Breathing worse with pred reduction- Dilemma

I wonder why they just used 2000 IU per day? The usual recommended approach in the UK now is 60,000 IU per week for 8 weeks (single dose or 3x 20,000 IU) and then check the vit D level. Here in Italy my husband is on 25,000 IU per week in a single dose - and that is regarded a slow approach. High dose is fine provided they keep an eye on the blood levels.

There is a lot of evidence now for the role of vit D in asthma - didn't realise it applied to other pulmonary problems.

Do you know here, in Nova Scotia, they discourage doctors from testing D level in anyone at all, except those at risk.  They just say everyone should be getting supplements.  Apparently I'm in a risk category, discovered through my own initiative and not by any investigation by my doctor, and I'm only allowed a single annual test.  A symptom of lack of funding, but as maintaining optimum D levels is key to good health it seems like a pretty shortsighted strategy if the aim is to save money.  I could be very ill now from too much active Vitamin D, and my neighbour could be suffering indeterminate symptoms of ill health because of low D despite supplementation.  

My hubby who has always had repiratory problems of one kind or another and who is currently claiming a bout of bronchitis (I accused him of having a man cold but maybe I should be a bit more sympathetic) is constantly being nagged by both my dietitian daughter and myself to take Vitamin D.  Maybe this information will make him more compliant?

Out of interest - is there no way you can get it tested privately? There is a lab in central England that does testing for the NHS and also privately. It costs about £25 for a one off in the UK, it is slightly more for samples from abroad - but the price goes down if you order a batch so you could do more than one or share with friends. But there must be a parallel service in Canada. I had a blood test done privately at a clinic in Whistler (not vit D) - I just had to present a referral from a doctor and pay the invoice there and then.

Google "vitamin d blood spot test city assays city hospital dudley road" for details.

Exactly - you can take supplements - but it doesn't mean you absorb it. Or you may have something that makes the level far too high. Just as my husband spends plenty of time in the sun here in Italy - his vit D was in low single figures! You can't tell by looking at the outside - and I'm getting really cheesed off with people who think their medical degree conferred them with extraperceptive powers!

The 2,000 u dose was used in 2011 because no one was sure of whether Vit D would be effective and the right therapeutic dose would be.

More studies have been done since.

It's one thing to raise the blood levels and another to maintain it.

The safe blood levels are 30-100 ng /ml so a wide safety margin. Some researchers believe levels ~ 50ng/ml are beneficial.

Yes, I believe I can actually pay for the test, or I could go to a naturopath (covered by our extra insurance, not public system) and have any tests at all, which I would pay for.  I believe all these tests are done in the same labs as the publicly funded ones.  I'm going to wait for the next test opportunity (end of May) and depending on the result I'll either wait 15 months for my next "free" test at summer end 2018, or pay to have the test in September this year to see if sun exposure has a significant effect.

There is a very strong resistance to "private" medicine in this province.  We are a poor province, especially when compared to BC, for example, and there is a perception, justified I think, that any erosion of the universality of our system, even such as it is with all its deficiencies, will disproportionately affect disadvantaged members of our society.

Yes, and 200 and above is toxic.  Mine last spring was 169 so I'd really like to know whether the changes I made have been right - too much?  not enough?  But maybe it's a good thing to have the followup test run exactly one year later.  With that information I'll be able to make some reasonable judgements, and hopefully all is well.  

I live in BC. My GP is willing to order me a Vit D test whenever I ask but I must pay for it. They have been costing me $65 and I get them done at the same place where I have my other blood tests done. 

My GP told me that To get the province to pay for this test in BC it needs to be ordered by a specialist. At this point I'm just glad I have have it done!

Suggest they come and have a look at South Tirol - it mixes well and no-one is excluded from care.

About the only justification for exactly a year is if it is done in spring (potentially lowest) and autumn (potentially highest) if you are making vit D from sun. 

