Deficiency issues and the best way to correct it (specifically calcium)?

I've been in the hospital for just over a week now dealing with drastically low calcium levels. Why this was not noticed early on before it got down to 1.2 (normal is 2.2 I believe I was told) is beyond me. Granted I have not had follow up care in my home province from a bariatric centre so whether that is to blame, who knows.

At any my question is regarding what I could or should do as far as calcium supplements when I am released? They have had me on IV calcium and they were giving me carbonate orally (I did explain that would be a waste as it is not well absorbed). I'm told I should likely be released today, but the attending doctor is concerned of what I will do at home.

Due to a lack of follow up care from a sugeons office that deals with DS at all I'm sort of in left field about how I can tackle this. I'm not sure if it is a matter of just taking a larger dose of calcium in the meantime to maintain and improve my calcium levels or what?

I assume that going on a higher vitamin D level (not sure what they were giving me here, but I doubt it was nowhere near say 50,000iu) might be helpful as well?

Any help or suggestions would be greatly appreciated if anyone knows of the proper procedure for this. My next step is to try and convince wealthy family that are semi-estranged to help me out out with covering a full Vitalady regimen or something of the like as I'd rather be proactive than see something drop dangerously low.

Being this deficient, I highly recommend you work with an endocrinologist to get your levels under control. Make sure they are familiar with the DS anatomy and correlated challenges.  

Calcium Citrate is best absorbed for most.

You didn't say what your D levels are, and low D can affect calcium.  Your D should be DRY (water soluble) since we malabsorb fat, which is how it's usually dispensed (in oil capsules).

Unfortunately I do not have any recent D levels to provide. I am not sure if they are even focusing on it at all in any of the blood work the hospital has done. I made note of the importance of D if my calcium is dropping each time they removed me from the IV. I also made it quite clear that the calcium carbonate they were giving me orally is a big waste so it is a given my that would not help my levels to either maintain the same levels or go up when taken off the IV each time.

It's frustrating when the doctors are not versed in bariatrics and when I give them credible information it seems to be ignored or I am seen as being either difficult or condescending.

Unfortunately in Ontario there is only one surgeon who has done the DS and it was my impression he/his office would provide the follow up care for me, but my file was transferred a week after my out of province surgery nearly four years ago and I have seen no one in bariatrics as no one wishes to take on a DS patient.

Docs here in the states aren't much better, I'm afraid, when it comes to nutrition.  Just because they recommend it, doesn't mean you have to follow it.  I tried that myself, and went deficient big time by following my DS surgeon's recommendations.  That's where groups like this are so valuable...sharing real life experiences and results.  Calcium Citrate and dry D3 are both available without prescriptions, so getting what you need is as easy as going to the drug store vitamin aisle or Amazon.  A curious PCP is all you need unless there are surgical complications.

I don't believe there are any surgical complications. I am 6.5 and nearly 4 years out respectively from each surgery. I do agree that people who have gone through the same thing are certainly great resources to try and deal with your own similar issues. It may not work for you, but at least it gives you a bit of a basis on which you can use to find what does work for you.

I suppose just because you have a piece of paper that says your are a doctor doesn't necessarily mean much in the grand scheme of things given the amount of knowledge that is available to us at a click of a mouse.

Jeff, I don't know what your local resources are in Ontario, but if you have any stores along the lines of CostCo, you can get their calcium citrate. Walmart might also have an inexpensive in-house brand, or perhaps there is a Canadian store along the same lines? Calcium citrate is calcium citrate, and you don't need to buy the more expensive products that are labeled for use by bariatric patients. Just keep in mind that they also sell calcium carbonate, so read the label carefully to make sure you purchase the right stuff, and also that a "dose" is two pills as each pill is only 250 mg and you need 500 mg/dose. Most of us need at least 3 - 4 doses of calcium citrate throughout the day as you can only absorb so much at once.

     Also, just about everyone with the DS needs at least 50,000 units of D daily, and NOT the prescription stuff because that's packaged in oil, so we don't absorb it. For that you need to spend the $$ to get the "dry" form, either from Vitalady if she has it in stock, or from Amazon (often the cheapest source) or from Bio-tech, which is the manufacturer. My most recent purchase was from Amazon. Do you know your D level? Don't just ask your pcp or his office staff if it's normal - it's best to know the number for yourself so you can follow the trend, and to stay at least in the middle of the normal range, not near the bottom.

I will also send you a pm.

Larra

You need the D, calcium citrate, and magnesium.  And ADD some calcium apatite if you can find it too.

Larra is on point here.  Find a cheap brand of calcium citrate Costco type place or in the states drug stores like Walgreens and CVS run regular Buy one get one sales.

Early studies have hown that dosages in the 500-600mg range are the best size with 2 - 3 hours in-between. Given your starting point I would do 4 or 5 doses per day. I've been able to maintain normal calcium levels art 3 doses per day.

