Sabrina Roger, MD Neuromuscular Specialist Facebook ad: “Methylated Neurotropic B Vitamins, the active form of B12…”

About this ad

Meta Ad Library ID

1402601728677379

Platforms

Facebook, Instagram and Messenger

Relaunches

1

Niche

Supplements & Wellness

How we count

Ad text

I don't give a f*ck if this upsets you. I am going to say something that nobody with MS wants to hear. I started my 1,687th patient on infusion therapy on March 3rd, 2025. Eight days later, at 5:15 PM on March 11th, I was in the chair receiving my own first one. I was 52 years old. I am a board-certified neurologist. Twenty-one years of practice. Fellowship trained in multiple sclerosis. The order was written by a colleague I had trained five years earlier. I have had MS for eleven years and I refused to escalate for nine of them. Because every scan I have ever had came back the same. No new lesions. No enhancement. Stable. Eight days before I sat in that chair, my left leg stopped working in the stairwell outside my own clinic and I could not get up. The rollator was $275. The stairlift quote was $5,900. The infusion has billed my insurance $74,000 in the ten months since. They let me keep practicing. My privileges are intact. But I will never write the word stable on another MS report without remembering that mine said stable every year for eleven years while I lost the use of my left leg. I am writing this because I know exactly what my colleagues will say when they see it. I do not care. If you have multiple sclerosis, or someone you love does, please read the entire thing. I know it is long. I know you are scrolling. I know you have things to do. Ten months ago I would have given anything for someone with my credential to sit me down and tell me what I am about to tell you. Nobody did. I was diagnosed with relapsing remitting MS eleven years ago at 41. It started with optic neuritis in my left eye on a Thursday. I lost most of the vision in it for twelve days. I diagnosed myself in my own office before I ever saw a colleague about it. My mother had MS. She was called stable for seven years. The spasticity took her walking at 58, then her standing, and she needed full-time help for the last six years of her life. She passed in a nursing home at 64. The last MRI in her chart was read clean. No new lesions. I had watched the pattern in my own family, and I had built my entire practice on treating people who looked like my mother. I did what any MS specialist would prescribe. I started on Rebif at diagnosis. I moved to Tecfidera three years later after three new lesions. I have not had a relapse since, and that is exactly why I would not escalate. Every year my scan was clean and every year I told myself the drug was working. I did everything else too. I took 4,500 IU of vitamin D every day for eleven years and kept my level between 58 and 78. I did physical therapy three times a week for eight years. I swam. I bought the cooling vest. I did the autoimmune protocol for eighteen months, no grains, no legumes, no nightshades. I lost 15 pounds and kept it off. I checked every box on my own protocol. I checked boxes most of my patients cannot afford to check. And every year, my MRI came back the same. No new lesions. No enhancement. Stable. Stable. That word again. This disease does not follow a schedule, and I know that better than most people telling you this. It does not wait until you are ready. It takes strength on a random Tuesday for no reason at all and calls that progression. I have patients who describe a cane sitting in the corner they never planned on needing, who have lost count of how many small pieces of independence quietly disappeared while every scan kept saying stable. I used to hear that and nod with the appropriate clinical sympathy. I did not understand it in my own body yet. Last October I did something I had never done in eleven years of having this disease. I ordered tests on myself that measure what an MRI does not. The first was an OCT. Optical coherence tomography. It measures the thickness of the nerve fiber layer at the back of your eye, in microns, and that layer is central nervous system tissue. It is the one place you can see the structural health of your nerves, and it can show the damage that is present even when your MRI is stable. Mine had been 89 microns four years ago. It came back at 64. For context, I have called patients over the phone with numbers half that size and used the sentence, we need to talk today, not tomorrow. My MRI over those same four years had not changed at all. The second was a timed 25-foot walk. It is the crudest test in MS and it is the one that predicts what your life will look like in ten years. Four years ago I walked it in 4.9 seconds. That afternoon in my own hallway, with a stopwatch and nobody watching, I walked it in 8.4. I had not had a relapse in eight years. There was no lesion anywhere on my scan to explain either number. I scheduled a neuro-ophthalmology consult for myself. And then I did not go. I want to tell you why. Because sitting in my office at 7:30 PM staring at my own retinal thinning on my own screen, I recognized something. I was doing exactly what my mother had done. She had been called stable for seven years before the decline that put her in a chair. She had been on an interferon and a muscle relaxant. Her scans had read clean. Her lesions had been controlled. And she had died at 64 in a nursing home two hours