Another hyperparathyroid question

[Shannon Nelson]

Also, I wonder whether anyone can help me understand something that seems
paradoxical in this case. (And FTR her poor lab readings and calcium
problems are only a drop in the bucket of her issues or her "case". But
it's a part I would like to understand better!)

The patient (age 80) has had a very longstanding tendency toward leg cramps
when she eats/takes calcium. In earlier years this would happen only(?)
from dairy foods, but then the list grew and her sensitivity increased. In
recent years she would get *severe* cramps (mostly night in bed, mostly
calf, > standing) from even a milligram or two of calcium in supplements, as
well as various foods. Finally it had gotten to where the cramps would
sometimes happen for no reason that she was aware of.

A few months ago she found that if she takes 2,000 miligrams daily of
calcium (along with 1,000 IU of vitamin D3 and 1,000 magnesium), she has no
cramping, and is able to take the previously troublesome foods and
supplements with no reaction.

Okay, that's odd: Why does a little calcium <

[Gaby Rottler]

Hi Shannon,

[snip]
In Hypercalcemia it is nessary to know more about all the parameters
involved:
- Calcium
- Parathormone
- Phosphate
- Ca-level in urine

If you only know about the elevated Calcium in serum, that doesn't help
you any further.

The cause of elevated Ca-levels could be
- primary hyperparathyroidism (Ca, PTH, Ca in urine elevated, Phosphate
decreased)
- familiary disposition of hypocalciuria (Ca, PTH elevated, Phosphate
normal, Ca urine decreased)
- paraneoplastic hypercalcemia (Ca elevated, PTH normal or decreased)
- sarcoid
- acute osteoporosis
- M. Paget
- Hyperthyroidism
- Vit D3- intoxication
and and and....

For a hint to diagnosis we need the totality of the parameters involved,
only then it is possible to interpret her reaction to the small Calcium
doses.

Best,

Gaby

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gaby Rottler
Germany
rottler@curantur.de

http://www.curantur.de
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

[J Lucas]

As I understand it Vit D has a huge significance in this situation - you
should some research on the condition maybe - and this also helps assimilate
the calcium. Also the cramping may or may not be due to calcium levels.

If calcium levels are low it is leached from the bones and if the
parathyroids are hyper and there is too much PTH then more calcium is
released (too much) and so bone density is threatened. The supplement will
help restore bone density.

best wishes, Joy

www.homeopathicmateriamedica.com
on 24/8/04 8:50 PM, Bob&Shannon at shannonnelson@tds.net wrote:

Also, I wonder whether anyone can help me understand something that seems
paradoxical in this case. (And FTR her poor lab readings and calcium
problems are only a drop in the bucket of her issues or her "case". But
it's a part I would like to understand better!)

The patient (age 80) has had a very longstanding tendency toward leg cramps
when she eats/takes calcium. In earlier years this would happen only(?)
from dairy foods, but then the list grew and her sensitivity increased. In
recent years she would get *severe* cramps (mostly night in bed, mostly
calf, > standing) from even a milligram or two of calcium in supplements, as
well as various foods. Finally it had gotten to where the cramps would
sometimes happen for no reason that she was aware of.

A few months ago she found that if she takes 2,000 miligrams daily of
calcium (along with 1,000 IU of vitamin D3 and 1,000 magnesium), she has no
cramping, and is able to take the previously troublesome foods and
supplements with no reaction.

Okay, that's odd: Why does a little calcium <
Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service
.
[Non-text portions of this message have been removed]

[Shannon Nelson]

Thanks Gaby, here's what I know:
They're callling it "primary" hyperparathyroid. Recent PTH readings have
been 72 and 90 (tho 2 years ago one was 128), and the surgeon emphasizes
that she has "slight" hyperparathyroidism -- yet they are all *so* hot for
her to have the surgery, and her osteoporosis has now become *very* bad.
(Actually it seemed that her spine began to deform in earnest *after* she
started taking calcium, and I think that is because she was taking pure
calcium, without necessary supporting minerals; she has switched to
hydroxyapatite, which should be much better.)

