Calcium crisis! PTH Intact =142 H-E-L-P!!!!!

From about a year out, I have been having a very hard time with calcium absorption.

My latest labs are back, with PTH Intact at 142.  Highest normal of lab's reference range is 72. My last normal PTH Intact (72) level was in my December 2012 labs.  I have been slamming calcium citrate to get my parathyroids to shut up since it rose in my last labs.! (we were taught in Anatomy and Physiology class that the normally silent parathyroids send the signal that starts leaching calcium from bones when a low blood calcium level is detected) Magnesium is solid at 2.1 (reference range= 1.7-2.6)  Zinc, despite increased supplementation (it was low last labs, 6 months ago at 621 ) is low at 550 (reference=700-1200)

Vit D (24)  is not great either, even though after my last labs I increased to 100,000 IU daily. It is better than it was, but still not at optimum level. 

Vitamin experts, chime in please!  Too late for this month's budget, but next month, Vitalady's deficiency package is on my must-have list!  My PCP will probably order infusions to at least get my levels back up so I can maintain them. After next week, I only have one more year with my surgeon, and after that...it's all on the PCP!   I've done my best to train her, but where I live there is very little, if any experience with DS patients. There are only three of us in town, all from the same hospital, which has established support groups statewide!   Already been to the Hemo for iron infusions last summer.  Last infusion a bag of calcium was added at my request, and PTH intact was 72 (absolute last number in normal limit reference range) in December 2012 labs.

 

What time of day was the blood drawn for your latest PTH?

Morning , after the required 72 hour vitamin/mineral fast, and I had not yet eaten.

Are you taking vitamin K2 MK7 and strontium? They both help with calcium adsorption. Sounds like it's worth seeing if you can get some vitamin D shots too.

I take calcium hydroxapatite (Jarrow Bone Up or Vitacost's Bone Booster Complex, BBC is the better of the two) in addition to Vitalady's calcium citrate for a total of >3g calcium. I take 6 batches as you can't absorb much more than 500mg in one go.

Calcium Hydroxapatite?  In our pre-op classes it was drummed into us that Calcium Citrate was the only kind DSer's absorb.  I take Cal/Mag/D together.  The last time I shut my parathyroids up, and got the reading of 72, I did liquid Cal/Mag.  I'm going to get some more of that tomorrow and start chugging it.  I do take K1 and K2, but have not gotten the strontium yet. 

I know about the max absorption rate from classes.  My calcium citrate capsules (4 at a time = 1 serving) supply 1000 mg, so I've actually been taking a double dose of what I would normally get with the other OTC CalMag with D. Eight a day of those is what my surgeon requires, for a total of 2400mg daily. I've been taking way more than that.  The capsules I have are from Solaray, and from the label description, looks like they are formulated for RNY's, since it states the calcium is bonded with citric acid to make them more absorbable by those with insufficient stomach acid. That's certainly not me!  I'm on omeprazole/Nexium for life, although, since I have a sleeve and the greater curvature is gone, the acid pool is not in the stomach anymore...who knows! Before I found the capsules, I was quartering my CalMag with D pills...and ruined a couple good pill cutters doing it!  I even created a home-made version of the "Silent Knight" pill crusher they have in hospitals (read: pill in freezer-strength Ziploc bag on a paper plate, on concrete porch, smash the heck out of it with a hammer!) I have used CalMag powder, and I finally thought I had it licked with the capsules!

I always take my calcium with a citric acid beverage (lemonade, orange juice).

 As for the D, I don't know what more I can do. Obviously the "OD on Dry D" approach didn't work.  I always drive with my sunroof open on sunny days, and I'm going to try sitting out in the sun  more.  Since I also have lupus, sun exposure is *not* my friend, especially when it's strong in the summer!  Too much sun, and I set myself up for a very painful lupus flare! it is entirely possible that some of my other Rx meds are cancelling out the D...I'll be going over all of this with my various doctors.

I see my Hemo Tuesday, my PCP Thursday and my DS Surgeon Monday next week.  My PCP and Hemo share office space, so they might just go ahead and set me up for Ca infusions, and since I'm already doing  my own B12 shots, I can do D shots on myself, too, unless it's one of those butt shots.  I think as long as it's IM, it doesn't matter where...but I'll find all of that out this week. 