from the hospital where I did my neurology residency. I did not go to my own consult because I already knew what it would show. I did not want it in writing. I told myself I had time. Four months later I went down in the stairwell outside exam room three. My left leg gave out at 1:40 in the afternoon. I remember the time because I had just finished a new patient consult and I looked at the clock to see how far behind I was running. I thought I had missed a step. I had not. It was the weakness I had described to three hundred patients in follow-up appointments. Left hip flexor first. Then the foot. Eight steps down and the leg would not hold my weight, and I went down against the railing and sat on the landing with my badge on. A resident I had trained through her MS rotation in 2023 came around the corner. She is not an MS specialist yet but she has heard me describe this exact presentation in that clinic for two years. She saw me on the floor and her face did the thing. She got me up, into a wheelchair, and down to imaging herself. They put me in the same machine I have sent three hundred patients into. I closed my eyes because I already knew what the report was going to say. Forty minutes. The same knocking I have described to three hundred people in follow-up appointments as nothing to be frightened of. They were looking for the relapse that would explain the leg. There wasn't one. The report came back the way my reports have always come back. Stable. No new lesions. No enhancement. I went home that night with my husband, a rollator, a leg that would not hold my weight, and a scan that said there was nothing wrong with me. After the fall, my colleagues wanted me to have a full workup. Every system, not just the leg. I did not want one. I ordered every one of those tests on myself anyway. Because I knew that if I did not, in three years I would be reading somebody else's chart and seeing my mother's numbers in it, and then my own. The neuro-ophthalmologist repeated the OCT on both eyes. Both nerve fiber layers had thinned. He used the phrase chronic axonal loss, which is what is left behind after the myelin in the optic nerve is gone. Nobody had flagged it in eleven years because OCT is not part of standard MS follow-up in most practices, including the one I built. The urodynamics study found 155 milliliters of post-void residual. Neurogenic bladder, which is demyelination in the cord between my brain and my bladder. I had been getting up twice a night for eighteen months. I had blamed coffee. The neuropsychologist put my processing speed at the 17th percentile, which is a direct measure of how fast a signal moves down a myelinated fiber. I had been taking charts home for six months. I had blamed my clinic volume. The physiatrist ran a nine-hole peg test. My left hand was three seconds slower than my right, which is demyelination in the tract running from my brain to that hand. I had stopped doing my own lumbar punctures the previous fall. I had told my partner the residents needed the practice. Every one of these was progressing while my MRI was stable. Not one of them was a relapse. Same disease. Same demyelination. Damage in my eyes. Damage in my bladder. Damage in my brain. Damage in my hand. And finally, damage in my leg. I sat in my office on March 14th with all four reports in front of me and I understood something I had never let myself understand in eleven years of treating this disease. Every drug I had ever been on was working on the immune attack. Rebif was working on the immune attack. Tecfidera was working on the immune attack. The infusion was working on the immune attack. All three did it well. Eight years without a relapse is those drugs doing exactly what they were built to do. Not one of them had touched the damage that was already done to my nerves. I hear the same cycle from patients constantly. Copaxone, then an oral like Tecfidera, then an escalation to Tysabri or an infusion. The names change, the pattern doesn't, and it's close enough to my own path that I recognize it before a patient finishes the sentence. I have patients who have been hospitalized after a string of falls in the same week, more than once, and every discharge summary uses the same word mine did. Nothing new. Stable. I am an MS specialist. I am supposed to be the person who knows how to stop this. I had put hundreds of patients on the exact protocol I was on. Every one of those prescriptions was correct. Every one followed the guidelines. Every one was the standard of care, and I would defend every one of them in front of any board in this country. And it had failed me at 52. I sat at my desk that night at 11 PM after my husband had gone to bed and I did something I had not done since medical school. I opened PubMed and I searched for the actual mechanism. Not the DMT trials. Not the management guidelines. The mechanism. The root cause. I read for four hours. I found what my training had covered lightly and never in the depth it deserved. PIRA. Progression independent of relapse activity. Failed remyelination. It is the explanation for why my scans never showed anything new, why I had not relapsed in eight years, and why my walking and my hand and my thinking got worse every year anyway. Every nerve in your body is wrapped in a fatty coating called myelin. The nerve needs it to carry a signal. MS strips it off, and what is left is a frayed nerve, starved of energy, that cannot do its