HYPERTENSION

Hypertension? Really?

So your doctor just slapped you with the diagnosis of hypertension. Before you start taking pills, let’s all pause and take a deep breath.

Not all “readings”of hypertension constitute a “diagnosis” of hypertension. Hypertension (abbreviated HTN) and high blood pressure (abbreviated HBP) are interchangeable terms for the same condition.

Under what conditions was the blood pressure taken?  Were you well fed and well rested? Or were you stressed out with tax bills, an aging spouse, and a thrombosed hemorrhoid?  Ideally, the blood pressure should be taken with the patient in a sitting position, both feet on the floor, with nothing to eat, drink, or smoke for 60 minutes prior to the reading. One must also have refrained from vigorous exercise for 60 minutes before the reading.

Is the cuff the right size? This is one of the most common errors. A large arm requires a large cuff.  A huge arm requires an elephant cuff. Make sure your blood pressure taker uses the right size equipment.

OK.

All of the above criteria have been met and it is still high. Now what?

Is this one high reading or is it one of 20 high readings? If only one in 20 is high, relax: it is a fluke, an aberration, perhaps a mistake.  If most or all of the 20 readings are high (under ideal conditions) you, my friend, do indeed have high blood pressure.

Now what?

Before you start taking pills, examine your lifestyle. There are a handful of so-called “lifestyle modifications” or “non-drug remedies” for hypertension.

Some are obvious.

1.        Do you smoke? If so, quit.

2.        Do you imbibe adult beverages to excess? If so, cut back. The real test is to become a teetotaler for a month with frequent blood pressure checks.  If your BP is 165/100 while drinking and 120/70 when sober, you have your answer right there.

3.       Ibuprofen. Occasional use of ibuprofen for pain or fever is okay. If used daily, this medicine can adversely affect the blood pressure — especially in those individuals with pre-existing high blood pressure and those with kidney disease.

4.       Caffeine – see number 2 above.

5.       Decongestants (Sudafed, others). This is not a big one, but some people are sensitive to Sudafed and responds with a rise in blood pressure. If you have high blood pressure, these agents are best avoided. (There is nothing wrong with letting a cold run its course)

6.       Salt. This is a tough one. You can count your cigarettes, your cans of beer, and your cups of coffee but unless you are OCD and record the sodium content of everything you eat and drink, it is difficult to get a handle on sodium intake. Most national health organizations recommend a lower salt intake for everyone. This recommendation is fine on its face, but let’s go a step or two further. Is your blood pressure normal? If so, salt is not a problem (for you). Is your blood pressure high on a low salt diet? Then salt is not THE problem (for you). Not everyone is salt sensitive. From my observations, it seems that black people are more salt sensitive than whites.  (Full disclosure: I have no hard evidence to back this up — only 30 years of observation).

 

Notwithstanding any of the above, if you have high blood pressure, a low salt diet is worth a try. It is safe, risk – free, and possibly effective.

 

So.

You are now clean living: off the smokes, no ibuprofen, down to one cup of coffee in the morning and one cocktail in the evening.  You walk 5 miles a day and have taken yourself off salsa, bacon, catsup, and soy sauce,and your blood pressure is still above 130/80.

 

Now what?

 

At this point, your doctor may want to run some tests looking for secondary causes of high blood pressure (Cushing’s disease,  pheochromocytoma, coarctation of the aorta, renal artery stenosis, others). He or she may just ask you to take a pill.

 

EITHER WAY IS FINE

 

My personal preference is to ask a few questions and if the patient feels fine and their exam is normal, I start a medication and follow them. If the blood pressure normalizes and the patient has no side effects, then I continue the medication and monitor the patient. If the blood pressure fails to come down with two, three, or more pills, then and only then do I recommend tests looking for secondary causes.

 

Most patients with hypertension need combination therapy, and that means multiple medications. This does not mean that the medications don’t work. It just means that your blood pressure is complicated and requires medications which work in different ways for control.

 

Untreated high blood pressure puts you at risk for heart attack, stroke, kidney failure, and heart failure. Check it. Recheck it. Change your lifestyle. Take your pills.

 

In today’s world, there is no reason for anyone to walk around with high blood pressure.

COPYRIGHT 2012 TIMEWISE MEDICAL

GERMOPHOBIA

I am a germophobe and proud of it. Washing my hands 60 times a day does not bother me in the least. I believe  it has been my clean habits which have kept my absenteeism to a minimum. (Two days in twenty years).

