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It increases intestinal motility, pancreatic secretion, and biliary secretion (this may be one of the reasons Cheney believes he sees reduced biliary secretion ejection fractions in the gall bladder in almost every patient), stomach pepsin secretion, it inhibits stomach acid, and it increases chronotropism and inotropism in the heart (Rx chronic heart failure?) Its a potent pulmonary vasodilator

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Shared decision making Use shared decision making to establish a long term frequency of B 12 injections for each patient and teach them how to self-inject.80 How cost effective is B 12

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