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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

Bone Health

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.

Osteopenia: lower than normal bone density, but not low enough to be categorized as osteoporosis

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

Calcium Phosphate

  • 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.


Talking With Your Doctor About Pain

Explaining your pain to your Doctor is more than just unpleasant, it’s difficult and it’s a very high stakes conversation. If you don’t convey your experience correctly the road to cure, management or treatment can be longer than it needs to be. I don’t want to diminish the value of having the pain talk with loved ones but because of the impact it can have on your entire approach to medical care I’m going to focus on how to talk to your Doctor.


Taking Calcium with Other Medications

Posted by Jim Sliney, Jr. on Dec 2, 2014 11:00:00 AM

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


Calcium is known to interfere with:
    • 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


These are just a few of the medicines that calcium may interfere with. For more information, visit the University of MarylandWebMD, and NIH sites or contact your healthcare provider.


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)
  • Dehydration
  • 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
  • Fatigue
  • Constipation
  • 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?

posted by Jim Sliney, Jr. on Dec 18, 2014 4:30:00 PM
Calcium supplements have gotten a lot of pounding in the press in recent years. One question that seems to be asked is, “Should I take calcium in smaller doses?” The simple answer to this is yes.
It is known that the body absorbs calcium best at amounts of 500 mg or less at a given time.
Taking more than 500 mg of calcium at one time does not mean that your body will absorb that extra calcium.
Cal-EZ is calcium carbonate powder and vitamin D powder. Switching from conventional calcium pills to Cal-EZ has been beneficial for many people. Here are a couple of customers who divided up their Cal-EZ doses over the course of the day.
The “symptoms” this person is referring to are the symptoms of hypocalcemia. Symptoms of hypocalcemia include brain fog, muscle or bone pain, paresthesias (pins and needles), and tetany (involuntary muscle spasms).
Cal-EZ comes in convenient, portable sleeves of 1,000 mg of calcium and 1,000 IU of vitamin D. This meets the Recommended Dietary Allowance (RDA) of calcium and slightly exceeds the RDA of vitamin D.


And to make a habit of taking your Cal-EZ, add it to a beverage. The Institute of Medicine says the Adequate Intake (AI) of water for males is approximately 3.5 liters a day and for females is 2.5 liters a day. Cal-EZ dissolves easily and tastelessly into water (or other beverages) so you can satisfy your fluid needs and your calcium and vitamin D needs all at once.
To learn more about Cal-EZ absorption, click here to go to the Cal-EZ website or click on the button below for a summary and link to the full study.



Increasing the Absorption of Your Calcium Supplement

Posted by Jim Sliney, Jr. on Jan 20, 2015 1:00:00 PM

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?



Marcy B. Bolster, MD is a professor of medicine in the Division of Rheumatology and Immunology at the Medical University of South Carolina and director of the MUSC Center for Osteoporosis and Bone Health.She says she recommends calcium carbonate because “it’s inexpensive, won’t cause discomfort, and is a good source of calcium.”
Calcium carbonate is also used as an antacid to relieve heartburn, acid indigestion, and upset stomach.You can buy it with or without a prescription; however, when using this medicine as a dietary supplement, take it with food or following meals.
The presence of food in the stomach causes the release of acid which is necessary to break down most calcium supplements. Also, when calcium is taken with food, it slows down the movement of calcium in the intestines allowing more time for calcium to be absorbed. Therefore, it is best to take calcium supplements with food.
So what counts as food?
The scientific answer is that food can be anything that causes the stomach to secrete acid. It can contain any combination of fat, carbohydrates, or protein. So, to a koala bear, eucalyptus leaves are food. To a dragon, knights are food. To pigeons, pretty much everything is food.
What about for those of us without the scientific mind? Here are a few food options. This is NOT a recommended diet, I’m just sharing a few things that might help you out.
  • 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)
Okay, so tell us, what food do you take your calcium carbonate with?
Interested in learning more about calcium? You can learn about the most common forms of calcium here, whether calcium actually will constipate you or not here, and how to take calcium with other medications here.

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

Dietary supplement use among adults in the US rose from an average 24.5% in the early 1970s to 56% in the mid-2000s. Supplements have grown into a $30 billion a year industry as of 2011.


Almost half the people who take supplements say they do it to improve their health
Can 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.[1]


Yet with all that supplement use, there seem to be a few things that most people don’t consider.
  • 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.[2]
So if you are using supplements, think about why, how, and when so you can make the most of them. Don’t just buy a supplement and assume it’s going to do all the work. You need to research, read, plan your day/week/month and look at your diet and overall health if you want to stay healthy. Supplements may be a big part of a wellness plan, but they’re still only a part.


Attending Patient Support Conferences

Posted by Jim Sliney, Jr. on May 9, 2015 9:30:00 AM
When there is a rare or under-served disease in your life it can be extremely difficult to know where you are on the scale of doing well or doing poorly. I know that sounds strange but let’s explore some hypothetical “what ifs” for a moment.
Let’s say in this hypothetical situation that your sister has gastroparesis. She’s married, works a full time job, has two kids, takes a prokinetic motility drug to help her digestion, and can’t eat fatty or fibrous foods. She’s been depressed and withdrawn about her condition because she can’t participate in the community activity of sharing a meal with friends and family. She has had to miss a lot of work for feeling poorly and is worried about job security. You propose that you and she attend a one-day patient conference on gastroparesis to get some perspective.
What happens at the conference?
She learns that there is a different drug that has had better effects than the one she is on. She meets dozens of people with the disease and makes some new friends. She also finds out that there is a fantastic doctor in her area that someone else at the conference is using who has had great success treating gastroparesis.
In the afterglow of the conference she makes a few changes:
  • 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.

