Friday, May 25, 2012

The Vitamin D testing sagas

Vitamin D testing is super complicated apparently. There are 2 forms one can measure-
1)      25-hydroxy Vitamin D: This is the less active form, and the normal range is around 30-100 ng/ml, and this is considered to be the far more reliable measure of vitamin D stores.
2)      1,25 dihydroxy Vitamin D: This is the exponentially more active form, but its levels are around a 1000-fold lower than the 25-hydroxy form, and the normal range is considered to be around 15-75 pg/ml. This one is considered less reliable because it has a short life (is degraded quickly) and its levels are regulated by calcium and other factors.

Remember I was freaking out about my ‘high’ D3 levels? It was the 1,25 dihydroxy form I was referring to.Below is a rundown of my supplementation and blood levels.

When I was taking 35000 IU/week (5000 IU every day for several months)
 25-hydroxy Vitamin D = 49 ng/ml (perfectly normal)
 1,25 dihydroxy Vitamin D = 86 pg/ml (ACK!)

Cut down to 15000 IU/week for 2 months
25-hydroxy Vitamin D = 49 ng/ml (perfectly normal and exactly the same as the last; my doc was rubbing his eyes in disbelief)
1,25 dihydroxy Vitamin D = 79 pg/ml (ACK! And  start to think that the lab test (from a small independent lab in Utah) may be effed up!)

Stop all vitamin D supplementation for 2 weeks . Decide to switch labs as I’m deeply suspicious of the 1,25 hydroxyvitamin D3 from the above testing lab. Go off to Labcorp, which is a big national chain.
25-hydroxy Vitamin D= 41 ng/ml (Falling- almost a 10 ng/ml drop in 2 weeks of no supplementation)
1,25 dihydroxy Vitamin D =11 pg/ml (Very different from the last value at 76 and in deficiency range)

Morals/Questions from this story:
1)Do not trust a small independent lab, you are much better off going to a large national chain, if you have the opportunity, for vitamin D testing. My endocrinologist is flummoxed as well- the perfect test to do is to actually send the same blood sample (or draw blood twice on the same day) to send to both labcorp and the lab in Utah to get to the bottom of this, but other than that, all we can conclude is that if one of the two tests is off, its logically more likely to be the first small testing lab, because labcorp is widely used and more validated, and most importantly, the values correlate with the amount of supplementation. I've observed this in the past, and  hence it was most disconcerting when the first testing lab reported those wonky 2nd test values. I hope this matter gets explored further, but I'm done with offering up my vein as the guinea pig.
2) Continuous Vitamin D supplementation is apparently necessary for some people, like me.  You cannot get much from diet and I seemingly get very little from sunlight ---normally I have no sun time, but during these past 2 weeks, I had 2  days (close to 8-10 hours) of sun exposure in Florida, with lots of skin bared, but sunblock applied. But my levels (of 1-25 and 25 forms) both dropped.  So unless I'm getting around 1-2 hours of sun with plenty of exposed skin (sunscreen free) on a daily basis, I would need supplementation. Had I continued to take no supplements, I project that, in around a month, I would have likely become deficient in the more stable  25-hydroxy form as well. 
3) But: taking too much may be less than optimal as well. I need to find that perfect balance.All of life and biology is about balance and this story is an excellent illustration of this. Right now, I’m going to go to around 12000 IU/week and see where that leaves me.

Tuesday, May 15, 2012

Rolling along...

Its very easy to get sucked into the whirlpool of  TTC anxiety/anticipation, even when you are far away from the actual event. God knows, the months between miscarriage 1 and TTC 2 went in a flurry of mental hand-wringing and hoping that stuff would be ok, and wishing time would just move faster, while not really paying attention to life. Well, things turned out to be decided *not* ok, but something amazing happened- I learned to switch off during the waiting period.  There were an eye-popping 16 months between miscarriage 2 and TTC  3 (which ended in a BFN). And I was mostly ok and relaxed for all of of it, which constituted a minor miracle. Now, there is going to be atleast four more months between TTC 3 and TTC 4 (tentatively planned for July), and I'm fine. I feel ok even when I anticipate delays past July- atleast in the getting pregnant bit.  I totally feel like I need to write somebody in the universe a big thank you note for my newfound Zen.

I've been doing a lot of thinking of how I am on the relationship front.  Its funny how emotionally detached, independent and mostly uninterested in the available fare I am and I can't figure out how I got this way. I became friends with this girl recently, and she is totally the anti-me. She has had a really rough time of it-- her mom died and the guy she had been seeing for 2 years and was totally in love with decides that he has fallen out of love with her & she is skirting depression. It amazes me how all her happiness, everything that is good in her life hinges on this guy and well, he is not delivering. I gave her the spiel on what the stages of grief are and I asked- have  you accepted that its over with this guy (Its been a month)? She said no. She also confessed she was afraid that she might be pregnant, but did not want to take a test to find out. The reason I'm accounting all of this is...its hard for me to get over how different people inhabiting this planet are, and how much better off one would be if one were not at the extreme end of an emotional spectrum.

I'd be a *lot* better off if I was a little bit more emotionally needy like this girl  and she'd do much better if she had some of my detachment and independence. Plus she could do with getting her head out of the sand for a bit- she was contemplating starting anti-depressants while pregnant, she should atleast clarify that question first, and get started on pre-natal nutrition if she is- she confessed she had lost a ton of weight because she had simply lost interest in food. Big ARGH. I may have overstepped many boundaries when I told her like 5 times that she had to find out one way or the other, STAT. I hope she tests.

On the TTC prep front, a source of frustration is my vitamin D levels. Over 2 months ago, my D3 levels were 86 which made me yelp in horror and drop my dosage by more than half. I figured this should bring it down to the 40s, which is where I want them to be. I tested last week- its gone from 86 to 79, which makes absolutely no sense. I have a feeling the levels may be so high that its maxing out the test and both reported values are inaccurate - that or there is some crazy biology at work. Anyway, I'm completely off the D now and the next time, my new wonderfully cooperative and available endocrinogist (I've added a review to my awesome doctors list) has agreed to send my blood off to an alternate lab for the next round.

So life is rolling along, and though on paper, my life does not look that great (single, maybe reproductively- challenged, staring at a possibly very difficult TTCing process as a single mom and I can't even tell which country I'll be in in 6 months), I'm not feeling any of the pain. I'm thankful.