Dear Dr. Roach: I am a 62-year-old white male who is 5 feet, 11 inches tall and weighs 205 pounds. I have diabetes, high blood pressure and high cholesterol. I was recently diagnosed with “moderate to significant coronary disease” by a CT coronary calcium scan. This was based on a finding of “severe calcification in the coronaries,” as per the radiologist’s cardiac scoring report.
Separately, for the past 20 years at least, my blood tests have shown a high level of calcium in my blood. I understand that the normal range for blood calcium is 8.5-10.3 mg/dL. However, my calcium level has been at 12-13 mg/dL in every test for the past 20 years.
My question is: How much, if any, do my high blood calcium levels contribute to my coronary disease?
J.L.J.
You very likely have a condition called primary hyperparathyroidism (PHPT), as it is, by far, the most common cause of high blood calcium in healthy people. I am quite surprised, though, that the diagnosis wasn’t made and you weren’t recommended for surgery, since a blood calcium level of more than 1 mg/dL above the upper range of normal is an indication for surgery. Your calcium level is more than 2 mg/dL above this amount.
A parathyroid hormone (PTH) level and an ionized calcium level are likely to confirm the diagnosis, and you should have these done if you haven’t already. PHPT is sometimes treated surgically or with medication.
Coronary artery disease are blockages in the blood vessels that supply blood to the heart. Although a high calcium score makes obstructive coronary artery disease more likely, it is possible to have calcium in the blood vessels without blockages in the coronary arteries.
Being a man of 62 with diabetes, high blood pressure and high cholesterol already puts you at a significant risk, even without the additional risk from having a high calcium level. It’s impossible to say which one of these risk factors was most important in your case.
It is true that high calcium in the blood leads to higher coronary calcium scores, but recent studies have shown that surgical treatment of the parathyroid gland tumours that cause PHPT do not reduce the risk of heart disease. So, it shouldn’t be part of your decision to treat PHPT with surgery.
Dear Dr. Roach: Over 40 years ago, I was diagnosed with sciatica. Along the way, I had a chiropractor who advised me to hug my knees as tight as I can each time before getting out of bed. She said that most doctors won’t tell you this because they want you to come back. I have had various problems, but I feel that this has helped me.
J.B.
Hugging knees is a good way to stretch the hamstring muscles. Tight hamstrings can contribute to back pain, abnormal posture, and even compression of the sciatic nerve, so this is good advice. Warming up the muscles first with walking might make the stretching safer and more effective.
I don’t agree with the gratuitous fling about physicians. Chiropractors and physicians have different approaches, but we are all trying to help our patients. Deliberately withholding effective treatments would be unethical.
Email questions to [email protected]
