Dear Dr. Gott: I am 71 years old. Just as a precaution, my doctor has me on vitamin D (2,000 IU). According to your article in October 2010, this is too much. I am wondering if the sweats I am having are coming from this. They occur with little exertion, like vacuuming or other minor chores. My face, hair and neck are dripping with sweat. I usually stop what I am doing until I cool off. My husband looks at me and can’t believe it. I am very healthy, except for taking simvastatin, which I have been on for years.
I read your column every day and enjoy it very much. I’ll be looking for a response from you.
Dear Reader: Vitamin D is a fat-soluble essential nutrient required for the growth and development of strong teeth and bones and for the absorption of calcium and phosphorous from the intestines. It is available in fortified milk products, egg yolks, salmon, tuna and other foods. A common source of supply is through exposure to the sun, followed by dietary supplements. In fact, one of the greatest supplemental sources is cod-liver oil (the stuff your mother made you take as a child), which contains 1,360 IU per tablespoon. According to the Office of Dietary Supplements and the National Institutes of Health, a 71-year-old female should take 800 IU daily. The tolerable upper intake level for adults is 4,000 IU daily. There is still debate regarding proper dosage, with some researchers saying that higher amounts are safe and appropriate.
Excesses can cause diarrhea, constipation, drowsiness, weakness and more. Deficiency can result in osteoporosis, fractures and rickets in children. So the question arises as to why your doctor wants you on 2,000 IU daily. Do you have a parathyroid gland disorder; a family risk of colon cancer or type 2 diabetes or heart disease; osteomalacia (a softening of the bones); osteopenia; or osteoporosis and don’t want to take a bisphosphonate because of potential side effects?
To my knowledge, sweating isn’t linked with excessive vitamin D intake. Instead, it may be a sign of a hormonal condition, infection, cancer or an anxiety disorder, although each person responds to prescription medication and supplements in a different manner. On the other hand, simvastatin has been linked to a feverish feeling, nausea, loose stool and more. Whatever the cause, your drenching sweats may be a sign that something is going on. Follow up with your primary-care physician, who may order some routine laboratory testing. Be sure to ask whether your medication might be the cause. I understand that you have been on the drug for years, but hormonal changes occur in our bodies constantly. They don’t stop when we reach middle or adult age. If there is a connection, he or she can switch you to something else and solve your problem.
Readers who would like additional information can order my Health Reports “Vitamins and Minerals” and “Osteoporosis” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order for each report made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.
Dear Dr. Gott: I will be 93 this month and have been blessed with good health all my life. My recent medical checkup was good, and everything was normal. However, during the past year, I have noticed my walking has become somewhat laborious and stressful. Even a small incline on the street makes walking more difficult. I have a little dog, and she needs to be walked.
My physician ordered an ultrasound of both legs, and the result was normal. He also prescribed pentoxifylline to increase the circulation in my legs. I go to an exercise class three times a week and even dance a couple of times a week. My right leg is slightly swollen and feels very firm in comparison to the left leg.
Holding you in high esteem as a doctor of medicine, I wonder if you could recommend anything to improve my walking to normalcy.
Dear Reader: We could all take a lesson from your lifestyle! It’s extremely important to remain as active as possible, and you are certainly a testimony to that.
Circulation can become impaired as we age, which is why your physician prescribed pentoxifylline, the generic form of a drug that improves blood flow and helps reduce symptoms of vascular disease such as you may be experiencing. Of extreme importance is that your personal physician be informed of any and all prescription medication as well as over-the-counters you may also take that might have been prescribed by another physician or specialist, because there are 33 (138 brand and generic) medications (such as aspirin and atenolol) known to interact with some brand-name drugs in this class.
I might question whether you eat foods that contain a lot of sodium (salt) or add it to your food, which might cause leg edema (swelling). We often fail to read labels to determine how much sodium is included, or we arbitrarily add salt to foods prior to tasting them to determine whether it is even a necessary additive. If appropriate, stay away from chips, salted nuts and other snack items that might have a high salt content. When you sit (between dancing and exercise), do you elevate your legs? These two simple measures alone might decrease the swelling and allow for easier walking. Beyond that, you might ask your physician his views on a mild diuretic that will remove excess fluids from your system and be sure that he checks your blood pressure on your next visit.
