Description
MR is a 42-year-old patient who presents with vague complaints of fatigue, malaise, sore mouth, abdominal pain, and tingling of the hands and feet. Her PMH is noncontributory, and her social history includes a 24-pack-year history of smoking. Her family history includes a mother with thalassemia and a father with coronary artery disease and diabetes mellitus.MR tells you that she has decided that she will initiate her smoking cessation plan after the holiday is over.At this time, you have decided what you think is going on and are suggesting laboratory studies to determine a diagnosis. To determine the next steps, what will you need to consider?Although you have considered multiple diagnoses by which to identify her current symptoms, you have chosen only one. Discuss this principle.What stage of change is MR in regarding smoking cessation?
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Answer:1- In this case 42 years old patient with history of smoking 24packs/day, complaining of
fatigue, malaise and tingling sensation of the hand and feet most common health issue that comes to
my mind is B12 deficiency. The reasons smoking can cause a vitamin B12 deficiency, is smoking
can cause damages to the lining of the stomach, which makes it harder for the body to absorb
vitamin B12 from food. Also, smokers are more likely to have gastrointestinal problem like Crohn’s
disease or ulcerative colitis, that interfere with absorption. In addition, some studies show that
nicotine might directly interfere with absorption of vitamin B12 by attachment to receptors in the
gut. Poor absorption of vitamin B12 due to low stomach acid: Low stomach acid can be due to age,
diseases that cause low stomach acid, or the use of drugs to decrease stomach acidity.
So, to confirm my diagnosis, we need to do lab work that include 1: Serum Vitamin B12 Level:
This blood test measures the concentration of vitamin B12 in the bloodstream. Low levels may
indicate a deficiency.2 Complete Blood Count (CBC): This test assesses the number and types of
blood cells and can help identify anemia, which can be associated with B12 deficiency.
2-there is a potential link between smoking and vitamin B12 deficiency. Smoking has been
shown to impact the absorption and utilization of certain vitamins, including B vitamins. Vitamin
B12, in particular, is crucial for various bodily functions, including the production of red blood
cells and maintenance of the nervous system.
Research suggests that smoking may interfere with the absorption of vitamin B12 in the stomach.
The chemicals in tobacco smoke could affect the gastric mucosa and reduce the production of
intrinsic factor, a substance necessary for the absorption of vitamin B12 in the intestines.
It’s important to note that while smoking can contribute to vitamin B12 deficiency, various
factors can lead to this deficiency. These factors may include dietary choices, certain medical
conditions, and age. If someone has a history of smoking and is experiencing symptoms
suggestive of vitamin B12 deficiency, such as fatigue, neurological symptoms, or anemia, it’s
advisable to consult with a healthcare professional for appropriate evaluation and management.
3Behavior change can be conceptualized into five progressive stages: precontemplation,
contemplation, preparation, action and maintenance
Pt is in contemplation is when a person becomes aware the problem exists and is seriously
considering a change. These individuals are still using tobacco but do intend to quit within the
next six months. Discussions should encourage and reinforce the decision to quit, highlighting or
focusing on the reasons for the change and its importance.
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