Patient conferences can be a shared experience where lifelong bonds are made. Better than an online community, you get to see and feel what others experience and make what can be a lonely, isolating condition more manageable. So go to your patient support association and ask about live events or patient conferences that you can attend. To read more about resources that may be available to you, please click here.

The Natural Cycle and Recycle of Bone

Posted by Jim Sliney, Jr. on May 14, 2015 8:30:00 AM
Bones – we think of them like we think of scaffolding and beams – hard permanent things. Unfortunately we also think of bones as something that fail as we get older. That’s not the whole story. There is a natural cycle and recycle of bone.
Let’s take a closer look at bone so we can better understand how they work.
original artwork by jjsjr
This is “Celia.” Celia is an OSTEOCLAST. Osteoclasts, chew up bone. Let’s not blame Celia for being hungry all the time, that’s just what she does. She travels along the surface of bones, which look like this.
As she does, she eats up old bone. Eating bone!?! Don’t worry, it’s not as bad as it sounds.
In fact,
1) Though Celia chews up our bones, it is by that very process that calcium gets released from the bone into our blood stream where we need it for many vital functions, also,
2) There is another type of cell that goes around fixing what Celia breaks up. That cell is called “Barry”.
original artwork by jjsjr
This is Barry. Barry is an OSTEOBLAST. Osteoblasts build bone. Barry has a lot of work making new bone and fixing up after Celia, but he’s good at his job.
This dance that Celia and Barry perform all the time (yes, even right now as you are reading this), the chewing away of existing bone and building up of new bone, is called “bone resorption”. Build it up here, break it down there, build it up here, break it down there, always on and on as long as you live.
Getting in trouble:
Things start to go wrong when Celia eats more bone than Barry can build. This creates an imbalance in bone resorption in which
Bones start to thin out (OSTEOPENIA), and if not addressed
They can become more brittle (OSTEOPOROSIS) and then,
Sometimes, they can collapse or break (FRACTURES).
Time also presents a challenge. Generally speaking, bones build from birth until about the age of 30 after which time the metabolic energy that drove the bone growth slows considerably. From that point forward, if extra steps are not taken to keep Celia’s appetite in check and to keep Barry working hard, bones can begin to gradually thin out, become brittle, and so on.
Getting out of trouble:

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 (

Staying out of trouble in the first place:

Use your bones! There was recently an article on how bones act in space and it basically said, with nothing to do out in zero gravity, bone-building-Barry goes on vacation and bone mass drops drastically! Sorry Barry, you’re not allowed to go on vacation.
Our bones respond to pressure. To keep Barry from going on vacation you have to pick stuff up. There is a relationship between gravity and our ability to push against it. Here on earth we need to keep pushing against gravity to keep our bones strong. If you were only an inch tall your bones wouldn’t be very strong because you wouldn’t have to push against gravity so hard. If you were an elephant, your bones would have to be very strong because you’d have to push much harder against gravity.
How do you resist gravity?
  • 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.

Another way to stay out of trouble is to think about Celia’s needs. She eats bone all the time. Sometimes she eats more because she is told there is not enough calcium in the blood. For the blood, the fastest way to get more calcium is for Celia to eat faster!
That’s right, if you don’t have enough calcium in your blood, it makes Celia even hungrier, which is good on the one hand because she gets us the calcium we need, but bad on the other because over time she can eat up too much. So, one of the best ways to keep Celia from eating too much bone is to make sure there is enough calcium in the blood all the time.

Bone Health and Corticosteroids

And what you can do to keep your bones healthy when you have to use them

Posted by Jim Sliney, Jr. on May 21, 2015 4:55:00 PM
Asthma, lupus, skin rashes, arthritis. These are just some medical conditions that use CORTICOSTEROIDS as a treatment.
Corticosteroid drugs such as prednisone, cortisone, and hydrocortisone do 2 major things: 
  • 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


Corticosteroids are used to treat the primary side effects of these conditions of inflammation and auto-immunity. While effective, corticosteroid use has several SIDE EFFECTS associated with it.
They include
  •  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
  • Osteopenia/osteoporosis
Bone health and corticosteroids
Corticosteroids also interfere with normal bone turnover. It does this by essentially creating a flaw in the osteoclasts cells in the bone. This is why people who use corticosteroids, especially over a long time, begin to experience losses in bone density which can lead to osteopenia, which can then lead to osteoporosis. Most people who use corticosteroids do so because the immediate benefits of the drug would seem to outweigh possible health issues the future.
What do I do if I have to use corticosteroids despite the risks to my bones?
You will have to work out what is best with your doctor, but some things you can do to counter the bone suppressing feature of corticosteroids could include
·         Getting adequate calcium and vitamin D – the most consistent way of doing so is by
  • 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
  • original artwork by jjsjr

So if you are using corticosteroids you will need to figure out what you can and should do to protect your bone health.