I invite all citizens to join our ranks. In order to join, please take a few moments to familiarize yourself with these few lessons.

Lesson number one: Handwashing in public restrooms

Wash your hands with soap and water and after the last rinse be careful so you:

DO NOT touch the faucets. (You and others turned the spigots on with DIRTY HANDS).

DO NOT touch the button on the blow dryer. Use your elbow.

DO NOT touch the wheel of the paper towel dispenser. Touch only the paper towels.

DO NOT touch the endless cloth towel. (Germs migrate along the fibers) (I don’t know of any place that actually has one of these 20th-century relics, but there it is).

DO NOT touch the door. This one is tricky. Huge restrooms have no door. Fancy restrooms employ a butler equivalent to open it for you. If the door swings out, you are in luck. You could conceivably WAIT for someone else to come in, but that could take a while. My best advice is to protect yourself and grasp the handle with paper towels. Disposal of the towel then becomes problematic but if there is a receptacle nearby, you have won.

Lesson number two

Wash your hands with soap and water when you get home — especially if you’ve been to a public place or have handled any money.

Lesson number three

Wash hands before eating.

Lesson number four: Buffet lines

This is a tough one. Progressive establishments and enlightened party givers will put out waterless gel hand cleaner at the start of the line. (I would like to make this a constitutional amendment but that would take time.)  If you can’t clean your hands at the start of the line do so after you’ve loaded your plate but before you sit and eat. ALWAYS use utensils and tongs to load up.  NEVER touch the food with your hands until you sit down to eat.

Lesson number five: restaurants

Wash your hands after ordering and handing the menu back to your server. Handle the salt and pepper shakers cautiously. Do not put your hands on the table or on the seat.  (How many times have you seen a server wash the table and then, with the same rag, wash the seat?  Unless that towel is disposed of immediately and a fresh one used for every table, just imagine the E. coli spreading like a bad rumor. ).

Lesson number six: Sneezing and Coughing

Use a handkerchief or a tissue or, if none available, sneeze into your elbow.

Lesson number seven: The handshake

When someone says hello and extends their hand towards you, take it and shake it warmly. To do otherwise is unspeakably rude and will ruin the moment (and probably more than that). From that moment, be careful not to touch anywhere near your face. Go about your business, act normally, and at your first discrete opportunity, wash your hands or refresh with hand gel.

Lesson number eight: Hand gel

Keep a bottle in your kitchen, bedroom, bathroom, office, briefcase, car, and pocket etc. etc. One cannot be too careful nowadays.

Master these lessons and you will quickly become a member in good standing of Germophobes Anonymous. Welcome to the club.

Copyright 2010 Timewise Medical

 

NOW TIME VERSUS CLOCK TIME

My oldest daughter had her first child one week ago. In our conversation last night, she told me that the concept of time had changed for her since the birth of her child. This new mother was not bound to any specific clock time. Instead she was following “now time”.  “Now time” is decidedly different than “clock time”.

Babies don’t wake up at 6:30 AM. They wake up “now”. Infants don’t have the first bottle at 7 AM. They have it “now”. Infants, toddlers, and a lot of children follow “now time”. They want to eat when they are hungry. They do not want to hear, “we eat at six and it’s only 4:30”. Statements like that just don’t register with a four-year-old. (They don’t exactly resonates with 14-year-olds either, but teenagers can at least process the information).

The younger set has no concept of time. They live in the “NOW”. Tell a child “tomorrow”, and what he or she hears is, “NO”.  Why do children ask daily “When is Santa coming?” Not until age 6 or so do they grasp the concept of hours, days, and weeks.

Back to my grandson.

He eats “now”. He sleeps “now”.  He poops “now”. His mother also now lives in the “now”and finds it refreshing. My daughter, by the way, is a rocket scientist and her team sent those robots to Mars. Talk about being a slave to clock time! The mission would have flopped without precise – millisecond by millisecond — timing of the entire venture every step of the way.

Her time is now also “now time”. She eats when she is hungry — not at seven, noon, and six.

When friends call and want to drop by, she invites them. They then ask, “When?”  BC (before child) they would get a clock time. Now, the answer is, “tonight”, or, “call us when you leave”.

Far too many of us live by the clock and not by the now. Are you reading this waiting for five o’clock so you can leave work? Are you counting the days until Friday? Until vacation? Until (fill in the blank)?