Unfortunately when I showed up for my regualr check-in last week my daoctor was not there, and I saw another preson in the practice.  She was nice enough, and was the one who told me my D test hadn't been done.  When I told her I was willing to pay for it, and asked her how that could be done she didn't really give me an answer.  So I've decided to take an extra 1000 IU over what's in the bones supplement as I suspect I need it and this amount shouldn't cause any harm, and as I think I said above, if things don't seem to be going well after next allowed test in late May I'll try harder to get at least one year worth of regular monitoring, quarterly, I think, would be a good idea.  Then I'll know how to manage things and can settle for an annual check.

Eileen, my understanding is, at higher latitudes the sun is not strong enough to easily convert Vit D through the skin..

The other problems contributing are sun blockers to prevent skin cancer and spending so much time inside (on our computers).

Though much maligned, tanning beds are a way of getting fake sunshine.I knew of a lady who had low D . She had terrible pain from a cracked vertebra.,Her husband gave her a tanning bed certificate as a treat. Her pain went away and the thing healed. She was young and hadn't fallen.

That's right - but even without the no vit D September to May if you live north of about Turin or Boston, even at those latitudes it doesn't always work, even in the summer! I live barely north of Turin, spend a lot of time outdoors all year round without sun screen. So does my husband. I was low but have got the level up with supplements. His level recently was in single figures! He's been on supplements since December - don't know the result yet.

And by no means all tanning beds will do it safely:

"UVB is the type of ultraviolet light that causes your skin to convert cholesterol into vitamin D. It is possible to get UVB from a tanning bed, but the EMFs produced by magnetic ballasts used by the vast majority of tanning beds are of major concern. You want to make sure you're using a tanning bed that employs newer electronic ballasts, which virtually eliminate this risk and are safe. They also use about 30 percent less electricity and produce more light, so they are far more economical to run.

But doesn't ultraviolet light cause melanoma?

Rates of melanoma, the deadliest form of skin cancer, have been rising for at least the last three decades, and this increase has been largely blamed on exposure to ultraviolet (UV) light from the sun.However, research published in the British Journal of Dermatology1 shows that the sun is likely nothing more than a scapegoat in the development of melanoma, and the sharp increase may actually be "an artifact caused by diagnostic drift."Researchers believe the rising rates of melanoma are due to an increase in diagnoses of non-cancerous lesions classified, misleadingly, as "stage 1 melanoma."

Exposure to sunlight, particularly UVB, is actually protective against melanoma—or rather, the vitamin D your body produces in response to UVB radiation is protective."

And to add to the problem; it is possible to OVERDOSE using a tanning bed! Though usually your skin factory switches off after making a certain amount...

Eileen, I am not advocating tanning beds. I just shared a lady's experience. I appreciate learning about the differences you describe. Science to the rescue.

Is it true that Arctic people get Vit D from whale blubber?

Mixed private/public won't work here for the simple reason there are not enough doctors.  Private clinics will just take doctors away from the public arena where wait times can already be ridiculously long, rather than shortening wait times for everyone.  Now if there were enough doctors I'd say "maybe" but my belief is that as long as the rich and/or powerful have a stake in the public system they will do what they can to make it work.  if they can just opt out because they have the money they won't care and things will get worse.

This is not to say that I don't take advantage of the areas where there is private care as well as public.  For example, one can get physiotherapy at a hospital through medicare, but the wait can be counterproductive.  I didn't even know there was physio available for "free" as I've always gone to physio with coverage from our workplace based health plan.  Our medicare coverage is not at all complete, coverage for teeth and eyes, for example, is very limited, so most people have extra insurance, and that same insurance may cover things like prescription meds, eyeglasses (pitiful amount) physio, podiatrist, etc.  It's a bit hit or miss.  Our particular plan doesn't cover occupational therapy or dietitian, but does cover chiropractor and naturopath .  

More importantly, Eileen, you have to remember the big country to our south where there are private health care providers slavering at the bit just dying to get a foot in the door here so they can take over and provide us with the American model of sickness care.  Because of terms we've stupidly agreed to under NAFTA we leave ourselves wide open to this exploitation once private clinics are established.  No thank you!

