Vitamin D's vagaries drive Dr. D to distraction
DEAR DR. DONOHUE: On my last three annual physicals, my doctor ordered vitamin D levels. The first two were normal. This year, my level was 27 ng/ml (normal is greater than 30). She wanted me to take a 50,000-IU capsule of vitamin D for 12 weeks. I refused. I take a daily vitamin D containing 800 IU. I also take calcium with vitamin D, to give me a total daily level of 1,800 IU. I fear too much can be toxic. My calcium level is normal, which indicates that I'm getting enough vitamin D. I'd like your opinion. -- K.T.
ANSWER: Vitamin D is driving me crazy. The recommendations for the amount required on a daily basis change with annoying frequency. This vitamin has a number of functions. The most important is the facilitation of calcium absorption. The current daily recommended intake of vitamin D is 600 IU for those between the ages of 19 and 70, and 800 IU for those older than 70. The upper safe limit of vitamin D is 4,000 IU a day. Rarely does vitamin D toxicity ever occur.
One panel of experts declares that a sufficient blood level of vitamin D is 30 ng/ml, and a deficiency occurs at 15. The Institute of Medicine feels that 20 ng/ml constitutes deficiency. You are so close to the 30 ng/ml ideal that I personally wouldn't recommend you take high replacement doses of D. Furthermore, you make a valid point: A normal calcium pretty much assures that you have enough vitamin D on board.
My advice would be different if you have osteoporosis or osteopenia.
TO READERS: The booklet on back problems provides the details of common back maladies and their treatment. Readers can order a copy by writing: Dr. Donohue -- No. 303, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I am 70 years old. Lately I have a continuous series of bladder infections for which I have taken antibiotics. They go away for a while and then reappear. I drink plenty of water, and I also drink cranberry juice. I feel I am heading in the same direction as the 78-year-old lady who passed away from ovarian cancer but was treated for urinary tract infections. I don't want to be a casualty of cancer. -- V.W.
ANSWER: The woman you mention was the grandmother of the letter writer. She had been treated for repeated urinary tract infections before she succumbed to an undiagnosed cancer of the ovary.
Urinary frequency with pelvic discomfort is a sign of ovarian cancer, but it's not a reliable sign. More often, it's associated with bladder infection. If other signs of ovarian cancer are present -- abdominal bloating, a feeling of fullness after only a few mouthfuls of food and an increase in waist size -- then the suspicion of ovary cancer is justified. Ovarian cancer is curable in its early stages. The problem is that it is rarely diagnosed in the early stages.
Frequent urination treated with equally frequent antibiotics brings to mind conditions other than bladder infections and ovarian cancer. Interstitial cystitis, a disruption of the bladder lining, produces the symptoms of bladder infection. It isn't an infection, and it doesn't respond to antibiotics.
The next time your symptoms appear, ask the doctor to order a urinalysis and a urine culture. If no bacteria are found, then conditions like interstitial cystitis must be considered. If bacteria are found, the doctor would do you a service by ordering a test to determine the bacterium's sensitivity to antibiotics.
DEAR DR. DONOHUE: Today you answered a question about nighttime leg cramps. You referred to the reader's condition as restless leg syndrome. A doctor finally prescribed Mirapex for me, and it works like a miracle. I hope you mention this to your readers. --W.G.
ANSWER: The entire topic of the date you mentioned was nighttime leg cramps. I mentioned the treatments only for that problem. At the very end, a reference to the booklet on nighttime leg cramps and restless leg syndrome was mentioned. They're two very distinct conditions in the same booklet, but they have distinctive approaches to treatment. Restless leg syndrome responds to Mirapex (pramipexole); leg cramps do not.
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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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