I was given by GP a 6 week loading dose of ONE 50000 ui tablet once a week of Vit D (.colecalciferol) . They came in two boxes of three tablets each.
somehow I misread and took one box at a time so that’s two Sundays where I took three tablets each week. Oops. when I had none left this Sunday just gone I thought might as well call GP surgery and ask what to do re remaining 4 weeks. I wasn’t overly concerned (should I be?) just wanted to know what do next re maintenance level or get loading dose for the remaining 4 weeks.
So I get given an appointment with a clinical pharmacist at the surgery (must be a new thing) who asked if had side effects but I couldn’t recall anything specific / new.
Pharmacist wanted me to have blood test to see if any issues as result of my mistake. Also very clearly Said don’t take any more vit d. And wanted me to speak to GP too so he got reception to book me a GP appointment for today.
GP called just now (didn’t seem to know why had appointment 🤔) and wasn’t very bothered at all and couldn’t see any need to do anything especially as I’d technically taken the full loading dose anyway. I asked about a maintenance dose and he said wait a week then can take 1000ui a day BUT didnt says wait for blood test now. Common sense tells me I should wait 🤨
But must say the speed at which being dealt with is “breathtaking” - I called Monday, got appointment with pharmacist same day, GP appointment today Tuesday and blood test tomorrow!
Just musing why such different approaches?. Is it because pharmacist is specialist and GP is - clues in the name - general?
Who’s right, who’s wrong? What about consistency?
🤔
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Fanfab1
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Your clinical pharmacist was right to be concerned and take the precautions to test you as it is possible to overdose on Vitamin D and it can cause some side effects or toxicity in some cases.Your GP does need to make sure you didn't increase your Vitamin D too high with a blood test. Unfortunately most GPs aren't that knowledgeable of vitamin deficiency conditions or the effects of supplement treatment.
You wouldn't continue taking any more vitamin D until you had those blood results as you could have high levels or you could find the dose you took has increased your Vitamin D for the meantime,
Unfortunately, UK labs will only test people for Vitamin D every 12 months so can often refuse your GPs request for retesting even though this is sensible to ensure that your Vitamin D course has actually worked.
Labs and GPs , again because of lack of awareness about nutritional and functional medicine problems , just assume if you take the supplements or loading doses + even as prescribed ) it will have worked so do not find it a necessary expense to retest.
Sadly. I know from experience and reading many accounts on HU this isn't the case.
There are lots of reasons other than diet choices that cause people to absorb less nutrients which sometimes means that an oral loading dose still doesn't work.
If you can't get the blood test done it may be worth checking it privately.
If you haven't been experiencing any new symptoms or symptoms of Vitamin D toxicity and the blood test the GP just did was ok ,or temporarily high, it would be better to do a Vitamin D test in three months time ( you'll probably need to do that one privately with an online service if the GP already did one ) just to make sure your results accurately reflect your actual Vitamin D level rather than the temporary high level you might have in your blood at the moment.
You should also choose not to take any other supplements or multivitamins containing Vitamin D for a month whilst things return to normal. Your body needs time to readjust.
If you were Vitamin D deficient causing you to be treated in the first place it would be wise to take a lower daily dose of Vitamin D , especially during the winter months to prevent you getting Deficienct again but leave it a few months before you begin.
Certain drugs used to help cardiac health can affect how well you metabolise and store Vitamin D so it is a good preventative choice to take it as a supplement. If you live in areas where it is hard to get out in daylight it is more important.
A safe daily dose is between 3000iu - 4000iu when you can eventually take Vitamin D3 again.
Often it's better to use an oral spray or liposomal option but still take it after the fattiest meal of the day to improve your absorption.
BetterYou make a D3 and K2 spray which is used by many of us.
Depending on your Vitamin D needs you can take this each day during winter months but choose to take it every 2-3 days in Summer.
Thanks, as I said I am getting a blood test (nhs) tomorrow as requested by the surgery clinical pharmacist- they are in the same surgery as my GP. Apologies if that was not clear.
After I posted I was rang again by clinical pharmacist as must have seen note from GP on system or heaven forbid they had actually talked to each other 😂 and they said clinical pharmacist’s plan of action is what will be followed i.e. blood test. The pharmacist said he’d look at results asap too. Seems the conscientious / belt and braces sort!
Having read your post I’m counting myself fortunate to have been reviewed by the surgery clinical pharmacist!
