*DV = Daily Value. DVs were developed by the U.S. Food and Drug
Administration (FDA) to help consumers determine the level of various
nutrients in a standard serving of food in relation to their approximate
requirement for it. The DV for vitamin B12 is 6.0 mcg. However, the FDA
does not require food labels to list vitamin B12 content unless a food
has been fortified with this nutrient. Foods providing 20% or more of the
DV are considered to be high sources of a nutrient, but foods providing
lower percentages of the DV also contribute to a healthful diet. The U.S.
Department of Agriculture’s Nutrient Database Web site [13]) lists the
nutrient content of many foods and provides a comprehensive list of
foods containing vitamin B12.
a prescription medication, usually by intramuscular injection.
Parenteral administration is typically used to treat vitamin B12
deficiency caused by pernicious anemia and other conditions
that result in vitamin B12 malabsorption and severe vitamin B12
deficiency.
Vitamin B12 is also available as a prescription medication in a
gel formulation applied intranasally, a product marketed as an
alternative to vitamin B12 injections that some patients might prefer.
This formulation appears to be effective in raising vitamin B12 blood
levels, although it has not been thoroughly studied in clinical settings.
Disclaimer: This fact sheet by the Office of Dietary Supplements (National
Institutes of Health) provides information that should not take the place of
medical advice. We encourage you to talk to your health care providers
(doctor, registered dietitian, pharmacist, etc.) about your interest in,
questions about, or use of dietary supplements and what may be best
for your overall health. Any mention in this publication of a specific brand
name is not an endorsement of the product. (Information from material in
the public domain.)
INDEX
TOP
PCNA BOARD OF DIRECTORS DECEMBER 10, 2012 MEETING UPDATE
Board Meeting Minutes and Financial Reports –
At every meeting, the Board reviews and approves
the minutes from the previous meeting supplied
by Secretary Pam Hart as well as PCNA’s financial
reports. At this meeting, Treasurer Wayne Hewlett
also led the discussion on drafting a budget for
2013. One of our primary financial goals for 2013
is to be able to maintain funding for the secretarial
support that we have found so valuable.
Strategic Plan Update – Treasurer Wayne Hewlett
also volunteered to update our strategic plan –
remove goals that we have completed or may no
longer be appropriate. The Board will now begin
identifying specific tasks needed to accomplish the
remaining goals as well as time lines and who will
responsible for the related activities. The Board had
reviewed the suggestions submitted by attendees
at the 2011 Annual Meeting and we found that our
members’ suggestions were all in-line with the
major goals identified in the strategic plan.
2013 Annual Meeting – Board director Sandra
Graforth has been researching locations for
our 2013 Annual Meeting and Mini-Medical
Conference. After several years of holding the
meeting in Woodland, CA, we anticipate holding
the 2013 Annual Meeting in Livermore in April.
Look for a ‘save the date’ announcement soon.
This is always a very worthwhile event.
Raising Funds for PCNA Is Easy through iGive.
com – If you haven’t visited our website lately,
we invite you to click on the iGive.com button
on our home page. This is a reputable sight that
has signed on more than 1,200 stores who will
give back to PCNA as a donation a percentage
of the price of items you purchase online. The
percentage donated varies by store. According
to iGive, the average iGive shopper raises $30
to $60 a year for their cause. Wouldn’t that be
wonderful? You purchase items and gifts you
already need, and PCNA benefits as well.
PCNA Planning Inaugural Walk-a-Thon (and
Mini-Health Fair) – In recognition of May as
Neuropathy Month, the PCNA Board is planning to
launch the organization’s first walk-a-thon to raise
funds for the organization and awareness about
neuropathy. The walk-a-thon will be held in the
Sacramento area. We’ll use this year as a learning
opportunity so that we can later mentor our
support groups to organize their own mini-walks in
their local areas so that everyone can participate
in some manner. If you live in the Sacramento area
we hope that you will plan to participate. ‘Save
The Date’ announcement on page 8.
Raising Awareness for PN – Three ‘campaigns’
we are working on to raise awareness about
PN include sending information about PN and
Support Group Meeting locations to: 1) all
libraries in California to post on their community
boards and have as a reference for patrons, 2)
certified/licensed pedorthic professionals, and 3)
neurologists.
Professional Memberships and Corporate
Sponsorships – We have updated the professional
membership brochure and developed corporate
sponsorships. We will be reaching out to various
audiences to recruit their membership as well as
corporate sponsorships to support our mission.
President’s Message - Continued from page 3
helps a great deal to lose some pounds. I’ve lost
25 pounds in the last few months and have much
more energy. My neuropathy is better too. Strict
limiting of salt and portion size helps. My doctor
gave me some assistance as well.
I wish you and your family a very Merry Christmas,
the happiest of new years, and enjoyment of any
other holiday(s) you celebrate this time of year.
