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In this episode, Ricardo Pedraza, MD an internal medicine specialist from WellMed at Pecan Valley, joins Ron Aaron and Rajay Seudath, MD from Optum-University to discuss a crucial health topic: What happens when you have too much calcium?
Dec. 17, 2024
Podcast transcript
INTROWelcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rache Sudoth and award winning veteran broadcaster Ron Aaron will share information to improve your health and wellbeing. And now, here are Ron Aaron and Dr. Rajay Seudath.
RON AARON
Hello there, and welcome to Docs in a Pod. I'm Ron Aaron. Delighted to have you on board. We come to you every week with a look at a variety of medical and social issues as they relate to folks, some Medicare eligible and others not. Our co-host Dr. Rajay Seudath is with us. He's a board certified family medicine physician. Dr. Seudath is a Tampa native and current lead physician for Optum. He's at the university location in Tampa. He received his medical degree from the University of South Florida Morsani College of Medicine, and he has a passion for primary care and guiding patients to meet their health care goals. For his career in medicine, this is interesting, he had a number of jobs, but one is an English teacher abroad, which led to his inspiration for the field of medicine. Dr. Seudath, I asked you before, but maybe for folks who don't remember, what led you into medicine by teaching English to foreign students?
DR. RAJAY SEUDATH
While I was over in Japan, my student population was from preschoolers all the way up to elderly students in recreation centers. That diversity of students led me to want to pursue a diversity of patients. So, that fits very well with family medicine. From the womb to the tom so they say.
RON AARON
Clearly. We're going to turn to an interesting topic. High calcium. Dr. Ricardo Pedraza is joining us. He's been on before and we've been delighted to have him then and happy to have him back. He is an internal medicine specialist who believes in patient-centered care. Dr. Pedraza gets to know his patients and their unique situations to collaborate on a treatment plan that aligns with their goals and their values. He studied medicine at the University of Texas Medical School in San Antonio, and he's certified by the American Board of Internal Medicine. Dr. Pedraza, in his spare time, enjoys watching movies, spending time with his wife, and traveling across the U.S. where he tries out new cuisines. He's also an avid gardener, spending most of his free time tending to his plants. Well, that's got to bring calm to his life. He's at the WellMed at Pecan Valley Clinic in San Antonio. Ricardo, glad to have you back on Docs in a Pod.
DR. RICARDO PEDRAZA
Thank you for inviting me again.
RON AARON
Are you growing vegetables that you bring to the clinic and share with others?
DR. RICARDO PEDRAZA
Oh, I used to, but this season was not very good for me. So, I just have some different plants like rosemary and other things, the herbs, but no fruits like that this year.
RON AARON
Was it too hot for you and too dry?
DR. RICARDO PEDRAZA
Here in San Antonio, yes, it was like that.
RON AARON
Well, we've been in a drought, and we can always use rain. There's no question about that. Tampa had its share, Dr. Seudath. Send it North!
DR. RAJAY SEUDATH
Yes. We've had more than enough of our share of water, but I will say it made my lemon trees bear quite a bit of lemons.
RON AARON
I bet.
DR. RAJAY SEUDATH
When life gives you lemons, make lemonade.
RONA ARON
Dr. Pedraza, talk to us about calcium and an issue involving high calcium because we often hear about low calcium and the bone issues that come with that. What is high calcium a result of, and what's the problem?
DR. RICARDO PEDRAZA
There could be many different reasons why we have high calcium levels. Either we are taking too much calcium from vitamins that we might be taking over the counter, different medical conditions can do that as well. Medications that we're taking that are prescribed can also cause our calcium levels to go up. We know high calcium can cause problems with abdominal pain, kidney stones, bone disease. We want to have a fine balance of how much calcium we have in our body.
RON AARON
When you interview a patient, when you talk with them, for example, there for the first visit, is their level of calcium something you're worried about and interested in?
DR. RICARDO PEDRAZA
Yes. When I see patients in my clinic, I'll get the pre clinic labs. Calcium usually comes in the chemistry panel that I order. I'm looking for the level to be anywhere between like 8.5 to 10.5, more or less. If I see that it's high, then I start asking patients questions about, what are they taking over the counter? Which medications are they taking? Or if I need to order any additional imaging or labs to follow up on it.Ê
RON AARON
What will those labs tell you?