As one of the traditional sources of Vitamin D is cod liver oil, and you can even get poisoned by the D in a polar bear's liver, I would think that Arctic dwellers have readier access to Vitamin D than those of us in temperate climes.  Yes, I believe that whale blubber is high in Vitamin D as well as omega 3 fatty acids.  Eating fresh raw fish and blubber also is a source of Vitamin C.

Probably! There is a lot of vit D stored in fat and liver. 

No - I didn't think you were advocating it - I was adding to your comment because it IS one way of doing it and done with care it is OK.

Oh yes - it's going to be a problem in the UK if they think they can get a good deal with the US after brexit - but the Cons are into privatisation god help us! They will be offered a good deal - but it won't be good for the UK if a certain gentleman has anything to do with it.

Not sure what is happening in the EU - there were a few groups bright enought to realise what could happen.

Trouble seems to be that politicians have no historic memory.  It only takes one generation for people to forget why certain things were brought into being in the first place.  Because my father was a doctor in a small town I have a good memory of what life was like for many of his patients - how often he was paid in kind - a wheel of cheese from the family farm, or a cut of venison from hunting - or not paid at all.  Medicare ended all that, and brought security to both patients and doctors.  But like every human institution instead of being gradually improved and extended over the years, there's been a steady decline as the system is squeezed by rising costs and reduced manpower.  I would be willing to say that when medicare was first brought in, Nova Scotia had one of the best sytems in the country, which would by extension mean in the world.  As young adults my husband and I found the NS system to be more accessible in NS than in either BC or Ont where we also lived for a time.  This has gradually been eroded to the point where we really are the poor sister.  The care continues to be very good - if you can get it.  A few years ago an acquaintance of ours broke her hip.  She was, oddly enough, not as upset as one would expect.  It meant that instead of a two year wait for a hip replacement suddenly she was number one on the list!  

At the moment the government is happily saying that "only" 25,000 people in the province do not have a primary care physician.  This really means that 25,000 people have self identified themselves by voluntarily placing themselves on an internet based waiting list.  The more likely figure is 90,000.  This in a jurisdiction of fewer than one million people.  A local clinic may close soon, for lack of staffing, as all the doctors are either already past retirement age or rapidly nearing it.  10,000 more patients without a family doctor.

Yup - all sounds like the NHS!

It isn't even a generation - it is the short-termism of government. At present the system here is still good although there are waits because of a shortage of doctors who want to work here. Difficult to sort since legally they must be at least bi-lingual, German and Italian. Only locals here manage that and they go out into the big world and often don't come back as they can't train here. Yet. 

But the regional government sees the problems - and is prepared to do something about it. Including encouraging the setting up of our own medical school,

Feeling much etter in the 10,000iu Vit D as discussed with my pulmonary. Specifically: less weakness; I am able to walk up my stairs without stopping to breathe; my inhalers "work" better; my mood has improved.

I also use an approved Vit D light following a specific timing protocol.

I was unable to tolerate by mouth so I bought a Vit D 5,000u patch(Mg and K) from a site for bariatric patients and open a 2,00 u dose and apply with aloe to crook of elbow. A recent study in Saudi Arabia used a similar transcutaneous application with increase in blood levels.

My understanding that pred might interfere with absorbing of D? I am missing part of my small intestine so I might not absorb pills.

There is a lot of research in Canada regarding D3. Current research suggests the usual blood values might be too low for optimum health. All I can say I feel so much better.

In 2 weeks will have blood levels measured and report.

I also read ridiculously high doses must be taken for months to reach toxic levels; I haven!t seen any reports of toxicity yet.

Vit D isn't affected by pred as far as I know - calcium and pred should be taken a few hours apart as they affect each other. 

Most of the world is accepting that the "normal range" levels found in the general population are not the same as "optimal levels"!!! But what doctors learn at a certain stage of their education sticks and it is often very difficult to convince them otherwise. It is improving though!