Here you will find my Patients Rising articles
which vary between patient empowerment, patient stories, and general medical education
the following are articles I wrote for Cal-EZ.com
Posted by Jim Sliney, Jr. on Nov 25, 2014 8:00:00 AM
The skeleton is responsible for many things, including
- Helping our bodies move
- Providing protection for internal organs
- Storing calcium and phosphorus
- Providing a frame for the body
Just like other organs in the body, our bones can be healthy or unhealthy. Healthy bones can do the things a skeleton is supposed to do. Unhealthy bones needs to be cared for. Just like you care for your heart when your cholesterol levels are not in range, you should care for your bones to ensure bone health.
One way bone becomes unhealthy is when it loses minerals, like calcium and vitamin D. This loss of bone is measured by the bone density test. Decreased bone density is termed osteopenia or osteoporosis, depending on how bad the calcium loss is.
Osteoporosis: literally “porous bone,” where the spongy interior of the bone becomes too thin and porous. Bones are more likely to break in this state
There is also a rare condition of having too much bone density that is often seen in patients with hypoparathyroidism (not enough parathyroid hormone production). While it is unknown if it is harmful to have too high a bone density, it is considered abnormal.
Your bone health is something that you may be able to control. Work with your doctor to figure out how much calcium, vitamin D or other supplements you may need, how to start an exercise plan, or introduce other lifestyle changes that can have a positive impact on your bones.
Four Most Common Forms of Calcium
Posted by Jim Sliney, Jr. on Nov 27, 2014 8:00:00 AM
There are a lot of calcium supplement choices out there from algae calcium that comes from ocean to calcium phosphate. It can get to be a bit mind boggling. Here are the four most common calcium types and a bit of information on each to help you and your doctor decide what might be best for you.
Carbonate (Calcium Carbonate)
- The most popular calcium on the market
- 40% of calcium carbonate is pure elemental calcium
- It is absorbed best when taken with food (even just some crackers, not necessarily a meal)
- Carbonate is relatively alkaline (not acidic) on the pH scale
Citrate (Calcium Citrate)
- The second most popular calcium on the market
- 21% of calcium citrate is pure elemental calcium
- No need to take calcium with food
Gluconate (Calcium Gluconate)
- Gluconate is the kind of calcium commonly used when given by intravenous infusion
- 9% of calcium gluconate is elemental calcium
- 38% of calcium phosphate is elemental
- Calcium phosphate can be taken with or without food
- Is not absorb as well as carbonate or citrate
- Because it is a phosphate, it might not be ideal for patients with certain medical conditions (like hypoparathyroidism)
There are other types of calcium that are less commonly used like algae calcium, bone meal, calcium chloride, coral calcium, calcium lactate, and oyster shell calcium. Whatever the type of calcium, try not to take more than 500 mg at a time and to talk to your doctor about other medications that may be affected by your calcium.
Taking Calcium with Other Medications
Because of the way calcium is digested and absorbed, taking calcium at the same time as certain other medications may reduce, increase, or otherwise change the effectiveness of those medications. Listed below are some of the medications that calcium is known to interfere with. If you are taking one of these medications, talk with your doctor to learn about the right way to take your calcium
|original artwork by jjsjr|
- Antibiotics. Calcium could interfere with the absorption of the antibiotic so the two should be taken at least one hour apart from each other. Of note, intravenous Rocephin/Ceftriaxon interacts dangerously with calcium, therefore calcium should be withheld for 48 hours prior to or after administration of this drug
- Bisphosphonates. Bisphophonates are osteoporosis drugs like Fosamax, Didronel, Actonel, etc. Calcium should be taken at least 30 minutes after a dose of bisphosphonate
- Calcipotriene/Dovonex. These are synthetic vitamin D derivatives. If taken with calcium, they can cause elevations in blood calcium
- Thiazide diuretics (water pills, like hydrochlorothiazide). If taken with calcium, can cause elevations in blood calcium
- Estrogens. Can also cause elevations in blood calcium, if taken together with calcium
- Blood pressure medicines (like Digoxin, Diltiazem, and Verapamil). Taking these at the same time as your calcium may cause irregular heartbeat
- Levothyroxine/Synthroid. Calcium can interfere with the absorption of medications for hypothyroidism. Calcium and levothyroxine should be taken at least 4 hours apart. For hypothyroidism patients one way to accomplish this is to take your levothyroxine in the middle of the night when you get up to use the bathroom
- Betapace. Betapace is an anti-arrhythmia drug. Avoid taking calcium 2 hours before and 4 hours after taking this medication
Are you taking too much calcium?