DR. RICARDO PEDRAZA
They will tell me where it's coming from. Sometimes it can be coming from our parathyroid gland or sometimes, in more severe cases, it can be from tumors in our body that produce the calcium or certain blood disorders like multiple myeloma that produce high calcium. So, there's different things that we can do to try to diagnose it.
RON AARON
When you mention tumors producing calcium, that's new to me, but of course, I'm not a doctor. Would that would be a trigger that you would then look for tumors?
DR. RICARDO PEDRAZA
Yes. So, for instance, let's say somebody smokes cigarettes, then I see a level of calcium that is high, I try to work up, is there something going on in the lungs? Do we need to start off with an X-ray that then leads up to a CT chest. So, depending on the history, I can tailor what path I take.
RON AARON
You say smoking will increase levels of calcium?
DR. RICARDO PEDRAZA
Smoking can increase the risk of lung cancer and there are specific tumors that can increase the level of calcium.
RON AARON
For sure. For those of you who just joined us, you're listening to the award winning Docs in a Pod, our podcast available wherever you get podcasts. We're also on the radio in a number of cities in Texas and Florida as well. Our co-host is with us, Dr. Rajay Seudath, and we're talking with Dr. Ricardo Pedraza. Dr. Pedraza at the Picon Valley Clinic in San Antonio, and we're talking about high calcium. Now, the flip side of that, of course, Dr. Pedraza, is issues involving low calcium and difficulties it causes with bone loss.
DR. RICARDO PEDRAZA
Yes. Whenever we have low calcium in our body, it could be due to medications or certain medical conditions. What our body will try to do is try to replace that calcium. So, sometimes what will happen is our body will start taking away the calcium from the bones and then that can cause bone disease, increase our risk of fractures. Our body has a specific metabolism and balance that it tries to find. So, when our low calcium level is low, it's going to try to replace that calcium. That's how we end up getting bone disease.
RON AARON
What I hear you talking about, there's a balance between having too much and too little calcium.
DR. RICARDO PEDRAZA
Yes.
RON AARON
How do we know as patients?
DR. RICARDO PEDRAZA
When it comes to what we recommend for supplementation, we'll recommend, for instance, for calcium, we should be taking about 1200 milligrams of calcium. I tell them that should be the limit. Try not to take more than that. When patients come in for a routine visit, we get labs and that's how we can determine what their calcium levels are at.
RON AARON
Dr. Seudath, is this something you see in your patients as well?Ê
DR. RAJAY SEUDATH
Absolutely. Patients who are having high levels of calcium, if they're there for a long time with high levels, you can actually start to get different symptoms. When you're in medical school and you're learning about this, there's a mnemonic stones, bones, abdominal groans, and psychiatric moans is the mnemonic we use. It's kind of all of the different things that can be caused by high calcium. When we're listening to our patients, we're trying to pinpoint, what's is the ones that kind of fit the bill? So, that takes your doctor knowing you, listening to your story, and then, like Dr. Pedraza was saying, doing some laboratory work to hone in on what could be causing those things.
RON AARON
Now, run that mnemonic back by me again.
DR. RAJAY SEUDATH
So, stones are going to be like kidney stones bones, painful bones or osteoporosis. Abdominal groans, so nausea, vomiting. Then psychiatric moans can be like memory loss, fatigue, lethargy, depression. In an extreme sense, even psychosis, if a person is getting profoundly hypercalcemic.
RON AARON
You spent all that time in med school learning all those little rhymes, right?
DR. RAJAY SEUDATH
That's correct. Those rhymes, they come in so handy. You never forget those.Ê
RON AARON
As you think about it, Dr. Pedraza, most of us generally don't hear much about the risks of high calcium rather, I think we hear a lot about, you got to keep that calcium up or you can end up with that curvature in your neck and your spine, and you're going to look like one little old lady, one little old guy. So, pump that calcium.
DR. RICARDO PEDRAZA
Yes, it is common that what I see with my patients. They'll try to stay as healthy as possible by taking different supplements and they'll bring in their whole bag of supplements and I look over it with them and then I realized sometimes they're overdoing the calcium. They'll be taking a multivitamin and then also calcium separate. Then you turn around and look at the ingredients and it's like far too much calcium for them. So, I tell them, this is the one you want to discontinue, you want to stay at this limit. Very common that I see that in my clinic.
RON AARON
See, it's interesting because I come from the old school that says less is more or more is less. You got to keep taking it.