 

Take a lesson from my daughter and her new son. Live in the “now”. Enjoy each breath, each bite, each sight.  As one wag put it, “Life is what happens when you’re waiting to do stuff”.  (Or words to that effect). Take your happiness and pleasure in the little moments of life. The past is gone. Tomorrow may never come. We are only here and now in the here and now. Enjoy these moments.

COPYRIGHT 2010 TIMEWISE MEDICAL

ROSACEA

 

“Acne?  Acne? Doc — how could I possibly have acne? I’m 35 years old!”

Acne rosacea, or adult type acne, is a fairly common condition affecting an estimated 13 million unfortunate citizens in the United States. Any ethnicity is at risk, but it is more common in whites. Women are affected more than men. Acne rosacea can significantly affect the quality of life of those afflicted by it.

It starts gradually with symmetric facial flushing, erythema (redness), prominent tiny blood vessels called telangiectasias, papules (raised bumps), pustules (tiny abscesses), thickening of the skin and enlargement of the pores.  Eye involvement is common with nearly 60% of rosacea patients showing ocular disease. Symptoms include photophobia, erythema, foreign body sensation, telangiectasias, corneal ulcers, and worse.

“But Doc, are you sure?”

Not everything on the face which looks like rosacea is rosacea. It can mimic other conditions and other conditions can mimic it. Your doctor should consider the possibility of lupus, drug rashes, peri- oral dermatitis, sarcoidosis, photosensitivity reactions, granulomatous skin changes, and polymyositis. If doubt exists, a biopsy may be needed.

So let’s say that the diagnosis is secure. You have acne rosacea. What now? Before (long before) your nose resembles that of W.C.Fields, there are things you can do and medicines you can take to treat it.

Avoid sun exposure. Use your sunscreen. Wear  wide-brimmed hats. Skin products containing astringents such as menthol, alcohol, witch hazel, clove, peppermint, or sodium laurel sulfate should also be avoided. Other triggers to be avoided are stress (ha! that’s a good one), wind, strenuous exercise, spicy foods, adult beverages, hot beverages, certain cosmetics, and both indoor and outdoor heat. The preceding list was based on a survey of over 1000 rosacea sufferers. You may have none, one, or more triggers. If you do find a trigger, do your best to avoid it.

After avoiding triggers, both topical and systemic therapies are available. What you choose and use is often a process of trial and error. Working together with your physician, you should be able to find a combination which controls the disease (there is no cure), with a minimum of side effects. Evidence for efficacy of treatment in controlled clinical trials is spotty and inconsistent. Be patient. Most therapies work. They just don’t work immediately and they don’t work all the time in all patients.

Topical agents include benzoyl peroxide, clindamycin, erythromycin, sulfacetamide, azelaic  acid, metronidazole, adapalene, permethrin, and tretinoin. They all have their place in the therapy, along with pluses and minuses, benefits and risks, and side effects.

Oral options include doxycycline, tetracycline, minocycline, metronidazole, azithromycin, and isotretinoin. Again, each option has its risks and benefits. Have a thorough discussion with your doctor about the best selection for your particular condition.

Nonpharmacological treatments include lasers, dermabrasion, carbon dioxide laser peel, cold steel excision, electro-surgery, and surgical shave techniques. Obviously, these treatments are reserved for only the most severe recalcitrant cases. Ocular rosacea almost always requires systemic therapy and the help of an ophthalmologist.

OK. So you have acne rosacea. Do not despair. It is annoying but not serious. It is treatable. Find a doctor who is familiar with it and work with him or her to find a treatment regimen which is right for you.

Copyright Timewise Medical 2010

 

BED BUGS

Nighty-night

Sleep tight

Don’t let the bed bugs bite!

How many nights did my mother tuck me in and recite that refrain?

Lately, the last line of that ditty has taken on new meaning.  Bed bugs are out there. Their numbers are increasing, and they are developing more resistance to pesticides.

Although there is little evidence that they transmit disease, they are definitely a nuisance and can be difficult to eradicate.

First of all, the bite: painless in almost all instances. They can be multiple, and often in a row (or, as we say in the trade, “breakfast  – lunch – dinner”).  After a while, itch develops in most if not all cases. Rarely a secondary infection which requires antibiotics occurs.

A word of caution: one bug bite looks much like another. It is impossible to tell from a row, a cluster, or even an isolated itchy red spot exactly which insect is responsible.

