High PTH low/normal calcium very low Vit D help

I had Duodenal switch surgery in May of 2000. I was 20 yrs old 430lbs. Lost 200lbs. I did not adhere to any specific vitamin plan. Honestly back then there wasn't as much importance placed on it. I took a normal personal multivitamin until 2016.

2010 - iron infusions

2021 - rushed to hospital with severe anemia. Been getting infusions since.

2018 - lots of teeth problems

Anyway , I'm older now and my laissez fairer attitude about supplements has gotten me into more trouble. Elevated intact PTH, vitamin D of 12. Calcium hovers around 8.9. Just had a failed dental implant where a little bit of bone came out with the failed screw.

im trying to make things right. High PTH, super low vitamin D, and low/normal calcium. I am attempting to take 1200mg calcium citrate per day, 5000 iu daily of vitamin D between supplements and vitamin D lamp.

I guess my question is do you all take calcium? I know I need as much D as possible but calcium is always in range so hard to know if I need it although high PTH means I do I believe. I'm afraid of overdoing calcium. Advice?

Probably not overdoing the calcium - calcium is one of those things where the body seeks to keep the serum levels even and, in this case, uses the bones as a reservoir to draw from, or add to, in order to keep that level right. So, seeing a normal calcium level in the blood would be expected and doesn't really tell us much unless it is low in which case you are in serious trouble. PTH and other factors give an indication of which way the calcium is going - depositing or drawing from the bones.

I suggest giving a look through dssurgery.com - that is Dr. Keshisian's site and he has a wealth of info in his blog posts and articles in his resources section; it may take a bit of digging to find what you need, but if it's DS related, it will be there.

Our doc, both my wife (DS) and I (VSG) used Dr. Rabkin, and he tends to prefer keeping D in the upper end of the normal range, so you have a bit of work to do there. It would not be unusual for DSers to take 50,000iu tablets, sometimes multiples, to get and maintain their D levels; my wife takes one every week or two to maintain, but some take one or two per day to build levels back up. It's a big YMMV thing with the DS. Also, make sure that you are using "dry" or water soluble form of vit D as the normal oil based is malabsorbed by your DS (along with the other fat soluble vitamins A, E and K.)

Good luck on getting back on track.

Thank you so much for your response! It's comforting to hear that I'm not taking too much calcium. As far as D, I remember having anxious reactions to it in the past that is why I am trying the lamp. Without taking any D supplement, my levels apparently have varied over the years from 10 to 23 just from tanning. I have an appt with my PCP on Wednesday to discuss further. I want to be sure I'm taking what I should be and have it closely followed. Also have a call out to a bariatric medicine dept of the local hospital.

Hopefully, the bariatric department there understands the DS - many don't really understand it if they don't offer it and it is quite different from the bypass. Another option for that could be to reach out to one of the established DS practices like Keshishian or Rabkin and see if you can get a "back on track" consult. They commonly do remote consults as they have patients all over the world, so doing a complete lab workup; my wife and I both do an annual follow up with Rabkin over the phone. That is useful, particularly for her DS, in getting some insight in what needs to be tweaked as he has experience that a typical PCP lacks; it's also good to have someone like that "on retainer" so that if our PCP comes across something odd, she can get him on the phone and ask about it, whether or not what she is seeing is a DS quirk, or something unrelated.

You can't take too much calcium, the body won't normally absorb much more than the 1200mg you are taking. Many of us take the same. When I took less the blood work always looked normal because your bones will make up for any shortfalls, and the become brittle over time. I had to have a urine analysis over 24 hours to see that I had a calcium deficit that did not show in my bloodwork. At the time I was taking 600mg per day, now up to 1200 like you. No issues any more.

I've done a couple of ds surgeries. Now I want to start again. papa's games

You might also consider seeing a good endocrinologist. Mine has helped me immensely with vitamin supplement levels.
I take 2500 mg of calcium a day in the form of Upcal D mixed in orange juice all at one time. That amount is necessary to keep my calcium in the range the endo wants it.
I also require 50,000 IU of vitamin D A DAY to stay in normal range.

becsuse we malabsorption so much it is hard to really overdose on supplements.

You have secondary hyperparathyroidism due to your DS malabsorption, and it is affecting your bone health. You need a lot more dry VitD3 and a lot more Calcium citrate. message me if you want more info

I had DS in 2008. I weighed 340. I have maintained about 155 since then. I have osteoporosis as the result of low calcium and vitamin D. I take 50,000 in of Vitamin D daily which is very high. I had two stress fractures last year. My endocrinologist manages my levels. I cannot overemphasize the importance of vitamin D and calcium and protein. Osteoporosis is serious business. Get a good doctor to manage all of your blood levels.

Yeah, personally, I've learned to stay on top of things by getting regular blood tests to see where my levels are at. It's like my own little health checkpoint. Chatting with your doc about specific tests or their take on managing calcium and vitamin D could give you some solid guidance.