DR. RICARDO PEDRAZA
Yes. It's very common. We want to try to keep ourselves healthy and take all these different vitamins and supplements, but we always want to talk about that with the doctors.
RON AARON
What is your recommendation on supplements and vitamins? Most of the PCPs I've had have said, you don't really need all those over the counter supplements. If you've got a balanced diet, you're going to get what you need.
DR. RICARDO PEDRAZA
You see, that can be tricky when it comes to a balanced diet. So, I always ask patients, well, what are you eating? For instance, I'll do a 24-hour recall where they tell me what's their breakfast, lunch, and dinner. Most of the time I can see areas that need to be improved. When it comes to specific supplements that I recommend for my elderly population, if I'm talking about calcium and vitamin D, I'll say, take calcium 1,200 milligrams a day and then vitamin D 3,800 units. The easiest way to take that is to find a calcium supplement that has vitamin D on it already. If you go to the pharmacy, go to the over the counter section, there will be a full section on calcium, and a lot of those calciumÕs already have vitamin D3 on them. So, I'll tell patients, get that. It's easier. That way, you don't take too much. You just follow the instructions on that bottle, and that's the amount that you need per day.
RON AARON
I gather the downside of slathering on sunscreen and wearing hats and long-sleeve shirts, we don't get our vitamin D from the sun anymore.
DR. RICARDO PEDRAZA
Right. Yes. We don't spend as much time outdoors as we used to hundreds of years ago. So, that's why a lot of us are low on vitamin D. Now, yes, we can get vitamin D from the sun. I do not necessarily recommend people go out there and spend time in the sun or that they increase the risk of skin cancer. Most of the time I'm going to recommend you take the vitamin D3. If the vitamin D level is low, we supplement with vitamin D.
RON AARON
And it's safe?
DR. RICARDO PEDRAZA
Yes.
DR. RAJAY SEUDATH
Another thing building on that sun issue, sometimes we even find that people who are living in very hot climates are vitamin D deficient because it's so hot. Nobody wants to go out into the sun. So, we often see some of our patients here in Florida, where it's the sunshine state, we should have tons of vitamin D just floating around, a lot of people are inside because it's so hot because there's air conditioning. Then the other thing is, with patients who may have kidney disease, they may not have the ability to transform that sunlight that gets absorbed by your skin into the active form by the kidneys. So, they may need to supplement.
RON AARON
I guess the question would be, Dr. Seudath, what's the chemical reaction that takes that sunlight? I mean, we're not plants. We don't have photosynthesis going on. So, how do you turn that sunshine into vitamin D?
DR. RAJAY SEUDATH
Now again, I'm a little far out from my medical school days, but I believe it's absorbed by your skin pigment. So, the melanocytes, which cause pigment in your skin, absorb that, and then from there it gets chemically metabolized to an inactive form of vitamin D. Then from there it goes to the kidneys to become the active form of vitamin D. So, when you're checking for levels, I was just reading something recently that you can't, I think it's the 125 OH vitamin D, may or may not be an accurate depiction of a person's vitamin D levels. But what it means is, you want to make sure that you're taking into account people's disease states when we're talking about their vitamin D, when we're talking about their calcium because not everybody's the same, there's no cookie cutter for one person.
RON AARON
All right, hold that thought, both of you. We're going to come right back. I'm Ron Aaron. If you've just joined us, you're listening to Docs in a Pod, the award winning podcast available wherever you get your podcasts. Our co-host is with us, Dr. Rajay Seudath, and Dr. Ricardo Pedraza, our special guest. You're listening to Docs in a Pod.Ê
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RON AARON
We appreciate you sticking with us right here on the award winning Docs in a Pod, our podcast available wherever you get your podcasts. We're also on the radio in a number of cities in Florida and Texas as well, including Tampa. I'm Ron Aaron, along with our co-host today, Dr. Rajay Seudath. We have our special guest, Dr. Ricardo Pedraza. Dr. Pedraza is at the WellMed at Pecan Valley Clinic, just on the south side of San Antonio, Texas. Carry us through, Dr. Ricardo, once again, for those who may have just joined us you're talking about the downside of high calcium. What are some of the issues that flow from that?Ê
DR. RICARDO PEDRAZA
If we have high calcium levels in our body, we, for instance, have an increased risk of kidney stones. Our calcium deposition in the urine builds up and those kidney stones are really painful, and they can be very difficult to treat. A lot of times we end up in the ER because of the pain. Again, increased calcium can lead to increased bone disease. It can also cause problems with how our intestinal tract work, so we get abdominal pain. It can cause problems with our memory or how we focus our mind. There are different things that can come up from having such high calcium level.Ê
RON AARON
I'm a guy, so I don't have childbirth, but people tell me that kidney stones are more painful than childbirth.