I am not making light of your situation by any means but I feel you are ahead of the game to be in the condition you are at the tender age of 93. Try my suggestions, speak with your physician and, above all else, keep up your lifestyle as long as you can. You’re incredible.
Readers who would like related information on medication (not longevity) can order my Health Report “Consumer Tips on Medicine” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.
Dear Dr. Gott: My left big toe is black 90 percent of the time. I assume this is a circulation problem. My GP said it was no big deal. (He didn’t look at it.) I wonder what your opinion is. I’m a 54-year-old male and very active. Thanks.
Dear Reader: Two hints from the minimal information you gave me — specifically that 10 percent of the time your toe is not black and that you are very active — lead me toward possible stress placed on your feet, primarily the big toe. In essence, you could have impact trauma from pushing your toe to the front of your shoe(s) when walking, running, or engaging in sports activities such as baseball, soccer and football. I must rule out a melanoma under the toenail or a fungal infection, because both conditions would be present 100 percent of the time.
Another consideration might be peripheral vascular disease or another circulatory disorder, but you are young. Do you have a history of smoking? Is there pain involved? Are you a diabetic or have a family history of another disorder? Are you on any medication or herbal supplements? Is it related to cold temperatures?
Not knowing the specific cause of your black toe and because your doctor said it was no big deal without even looking at it, I urge you to be seen by a vascular surgeon for a proper diagnosis. The history you provide, coupled with examination of the toe, should allow him or her to direct you toward the most appropriate next step. I urge you to stop smoking, if you even do so, wear good support footwear depending on your level of activity, and get advice for what could be a health issue.
Dear Dr. Gott: Although I am seeing a neurologist, I want to run my situation by you because I love your column and trust your expertise.
I am a woman in my 20s in good health, not overweight. I try to work out three to five times a week, if not more. I don’t smoke or do drugs, but I occasionally drink. I am taking medication for birth control, anxiety and stress. I have what I would describe as occasional panic attacks. I have a high-stress job and other stresses in my life.
Recently, I felt nauseated and slightly dizzy at work. I also had a mild headache. Since a lot of people in my office were sick at the time, I figured maybe I was getting the flu or a cold. I left to get checked out by a doctor, as the symptoms didn’t improve. By the time I made the five-minute drive, I was sure I was going to throw up. I checked in at the office and quickly went to the bathroom and sat on the floor. After five minutes, I had not thrown up. That was when I realized I could not stand solidly on my own.
Someone came, got me in a wheelchair and to an examining room. That’s when my motor skills were affected. My right arm would not stop moving up and down, and my right leg was also shaking. My speech was affected, reduced to stuttering. They took my vitals, and as I waited for the doctor, my back arched and my body started jerking. I had no control and could not talk. Instead, I mumbled loudly so someone would help me. They thought I was having some panic episode, but it would not stop. This continued for hours. During all of this, my mind was OK. I knew what was going on and could answer questions. I just didn’t have control of the stuttering or of my body movements. I had an EEG and MRI and will get the results soon. Could it have been a form of a partial seizure or severe migraine that many women get around this age?
Dear Reader: Yes, it could. Let’s discuss seizures first. They are caused by abnormal electrical brain activity that may be provoked by high fever, low blood sodium or magnesium, low oxygen levels in the brain, hypoglycemia (low blood sugar), alcohol, medication withdrawal or may have no identifiable reason. A solitary seizure doesn’t imply epilepsy, but even mild forms of a seizure might require treatment because they can occur at inappropriate times, such as when driving an automobile. You may have experienced a partial seizure or a pseudoseizure (pyschogenic non-epileptic seizure) that didn’t result in a loss of consciousness but manifested in confusion and jerking.
Most migraine types in adults, and there are many, are associated with headache; however, a vertiginous migraine associated with recurrent episodes of vertigo with or without nausea, vomiting, photophobia or headache in a setting of positive family history of migraine or previous personal history might support the diagnosis.
Other possibilities include a nervous-system abnormality that resulted in seizure-like activity. Infection (specifically meningitis), hormonal changes of the menstrual cycle or medication may be the culprit. Overdose or abrupt withdrawal of many medications can trigger symptoms such as those experienced.
Whatever the cause, you need the results of your EEG and MRI so your neurologist can pinpoint why you experienced such symptoms and the best way to prevent them from happening again in the future.