Posted by Larry Hoover on March 18, 2007, at 12:04:05
In reply to Re: Vitamin D deficiency, posted by natrfrk on March 13, 2007, at 10:07:32
> Lar, Thank you so much for taking the time to help me understand this. I appreciate your help so much.
I'm glad to help. I had the flu this week, so I wasn't really functional for a few days.
> It will be another two or three weeks before my follow up with the doctor and it's almost impossible to get understanding from his staff over the phone.
Ya, I know. And I wouldn't expect them to provide much understanding in person, either. There's an analytical process involved, learned by rote. They might not even remember why.
> Right now, I am trying to absorb all the information you've given me. Trying to make sure I don't miss any of your concerns or questions too. I am doing online research for further understanding. I'm having a little trouble comprehending the whole PTH part. I know it's not that difficult to understand, I just need to get it all straight in my head. And no, there was no test for that.I've done some more research myself, and I find that I've been a little too cautious with respect to PTH. The parathyroid glands (there are four of them) regulate blood calcium. They probably do more than that (there are tissues in the gland that we haven't yet identified with a particular biochemical process). Directly sensing blood calcium as it flows to the brain, the parathyroid glands are constantly and instantaneously responding to any variations in calcium concentration by instantaneously increasing or decreasing the release of parathyroid hormone. If calcium goes down, PTH goes up, and vice versa.
The kidneys receive this PTH signal, and respond in two ways. First, high PTH will increase the kidney's tendency to pull calcium back from the fluid that will enventually be released as urine, reducing excretion of this mineral. Second, the kidneys convert 25-hydroxy-vitamin D3 (really a prohormome, also known as calcidiol) into the more active form 1,25-dihydroxy-vitamin D3 (also known as calcitriol). Of course, that conversion depends on there being some 25-(OH)-D3 (calcidiol) circulating in the blood. That's the stuff you've proven to be deficient in. With the high PTH that I'm assuming, the kidneys are doing their utmost to convert every molecule of the prohormone they can find, to respond appropriately to the parathyroid's commands.
In turn, the kidney's output of 1,25-D3 (calcitriol) would ordinarily turn on the intestinal calcium pumps, but there just won't be enough produced to induce the formation of the calcium-binding proteins that accomplish this task. So, in vitamin D deficiency, calcium uptake from diet decreases, and kidney excretion increases. Less in, and more out. The only alternative source is the massive storehouse in bone.
Bone is composed of little compartments called osteons. Osteons are constantly being formed and dissolved. The balance between the two processes determines whether bones are getting stronger, or getting weaker. Under the influence of high PTH and low 1,25-D3, the dissolution of bone rate is far higher than the rate of deposition of new bone. The adult form of rickets, osteomalacia, will develop over time, if this condition persists. I'd suspect yours has been around for a while.
> Should I request a test for the PTH?No. Your normal calcium levels show your parathyroids are doing their job. It's not really necessary to test for PTH. Yours is definitely going to be high. Well, it was.
Now, what I didn't understand before is how quickly the parathyroid hormone level falls, once adequate D3 is made available. We're talking minutes, not weeks. So, that concern I raised about waiting for PTH to fall is not warranted.
However, the intestinal uptake pumps are going to take a little while to respond to increases in 1,25-D3, as it must bind with nuclear DNA and activate protein synthesis. That will take a little time. Assuming you've already initiated D3 supllementation, you can increase calcium intake at any time now.
> You seem pretty confident that mine is high... So, I am trying to understand the consequences of that. I think I understand why you are saying to NOT take any calcium. Is it to prevent hypercalcemia?
That was my fear, but it was unwarranted. Just an overabundance of caution from someone who isn't a doctor. I'm trained in toxicology, not medicine.
> You asked if I have any back pain or leg or arm or rib pain... I have had lower back and hip pain for years. It started a few days after the birth of my child. It was intense and debilitating during the breastfeeding years. But once I weaned her, it slowly became less and less debilitating. Now six years later, I only get flare ups. And they are usually in time with PMS. I was told by my chiropractor that it was caused by hormones. He had a name for it, that I never could remember. But he said it was pregnancy induced, and if I had another baby, the problem in his opinion would be WORSE.
The extra symptoms I asked about were commonly seen in osteomalacia.
http://www.nlm.nih.gov/medlineplus/print/ency/article/000376.htm
According to the above article, complete healing can occur within six months of treatment.
If your hip pain remits with this vitamin D treatment, I'd be thinking you've had this disorder for some years. If nothing else, it complicates whatever else might be involved with your pelvic pain. What's your ob/gyn say?
> So, I haven’t tried to get pregnant again out of the fear of living like that for another three years again (The most intense part of it was the first 3 months after her birth). Could he have been wrong? Could it be from the D deficiency, and just the pregnancy and all the hormone changes brought it on?