job. Rebuilding that coating takes material and energy, and both have to be inside the nerve cell. That is all PIRA is. It is not new damage. It is old damage that the MS already did and that never got repaired. And this is why your MRI scans can come back stable while the demyelination is still happening in your body. None of this was hidden. It sat in journals I have had access to for twenty-one years. The Lancet Neurology. JAMA Neurology. Multiple Sclerosis Journal. The New England Journal of Medicine. I had read those journals every month. I had read them for the DMT trials. I had never read them for the mechanism papers, because my training had never told me anything about the root cause. My training was wrong. I closed my laptop at 3 AM and I sat at my kitchen table and I could not sleep. I understood at that moment that I had told hundreds of people they were doing well while this was happening inside them. I had said the words your scan looks great to people whose myelin was degrading while I said it. Two weeks later I saw a patient in follow-up who should not have been in the numbers she was in. Her name was Keiko. Diagnosed sixteen years. She had transferred to me five years earlier after a bad relapse. Her timed 25-foot walk at intake had been 9.6 seconds. Her fatigue score was one of the worst I had on file. I pulled her chart before she came in expecting to talk about a wheelchair evaluation. Her walk was 6.3 seconds. Her fatigue scale had dropped from 68 to 21. She had come off tizanidine eleven months earlier at her own insistence, and her walk only got faster after she did. I looked at her across the exam room and asked her what she was doing. She was quiet for a moment. Then she said, Doctor, my grandmother Yoshiko runs a small garden outside a town in rural North Carolina. She has been telling all of us for years. I did not bring it up because I did not think you would take it seriously. I asked her what her grandmother had told her. She wrote a name and a town on the back of my prescription pad. The name was Yoshiko Higa. The town was one in rural North Carolina I had never heard of. I drove there the following Saturday. I did not tell my husband where I was going. I did not tell my colleagues. I did not tell anyone in my department that a board-certified MS neurologist was driving three hours to meet a 79-year-old Okinawan grandmother because everything I had been taught in twenty-one years of practice had not saved me. I pulled into the driveway of a small house at 10:50 AM. She was in the garden along the front walkway. Goya. Mugwort. Sweet potato vines. A shikuwasa tree by the door. She was 79. Small woman. Straight-backed. Gray hair pinned back. She stood up out of that garden without putting a hand down to push herself up. I introduced myself. Not as a neurologist. As Sabrina. She looked at me with sharp clear eyes and asked me why I had come. I told her. I told her I was an MS specialist. Twenty-one years in practice. That I had my accident in my own clinic four months earlier. That my scans had been clean for eleven years. That four separate tests in my own body were showing the pattern I had watched in hundreds of my own patients. That one of my patients had told me about her. She listened. She did not interrupt. When I finished she said, Come inside, doctor. Her kitchen smelled like turmeric and ginger. She poured me tea without asking. She had been a hospital pharmacist in Naha for twenty-four years before she came here. Her sister in Okinawa was diagnosed with MS twenty-six years ago. Her sister is 77 now and still swims in the ocean every morning. She sat across from me and said, You are here because your scans are clean and you are getting worse. I said yes. She said, Then you already know your medicine is fighting the wrong battle. You know this. Nobody has ever given you anything for the root cause. I did know it. She said, In Okinawa we treat the nerve. Here they treat the immune system and they wait. Both are necessary. Your doctors gave you one. She got up and set three small bottles on the table in front of me, side by side. She tapped the first one. B12. The material your body rebuilds myelin out of. She tapped the second. B1. Rebuilding myelin takes an enormous amount of energy, and this is the coenzyme your nerve cells make that energy with. She tapped the third. B6. What your nerve cells need to send clean signals through your body. She pushed the three of them together until they were touching. Together they are called the neurotropic vitamins. Not general health vitamins. Neurotropic means they act on nerve tissue. In Okinawa this is what the clinics use for nerve damage and they have used it for decades. Your doctors gave you none of them. I told her I understood the biochemistry. I told her I had read the papers. She said, Then you understand it on paper. You do not yet understand it in your own body. Now here is what nobody taught you in medical school, she said. For as long as anyone in my family can remember, this is what we have used for nerves. My mother. Her mother before her. I am seventy-nine and I have never had a nerve problem in my life. My sister has taken these every day since the month she was diagnosed. She said, There is a cheap version of each of these and a real one. The cheap ones are synthetic. Cyanocobalamin instead of methylcobalamin. Pyridoxine hydrochloride instead of P-5-P. They are far less bioavailable