I’ll wait to see what pharmacist recommends as maintenance dose! I think I need it.
as far as relationship of pharmacist with gp is concerned, I think it’s a great idea that doctors can call upon the expertise of those who know far more about pharmaceuticals than they do.
In my docs practice, they used to have twelve gp’s and are now down to four, some of them part time, so they rely on the pharmacists to help them. As I understand it, a group of surgeries gets together and employs one or more pharmacists. And this is so throughout England and has been for a couple of years.
My annual medical review is done by the pharmacist, and she contacts the doctor when she needs his input but she’s changed my dosages without referring to the doc, with my input.
It's a nice thought that all surgeries have a clinical pharmacy, sadly that's not the case in our village, despite the fact the chemist is just a few hundred feet from the surgery.
The pharmacist won't get involved with my husband's medical condition at all, not even to take his blood pressure, he says my husband's medical condition is too complicated for him to get involved!! Last year we asked him to take my husband's blood pressure as our home monitor was showing 80's/40's & we wanted to see if our home monitor was correct. After telling us my husband needs to go to the surgery to get his BP done, he did eventually take the blood pressure reading but he was very reluctant to do so, he said he only does BP for those who have not already been diagnosed with a heart condition or high blood pressure!
Our last surgery wasn't attached to a pharmacy either.
It would be great if the pharmacist did do the annual meds reviews, the GP really doesn't have a clue about HF meds unfortunately. Our last GP caused a lot of problems as she stopped a lot of my husbands medication because she felt he didn't need to be on them, she actually used to argue with his HF nurse about his meds!! When his cardiologist found out he was furious, said if a GP did that again to contact him & he'll sort it out!
I also live in a rural area, the GP practice doesn't use the commercial pharmacists, they employ clinical pharmacists who can access health records of a patient they are dealing with, and often work remotely, although not always. I have had phone appointments with a variety of different ones, and have occasionally been offered a F2F appointment. It's a fairly recent developmant, after the 3 previous GPs retired, since when we've had an ever changing parade of different doctors who don't have the time to build a relationship with, or knowledge of, their patients in the same way.
I had been given the impression a couple of years ago that all English (not sure about the rest of the NHS) doctor’s surgeries were supposed to employ a pharmacist of their own, in conjunction with other local surgeries. As scented gardener says. I expect that very rural areas would have difficulty doing that.
And for the last few months dispensing pharmacists - those on the High Street - are meant to deal with minor complaints.
Certainly a few years ago my local pharmacist actually interviewed my husband, with blood pressure readings, and wrote to the surgery suggesting a change in medication which was implemented by the doctor. Saying that, the doctor knew that the pharmacist also does stints at the local hospital advising the doctors there.
All pharmacies are supposed to check anyone's BP if asked. They are not being asked to treat it, only to check it. I take my BP machine down to ours once a year. They make me sit for 15 minutes, take my BP with their machine then with mine so I c an compare the results to make sure mine's working properly. They don't treat m,e- that's down to my GP or the pharmacist at the surgery. Your chemist should not have refused.
He didn't refuse to do it he was reluctant to do it, but he did do it after trying to steer us towards the GP because he knows my husband's medical condition is complex. I think the fact we had already taken my husband's blood pressure which was very low may he why he suggested going to surgery.
Tbf, I think it may be because he knows my husband's history & because the BP reading that I'd taken at home was very low, 80's/40's that he thought he should go straight to the surgery, which is only across the road. When we explained that his nurses know his BP is too low & that they wanted me to monitor it & I wanted to check that our monitor was correct in case I needed to buy a new one he agreed to do it. His reading was pretty similar so it proved our monitor was working but it still concerned him.
Perhaps if I hadn't told him the low BP reading he may have done it or maybe not 🤷♀️
In hindsight that's a good idea! but never having asked before I didn't expect there to be a problem. Anyway, that was last year and he did it, so it's all good & I'll know next time
Geography/ economics has a lot to answer for health wise!
But when it comes to heart meds or once I explain my heart condition - albeit this is in my expedience with local chemist and I’m in a City - it’s like I have two heads and they are too scared to advise anything and say see your GP or cardiologist. 😂
I had a disagreement with my GP about the dosage of one of my medications which I felt was way too high. Thankfully he passed me onto the clinical pharmacist at the practice which was the best thing he could have done. We discussed the issues I was having and agreed what should be changed and I now have a stable mix of medication with no side effects.
With regards to the Vitamin D matter, I believe the pharmacist's approach is very wise. I take 1000IU normally as I get quite a bit naturally and increase this to 2000IU in winter. I have never been vitamin deficient, but keeping topped up has certainly helped with recent viral outbreaks.