It's a possibility. I've tried to stay clear of complicating an already complicated issue, but estrogen metabolism also affects bone density, and thus, symptoms arising from calcium loss from bone, leading to pain. Pregnancy certainly messes with female hormones.
> I really don’t want to live like that again. I mean, since I have my daughter and I know her, I would do it all over again to have her. But I don’t know the next one. I don’t even know if there IS a next one. (I’ve been married 15 years, only been pregnant twice, miscarried the first. And we have NEVER used ANY birth control.) But if this was caused by the D deficiency, and I knew I would not have a relapse and have to live like that again… I would love to have another baby, God willing.
It's going to take some time to effect the changes we'd expect with vitamin D supps. But it's possible that these symptoms will disappear.
> But I was so bad that first three months, my husband had to work from home and help with the baby. I could not get out of bed with out him manipulating my body. My pelvic region would be stuck, froze, caught…. My husband had to “uncatch” everything. It took almost an hour to get me out of bed every day…
Sounds like pelvic ligaments were strained. Again, I'd consult an ob/gyn. You might have been able to use analgesia, if the pain was not caused by a true functional disorder. I have chronic pain, and I know I'm not hurting my tissues by using them. I simply have to manage the pain, and maintain all the function that I can. Pain sometimes warns of injury, but not always.
> Anyway, now the only BONE pain I am aware of is my tail bone, and sometimes the bones on the top of one of my feet.
Just trying to match up symptoms with disorders, to get an idea of severity.
> And then the tooth thing started the beginning of February. And it was at it's worst during PMS time. The teeth started to heal, it seemed, slowly, but steadily in the last month. But we are back at the PMS time, and they are not showing any new signs of healing. But I don't think they are showing any new signs of getting worse either. So, I am hoping they are really healing. My husband claims he can see a difference. Where they were getting pointy, he says they are squaring off, or rounding off. I hope that means they're healing and not dissolving more. But he says they look more like their old normal selves. Not completely though. They are smaller and still somewhat misshapen.I'd expect this to gradually improve, too. Fingers crossed, anyway.
> Geez, I'd have never guessed a single vitamin deficiency could cause so much trouble all by itself. The doctor's office is acting like this is not such a big deal. Like if I take the prescription, everything will be all better. But it won't, will it? Don't these other things need to be concerns, at least? Shouldn't they be addressed as possibilities?There is a point of bone resorption beyond which damage is irreparable, but I don't see any evidence you've crossed that line. You are vulnerable, but you're intervening in a timely manner.
> I don't know that they aren't in the doctor's plans, because I have not gotten to talk directly to him. I guess I may be worrying prematurely. But it's good... this way, I will be informed BEFORE he brings stuff up to me, and informed to bring it up myself if he does not.
>
> I don’t remember if I said so before or not, but I chose NOT to fill the prescription through the pharmacy. They wanted $21 for 12, D2 50,000IU. I bought D3 50,000IU from Bio Tech online. A website called Vitalady.com, for $24. And I’ve been going outside every day. : )If you're north (or south) of the 40 degree latitude marker, seasonal UV-B penetration goes to zero in the winter. It's just starting to come back up, as the angle of the sun changes. The light goes through far less atmosphere in summertime, penetrating more closely to the perpendicular. Getting out is good, though. It certainly can't hurt.
> I finally got my bill for the Vitamin D test… $215!!! I called the lab to tell them I am uninsured, and they were absolutely NO help. They just offered to set up a payment plan. I will just pay it. But I just think that is way too expensive for one test. And since I have to keep monitoring this level, I will have to pay this amount every month or however often the doctor tests me.
Dear me. That's quite a cost. Barring some rare genetic quirk, you can be pretty certain you're getting the benefit from the D3 supps, without needing any further testing. According to one site I read, D3 uptake is passive (meaning it just happens), and 50-80% is absorbed. Moreover, the half-life is said to be 288 hours (12 days).
> I hope I at least don’t have to pay an office visit for and after each.
I'd simply raise the cost issue with the doctor. Unless your peace of mind is suffering greatly, you can likely skip any more blood tests, without any real risk.
> Wow, this is a long post. I hope you don't mind. But I think I am finally putting this all together. What do you think? Do you think I'm "getting" it?
Yes. Every concern seems relevant, IMHO.
> Sorry it took me so long to get back to you. I had a busy weekend. And a hectic Monday.
> Thank you again so much!
>You're welcome.
And about your daughter......good chance she has your genes, and thus any vulnerabilities that you have. There are genetic quirks in vitamin-D receptor structures, blah blah. You can safely supplement your daughter as well. Just adjust the dose on a body-weight basis.
Best,
Lar
poster:Larry Hoover
thread:739011
URL: http://www.dr-bob.org/babble/health/20070227/msgs/741950.html