A rather recent problem that I want to alert you
to is that Microsoft does not call anyone. If you
get a call that says they are from Microsoft or
Windows Technical Department or some other
line, just hang up. They are up to no good. It is
a scam for which you will pay dearly. I think I’ve
been called about five times in recent weeks.
In this issue, please note the information on B12
and Alpha Lipoic Acid. Be sure the test for B12
level is included in your annual blood work. You
and your doctor should know whether you need
supplementation or not. We don’t absorb B12 as
well when we are older. Low B12 is one of the
causes of neuropathy. If you are not taking Alpha
Lipoic Acid and have never tried it, I recommend
you check with your doctor before you to take it.
It is purchased over the counter but your doctor
should know you are taking it.
One further hint I’d like to pass along to consider
in the new year is that if we are overweight, it
By Karen C. Polastri, Vice President
P.S. You have recently received a letter from The
Pacific Chapter of The Neuropathy Association
over my signature. You are a member so you either
received the one saying your dues are due or the one
that let you know your dues are paid. Nonmembers
received a letter that offers them the opportunity of
joining. All letter mentioned dues and the need for
donations. It is a good opportunity to give end of year
contributions. If you just joined, you may receive the
incorrect letter as the lists were compiled one day
and memberships could have been received after that
before the mailing is sent out.
INDEX
TOP
Video Program
PCNA DVDs
Available
$5 each
Gentle Yoga
Spring Meeting 2010
Spring Meeting 2010
Special Material
Dr. Ezekiel Fink on
Small Fiber Neuropathy
Neuropathy Action
Awareness Day 2009 #1
Neuropathy Action
Awareness Day 2009 #2
Neuropathy Action
Awareness Day 2009 #3
Spring Meeting 2009
Dr. Peter Skaff
Dr. Jeffrey Ralph
For details about the
program on each DVD, an
order form, and handouts
for some of the
presentations,
see our website
www.pnhelp.org/resources/
audio-and-video/
Page 7
The Pacific Chapter
of The Neuropathy Association
NONPROFIT
ORGANIZATION
U.S.POSTAGE
A California public benefit, nonprofit,
tax exempt corporation
PAID
P.O. Box 276567, Sacramento, CA 95827-6567
PERMIT NO. 25
AUBURN, CA 95603
Call PCNA using Our Toll Free Phone Numbers:
(877) 622-6298 • Email: [email protected]
• PN Information/Advice • Support Group Inquiries
(888) 556-3356 • Email: [email protected]
• Membership Information/Inquiries • Sponsorships
• General Organizational Inquiries • www.pnhelp.org
A SURPRISING CAUSE OF NEUROPATHY
A question was sent to Dr. Jeffrey Ralph, Director of The Neuropathy Center at
U.C. - San Francisco that a member of a support group asked, “Can anesthesia,
if one has multiple operations, be a cause for neuropathy?”
Dr. Ralph’s answer was, “General anesthetics are not known to cause neuropathy,
except for nitrous oxide (which is not widely used anymore).
This is otherwise known as “laughing gas.” It was sometimes offered to patients
in dentist offices as a light anesthesia. This has also been used during labor as a
child is being born or for light surgery. Another use has been during major surgery
in combination with oxygen and other more potent drugs. It might be likened to
mercury. Children, and even adults, have been known to enjoy playing with it.
However, it is highly toxic and could be the reason some have neuropathy.”
The Pacific Chapter of
The Neuropathy Association (PCNA)
A California public benefit, nonprofit,
tax-exempt corporation.
Bev Anderson, Editor
P.O. Box 276567
Sacramento, CA 95827-6567
(877) 622-6298 • (888) 556-3356
[email protected] • www.pnhelp.org
PCNA Headquarters: [email protected]
Our mission is to provide support, information and
referral to people with neuropathy and to those who
care about them, to inform and connect with the
health care community, and to support research.
Dues - $30 a year
All contributions and dues are tax-deductible.
SAVE THESE DATES
The Pacific Chapter of The Neuropathy Association - Annual Conference
Date: Thursday, April 11, 2013
Location: Asbury United Methodist Church, 4743 East Ave., Livermore, CA
PCNA Inaugural Walk-a-thon (and Mini-Health Fair)
Date: May (specific date to be determined)
Location: Sacramento Area
The Neuropathy Action Foundation Annual Neuropathy Action Awareness Day
Date: Thursday, June 20, 2013
Location: Mr. C Beverly Hills Hotel, 1224 Beverwil Dr., Los Angeles, CA
INDEX
We are supported by dues-paying members,
contributions by members and friends, and
occasionally, small grants.
This newsletter is designed for educational and informational
purposes only. The information contained herein is not intended
to substitute for informed medical advice. You should not use this
information to diagnose or treat a health problem or disease without
consulting a qualified health care provider. The Pacific Chapter of the
Neuropathy Association (PCNA) does not endorse any treatments,
medications, articles, abstracts or products discussed herein. You
are strongly encouraged to consult a neurologist with any questions
or comments you may have regarding your condition. The best care
can only be given by a qualified provider who knows you personally.