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Work, Vitamin D

Posted Sep 07 2008 8:37pm

Work has been extremely busy lately, especially the last 2 weeks. Part of it is the fact that school is back in, but a lot of it is just that there is a lot of work (I’m not complaining; job security). I don’t do any direct patient care at my full time job (at least for now, due to my immunosuppression); it’s all taking care of phone messages, authorizations for meds, advice calls and emails, and many other things.

The job is rarely boring, and although I’ve been fielding phone calls from parents, patients, pharmacists, home medical suppliers, nurses, and many others, I never run out of new situations.

A parent recently contacted me about her child, who apparently is just entering college for the first time. One of the classes involves the students going out “in the field” to catch wild bats, so the students need pre-exposure vaccination with Rabies vaccine (which differs from Post Exposure Prophylaxis, which is given after exposure to a potential rabies contact).

Well, there is a serious nationwide shortage of Rabies vaccine. In Pennsylvania, the Department of Health is now overseeing the distribution of Rabies Vaccine/Rabies Immune Globulin. In order for a provider to get the vaccine to administer to patients, they must call the DOH, provide the history and rationale for giving the vaccine, and if approved, they will be given an authorization number. The provider must then contact the manufacturer, and they will ship the vaccine overnight.

Back to the parent. The parent is a RN, and I explained to this person that there is a shortage, and the PA Department of Health will not release vaccine for pre-exposure prophylaxis. As the conversation progressed, she stopped short of calling me a liar, and insisted on speaking with the doctor. I forwarded the message to the doc, and she called the parent.

I’m not sure what happened with the phone call (but can pretty much guess), but I was annoyed not so much at the mother, but more at the professor who reportedly was having untrained Freshmen college students go into the wild and risk death for a class (except in 1 case, Rabies is nearly 100% fatal if not given post-exposure prophylaxis, and bat bites can very easily go unnoticed).

I called the Health Department office in the county of the University, and explained the situation to the nurse. She basically couldn’t believe it, especially knowing that there is a severe shortage of vaccine. She was going to call the University and speak with someone there.

This is proof that having an advanced degree does not necessarily equate to common sense. Why do these untrained students need to catch wild bats? I’m sure there is a wealth of information out there obtained by trained professionals who have caught bats, that these students don’t need to do it, but can read about it on the internet or in books. End rant.

My Vitamin D level is finally back. I can’t compare the previous level back in January, because they checked different labs. The one I had this time is probably the one that is appropriate (although the January test, Vitamin D1,23 Hydroxy, was probably appropriate back then, as I was on dialysis at the time). Anyway, my Vitamin D 25 Total was 41 (norm 20-100), my Vitamin D 25 OH D3 was 21, and my Vitamin D 25 OH D2 was 20.

Vitamin D 25 OH D3 indicates both endogenous production and supplememtation.

Vitamin D 25 OH D2 in an indicator of exogenous sources such as diet or supplementation.

Therapy is based on measurement of Total Vitamin D 25 OH, with levels below 20 indicating defiency, 20 to 30 indicating insufficiency, and optimal levels being over 30 (again, mine is 41).

I had been taking 50,000 units of Ergocalciferol per month (prescription), although I’ve read that Cholecalciferol is the preferable form. I think I’ll ask the Nephrologist if I can just switch to Citracal + D.

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