This nutritional crap is holding up my thighplasty, and I specifically took this year off from school to get it done!  Also wanted to be healing from the big incisions when there's no snow and ice, lest I fall and bust open every stitch I've got! There's lots of skin to be removed, and I want it gone yesterday!  It's interfering with hygiene, and I've had a few cellulitis attacks, too.  Ironically, even though cellulitis is associated with SMO, I never had it before I had surgery.  Let's not even talk about the cleansing ritual I go through to make sure I *don't* have a cellulitis attack!  That's why the skin removal is not vanity for me..my health depends on it!   An infection of that type can get to the bloodstream very quickly, and that's very bad news!  Last time I had one, just about six months ago, I had to take *two*  different antibiotics (Keflex followed by Cipro) to get rid of it completely, which means the ish is getting to be antibiotic-resistant!

When I wake up in the morning with that burning sensation in my esophagus, that tells me that the acid factory in my stomach is working overtime, when  my daily dose of omeprazole can't stop it!  I have never had that happen when my PTH has been either OK or high-normal, as it was last December.  During some of my coursework, and I *know* I read this, because it was a test question, stomach acid production increases when bone-leaching due to calcium deficiency is going on.

 

I do 3 batches of calcium citrate and 3 batches of Microcrystalline hydroxyapatite (MCHC) to hedge my bets.  There's an interesting article on strontium here http://www.worldhealth.net/news/strontium_breakthrough_again st_osteoporo/

I wouldn't bother with trying to sit in the sun if it causes you issues as your dark skin will filter out most of the vitamin D.  I'd head straight for the shots (I'm hoping to get shots soon myself).

I will still get some benefit from the sun, as my particular pigment is considered medium-light as far as African American skintones go. I appear a bit darker than I am in real life in the profile pic. 

It just means I need to stay in the sun a little longer to get the same effect as someone with less melanin.  That also means I have to make a decision about which is more important, overall health, or dealing with the pain and/or possibly being incapacitated by a flare.

I knew this was going to be a tough row to hoe when I had the DS with my attendant health issues, but my doctors and I decided that the benefits of reducing my 400+ pound girth  would outweigh the risks.

I still feel that way, and I don't want anyone talking to me about revision after 4+ years!

Good article!  I've already got strontium in sight as an addition to my supplements.  I found some Ortho Molecular at a reasonable price.  Any other manufacturers you recommend?

We only have this one which is the only thing available on script in the UK "Protelos 2g granule sachets".  It's Strontium Ranelate, which is the salt.  You'll have a a lot of buying choices in the US.  680mg seems to be the number to go for.  The article I supplied you the link for does say "2 gm/day of strontium ranelate (providing 680 mg strontium)" and that's what mine must be (I checked the leaflet that comes with it and doesn't specify).  They wouldn't over prescribe normies, esecially when they only have one form of strontium here.

You have to take strontium at bed time 2 hours away from ANY food, or a drink containing milk!! :-S  I wasn't hungry last night so did fine.  I do often get up after I've been in bed a couple of hours so I'm just toying with taking it in my first toilet break.  The sachet I had tasted pretty much like plain water.

100 k of D a day is not "overdosing."   Some of us take even more than that.   I was taking 200 k for a while, but managed to raise by D levels by taking Vitamin K1, Vitamin K2 and boron along with the D.    I also started taking my zinc and copper on alternate days.   I just started taking strontium    I'm assuming you did not learn this in your A&P class, but calcium and zinc should not be taken together, as they compete for absorption.   The calcium will win.   Take your zinc at another time, and your zinc will probably go up.    I know that some formulas combine both, but they should not be.  I take a combination of calcium citrate and calcium hydroxyapatite.    My PTH was up over 200.   Your PTH may always stay high, despite correction of your D and calcium, because the gland can remain enlarged permanently.    I would suggest that instead of dinking around with a PCP, you see an endocrinologist - specifically one that specializes in bone and mineral issues.  

The calcium/zinc thing would be chemistry and/or biology, but I already knew not to take them together. 

I do take them separately.  Calcium itself, from what I've observed on my own, seems to buffer or block everything else it comes into contact with, except in the synergy that exists with Magnesium and D.

I usually take my last dose of calcium at bedtime, and my zinc during the day, and I alternate the doses two hours apart.

I know 100,000 iu is not overdosing.  I was trying to inject some levity to get over being very, very afraid.