Every day is an oportunity to learn something new and medicine is full of a
tremendous amount of complexity where the information changes on what seems a daily if not hourly rate. I'm always trying to keep up with what's new and there are many sources of information. Of course there are journal articles, meeting updates, and even the newspaper can be a source of knowledge. The trick is to integrate that information in a way that has a meaningful impact on patient care.
One of my more surprising sources of information is from a colleague of mine, Dr. Dawn Motyka. Dawn has a radio call in show on public radio in my community. She starts off with information about journal articles or publications she thinks may be of interest and then she takes calls from patients. People call her about a wide variety of issues and interestingly some call from quite a distance. I recall one person calling from Florida. Dawn is a Family Practice physician so she often times introduces topics of interest that without her talk show I would be unlikely to have any exposure to.
One phenomenon that has been increasingly recognized in medicine is the increasing number of patiets diagnosed with elevated calcium levels associated with an elevation of a hormone called Parathyroid hormone. Parathyroid hormone is secreted by four small glands that surround the thyroid. When they sense a low calcium level they secrete parathyroid hormone which tells your bones to breakdown a little and secrete calcium into the blood stream.
Sometimes the system goes haywire and the hormone is secreted when it isn't supposed to be and one ends up with elevated levels of calcium in the blood stream with demineralized and weakened bones and elevated levels of the hormone. For an unknown reason we have been finding more patients with this condition in the past several years. This has been attributed to the fact that doctors are more frequently ordering routine blood panels that include calcium levels now than they did in the past and therefore have uncovered more people with the condition.
So, a couple of years ago I was referred a patient with this exact same issue. Since she had elevated calcium levels and had a high parathyroid hormone level the concern was that she needed surgery to remove the glands that were over secreting the hormone. When I see patients with these findings I think of three possible sources of the problem. First is that this is seen in people with renal failure, but that was not the case here. Second, is that there is a single gland that has developed into a benign tumor called an adenoma that is the source and the third possibility is that the glands have just become defective.
To further evaluate I did some imaging studies to see if one of the glands had a tumor but the result was negative. I was considering surgery for the patient but I was uncomfortable because her calcium level wasn't terrible elevated and she wasn't having problems such as evidence of bone loss or kidney stones from the high calcium level. The surgery involves removing three and a half of the glands, thereby leaving just enough tissue to kick the body into a normal level. But if one removes too much the opposite occurs and the patient is stuck with low calcium which can be even more dangerous. So just to be sure I repeated the blood testing for her third time and surprisingly, everything was normal. The situation was strange, I advised her to have monitoring and I placed the experience in my library of unsolved mysteries.
Now, back to the present. Last week I was listening to Dawn and she was discussing another problem we are well aware of in medicine which is that we are prescribing large quantities of very powerful antacids called proton pump inhibitors which are more familiar to most of us as Prilosec and Prevacid among others. In fact currently those two are available without a prescription. The usage of these medications has gone up probably in direct correlation with the increase in obesity in our population. Unfortunately, these medication are not used without risk. They have been shown to be asssociated with poor calcium and vitamin B12 absorption as well as increased levels of osteoporosis.
But, interestingly Dawn found an article with some new information. Apparently these medications are also associated with an elevation in the secretion of parathyroid hormone. This recently published study immediately caught my attention because it may explain why my patient had the combination of elevated calcium and parathyroid hormone and then spontaneously returned to normal. Of course, now that three years have gone by I have no recollection of the name of the patient so I can't review her records to see if she was on this medication at that time.
But, I wonder if this mini epidemic of patients being found with high calcium levels might be a result of these now very common medications. Ironically, a couple of days after Dawn's radio show I bumped into her and shared my thoughts with her. She certainly was intrigued and we both agreed it was something we were going to share with our colleagues and monitor for among our patients.
So, in answer to the title of today's blog. Yes, a talk show can change how I treat my patients and I view every source of information as valuable as long as it comes from a legitimate background.
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