than the active forms, which is a long way of saying your body can barely use them. Almost everything on an American shelf is the cheap one. And the cheap B6 is not only useless. At the doses they sell it in, pyridoxine hydrochloride causes peripheral nerve damage. There are nerve formulas in your pharmacies at 100 milligrams. The requirement is one to three. She is right. It is well documented. I have diagnosed it twice in my own clinic, and both times the patient had bought the product to help their nerves. I asked her if the delivery mattered. She nodded. Your blood test for B12 is not measuring what you think it is measuring, she said. It measures what is floating in your blood. It does not measure what got inside the nerve cell. Those are two different numbers and your doctors only ever check one of them. I argued for a second. Then I stopped, because she was right. She said, A B vitamin that is not liposomal gets into your bloodstream and does not get into your nerve cells. It raises the number on your lab report and it changes nothing about the tissue. That is a general maintenance product. It is not therapeutic and it will not rebuild myelin. A liposome is a microscopic sphere built from phospholipids. The same material your own cell membranes are made of, with the vitamins sealed inside. Because the shell and the membrane are the same material, the two fuse, and the vitamins are released inside the cell. Where myelin is rebuilt. In Okinawa the doctors give it by injection because they know the swallowed form does not arrive. The liposome does the same job without the needle. She paused. There is a company my nephew in Seattle told me about. All three neurotropic vitamins in one formula. The active forms, not the synthetic ones. B6 held where it is safe. Liposomal, so it reaches the nerve. She wrote a name on the back of an envelope and slid it across the table. Nuvel. Liposomal Neurotropic Vitamins. I read it in her driveway before I started the car. 5,000 micrograms of active methylcobalamin. Thiamine at a clinical dose. B6 as P-5-P, held where it is safe. All three neurotropic vitamins in one formula. Liposomal. I ordered three bottles from her kitchen table before I left North Carolina. I drove three hours home. I did not tell my husband where I had been. They arrived that Wednesday. I took the first dose the next morning. Week one. Since the fall I had been shutting my office door between 2 and 3 every day so I could lie down. On day five I worked straight through to five. Week two. I had been sleeping with my feet outside the covers since the summer because of the burning. That week I pulled the covers up. Week three. I timed my own 25-foot walk at home. 8.4 seconds in October. That week, 7.2. I ran it four times because I did not believe it. All four came in under 7.5. Week four. I did my own lumbar puncture for the first time in over a year. I ran a nine-hole peg test out of my office drawer. My left hand had closed to under a second behind my right. Week six. I slept through the night without getting up. Twice that week, four times the next. Week eight. I had the neuropsych battery run again. Processing speed had moved from the 17th percentile to the 40th. Week twelve. The same full workup I had run on myself in the fall. Timed 25-foot walk, 5.7 seconds. Down from 8.4. Nine-hole peg test, normal in both hands. Post-void residual, 38 milliliters. Down from 155. Fatigue scale, 23. It was 57 the week I started. OCT, 64 microns. Unchanged. After four years of losing five to six microns a year, that is the number I care about most on this entire list. And my MRI said exactly what it has always said. No new lesions. Stable. Same two words. Completely different body underneath them. I brought the results to my practice partner. Another MS neurologist. Fourteen years in practice. I put the October numbers next to the twelve-week numbers on his desk and I did not say anything. He read them. He looked at me. He said, Sabrina. What did you do. I told him. The 79-year-old pharmacist. The kitchen table. The three bottles pushed together. The liposome. All of it. He listened for an hour without interrupting. Then he asked the only question that mattered. Whether the infusion could account for it. It cannot. The infusion stops new lesions. It has no remyelinating mechanism and no trial of it has ever measured one. I had been on it eight weeks before I drove to North Carolina and my walk had not moved a tenth of a second. Then he said, I was not trained on any of this. But I want to see it in my own patients. Give me the name. I gave it to him. He has been running it with twelve of his MS patients for three months. He called me two weeks ago. Eight have improved their timed walk. Six have dropped their fatigue score by more than twelve points. One is out of a rollator he had been in for over a year. I am still on Kesimpta. That is not what this is. This is the other half. The half nobody gave either of us. In May I stood through my son's entire baseball championship. Two hours, outside, in the heat. I have not been able to bear the heat since 2020. My last timed walk, two weeks ago, was 5.1 seconds. I went down in the stairwell of my own clinic at 52 with a scan that said stable. I am writing this because I still have my practice. I can still do my own procedures. And I have watched four separate measurements in my own body reverse in twelve weeks, after eleven years of watching