The bugs can be found in cracks and crevices of mattresses, wallpaper, upholstered furniture, luggage, curtains, carpets, and picture frames… The live bug is about the size of an apple seed and is reddish brown in color. You might find a crunchy cast of shed skin. Other evidence of infestation is pinpoint blood spots on sheets and pajamas and black flecks (feces) on beds and bedding.

Bedbugs crowd where people crowd: hotels, homeless shelters, military barracks, college dormitories, and apartment buildings. In short, almost everywhere. Because they can live for up to 10 months without a blood meal, they have been found in vacant houses.

Prevention:  As Ben Franklin said,”an ounce of prevention is worth a pound of cure”. To avoid bedbugs, avoid the places where they are.(DUH!) Since it is almost impossible to avoid a hotel stay now and then, carefully check out the mattress before you unpack. Keep suitcases off the floor and away from curtains. Don’t buy secondhand upholstered furniture or mattresses. You could be buying trouble.

Treatment: both heat and cold will kill the bugs. Wash clothes and bedding in water 120°F or higher.  Twenty  minutes in the dryer on high heat will also work. Several days of freezing (32°F or below) will kill the bugs. One novel idea is to leave the suspected items in a car with the windows up and parked in the hot sun for a day. Make sure you bag the items first so that your car does not turn into a bed bug limo. Vacuuming has been mentioned but it obviously can’t reach all places.

If you elect to treat with chemical insecticides, call in the professionals. This is not a do-it-yourself job.

COPYRIGHT TIMEWISEMEDICAL 2010

DEPRESSION

Google the word  “depression”and you will have 78,500,000 websites to look at. Most aren’t worth the photons on the screen. Some have to do with economics. Most want to sell you something. Millions of trees have been sacrificed  for multi-volume,  dust gathering tomes written about the many faces of the depression. How can I do justice to the topic on a blog?

I can’t. Here goes:

THERE IS MORE THAN ONE KIND OF DEPRESSION

There is bipolar depression, postpartum depression, depression associated with major medical conditions (heart attack, cancer), grief reaction, depression as a side effect of certain medications (birth control pills, others), depression associated with substance abuse or withdrawal, depression associated with lack of sunlight (Seasonal Affective Disorder, or SAD – psychiatry’s greatest acronym), depression associated with vitamin and nutritional deficiencies, etc.etc.

DEPRESSION OCCURS IN A SPECIFIC CONTEXT

The doctor or therapist must determine the specific cause of depression. Additional problems  such as anxiety and other chronic diseases must be addressed. It is absolutely essential that the patient’s social situation and  support network  be explored. Are alcohol or other recreational drugs involved? Is the depressed person subject to verbal or physical abuse? What has the patient tried on their own to overcome their depression? Are suicidal thoughts creeping in?

TREATMENT MUST BE INDIVIDUALIZED

If the patient is suicidal, inpatient admission is required — even if it means an involuntary 72 hour hold. Depression is, unfortunately, at times, lethal. If a specific  cause is identified, this must be addressed as well. Other mental health problems  should be confronted head-on.  For example, if the diagnosis is SAD, light therapy is the treatment of choice.

BIPOLAR DEPRESSION IS DIFFERENT

It has been my experience that unless the topic is purposefully explored, the diagnosis of bipolar disorder  (old term = manic depressive illness) will be missed. Bipolar patients usually do not think they need to go to the doctor when high, or manic. No. They go to the doctor during the depressive phase and often (intentionally?) fail to mention the mania. This distinction is extremely important. If a bipolar individual is put on an SSRI, THEY WILL GET WORSE. (SSRI = Serotonin Specific Reuptake Inhibitor, i.e. Prozac, others) These patients need a mood stabilizer. Once the right mood stabilizer at the right dose is in place, then and only then can an SSRI be started and even then, only if needed.

Once bipolar disease has been ruled out, the doctor should offer the patient medication.  There are  many different kinds of antidepressants on the market. It may take some trial and error before the right medicine, the right dosage, or the right combination of medicines is found. Also, these medications usually takes 4 to 6 weeks to work. Be patient. Don’t give up too early.

DRUGS ALONE ARE NOT ENOUGH

In addition to medication, counseling is often useful. Cognitive behavioral therapy may help. Exercise is a natural antidepressant. Diet and nutrition often need attention. Abuse situations must be corrected – sometimes by involvement of the police and courts, if necessary. Often it is necessary to involve family in the treatment of the depressed individual.

