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Dr. Andrew Rynne

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Exp 50 years

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Suggest treatment for weakness in leg with dfficulty walking

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Dr. Minal Mohit

Endocrinologist

Practicing since :1998

Answered : 790 Questions

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Posted on Wed, 20 Aug 2014 in Bones, Muscles and Joints
Question: I was having Vitamin D Low that was found 35 days back by the Blood Test.
I had taken 2 Arachitol 6Lac Injections.and 3 tablets of Uprise 60000 in last 35 days.
After the Medication , now I am not able to climb stairs , not able to walk fast and walks slowly.
Along with the Vitamin D medicines , I had not taken any calcium during this period.

Request to Kindly please advise the medication that can help me to walk properly and have proper Calcium and Vitamin D .
First Arachitol 6Lac Injection was taken on 21 XXXXXXX 2014. After one week I took first Uprise 60000 without calcium. After another week I took one more Uprise 60000 and their was no calcium supplement taken. I was then not able to walk properly and climb stairs.
After a week a took the third Uprise 60000 and still their was no calcium supplement taken.
I then took the second Arachitol Injection on 16 July 2014.
Still not able to walk fast and climb stairs.

Please advise the right dose of calcium and Vitamin D.
Please advise the treatment for this.
Please suggest the component of Blood for checking the Vitamin D Toxicity , Vitamin D and Calcium level.
doctor
Answered by Dr. Minal Mohit 38 minutes later
Brief Answer:
Overdosing of vitamin D probably.

Detailed Answer:
Dear Mr. XXXXXXX

You have probably been overdosed with vitamin D.

Kindly get your 25 (OH) D checked and let me know. Also do not take any more vitamin D for next 6 months at least.

Please start with calcium 1gm /d. Brands like calcimax forte contain 500 mg of elemental calcium, so twice a day course, after meals is sufficient.

But first give a sample for serum calcium, serum albumin and 25 (OH)D and let me know the reports.

Waiting for the reports.

Regards!
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Minal Mohit 33 minutes later
Hi,

Thanks for the advise.

Please advise that when should be the serum calcium, serum albumin and 25 (OH)D test be done ( Before / After food).

I had also taken one Vitamin B12 Injection before 2 weeks.

Also please advise if other tests like CBC, Thyroid ,B12 is required.


Thanks and Regards,
XXXX
doctor
Answered by Dr. Minal Mohit 11 minutes later
Brief Answer:
yes if not already done.

Detailed Answer:
dear ma'm, usually the preferred time for calcium is morning fasting sample. for remaining tests it does not matter much. but then to prevent double prick, i would suggest get all tests in the same morning sample, overnight 12 hrs fasting state.
if you are a vegetarian definitely b12 is required. CBC, ESR, RFT, LFT, Lipids, TSH, FT4, RA, anti CCP are some of the basic tests which I take for granted you must have done and are normal so we are only discussing grey zones, where there is a problem. but if not really done so far please get them done. regards!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Minal Mohit 5 hours later
Hi,
Thanks for the advise.
I had already taken Vitamin D in this month. kindly advise that should I take calcimax forte 500mg as it is having Vitamin D although less.

Also I had taken one B12 Injection ( Nervup), so can I take B12 tablets.

Best Regards,
XXXX

doctor
Answered by Dr. Minal Mohit 14 hours later
Brief Answer:
please do take B12 every day.

Detailed Answer:
Dear Ma'm, you can take any other preparation of calcium without vitamin D, but it should make up 1gm of calcium per day. B12 needs to be taken everyday. regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Minal Mohit 32 minutes later
Hi,

Please advise if Calcium with Vitamin D is good for me then I would take that and if you advise that Calcium with other preparation is good for me that I would take that.

Please Suggest again on the recommended medicine / brand name good for me.

Thanks and Regards,
XXXX
doctor
Answered by Dr. Minal Mohit 34 minutes later
Brief Answer:
do not take any more vitamin D.

Detailed Answer:
Dear ma'm, please do not take any more vitamin D. check your levels first. calcium you can take shelcal or corcal . dose i have been repeatedly telling you 1g /day. regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Minal Mohit 3 days later
Hi,

I had got the blood Report with below result found.