Thanks for replying, reassuring that a clinical pharmacist can bring good outcomes.
I don’t get enough naturally as I stay out of the sun alot as the heat isn’t great for my angina. Your 1000 dose is the dose the GP recommended as a maintenance dose but will certainly be waiting to ask the pharmacist! Good point about upping it in winter.
I’m British born with south Asian ethnicity and I see a quick google on reliable sites shows a clear link to vitamin d deficiency! Going to make sure my kids keep their levels up.
The Pharmacist was right. VitD toxicity can be dangerous. Sounds like the comms weren't great, or the GP was blasé. I suppose it depends how low your vitD was to start with, but nonetheless, you can still be overwhelmed by such a high dose.
Thanks for replying I’m glad the receptionist thought to refer to pharmacist then. That GP is the one that insisted I was just anxious and didn’t have a heart issue when I first discussed my heart symptoms, he accepts it now though! 😂
Seems to be a theme. I spent 2 years with fatigue and breathlessness. I had a 24 hr monitor that showed a >25% ectopic burden, but my GP said it was normal. A year later I was in A&E 6 times in a month, I was told I had anxiety and prescribed Propranolol, which I reacted badly to .
Private tests showed prolonged bi and trigeminy - PVCS/PACS and SVT and a borderline ejection fraction - common with prolonged, untreated arrythmia. I was referred to an arrhythmia clinic, prescribed Bisoprolol and Flecainide and put on the list for ablation.
HOWEVER, in common with your original question. Much of my problem was caused by extremely low vitaminD (23 nmol/l), folate and slightly low ferritin. I've increased all of those and my arrhythmia has improved.
It can be quite the journey to be eventually diagnosed and helped.
That’s interesting about low levels and arrhythmia, I get flutters and flip flops but shown via week long ecg couple of months ago nothing of concern. Maybe the ones I get periodically they will stop!
I spoke to my pharmacist regarding issues with a statin and explained that I couldn’t get an appointment for weeks, she said “don’t worry, I’ll write to the surgery (next door ) and explain, they will listen and act on what I say !” 🙌🏻🙌🏻🙌🏻 love my pharmacist 🤣🤣🤣
I had texts , email and an appointment the same week
Yep…clue is I the name General Practitioner, GP ..but there does alsoseem to be an alarming change in GP’s attitudes, ‘just a job’ and ‘ far less of a professional calling’. I’m tired of the excuse of them being under pressure etc tbh, everyone is, it’s called being busy. My GP rolled his eyes when I said I’d seen a clinical pharmacist- lack of respect. Pharmacists are proving to be far nicer but of course restricted.
most of the GPs I see - any one of usually three - they often rarely look up from their computers. And they can be snappish on occasion. I always think that that GP behind Closed Doors programme on telly is fantasy TV with their attentive and caring and engaged GPs - must be for the cameras 😂
Since a skin-cancer scare ten years, I'm very careful in the sun and was taking 400iu in the winter. After a while, I suggested to my surgery that a Vit D test might be useful, but was told this was only available if something appeared to be not right with me. A couple of years ago, I started having periods of intense fatigue, which I put down mainly to a dodgy heart valve that was replaced 13 months ago.
All was well for a few weeks, then the intense fatigue returned, leading to two trips to A & E. A private blood test last December gave a reading of 63 (reference range 50-200), but this result could not be assimilated into my NHS records that embraced many other blood-test results. On my recent trip to A & E, I - at last - was given a test for Vit D, with a result of 38. My GP recommended that I buy 1000iu tablets, but I still had some 400iu, which I started taking two or three times a day. Five days later, on a Sunday, the hospital delivered 800iu D3 by taxi (??!!). Last week an NHS haematologist was adamant that lack of D3 did NOT cause fatigue, though many authoritative websites says that it does.
I'm due to have more tests at the end of November, but am minded to have some private ones in mid-September to see what progress is being made.
for what “seems” like a simple thing to test on blood test, you’ve jumped through a lot of hoops with conflicting advice to boot.
Mine was picked up on annual blood test but maybe vit d is routine in my area but GP extended the blood test in light of my complaint of muscles pain and pins &needles in left shoulder, arm and hand. Also picked up low iron and blood count so also prescribed ferrous sulphate and ferritin - must admit getting less pins and needles and muscle pain.
I hope your levels improves and fatigue relieves - its so oppressive on the body and the mind.
