Could your vitamin D count be too high?

DEAR DR. ROACH: I am an 86-year-old woman with three doctors battling over my vitamin D level for many years. I am 59 inches tall and weigh 95 pounds. I play nine holes of golf three times a week. I have always been a poor eater, so I get little nourishment from food. I drink 3 ounces of scotch every evening with chips. That's my nourishment.

I've beaten lung cancer and recently had skin cancer surgery in my ear. The vitamin D situation never goes away, and the doctors keep changing my meds. One of the doctors claims that my vitamin D count is almost toxic (my blood levels of vitamin D are 121 from my rheumatologist and 145 from my internist), and I have been taken off any meds with vitamin D in them, but it's still high.

I am feeling OK now and want to forget the whole matter of the vitamin D level. Your opinion would be appreciated. — Anon.

ANSWER: I admire your spirit for life, even if I don't agree with your diet.

I have seen only one case of vitamin D excess in my career. It is very rare if people are taking less than 4,000 IU of vitamin D daily, so I suspect you were taking much higher doses at some point. When I hear that multiple doctors may have been taking care of you, I worry that more than one was prescribing high doses of vitamin D. There also have been cases of manufacturing errors and excess fortification of milk, but these are quite rare.

Vitamin D is normally stored in the liver, with the fat cells becoming a second reservoir. The toxicity of vitamin D is due to high calcium levels, which can cause confusion, nausea and vomiting, and muscle weakness. Toxic levels can be treated with short-term prednisone, but that isn't necessary unless there are symptoms or a dangerously high calcium level.

By the time your letter is published, your vitamin D levels should have returned to normal. If they haven't, it's time to look for a rare cause, such as sarcoidosis, where occasionally the abnormal cells can make vitamin D.

The booklet on sodium, potassium and mineral discusses the importance of these and other substances to our health. Readers can obtain a copy by writing: Dr. Roach — No. 202W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: My mother was diagnosed a few years ago with macular degeneration (both wet and dry). Is this disease hereditary? What can I do to prevent myself from getting this disease? — K.

ANSWER: There does seem to be an increased risk in people with a family history. Several studies have shown that vitamins, especially B vitamins, can reduce risk by a third or so. Since a combination of zinc and vitamins A, C and E was shown to help reduce progression of macular degeneration, many experts recommend it for prevention as well.

DEAR DR. ROACH: I'm 67 and male. When I had a male doctor, he did a yearly testicle and prostate exam during my physical. Now the practice has been taken over by female doctors, and for the past three years, this has not been done. Is this new? Is there a correct way to ask why the change? Believe me, this exam is not one I look forward to, but with a family history of prostate cancer and other cancers, the bloodwork I get each year alone does not seem to be enough. — Anon.

ANSWER: There has indeed been a change in the way prostate and testicular screening tests have been considered in recent years, and recommendations by advisory groups have changed as well. The current recommendation by the most influential group in the U.S., the Preventive Services Task Force, is against routine screening for prostate cancer and testicular cancer. However, there are some situations, such as with a strong family history, in which screening for these conditions is appropriate, and it is always appropriate for your doctor to listen to your concerns and preferences.

As far as male doctors versus female, most studies have shown that women physicians tend to spend a bit more time with their patients and tend to be more in compliance with practice guidelines. However, differences between individuals are more important than differences between the groups. Just tell your doctor, male or female, that you would like to further discuss prostate and testicular cancer screening.

READERS: The new booklet on the prostate gland discusses enlargement and cancer. Readers can obtain a copy by writing: Dr. Roach — No. 1001W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I have had episodes for many years where I am shocked, like an electric shock, which wakes me from sleep. I jump out of bed, then my legs and feet tremble rapidly, and I need to sit down or I will fall. I have been diagnosed as having "night terrors," but it is not that. I had a normal MRI.

It used to happen twice a week, then dwindled to monthly. Lately, I have it pretty much under control. I wonder if there is some diagnosis out there for me. I hope you have an answer. It would make me feel like less of an idiot! — J.N.

ANSWER: I don't think you are an idiot at all, and I do think I know the cause of these episodes. You have a pretty severe case of nocturnal myoclonus (which sounds like I know what I am talking about, but it just means muscle jerks at nighttime). These are very common and usually are normal, but are sometimes associated with epilepsy. Since yours aren't getting worse over time and you haven't had seizures, you are almost certain to have the "physiologic" type. Occasionally, there is a family history. I don't think you will need any treatment.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.

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