ESR :
End of 1st hour : 35
End of 2nd hour : 75

Vitamin D : 35.21
Intact Parathyroid Hormore (iPTH) : 6.5
Calcium : 9.0
Vitamin B12 : 544
Anti CYCLIC CITRULLINATED PEPTIDE ANTIBODY : 0.15
BLOOD FOR C REACTIVE PROTEINS <6 ( Negative)
R A FACTOR 4.0 ( Negative)

Please advise on this and next step.

Please advise on the mediation / treatment .

I am having the same symptoms as updated before.

Additional symptoms
Feels something is stuck in stuck.
pain on back side and down of ear on the neck.
breathing cause pain feeling on the back side and down of ear on the neck but not always.
stomach ( feels like pulling down)
can not lift head while on the bed.
Vomiting feeling in the morning but can not vomit.

Kindly please advise.

Thanks,
XXXX


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Follow up: Dr. Minal Mohit 9 minutes later
Hi,

I had got the blood Report with below result found.

ESR :
End of 1st hour : 35
End of 2nd hour : 75

Vitamin D : 35.21
Intact Parathyroid Hormone (iPTH) : 6.5
Calcium : 9.0
Vitamin B12 : 544
Anti CYCLIC CITRULLINATED PEPTIDE ANTIBODY : 0.15
BLOOD FOR C REACTIVE PROTEINS <6 ( Negative)
R A FACTOR 4.0 ( Negative)

Please advise on this and next step.

Please advise on the mediation / treatment .

I am having the same symptoms as updated before.
( Can not climb single stair , can not stand for more than 15 minutes at a place, slow walking, jaw and tong movement restricted, chewing difficulty, neck movement somewhat restricted...weight 39.9)

Additional symptoms
Feels something is stuck in Neck.
pain on back side and down of ear on the neck.
Breathing cause pain feeling on the back side and down the ear on the neck but not always.
stomach ( feels like pulling down)
Can not lift head while on the bed.
Vomiting feeling in the morning but can not vomit.
Feels like Strength is very less in hands and leg.

Kindly please advise.

Thanks,
XXXX
doctor
Answered by Dr. Minal Mohit 18 minutes later
Brief Answer:
ESR is high.

Detailed Answer:
Dear ma'm, all seems fine except the ESR. i am still waiting for RFT, LFT and lipid profile. please let me know those reports as well. regards!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Minal Mohit 6 hours later
Hi,

Please find below the report result.

BLOOD UREA 18
URIC ACID 3.9

ELECTROLYTES
CHLORIDE 104
POTASSIUM 4.80
SODIUM 139


LEVER FUNCTION TEST
TOTAL BILIRUBIN 0.6
DIRECT BILIRUBBIN 0.02
INDIRECT BILIRUBIN 0.58
SGPT 12
SGOT 14
ALKALINE PHOSPHATASE 62
TOTAL PROTEIN 6.3
ALBUMIN 3.6
GLOBULIN 2.7
A/G RATIO 1.3

RFT was partially done
CREATININE 0.90

Lipid Profile was left by the mistake as I was checking the prescription file from the other website that I received from you.

Also on the day of blood test I was feeling week and had taken
1/2 cup of tea with a small biscuit and after some time 1/2 glass
of coconut water.
Could it have a significant impact / any impact on the report.

Also I was on period (Fourth day) on the day of blood test.

Kindly please advise on the possible cause of low PTH and high ESR.


Blood report mentions in commented line that hypercalcemia generally displays low or high PTH. Kindly advise that is it Hypercalcemia.


Is their any possibility of further rise in the calcium level as the last VITAMIN D3 injection was taken just 12 days back.( I had not taken any calcium after the injection)


Also please advise on the possible impact of low PTH and high ESR.


Please advise the medication and the next step that I can take.


Thanks and Regards,
XXXX
doctor
Answered by Dr. Minal Mohit 17 hours later
Brief Answer:
primary hypoparathyroidism can explain things.

Detailed Answer:
Dear ma'm, hi! most of your reports are good. a small food intake will not affect the reports actually.
high ESR needs a little thinking. have you been coughing? did you undergo chest X - ray? any signs of weight loss? TB?
low PTH explains that your parathyroid is not adequately working, causing weakness of bones. you must start the treatment as i have already advised. you may need further work up, ie, dexa scan for bones to find out osteoprosis.
if it is confirmed, i would suggest inj teriparatide 20 mcg s/c every day for at least 6 months. regards!





Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Minal Mohit 2 hours later
Dear Ma'm,

Thanks for the advise.