FOLLOW UP        FOLLOW UP         FOLLOW UP

I recall  an elderly gentleman some years ago. His depression stemmed from age, the loss of his wife, and some physical infirmities.  He received counseling. He was placed on state-of-the-art medicine. At our last visit, he was improved and had a brighter outlook on life, was relaxed, and knew what he wanted to do. A few days later, I read in the paper that he had shot and killed himself. My point here is critical: In the first few days of emergence from a serious depression, the patient may have just enough energy to carry out a plot which they have kept a closely guarded secret. This is a very delicate time for the patient and the patient’s family. It is at this time, when all involved start to see the light at the end of the tunnel, that patients are often discharged from the hospital. Unless the patient is closely followed up, disaster might ensue.

Depression is real. Do not ignore the signs and symptoms. If someone you know is depressed, or looks depressed, or you even think they look depressed, do them a favor and ask. Talk to them. Get help. You may save a life.

COPYRIGHT TIMEWISEMEDICAL 2010

SLEEP

 

                Sleep. Such a simple concept. Babies do it. Dogs do it. So simple. So easy.

                Until you can’t.

                Sleep is like money. If you have it, you’re not concerned. If you lack it, it’s a problem.

                If you haven’t drifted off to sleep reading this blog yet, perhaps you have insomnia. Insomnia is but one of many sleep disorders, among which are narcolepsy, periodic limb movements, myoclonus, cataplexy, sleep apnea in its many forms, restless legs syndrome, jet lag, sleepwalking, sleep talking, sleep eating,  night terrors, and others. These so-called “parasomnias” are beyond the scope of this essay.

                So what is a person to do if they have simple, ordinary, uncomplicated, garden-variety insomnia?

                First of all, make sure that your lifestyle takes advantage of your natural biological rhythms. By that I mean, if you are a morning person do not take a 3 PM to 11 PM job. The reverse is also true. If your engine doesn’t get started until noon, but you can work or party ‘til the wee hours, don’t sign up for the 6 AM shift. Find out what your natural rhythms are (it’s not that hard) and adapt your lifestyle to it.

                If you are work schedule jibes with your biological rhythms and you still can’t sleep (or can’t sleep well) assess your daytime energy level. If your daytime energy level is average or above, chances are high you are getting enough sleep. Only if you experience chronic and excessive daytime fatigue is insomnia problem.

                So. Here you are: a morning person, have a 7 AM to 3 PM job, and have trouble falling asleep, staying asleep, and are awake for two hours before the alarm goes off. What gives?

                Take a closer look at your lifestyle. Too much caffeine? Still smoking? Drink too much? Exercise too little? I don’t mean to preach, but if you don’t sleep well, are tired during the day, put down a six pack of Dew per day, smoke, and vigorously refrain from anything vigorous, what do you expect?

                Connect the dots, man. Ditch the cigarettes. Alcohol on weekends only (and even then not to excess). Stop caffeine after 1 PM, and for Pete’s sake get in a workout at least five days per week. I would much rather you change your lifestyle than take a pill. In fact, I will insist on it.

                So. Here you are. One cup of coffee with breakfast, to drivetime cigarettes, one glass of wine with dinner, and a 4 mile walk every day. You still can’t sleep and are still tired. What gives?

                Are your medications timed properly? Decongestants, Wellbutrin, ADD drugs, Provigil, and others are notorious for causing insomnia. Discuss with your doctor your medications, their dose, and timing.

                So. Here you are. Impeccable lifestyle. No meds. Living on food, water, and fresh air. Still can’t sleep and  still tired. What now?

                Is there any stress in your life? Statistics are difficult to come by, but along with a crummy lifestyle, stress is on the short list of the causes of insomnia. If it is short-term stress, the insomnia is likely limited to the duration of the stress — whatever it may be.

                Long-term stress is an entirely different animal. And if the long-term stress comes with little or no control over the situation, that makes things doubly difficult. It is well known that the less control the more the anxiety, the more control the less the anxiety.

                Thousands of books have been written regarding insomnia, stress management, anxiety, etc. If you find a technique in one of these books, fine. Use it. There are dozens of such tricks.

                So. Now we come to sleeping pills.