The calcium levels have varied mostly between about 10.2 and 10.8 (slightly
high?)

Phosphate levels were taken, I think, but I don't remember them nor have
them here. From the fact that "primary hyperparathyroidism" is the
diagnosis can I *assume* that blood phosphate was low and urine calcium
high, or not necessarily?

She's now working with a doctor who -- Glory be! -- she likes and respects
[very holistically oriented MD who has also been eager to avoid surgery if
possible, but...], so it will be easy to ask for whatever further tests
might be useful. (I assume that all of this (tests) isn't necessary for a
strict classical approach, but since that has so far failed us and I am
grasping at straws, and heck, might as well learn something from this...)

Thanks again,
Shannon
on 8/25/04 12:43 AM, Gaby Rottler at rottler@curantur.de wrote:

[Shannon Nelson]

She has been taking Vitamin D for many years. I wonder whether she may have
had *too much*, but that was specifically tested for and her blood levels of
vit. D are fine.

Does the fact that taking large amounts of calcium >>> the cramping (and
small amounts >>>) indicate that it *is* due to calcium imbalance, or maybe
not? What other possibilities should I look at?

Her PTH is high ("slightly"?) and her bone density is very poor.

Shannon
on 8/25/04 2:28 AM, J Lucas at j.lucas@ntlworld.com wrote:

[Gaby Rottler]

Hi Shannon,
Primary hyperparathyroidism can be due to an adenoma or can be caused
by multiple 'hyperplasia' of different endocrine organs.
Hmh - the Ca is only slightly elevated, so is the PTH.
To be sure about the effects the hypercalcemia is havong, generally a
renal check up should have been done, to assess the status of the
kidneys (i.e. if there is already calcinosis, stones etc.)

I would NEVER assume any lab values.......!
In your first post you had written, that in the beginning, that small
doses of Ca caused cramps.

This is somewhat surprising - as muscle cramps are generally associated
with HypOcalcemia, not with hypercalcemia.

Let's speculate:

- in the beginning she never tolerated food rich in Calcium. Small doses
of Calcium caused cramps.
Calcium is resorbed via the intestines. There is a negative feed-back to
PTH, i.e. high Ca-levels in blood normally suppress PTH secretion,
therefore no further mobilisation of Calcium from the bones, less
Calcium in plasma, which may lead to cramps.
Possibly the PTH reacted too sensitive to Ca, i.e. suppressing the
circulating Ca-levels, in the beginning.

Overwhelming the parathyroid gland by giving massive doses of Calcium,
may have (mere speculation) interrupted the feed-back mechansim, making
the parathyroid 'insensible' for the massive doses, and PTH beginning to
secret continually.

So I would NOT exclude that before there was an undiagnosed
Hypocalcemia, that was then turned into a Hypercalcemia.

In any case, she really needs assistance concerning the intake of Calc
and Vit D (which in the case of Hypercalcemia should really be
regulated).

Of course, I don't know anything about her other diseases, besides the
osteoporosis, nothing about her 'characteristic' symptoms (and it's
often necessary to know the 'normal' symptoms in a disease, to be able
to extract the REAL characteristic symptoms of the patient.

But the constant dosing of Ca + Vit D may be regarded as an artificial
disease, and it could be difficult for you to look beyond that.
Her symptoms BEFORE are (from the small info you gave), the most
interesting.
The sensitivity to milk and dairy food, causing cramps.

So at the moment I would rather look at remedies which are antidoting or
following well after Calc, have a history of cramps, an agg. from milk +
the characteristic symptoms which I don't know anything about.

As an idea I'd throw in Ph-ac, which mirrors the 'old' patient, agg.
from milk (vomiting, and vomiting mother's milk...so really a deep
remedy in this respect), has MANY cramps and others.

But of course, the characteristic symptoms should guide you.