Dexa scan was done before the second dose of Vitamin D3 injection. It was done on 07 / 07/2014.

DXA Bone Densitometry Report

BDM measured at A P Spine L1-L4 is 1.088 g/cm2 with a T-score of -0.8 is normal.
Fracture Risk is low.

BDM measured at Femur Neck Left is 0.906 g/cm2 with a T-score of -0.9 is normal.
Fracture Risk is low.

BDM measured at Femur Neck Right is 0.837 g/cm2 with a T-score of -1.4 is considered moderately low. Fracture Risk is moderate.
Treatment advised if there are other risk factors.

BDM measured at Femur Total Left is 0.990 g/cm2 with a T-score of -0.1 is normal.
Fracture Risk is low.

BDM measured at Femur Total Right is 0.905 g/cm2 with a T-score of -0.8 is normal.
Fracture Risk is low.


BDM measured at Forearm Radius 33% is 0.802 g/cm2 with a T-score of -1.0 is considered moderately low.
Fracture Risk is moderate. Treatment advised if there are other risk factors.


Site           Region Age Mached Z-score     Young Adult T score
AP Spine      L1-L4          -0.8               -.08
DualFemur      Neck Left      -0.8               -0.9
DualFemur      Neck Right -1.3               -1.4
DualFemur      total left      00               -0.1
DualFemur      total right      -0.7               -0.8
DualFemur      radius 33%     -1.0               -1.0

BDM mentioned above.


1) Blood report mentions in commented line that hypercalcemia generally displays low or high PTH. Please advise on the possible cause of low PTH and high ESR and is it related to Vitamins or is their possibility of hypercalcemia.

2) Is their any possibility of further rise in the calcium level as the last VITAMIN D3 injection was taken just 12 days back.( I had not taken any calcium after the injection)

3) Primary hypoparathyroidism is suspected . Request to kindly update the medication and root cause for this.


Please advise on the possible impact of low PTH and high ESR and advise the medication and the next step that I should take which could help me to recover health.


Thanks,
XXXX

doctor
Answered by Dr. Minal Mohit 20 hours later
Brief Answer:
Dexa is not s/o osteoporosis.

Detailed Answer:
Dear Ma'm, Hi!
1.Low PTH is the primary cause of low calcium in your case.
2. low Vitamin D was also an important cause of low calcium. but you have been replaced with vitamin D. 12 days is a sufficient time for serum levels to come up. so the report is just fine, suggesting no toxicity.
3. calcium supplementation is required, 1 gm /d
4. Vitamin b12 is required 1500mcg /d
5. cause of low PTH, is primary and not calcium. ie, some cause internal to parathyroid gland itself. it needs management if calcium alone is not able to maintain serum calcium. but as of now your calcium is normal.
high ESR is suggestive of some underlying infection. it can be urinary tract , TB, or something else.
regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Minal Mohit 24 hours later
Dear Ma'm, Hi

Thanks for the Advise.

ESR
No Coughing and had not undergone chest X - ray.
Signs of weight loss but not significant.
Current Weight : 39.5 kg
Weight before 35 days : 41 kg
Weight is not increasing although taking proper food.
Height : 162 cm.


Please advise on the food that I could take to improve the weight.

Please advise on the possible cause of high ESR and ways to find it.
Please advise on the medication and treatment for making it proper.


PTH
Please advise on the possible cause of low PTH and ways to find it and make it proper.
Please advise on the possible cause of somewhat restriction of neck/tong/jaw movement and restriction of leg movement (not able to climb a single stair) and strength reduction of body.

Can not lift the head when laying on the bed and difficult to turn on the bed.
Walks very slowly.
Kindly also suggest that is it related to PTH and ESR.

Thanks and Regards,
XXXX
doctor
Answered by Dr. Minal Mohit 20 minutes later
Brief Answer:
Repetition of the queries and the answer

Detailed Answer:
Dear Ma'm, hi! probably you do not read the answers in details, you have been asking the same question repeatedly and i have been answering the same. so this is last , i would be closing this query after this answer.
ESR
underlying infection, need to find out.
see your doctor.
PTH
idiopathic , primary hypoparathyroidism. need calcium and vitamin D . Vitamin D you have already taken, do not take more. PLease take calcium1gm/d, b12 1500mcg /d.
as no osteoporosis, do not need PTH per se.
diet
keep it healthy and balanced
physiotherapy
may be required, slow stamina building exercises.
regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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