Posted by Jim Sliney, Jr. on Dec 11, 2014 1:53:00 PM
Are you taking too much calcium? Having too much calcium in the blood is called hypercalcemia.
It can be brought on by a number of things including
- Taking too much calcium or vitamin D
- Elevated vitamin D levels
- Overactive parathyroid glands (hyperparathyroidism)
- Certain medications (eg, lithium, which can cause hyperparathyroidism)
- Certain cancers (eg, bone, breast, parathyroid)
So how do I know if I’m taking too much calcium?
The amount of calcium in the blood that causes hypercalcemia will vary from person to person. Mild hypercalcemia may have no symptoms; the best way to check for it is with a blood test.
Hypercalcemia is usually accompanied by some or all of the following symptoms:
- Headache – possibly secondary to dehydration as your body focuses on getting rid of excess calcium through the urine
- Increased thirst – you get thirsty, so you’ll drink more causing you to urinate more
- Frequent urination – this is how the body gets rid of excess calcium
- Nausea – possibly secondary to dehydration
- Brain fog, confusion
- Muscle weakness
Why should I be concerned about hypercalcemia?
Well, the symptoms can be pretty unpleasant. But if left unaddressed, it can lead to serious health problems over time. If the calcium levels get high enough some of the symptoms may present themselves.
- Chronic hypercalcemia can lead to
- Abnormal heart rhythms
- Kidney stones or kidney failure
- Neurological problems (eg, brain fog, confusion, dementia)
- Osteoporosis – if your bones are giving away their calcium, as in the case of hyperparathyroidism, this can lead to thinning of the bones
So remember when taking calcium, it is best absorbed at doses of 500 mg or less and in the company of vitamin D. If you think you are experiencing symptoms of hypercalcemia, please consult with your healthcare provider.
How much Cal-EZ should I take?
Posted by Jim Sliney, Jr. on Dec 16, 2014 8:32:00 AM
When taking calcium supplements, the recommended dietary allowances are a good starting place but it’s not unusual for doctors to prescribe more or less depending on lab test results or specific needs.
When trying Cal-EZ calcium and vitamin D supplement for the first time, you should work with your doctor to get you started on the right dose. You can do that by testing the amount of calcium in your blood both before and after you start Cal-EZ and by paying close attention to your body. For patients with high calcium requirements it’s probably safest to start off matching milligram for milligram.
Studies have shown that the calcium absorption of Cal-EZ’s powdered calcium carbonate is better than calcium citrate tablets so you may end up finding that you don’t need as much Cal-EZ as you did of your previous calcium.
That is also in part because the powdered vitamin D in Cal-EZ is proven to help your body absorb calcium more efficiently.
In this way, Cal-EZ may also help you address low vitamin D levels which, once normalized, can help elevate calcium levels.
So be prepared to start by using the same dose you were using with your previous calcium supplement, but work with your doctor to get some labs done and pay close attention to changes in signs and symptoms and you may find that your dosing requirements will change over time.
Calcium: Smaller doses, better absorption?
Increasing the Absorption of Your Calcium Supplement
Absorption of your calcium supplement is crucial for getting enough calcium into your body for it to work. Anything you eat has to be digested in order to be absorbed. When we eat food, chewing is the first step in absorption because it breaks food into smaller bits, saturates it with saliva which moistens it, and begins the digestion process. You can’t chew your calcium supplements (YUCK!) unless they are labeled as “chewable” (DOUBLE YUCK!), so how do we best absorb our calcium?
- A cracker – that’s right, a teeny, tiny cracker. You don’t have to have a cheeseburger and fries in order to digest calcium carbonate
- But then again, cheeseburger and fries – because they taste so good!
- Shakes – like protein or nutrient shakes. Why? Because they contain fine or very small solids
- Pizza and for argument sake, this includes that deep dish stuff which is really more of a savory casserole (Disclaimer: I’m from The Bronx)
- Coffee with milk, not so much coffee without milk, that’s too much like water
- Bread, with or without butter, margarine, peanut butter, hot sauce, whatever…
- Oatmeal or oatmeal-ish foods
- Spaghetti, with or without meatballs, sauce, or tuna (My mom tried that tuna thing on us a few times as kids…not awesome…love you mom!!!)