them only ever get worse. I have watched a colleague read my numbers and say the word I had waited ten months to hear. Improving. Not stable. Improving. I am also writing this because I know the truth about what my profession is doing, and I am the profession. I have read 7,940 MRIs. Every single time I wrote stable, no new lesions, I believed I was delivering good news. I watched the relief on people's faces. I said the words your scan looks great to a woman who told me in the same visit that she had stopped gardening, and I did not connect the two. I do not know how many of those people are in a chair now. I do not know how many of them are gone. I know that the standard of care I was trained in, and that I taught to residents, is built on the assumption that stopping new lesions is all you need to do. It is not. I have four sets of measurements in my own body that prove it is not, and my mother's chart proves it was not for her either. Seven years of clean scans, and she stopped walking at 58. I went down in that stairwell at 52. Six years ahead of her. The difference is that somebody's grandmother told me what my medical school did not. If you have MS, or your wife, your husband, your mother, or your daughter does, and you have been told your scan is stable while your body keeps getting worse, please listen to what I am telling you. The scan cannot see the myelin degrading. It never could. Stable means no new lesions. It does not mean the damage is being repaired, because nothing you have been given repairs it. Your DMT does not rebuild myelin. It is not designed to and it never claimed to. Whether it's Copaxone, Tecfidera, Tysabri, or an infusion, the mechanism is the same across all of them, slow the attack, leave the damage already done exactly where it is. Steroids do not rebuild myelin. They end a flare faster and they do nothing about what the flare left behind. Physical therapy does not rebuild myelin. It teaches you to work around the damage you already have, and you should still do it. Vitamin D does not rebuild myelin. I took 4,500 IU a day for eleven years and I went down in that stairwell anyway. Cutting grains and nightshades does not rebuild myelin. I did eighteen months of the autoimmune protocol and my nerve fiber layer thinned the entire time. Rebuilding myelin takes three specific things, and they have to get inside the nerve cell. B12 for the material. B1 for the energy. B6 for the signal. All three, in their active forms, at clinical doses, in a liposomal delivery that puts them inside the cell instead of leaving them in your blood where a lab test can see them and your nerves cannot. Nuvel Liposomal Neurotropic Vitamins. All three neurotropic vitamins in one formula. 5,000 micrograms of active methylcobalamin. B6 as P-5-P, held at a dosage where it is safe. Every ingredient in its active form. Liposomal, so the vitamins actually get into the damaged nerve tissue. One dose every morning. That is the whole protocol. 90-day money-back guarantee. If nothing about your walking, your fatigue, or your hands improves in three months, you pay nothing. The system that trained me did not give this to me when I needed it. It is reaching you now. P.S. My mother was called stable for seven years. She stopped walking at 58 and she passed in a nursing home at 64, and her final MRI report says no new lesions, and I have a copy of it in my desk. I built my entire practice on the belief that I would prevent for my patients what nobody prevented for her. Instead I walked the same road in my own body, under the same word, and I got there six years earlier than she did. The difference is that I got up off that stairwell landing and she did not get a second chance to. Please do not wait for a scan to give you permission to take this seriously. It will not. That is the entire point of what I have just told you. P.P.S. I do not work for Nuvel. I do not receive a penny from this. I am writing this at 11:15 PM on a Sunday, alone in my office, because a patient came in on Friday whose timed walk had dropped two seconds in six weeks and I recognized my own numbers on her chart. She had found it herself after reading something a man had written about his wife. She told me it had been going around an MS group she is in. I read it that night. It was the second time in four months that I have recognized my own patient in something written by a stranger, and not in anything written by my own field. Please send this to anyone you love who has MS. Even if they are doing well. Especially if they have just been told they are stable. P.P.P.S. Several people have asked whether this applies beyond MS, nerve problems in the neck, the back, anywhere a nerve has lost its coating. The mechanism is not MS-specific. Myelin is myelin, wherever it sits in your body. A nerve that has lost its coating needs the same material, the same energy, and the same signal support to rebuild it, regardless of what caused the damage in the first place. I would still get any new or worsening nerve symptom properly evaluated by a doctor before assuming the cause, but the biochemistry of repair itself doesn't change based on diagnosis. Edit: Several people have asked for the link so here it is - https://trynuvel.com/products/vitamin-b-complex-limposal

Where the ad sends people

trynuvel.com

Methylated Neurotropic B Vitamins, the active form of B12 at 5,000 micrograms

Clinical-grade dosed formula proven in studies