I have a pharmacist at my surgery and they are brilliant. They know far more than the GPs regarding medications. If I have any problems concerning my meds I contact them instead of my Gp. They have a small window where we can phone up and speak to them.
It certainly sounds like this is a good development at my surgery then!
I am assuming the clinical pharmacist has access to medical records that the “chemist” pharmacist down the road wouldn’t. That must help a lot in understanding us.
I assume because mine is based in the surgery that they communicate with the GPs. I don’t know what access they have but they definitely have access to the meds I’m on. Also I was told my Gp still signs the prescriptions.
Recently I was changed from warfarin to one of the newer anticoagulants. The pharmacist communicated with the hospital and me concerning the change over. When I was put on a lipid it was the pharmacist who contacted me and arranged the blood tests for my new medications and explained why I’ve been put on it.
That’s what we all want - a joined up efficient health service that gets things done! A positive experience as result of having a specialist on the case. ❤️
I would trust pharmacy's opinions over a Dr when it comes to medication. As that's there area of expertise. I have seen on many occasions pharmacy has picked up in drs mistakes
I wouldn't think of asking my pharmacy for anything other than very basic advice. Too hard-pressed, succession of pharmacists, no privacy, no access to my records. Luckily my GP surgery does have its own pharmacist.
We are quite lucky we use independent pharmacy's that are run and own by the same pharmacist. And they have private consultation rooms. My Nephew was given medication by the hospital and then another hospital gave him different medication second Dr didn't tell him to stop taking the first medication. But luckily the pharmacist picked up on the mistake. But I know larger pharmacy's are not that reliable. I use to get my medication from boots. And there's no literally personal interaction. So went to my local independent. The service is better and my medication is given to me even if prescription delayed by GP. As they know it's part of my regular
We got at our Doctors Surgery Two new Junior Doctors. Never seen either of them always saw the same Doctor, who has now sadly left. Out the blue I got a phone call from one of them and told I needed to take Vit D. Same as yourself 5000 iu, for everyday for the first 28 days then one a week. I didn't I took one a week until I ran out. When I put in a repeat for these I was told you can buy them at the chemist. I politely reminded them of my age, I had always worked and was now entitled to a free prescription. They would not prescribe free so I didn't take anymore, told them I wasn't going to buy them, and they said ok, no problem. So how important was it? Had loads of blood tests since no one has mentioned it.
Me and my teenage son happened to have blood tests at same time. If the vit D or other vit deficiency is a certain level they’ll text and say what level and that we are to buy it. I tend to always buy for son. But boots or Asda own brand as cheaper.
but I guess if we do self maintain levels I’d not now be using up NHS resource by having to be prescribed higher dose of vit d (I use prepaid prescription) plus now having “overdosed” using up more resource 😔
I hope to make sure I keep my vitamin d in check from now on.
But I see your point if a test shows a deficiency then should be treated via prescription but as with alot of health stuff it’s all comes down to money!
I just wonder how important it was. This new Junior Doctor called out the blue, sounding so concerned, but when I said I'm not purchasing all was ok. So how important was it.
these days everyone at GPs surgeries seem to think they’re GPs ! Mainly because there aren’t any GPs. I get conflicting advice all the time ….and neither Physician Assistants, Advanced Practioners..Pharmacists …Nurses …….occasionally a GP….and the receptionists seem to talk to each other..
Hi Fanfab1 I just want to clarify I do buy my enteric-coated Asprin as Doctor only can prescribe disposable Asprin. I would hate any one to think I'm tight. 🤓
😂 Not at all, if we don’t see the point why pay? We all make different decisions for different reasons. I guess they would have tried harder to persuade you or give you a prescription so totally get your point,
Clinical Pharmacist every day of the week. They've flagged up Contraindications in my Meds a couple of times. Without the Pharmacists intervention the Meds prescribed by the Cardiologist and GP could have made me seriously ill. I have Liver Cirrhosis as well as heart issues so have to be extremely careful with dosage and type.
That’s Scary, I suppose a pharmacist will / should look across the board / as a whole and look for interactions whereas the cardiologist and GP work in isolation most often - if only people talked! 👍
GPs are, as the name implies, extremely well educated *generalists* specialising in diagnosis. They are educated to a Consultant level but have to know something about everything (and when to refer a person on to a specialist).
Full qualified pharmacists are specialists in their field which is knowing about individual med's of all kinds and the interractions between them. Even Consultants in hospital defer to clinical pharmacists' knowledge of med's.
The GP will be focussing on whether there's something s/he needs to act on.
The pharmacist will be looking at the greater detail.
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