The D3, magnesium, and possibly K2 are all said to help the absorption of calcium. and specifically D3 and magnesium levels, if they are low, can cause you problems absorbing calcium.

I wouldn't be too hunh up on a bariatric center. Could you ask your primary care Doctor to do follow up blood work? At least to verify that you are making progress on the calcium levels? I think someone should be involved in a followup to your hospital stay. Many of us don't see our surgeons after the first year and those that go out of the country never get a surgeon follow up but we can usually find someone that will do the necessary blood work so we can keep track ourselves even if the Doctor ordering it isn't up on all the ins and outs of the DS.

You didn't say but were you doing anything with vitamins prior to your hospital stay? If so it might be helpful to list what you were taking.

You can turn this around it will just take some time.

Pete

Thanks for the additional input Pete. My supplementation was very limited due to my low/fixed income. No one makes it clear that there is absolutely not coverage on a provincial or welfare drug benefit plan they only ask if you are willing to take the copious amounts of supplementation that is usually required for the DS. My financial situation took a drastic turn when my grandmother took ill with terminal cancer as she did help me a bit.

Really my supplementation was dictated by what was on sale each month. So one month I might only have a multi-vitamin, another I might have added in some calcium or vitamin D, etc. The problem is that $10-$20 for each individual supplement quickly adds up and can eat away 10-15% of my total monthly income. The whole point of 'welfare' is that they give you just enough to live off of, but not enough to maintain or get better as it is a more cost-efficient means for them this way.

I spoke with the pharmacy and they weren't exactly helpful as the pharmacist didn't grasp the question or point I was trying to make. She just kept reiterating that vitamin D is fat soluble. I said I was aware, but that I wanted to know if they carried a dry formulated version (water soluble), but I was getting nowhere. Now my issue is finding the means to get it from Amazon.com via someone living in the US. My friend in California stopped talking to me at the beginning of the month so that option is likely out sadly.

The issue with follow up through my family doctor is that most tests for blood labs are not covered outside of a hospital. I am not sure what levels they actually check for vitamin D. I know that the doctor has to specifically mark it as OHIP covered or they will charge for it, but again not really sure if it covers what I would be wanting. I haven't really found any figures online that sort tells me what is considered GOOD for someone with the DS. Not sure if just being 'normal' is sufficient enough?

For now I have a liquid calcium supplement. It is 1,000mg and it states that it is 1,000mg tricalcium phosphate & calcium citrate (not sure what the actual amount of citrate is), but below that it is also states there is 200mg of tricalcium phosphate, and then a small amount of vitamin D. I figure for now that would wor****il I get all my ducks in a row. The calcium D will be the main focus right now as there just simply is nothing available up here in the 50,000iu range that is dry formulated that I am aware of.

I only found name brand calcium citrate tablets at Costco that were 300mg. I believe it was $13 for the bottle if memory serves. I didn't notice a Kirkland equivalent.

Ideally I'd prefer to get say a DS regimen from Vitalady, but I was told with the original owners both being ill and stepping away that many things tend to be on backorder so that may not be a realistic solution anymore? I just thing from a cost standpoint and the fact it is all coming from one place it would be the least stressful option.

I do sincerely appreciate those who have taken the time to offer advice to me to help. I will say compared to a week and a half ago I feel a heck of a lot better so that is a good thing. I'm optimistic about this.

Glad you're doing what you can. 

You'll get different viewa on good levels of Vit D for DS'rs but I'm always happy to be midway in the normal range. For my lab tests that puts in the high 50's low 60's. Some people thing it would be better much higher like the 80-100 range. I never thought that was necessary.

Juat a couple of things that might help in the future.

Sometimes Docs understand better if you say the DS is like having "short bowel syndrome". I guess they have seen that more than the DS and my understanding is that the malabsorption issues are the same.

Calcium carbonate - not completely useless but absolutely the last choice for a DS'r. It has to do with the bioavailability for a DS'r being very low. It's just if the choice is between carbonate and nothing - take the carbonate - just try to get a lot of it.
The liquid calcium you are taking sounds great. If one dose is 1000mg then you might want to split the dose in 2 with an hour or 2 between doses. It is a little more complicated than we make it but taking over 500 - 600 mg  doses may lead to the overage being wasted and just excreted in your urine. 

Some very few people in the states can get their vits covered if a Doc says it is medically necessary. I wonder if you can make that argument for at least your calcium since you were hospitalized about it.

Biotech is not the only dry D, it just is the one that comes in the highest dosage. You can probably find some in the 5 to 10 k range that is not in a gel cap in your local drug store. You might use teh phrase "water miscible" instead of water soluble. I know they mean the same thing but I think for medical professionals they draw a distinction or just get confused about what you are really saying. You might also try to explain that you need it to be in a form that will dissolve in water not in a gel cap. None of this may help but just some things to try.