I'll be off now to JW's seminar + holiday now - so don't expect a reply
from me during the next 12 days.

Hope the remarks were a little bit helpful,

Gaby

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gaby Rottler
Germany
rottler@curantur.de

http://www.curantur.de
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

[Shannon Nelson]

I recall she's been told recently that her kidney function tests fine (tho
with all of her longstanding fluid retention issues plus f/h -- mother died
of kidney failure -- I am not sure why!) I don't know whether they've
checked for stones (and don't recall seeing any urine test results, but I'll
ask), but she has never had any symptoms that would suggest kidney stones.

She had a "Sestambisi scan" to image the parathyroids, which showed a
"blockage" (which the doctor seemed to presume meant a tumor?) on the left
side, but a later ultrasound showed nothing remarkable (???).

By "multiple 'hyperplasia' of different endocrine organs", what exactly do
you mean? What organs might be involved, how would one check for this and
might this information be useful for homeopathic prescribing (or useful in
whatever way comes to mind)? We can ask for more tests, if we knew what to
ask for!

More interspersed below:
on 8/25/04 7:16 AM, Gaby Rottler at rottler@curantur.de wrote:
Good point! I will check.

Is the blood level different from the plasma level?
The cramps have been ongoing during the same time that her calcium levels
have tested consistently high...
You mean, in the beginning perhaps taking small amounts of calcium led to
depressing PTH (overreaction) which led to depressed circulating (blood?)
calcium? Maybe... Yet this pattern continued into the time that her blood
calcium have been consistently high -- ??
But the high PTH dates from two+ years ago (cramps and ca sensitivity slowly
worsening), but the huge amounts of calcium started only a few months back,
and the PTH reading actually *worsened* (or at least wobbled to the up-side)
during this time (from 72 to 90). My understanding is that that it's quite
"normal" for the readings to vary by this amount; re the fact that the
reading from two years ago was 128 -- is it also normal for it to "wobble"
as far as 128 to 72, or does this suggest that there has been at least
*some* improvement? I never managed to ask the doctor that one...)
I got a little lost in some of the reasoning, but yes, I assume there was a
prior hypocalcemia (since she was getting so little). So maybe the
hyperparathyroid developed as a sort of "irritation" response to the
overwork??? (But if it did, then I would I use that anyway...)
Could you say more about this? I'm going to ask her to experiment and see
just how *much* calcium she needs in order to keep the cramping at bay. And
I'm keeping after her to use a *balanced* calcium supplement, that supples
*all* (trying, anyway) of the minerals needed for bone support; calcium is
only a small part of that picture, I understand.
Yep, it's a lot to tell... I wrote about her a year(?) or so back and
received some helpful input, but clearly need more! I'll try again, tho,
and put up more in case your or anyone have more inspiration to offer.
Yes, that's part of what I'm after! But my web reading really hasn't been
very helpful with that so far.

One thing I am wondering about is her "obsessive" behavior with the mail!!!
Certain of "her" docs insist that she is OCD, and thinking about it, I can't
really disagree...
Very helpful Gaby -- thankyou!
Have a blast at the seminar! And I look forward to hearing about it (and
this) when you get back! Meanwhile I'll explore your thoughts above --
thankyou!

Shannon

[Phillip Wade]

Chronically low Calcium intake causes a biofeedback via the pituitary to the
parathyroid, raising PTH levels & exciting osteoclast activity.
High Ca intake causes an imbalance with Mg and will cause cramping. Don't
forget, high calcitonin also gives low blood Ca levels --> rebound high PTH.
Have they checked thyroid activity?
Also Ca supplements alone won't give good bone uptake unless it's balanced
with Mg.
If PTH is only slightly high, it does more indicate a dietary imbalance or
low oestrogenic activity - which indicates poor adrenal activity if
menopausal. So support that also.
Bottom line - balance her Ca intake to 1200mg a day (if average body weight)
and 500mg Mg. Perhaps use the duglycinate form or the Blacknores celloids in
the early stages.
Phil Wade