- Gummy bears – yes, I went there
- Broccoli, baked beans, and Brussels sprouts smoothie with a side of cauliflower (also a great way to get a subway car all to yourself during rush hour, ahem)
Disclaimer: The information in this article is for informational use only, it does not intend to replace the services of a healthcare professional. Please see your healthcare professional if you have any questions about calcium or calcium supplements.
Dietary Supplements: 4 things you can be doing better
Posted by Jim Sliney, Jr. on Apr 21, 2015 11:29:56 AM
Almost half the people who take supplements say they do it to improve their healthCan supplements really help your health? Well that’s an ongoing debate but when Americans were asked…
- About a third say they do it to maintain their good health
- Less than a quarter say it is to supplement the nutritional value of their diet.
- Read the labels carefully: failing to read those labels can lead to unexpected or unwelcomed side effects or under-performance of the substance. Some key points include:
- Calculate the serving size (eg, 1 serving = 4 pills)
- Take the supplement with or without food as directed
- Don’t take the supplement along with another supplement or drug that can interfere with its efficacy
- Incorrect storage of supplements: do you put your pills into a weekly planner? What then? Do they sit in the refrigerator? Being refrigerated can cause them to go bad faster. Do they sit where the sun can hit them? Temperature fluctuations are bad for most medicines. Do you store them in a dry place? Moisture is especially bad for most medicines.
- Giving one pill too much credit: the classic example is taking calcium for your bone health. Calcium alone is only part of the plan. Vitamin D helps calcium absorb in the digestive tract and magnesium is vital to bone health as well. This is why talking to your doctor or dietician/nutritionist about your supplements is so important.
- Cash for health: spending a small fortune on supplements may not get you any further than making a sensible choice of supplement. The important factor is that the supplement you do buy has been quality tested and will most often display a guaranteed quality seal.
Attending Patient Support Conferences
- She joins the patient support group for gastroparesis sufferers and their families and stays actively engaged with patient advocacy
- She makes an appointment with a new doctor who gets her started on a new medication and discusses some treatments that she might benefit from
- She learns about the legality of being an employee with a chronic disease, speaks with her employer, and learns how to be more productive within the limitations of her condition
- She also learns that depression is not unusual in the case of chronic diseases and talks to her doctor about getting treatment
Attending patient support conferences affords you a rare and wonderful connection with other people who really understand your condition. It opens lines of communication and possibility. It can give hope or perspective by highlighting the experiences and challenges of others who share your challenge. Most importantly, patient conferences empower patients and their caregivers with the knowledge and support to make positive changes in their lives.
The Natural Cycle and Recycle of Bone
|original artwork by jjsjr|
|original artwork by jjsjr|
There are drugs available that can slow Celia’s eating. Drugs like Fosamax, Actonel, Boniva and others in a class called Bisphosphonates which are usually taken as pills or intravenous injection. There are others too, like Prolia, which also slow Celia’s eating. Prolia is given by injection. There are even drugs like Forteo which don’t pay much attention to Celia, rather, they give Barry new energy so he can build faster. Forteo is a daily, at-home injection. Drugs have come a long way towards being able to slow bone loss, stop it, or even cause bone growth.
|Where the hip meets the pelvis (Brittanica.com)|
Staying out of trouble in the first place:
- Lift weights
- Climb stairs
- Go walking with a backpack on
- Be a farmer
- Get down – get back up again – get down – get back up again (isn’t that a dance?)
When you fight gravity, your bones get the message.
Bone Health and Corticosteroids
And what you can do to keep your bones healthy when you have to use them
- Reduce inflammation by reducing a swollen rash or lung inflammation like in asthma or joint inflammation like in arthritis
- Suppress the Immune System which is important for someone experiencing an AUTO-IMMUNE response in which the immune system mistakenly attacks the body; like in cases of severe allergic reaction, Addison’s disease, lupus, type 1 diabetes, and celiac disease just to name a few
- Glaucoma – increased pressure in the eye
- Cataracts – clouding of the lens of the eye
- Edema – fluid retention (think swelling in the lower legs)
- Increased blood pressure
- Increased blood sugar levels – this can complicate diabetes
- Increased risk of infection
- Mood swings
- Weight gain
- Adrenal gland suppression – this could lead to lower levels of some of the adrenal glands hormones like Aldosterone, DHEA, and Cortisol
- Skin bruising and slower wound healing
- Taking a supplement
- Weight bearing exercise – fight gravity a lot!
- Reduce or eliminate smoking and alcohol consumption
- Get a bone density test – this can tell you where you are in relation to osteopenia or osteoporosis
So if you are using corticosteroids you will need to figure out what you can and should do to protect your bone health.