DR. RICARDO PEDRAZA
Yeah, a lot of patients will say that. They'll say it's super painful, and we want to avoid that for sure. But yes, once a patient has experienced a kidney stone, they don't forget that.
RON AARON
When you've had a kidney stone, what is it you can do long-run to reduce the risk?Ê
DR. RICARDO PEDRAZA
The number one thing is going to be to drink more water. So, hydration, fluid intake. I'll say two to three liters of water every day so that we can reduce the risk of calcium buildup in the urine that leads to kidney stumps. Also, there's a decrease in things like sodium in the diet that also helps. If we need to give supplements like potassium citrate, we can do that too to help reduce the risk of calcium. But the number one thing is going to be to drink water.
RON AARON
Dr. Seudath, what do you recommend to your patients? Most of us don't understand what liters are. What do you tell them to drink?
DR. RAJAY SEUDATH
64 ounces of water is a good start. That's kind of the daily recommendation. That's eight cups of water. I usually try to tell patients we're trying to dilute the calcium in your blood. If you've had a kidney stone and they say, Doc, what caused this thing? You say, well, we looked at your stone, it's calcium oxalate. There's going to be a concentration of calcium in your blood. If we add more water to your blood, it's going to dilute the blood and then there'll be less of a risk of that blood turning into a stone. So, you want to prevent it from crystallizing. When that happens, that calcium level gets too high, and it crystallizes. So, it works for high calcium levels, and it works for gout. Gout has to do with uric acid levels. So again, we tell people we want you to dilute that chemical, so it doesn't turn into a crystal.
RON AARON
Gout is triggered by high calcium levels?
DR. RAJAY SEUDATH
No, not necessarily. That's a different chemical. That's uric acid. Calcium levels can sometimes play a role in that, but it's a different disease, but a similar issue with diluting the calcium.
RON AARON
People who have gout will tell you, it really is painful in the joints like the big toe.
DR. RAJAY SEUDATH
Yes, and it's a similar process where that chemical, uric acid, is getting too concentrated and it crystallizes. Same thing with the calcium in the kidneys. It gets too concentrated, and it crystallizes.
RON AARON
Interesting. Is it something, again, you can predict and prevent from happening? Can you say to somebody, hey, look, I'm concerned about your uric acid. I'm concerned about your calcium. We want to reduce the risk of kidney stones and gout. Dr. Pedraza?
DR. RICARDO PEDRAZA
Yes, we can check that on routine labs, and as we see, for instance, the calcium going up or the uric acid going up, we talk to patients that we're worried about it. We take preventive measures to avoid any serious complications. If we have to start medication specifically to reduce the uric acid, we can do that too. But I also try to get to know their diet, what are they eating, are they consuming something that is increasing their calcium or their uric acid.
Ê
RON AARON
I have a friend who was speaking for a friend, who was convinced he had a broken toe because the pain was so excruciating and he went to the doctor and the doctor looked at him and said, I'll bet it's gout. And sure enough, it was gout.
DR. RICARDO PEDRAZA
Yes, it can be that painful. Patients will say they can't even put a blanket over their feet because it gets that painful. So, we want to prevent that from happening.
RON AARON
As you take a look at the other issues involved with calcium, it's funny because I don't spend a lot of time thinking about calcium, now it's all I'll think about for the next few weeks that we've talked about it. Are there recommendations on food as well to include or to avoid that can trigger high calcium? For example, I'm a broccoli a-holic. I love broccoli. I'm convinced broccoli is the cure all for everything in the universe. So, I eat a lot of it. Is it high in calcium, for example?
DR. RICARDO PEDRAZA
I believe broccoli does have calcium. Kale, spinach, and then there's dairy products, of course, that have calcium, you know, milk and yogurt. There's a lot of food that will actually have extra calcium added to it, so that can help with, not with bone health, but at the same time we don't want to be overdoing it. Especially if we're already taking supplements as well.
