#MiddleburyCT #HighBloodCalcium #CRPS 
DEAR DR. ROACH: A friend has been diagnosed with high blood calcium, and when I googled it, the results concerned me. Can you give information on this and how to discuss it with the doctor? I want to forward the column to my friend, and hopefully, the information encourages/helps with the medical discussions between my friend and their doctor. – Anon.
ANSWER: There are many causes of high blood calcium levels, and some of them are quite scary to read about. Hopefully, your friend’s doctor is already in the process of discovering the underlying cause. Some causes are pretty clear, as some medicines are well-known to cause high calcium, such as thiazide diuretics like HCTZ.
The first step is being sure that there really is high calcium by repeating the blood level. A tourniquet left on for more than a minute can cause acid buildup in the arm, which displaces calcium and causes a false elevation. This problem can also be avoided by being expeditious with blood draws or by measuring the “ionized calcium” for changes in the protein albumin, which also affects the calcium level.
If the calcium level is repeatedly high, the next place to look at is the parathyroid hormone, which is one of the main regulators (along with vitamin D) of blood calcium levels. Most cases of high calcium in otherwise healthy people are caused by excess parathyroid hormone, most often from a benign tumor in the parathyroid gland. In the unusual case that this isn’t the issue, less-common causes, including excess vitamin D and some cancers, should also be considered.
As far as an encouraging discussion, if your friend’s doctor isn’t bringing it up (which they should), being as open-ended as possible is best, with questions such as: “Why is my calcium high? Do I need to do anything about it?”
DEAR DR. ROACH: I had left knee-replacement surgery 10 years ago, and two days after surgery, I developed CRPS (complex regional pain syndrome). My shin, below my incision down in my left foot and toes, was burning and stinging for two years. It then receded to my toes for the past eight years.
Over the past three months, the pain has returned to my entire foot area, wrapping around my foot and ankle. It’s very painful. I have taken 20 mg of prednisone to get rid of my CRPS, and it does help somewhat. (I was only given a 14-day supply.) Is there any cure yet, or at least a good pain medicine that won’t wring me out? – G.D.C.
ANSWER: CRPS is a pain disorder that is not well-understood. It usually begins after trauma, including surgery, but this is a complication that can happen even after a surgery that was correctly done. Older women are most likely to get this condition.
Steroids like prednisone are sometimes used early on in CRPS, but they are not usually effective in chronic CRPS. Due to their long-term toxicity, they are not usually continued. It is, by no means, a cure.
The best treatment regimen includes physical and occupational therapy, medications such as anti-inflammatories; psychosocial support, and sometimes management by a pain-management specialist, who may use local injections, nerve blocks or nerve stimulators.
My experience is that CRPS follows a highly variable course, but I have never had a patient with a recurrence after such a long time, as you have had.
Dr. Roach regrets he is unable to answer individual questions, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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