Even doctors don't get good care!

[southernlady]

My oldest half sister is a vet. Knows lots of medical shit but even she is at the mercy of a human doc who insisted that a ferritin of 7 is not anemic.

Her D and B12 are in the toilet too. (D was 29) B12 was 400 something.

Told her to get on carbonyl or heme iron. Told her to take dry D3 5000 a day. And get some B12 from Costco.

I wonder how bad her labs would be if she actually got a full DS list?

Btw, for the record, she is a normie and "I" am the one suggesting what she needs to take.

Aaaaaarrrrrrrgggggg!!!! And her labs/
endo are at Mayo Jacksonville. They are who pulled the labs.

 

[bearmom]

Low vitamin D is a global problem for women. There really is no excuse for it not to be checked and treated properly in the medical community. When looking at my moms labs, I saw she was on D and b12 as well, and then looked back in her records as many years as I could, and realized it had unmentioned for decades. If the Dr didn't mention it, she assumed it was fine. Of course she has had osoeporosis for years now, and when I recently when with her to an appointment and brought this up, he said, "well, she can chew a few Tums a day for calcium". Oy.

I don't think that until I had the DS, and came to places like THIS, that I had any idea how clueless my Drs were. Of course saying that anywhere else you'll get plenty of eye rolls when you claim that posters on a site like this know SO much more than any of your docs, lol.

I hope you convinced her to get copies and go over them herself.

 

[southernlady]

I hope you convinced her to get copies and go over them herself.

She shared them with me last night, so I was able to recommend which kind of iron, a suggested amount, etc. She's use to reading dog and cat labs not human.

I also suspect my decades of untreated D is at the bottom of my current osteoporosis. I finally had a doc mention it when he had it drawn and it came back as too low to register in 2007.

 

[hilary1617]

@southernlady Wow. So frustrating. Hope she listens to you.

I know you are a vitamin expert, but for other readers, below are some decent explanatory excerpts from a paper about vitamin D deficiency (in the context of thyroid disease) written by my son's endocrinologist, Theodore C. Friedman, M.D., Ph.D.:

Vitamin D

Vitamin D appears to have many effects besides being related to calcium and bone health. Some patients with low vitamin D levels have fatigue and bone pain, which is easily reversible with proper replacement of vitamin D. Vitamin D may protect against heart disease and some types of cancer. Vitamin D may also have some role in regulating the immune system and also reducing blood sugar levels in patients with diabetes. Proper vitamin D levels are needed to prevent osteoporosis. In conclusion, proper vitamin D levels are essential for one’s health, especially if you have thyroid problems

Vitamin D is really two different compounds, ergocalciferol (vitamin D2), found mainly in plants and cholecalciferol (vitamin D3), found mainly in animals. Both of these hormones are collectively referred to as vitamin D, and they can either be obtained in two ways. One is by exposure of the skin to the ultraviolet (UV) rays of sunlight or also from dietary intake.

When it comes to replacing Vitamin D, again we have to understand the difference between D2 (ergocalciferol) and D3 (cholecalciferol). Even though both forms of vitamin D are fat soluble, studies have shown that if you take D2, your levels rise, but then fall back to almost baseline in a few weeks. . In contrast, after D3, the levels stay high for a longer period of time. [NOTE: DS Patients need to take DRY forms of Vitamin D]

Different Forms of Vitamin D and How To Diagnose Vitamin D

Vitamin D itself is inactive and needs to get converted to the liver to 25-hydroxy vitamin D (25-OH vitamin D) and then in the kidney to 1, 25-hydroxy vitamin D. It is only the 1, 25- OH vitamin D which is biologically active. This form of vitamin D acts to allow for absorption of calcium from the intestinal tract. Therefore, patients with low vitamin D levels will have low calcium and in severe cases get rickets (in children) or osteomalacia (in adults) which is when the bone bows out and is poorly formed. In mild cases of vitamin D deficiency, osteoporosis occurs, but low calcium is rare.

The conversion from the 25-OH vitamin D to the 1, 25-OH vitamin D that occurs in the kidney is catalyzed by parathyroid hormone, also called PTH. Therefore, patients with very low vitamin D levels will have relatively high PTH levels often with low calcium levels... Additionally, the 25-OH vitamin D form which is the storage form and is much more abundant that the 1, 25-OH vitamin D form which although is active, is less abundant. Therefore, in states of vitamin D deficiency, low levels of 25-OH vitamin D are found, but the 1, 25-OH vitamin D levels are either normal or actually slightly high.

They are slightly high because the excess PTH that is stimulated by the low 25-OH vitamin D levels stimulates the conversion up to 25-OH vitamin D to the 1, 25-OH vitamin D. Thus, patients that are vitamin D deficient usually have a low 25-OH vitamin D level, a high PTH level, a low normal calcium, and a normal or an elevated 1, 25- OH vitamin D level. However some patients may actually have a high normal calcium as the elevated PTH and 1, 25-OH vitamin D may cause increased calcium absorption from the GI track and reabsorption from the kidney. If 25-OH vitamin D levels were not measured, these patients might have been incorrectly diagnosed with mild hyperparathyroidism as they have a high normal calcium and a high PTH.

Dr. Friedman usually recommends measuring a 25-OH vitamin D to determine if a patient does have vitamin D deficiency... PTH and calcium can also be ordered. The 25-OH vitamin D assay has a normal range of approximately 20-60 ng/dL. However, this range may be too low for many patients. In general, Dr. Friedman would recommend treatment of patients that have a 25-OH vitamin D of less than 30 ng/dL. Optimal levels of 25-OH Vitamin D for patients with thyroid diseases are probably 35-60 ng/dL.

 

[southernlady]

Thanks, @hilary1617
What is so damned frustrating is that this was at Mayo, supposedly a great facility.

I know, like me, she is built more like our daddy than our mothers. I suspect I might not have gotten osteoporosis (at least so early in life, 60 at diagnosis) had it not been for lack of D. My Mother had a dowager's hump and shrank at least 3 inches but swapping meals for alcohol was in play there. Her mom was the classic thin boned female and while never showed signs, she died very young at 59.

I don't want my sister to battle the same fight I am to maintain healthy bones. I've had two Reclast infusions in the last three years to help stabilize mine.

But she saw the endo cause she lost her thyroid altogether about 10-15 years ago. And she wasn't pleased with the quality of care in Tallahassee which is how she ended up years ago at the Jacksonville Mayo. And her D was 29 which THEY stated was NORMAL! And yet the range on their slip stated 30-100. How in the hell is 29 normal when their range STARTS at 30??????

 

[hilary1617]

@southernlady - AAARGH!

I think there is some degree of variability in quality at Mayo by area of expertise. For example, most neuroendocrine tumor patients are warned by vets avoid the Rochester MN campus, except for a specific cardiologist who does a great job repairing damage from the condition. They don't have a great reputation with vets in the Cushing's diagnostic world either, though they have good neurosurgeons.

Generally, I think many/most endocrinologists these days spend the bulk of their time diagnosing and treating diabetes and PCOS patients, with a smattering of Hashimoto's and Graves thyroid cases. It's hard to find an endocrinologist with significant depth of experience with other conditions - have to seek out specialists.

Best wishes for your sister. I hope she vitamins up to avoid bone issues!