RON AARON
Well, that's interesting. So, when it says added calcium to prevent bone loss, you may not want that.Ê
DR. RICARDO PEDRAZA
Yeah, especially if you're already taking supplements and then you take a milk that specifically says Fortified calcium, Fortified vitamin D. You may want to take that into account and talk to your doctor about it.
RON AARON
Interesting. So, Dr. Seudath, again, I don't imagine many patients walk in unless they have osteoporosis or a similar disorder where they're worried about their calcium.Ê
DR. RAJAY SEUDATH
Yes, some patients may say, well, my brother, his doctor told him he has high calcium, or my mom had thyroid disease, is that something I have to worry about? So, people often hear different words, different terms, so thyroid, parathyroid, and they kind of get interested in wondering, am I at risk for that? So, that's one of the things that we check for as one of the causes of high thyroid disease. Calcium is a parathyroid disease. So, that's one of the laboratories that we're looking for. Those things, if we do a regular screening and a person has high calcium, now we're going to investigate it. Is it thyroid? Do we need to do some imaging for your bones? Are we looking for multiple myeloma, as Dr. Pedraza said. So, when people come in, it's usually something that's tripping them off to, you know, I want you to check my calcium. And we kind of drill down a little bit and understand what's the motivation behind that.
RON AARON
It didn't come out of nowhere?
DR. RAJAY SEUDATH
No, usually not.
RON AARON
And often it's triggered by a TV ad.
DR. RAJAY SEUDATH
Yes. That's correct. They may have seen something on it, or it may be a new drug, you know, get bon-niva or alendronate for your osteoporosis. I you have high or low levels, think about this drug. Ask your doctor about this. I can't say that it's a bad thing because it oftentimes starts that conversation with patients, and that's where a lot of the education starts.
RON AARON
As you think about all this, Dr. Pedraza, you're not only a physician, you have to be an educator for your patients.Ê
DR. RICARDO PEDRAZA
That is one of the most important parts of primary care is educating patients about different diseases and what medications they should be taking, what steps at home in terms of their diet and exercise they should be doing. So, yeah, very common that I'll educate my patients about the appropriate level of calcium, the appropriate level of vitamin D, different things like that.
RON AARON
You mentioned exercise. My cardiologist, Dr. Chris Thompson, who's a WellMed physician in San Antonio, is absolutely convinced, and he's probably right, that if we did exercise on a regular basis, we probably could reduce a lot of the medication we're on.Ê
DR. RAJAY SEUDATH
Yes, absolutely. Yes. If everybody were to do, let's say at least 30 minutes a day of exercise five times a week, that could help with our cardiovascular health, with our weight, with our blood pressure, so many different things.
RON AARON
It's funny. Someone will say 30 minutes a day? You've got to be kidding. That same person spends two hours a day looking at reels on Facebook.
DR. RAJAY SEUDATH
Yes, absolutely.
RON AARON
Because the time just slips by.
DR. RAJAY SEUDATH
That's right. Sometimes you can, you can present it to them as, well, you can do that on the seated bicycle with your Silver Sneakers. Hop in there, grab your tablet, grab your phone, put it on. You can still swipe while you're doing your bicycle.
RON AARON
Now, for those who don't know, Silver Sneakers is a program that, depending on your insurance, will provide a gym membership for you at no cost.
DR. RAJAY SEUDATH
Yes.
RON AARON
That's a pretty good deal.
DR. RAJAY SEUDATH
It is a pretty good deal. And again, even if it's not Silver Sneakers, there's other plans that usually offer some sort of gym membership or some kind of physical activity incentive.Ê
RON AARON
You don't have to join a gym to exercise, do you, doctor?
DR. RAJAY SEUDATH
Not at all.
DR. RICARDO PEDRAZA
Not necessarily.
RON AARON
Right? I mean, you could exercise at home. You could exercise in a mall. All right. Well, we appreciate both of you spending your time talking about calcium and high calcium. If you want to know more, talk to your primary care physician. Thank you to Dr. Ricardo Pedraza. Appreciate you being with us on Docs in a Pod and to our co-host, Dr. Rajay Seudath. Thank you very much. I'm Ron Aaron. We'll talk with you soon, right here on the award winning Docs in a Pod.
OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed. Be sure and listen next week to Docs in a Pod, presented by WellMed.Ê
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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