                Sleeping pills are there for a reason: to help you sleep (DUH!). While it is not a perfect solution, it IS a solution. The sleep quality may not precisely mimic the refreshing REM dream filled sleep, but it is SOME sleep, nonetheless. For short-term use, I have no problems with a few sleeping pills. Among the situations or which I prescribe sleeping pills are: 1. Jet lag 2. Sunday night insomnia (those who get keyed up thinking about another week of work — more common than you may think). 3. Grief reaction (loss of a loved one), and 4. Temporary change of circumstances which are significantly disruptive (change of job, residence, salary).

                So. Here you are. Healthy lifestyle, stable circumstances, on no meds, no worries, doing everything right, and still have poor quality sleep and daytime fatigue. What do you do now?

                Unfortunately, there are people who fall into this last category. For these individuals, I will work with them to develop a program of medication which helps. The medication should be effective (DUH!), Free of side effects (another DUH), and cheap (this one may be difficult). There are a lot of choices out there and every patient merits an individualized program.

                Insomnia? It’s nothing to lose sleep over.

                           COPYRIGHT TIMEWISEMEDICAL 2010

FATIGUE

 

          Fatigue is defined as a feeling of tiredness or low energy which is relieved by a period of rest. We all have fatigue. Our energy levels wax and wane throughout the day. Pathological fatigue is the feeling of low energy which does not respond to rest.

          There are obviously many causes of pathological fatigue, among which are sleep apnea, heart disease, respiratory problems, chemical imbalances, too much medication or the wrong kind of medication, poisons such as alcohol or tobacco, cancer, thyroid problems, and depression just to name a few.

If you or someone you know feels they are tired too much of the time, they may need to see a doctor. The doctor’s evaluation should consist of a thorough history, a careful physical exam, and special testing if a specific diagnosis or syndrome is suspected. The most important aspects of this evaluation are the history and the physical.

          Most serious causes of fatigue (such as cancer) have other symptoms associated with them. These other symptoms may include fevers, chills, weight loss, various levels of pain here and there, loss of function, and a decline in one’s performance status. If you have fatigue, and only fatigue (without other symptoms) the answer most often lies in your lifestyle.

          First, look closely at your diet. Are there enough fruits and vegetables? Is it a well-balanced diet? Do you eat only one meal a day? Next, consider exercise. Are you getting 30 minutes of moderately intense exercise four or five days a week? Also, are you putting poisons in your system such as cigarettes or alcohol? Are you overmedicated? Are you depressed or anxious?

          All of these issues and more must be considered by the physician who undertakes the diagnosis and treatment of a person with excess fatigue. The process is not simple (I wish it were!). It often evolves into a journey taken by  the patient and the physician together  as a team.  As always, close follow-up is needed to ensure a successful outcome.

                            COPYRIGHT TIMEWISE MEDICAL 2010

Vitamin D

VITAMIN D

Copyright timewise medical 2009

                Are you vitamin D deficient? If you live in Minnesota, chances are that you are.

                The only way to tell if you are vitamin D deficient or not is to get a blood test. A 25-OH Vitamin D level blood test costs $89. In many ways it is a more important test than a cholesterol level. Vitamin D deficiency has been associated with many diseases including cancer and infections.

                Most folks are aware that vitamin D is intimately tied up with calcium metabolism, bones, and osteoporosis. Research also shows that vitamin D is important for diabetes, multiple sclerosis and other autoimmune diseases, some cancers, asthma in children, high blood pressure, heart disease, cognitive impairment, chronic fatigue, pain, and depression.

                  The present United States recommended daily allowance (RDA) of vitamin D is 400 IU. Experts agree that this is far too low. You would need to drink a quart of vitamin D fortified milk in order to get 400 IU. In the winter months, the sun is too low on the horizon to generate much vitamin D in your skin. In the summer months, you can generate as much as 10,000 IU per day of vitamin D. Sunscreen with an SPF of 8 will decrease that production by 95%. Experts disagree, but looking at recommendations from a  variety of sources there seems to be consensus that about 2000 IU per day of vitamin D is the proper amount.

                                .

                Some experts say that the level of 50 nmol/L  (or 20 ng/L) or higher is adequate. Others recommend the level of 80 nmol/L  (32 ng/L) or higher. Supplementation is straightforward. I routinely put patients on 50,000 IU per week for 12 weeks. This almost always returns the level to the normal range.

                If you want to supplement at the dose of, say, 4000 IU per day for three months and then check a level, that might save you some money on a second blood test.

Welcome to TimeWise Medical

Welcome to TimeWise Medical blog.