QuestionHi Charles
First of all thank you for offering your help on this site. I am an expert on another site (orthopedics)but I answer questions from a patient's point of view. I have had eight hip replacement surgeries due to prednisone use to maintain a successful living donor transplant done in 1972 when I was 14.
In general I have been healthy except for AVN due to prednisone usage. I currently take many medications and my nephrologist is wonderful at monitoring the meds.
Just recently I had blood tests which showed my Vitamin D level to be 40. I was told the normal level is about 130. So my nephrologist immediately put me on ergocalciferol. I am to take one tablet once a week and he also suggested that I take a multivitamin. I am to have blood tests again to check phospherous levels in two weeks from now. My phospherous was a bit high. I also had kidney stones in the graft about 16 years ago and am not allowed to eat much dairy. I take fosamax weekly.
I have five questions for you:
1. Normally how long would it take for the level of Vitamin D to drop so low? The reason I ask this is because for over two years, I have been getting severe cramping in my toes. The cramps are so bad that that you can see the toes actually moving. When I asked my doctors about this, they suggested potassium and drinking more water, neither of which helped.
2. In taking the Ergocalciferol (1.25 mgs) per week, and a multivitamin containing 400IUS of Vitamin D, how long should it take for the levels to rise to a normal level of vitamin D.
3. I am 49 years old and in perimenopause. For the last three months I have not been menstruating, could this be a symptom of low vitamin D levels?
4. I have also been having clicking sounds and pain in both shoulders and sometimes it hurts when I move the shoulders. This is has been more recent (within the past 6 months), it almost feels as if the shoulders are going to dislocate and then the pain goes away. X-rays were taken and the shoulders look fine on the X-ray. When I complained about this to my primary physician (before the vitamin D levels were found to be low), he suggested to lift five pound weights to build muscle. Could this pain be related to the low vitamin D levels?
5. What are the most common problems that you have seen related to vitamin D levels as low as mine are? I seem to have many small bothersome problems and I don't know if they are related to the levels of Vitamin D. My primary doctor wanted me to take an antidepressant saying that many of these symptoms are related to general anxiety disorder or depression. I am neither anxious or depressed and I don't think my symptoms are related to depression and I feel that he is pushing a therapy that is not necessary with prescribing antidepressants.
The most bothersome of my symptoms are:
1. Shoulder pain and pain in the area between the breasts that feels like an ache or pulling sensation
2. Absence of menstruation (although I am in perimenopause)
3. Fatigue
4. lack of appetite and inability to gain weight (I am 5 foot 5 and weigh 117).
All other blood values are normal.
Thank you for taking the time to read this, and answer my questions. I do appreciate it.
Sharon Davis
AnswerHi Sharon,
By definition, you have Ricketts.
Your Vitamin D levels have been dropping for a while. Symptoms of Vitamin D deficiency are depression (also a side effect of Prednisone), aches and pains and generalized fatigue.
Your Prednisone use will have some bearing on maintaining Vitamin D levels. Vitamin D is metabolized by the kidneys. Calcium is an important factor in Vitamin D utilization. When you have marginal renal function, that will upset the process because you can't just take large doses of D and Calcium. Prednisone can cause a secondary osteoporosis and in your case, calcium alone isn't enough to make up th deficit.
This is a very complicated process and needs close attention. Cramping can be caused by low magnesium levels as well. So much to tell you and this forum doesn't lend itself to that very well.
I'm typing this from our ER computer as I work out here every thursday, so if I don't make too much sense, it's because it's hard to concentrate as it's a looney bin here. I hope I've been some help to you.
