Vitamin D works slowly

#Middlebury #Health

DEAR DR. ROACH: Is there any reason to start taking vitamin D at age 90? I’m in good health except for osteopenia and high blood pressure. How long does it take to have an effect? – P.S.

ANSWER: In your case, there are potentially two good reasons to start taking vitamin D – if your blood levels are low.

One is that with osteopenia (a condition of low bone mass, a precursor to osteoporosis, which increases risk for bone fractures), replacing low vitamin D can improve bone strength and reverse bone loss. This can keep people from needing other medications for osteoporosis, which are much more likely than vitamin D to have side effects.

Older people with vitamin D deficiency also often have some muscle weakness. If you can’t get out of a chair without using your hands and you have a low vitamin D level, replacing vitamin D may help with the weakness. Of course, there are many causes for weakness in a person and there is no guarantee of effectiveness, but vitamin D is very safe in moderate doses, like 1,000 to 2,000 IU daily. Vitamin D also may reduce fall risk, probably by improving strength, especially in combination with exercise.

Vitamin D works slowly – weeks to months for muscle effects, and months to years for bone effects.

DEAR DR. ROACH: I was seeing my primary care physician every six months for about five years. We had mutual respect, and I enjoyed seeing him. Then, I got diagnosed with breast cancer and had to see other doctors for a long time. Meanwhile, the spinal stenosis my primary care physician had diagnosed was becoming untenable and ruining my quality of life. Even though I am still seeing cancer doctors, I called my primary care physician to make an appointment to discuss the spinal stenosis situation with him.

After a long wait, I finally got someone in my primary care physician’s office and, after another long wait, was informed that he could not see me for six months – there was not one opening until then. I was flabbergasted and asked to be put on a cancellation list. “We don’t keep those,” the lady responded. I reluctantly took the appointment and decided to wait it out.

Meanwhile, I saw one of my cancer doctors today, and after explaining this situation to him, he replied, “Doctors don’t do that. He obviously doesn’t want you as a patient anymore. I would find another primary care physician.” What is your response to this? I am 71 years old, and other than spinal stenosis and breast cancer (which was caught early and treated with surgery and radiation a year ago), I enjoy reasonably good health. – J.E.Y.

ANSWER: I hope there is another side to this story, since I am horrified that a physician would make a longstanding patient with cancer and spinal stenosis wait six months for an appointment. That is not appropriate medical care.

While I fully understand the point of view of your cancer doctor – and would be tempted to find another doctor – it sounds like saving the relationship you had with your PCP might be worth another try. I think speaking directly with your primary care doctor might clear up any misunderstanding.

Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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