One detail Gary’s neuropsychologist recently brought up was his low vitamin D level. Everyone knows calcium and vitamin D help maintain healthy bones, but we had no idea the role it plays in cognitive decline. Studies found patients with a vitamin D deficiency experience faster declines in both episodic memory and executive function. Patients are also seen to underperform on one or more cognitive function tests and have a higher diagnosis rate of mild cognitive impairment (MCI) or early dementia.
A blood test now gives your health professional a simple yet reliable tool to identify at-risk patients. A vitamin D deficiency can be corrected if found early, with a good chance progression from MCI to dementia will be slowed or avoided.
Natures Vitamin Store
The dangers of sun exposure and skin cancer have us all aware of the importance of regularly wearing sunscreen. What no one told us is while we practice good skin health we are also blocking our prime source of vitamin D. If you mix in low absorption from diet sources, seasonal or geographical limitations to sunlight, then you may be headed for vitamin D deficiency.
Vitamin D2 or D3?
Vitamin D as a supplement is available in two formulas. Ergocalciferol (Vitamin D2) comes from ultraviolet irradiation of the ergosterol in yeast. Vitamin D2 is the most common form offered by retail sources.
In the past, a physicians first choice was ergocalciferol for vitamin D deficiency. But studies have proven Cholecalciferol (vitamin D3) to be more potent, longer active life and closer to naturally synthesized vitamin D3. Modern formulas come from irradiation of 7-dehydrocholesterol from lanolin and chemical conversion of cholesterol.
Ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3) are not bioequivalently interchangeable. Research now proves ergocalciferol potency is less than 30% of cholecalciferol and peaks at day three. Vitamin D3 levels will continue to increase past day three and peak at day fourteen. Potency is an important consideration when your goal is to stem the cognitive decline.
What to do if you’re at risk
Gary has been taking a daily dose of 2,000 units of Vitamin D3 since early November. His PCP had his levels checked last week, 90 days since his prescription and found while he is improved it’s still at the low end of normal. His doctor increased his dose to 4,000 units daily and suggested taking it with a meal or whole milk. Gary had been taking it in the evening but since vitamin D is fat soluble changing his schedule to mealtime should help his body absorb it.
If you have been diagnosed or at risk for developing mild cognitive impairment, the best choice would be a visit to your physician. It is possible to overload yourself, so a blood test is a simple and quick means to determine what your vitamin D level is. It may be time for a discussion about supplementing your intake.
Gary woke this morning without a headache. The first pain-free moment in 12 very miserable years. Complete pain relief. I just want to read those words over and over. A chronic headache or migraine pain sufferer understand the long and tearful journey. Imagine the pain of a migraine. Now imagine enduring it for 76 unending days. Light, sound, and movement become the enemy.
It lasted for a glorious few hours. A small twinge has returned to the base of the skull area, but Gary says it’s so light now (He describes it as a one on the pain scale) he would be ecstatic even if this is as good as it ever gets.
Living With Daily Pain
Gary has lived with pain for years. His daily headache level hovered around a three. Seven days a week. He learned to work and live with a chronic headache for years. His original neurosurgeon explained the pain was caused by a pressure change as spinal fluid moved in and out of the pseudomeningocele created when he removed his tumor from the C-2/C-3 area of his spine. Fixing it would be more dangerous than living with the pain. Come back when he couldn’t stand it. Twelve years and he was there. He couldn’t take days of a six or seven pain level. Hitting 10+ during the past year was the last straw. You can read our posts covering the search for relief.
Change Of Plan
When the neurosurgical department reviewed Gary’s latest MRI, it was their opinion the tear in the dura had closed. The spinal fluid movement was not to blame. Intracranial hypotension was ruled out since position change brought no pain relief. We discussed Dr. Levy’s hypothesis on active bleeding. The neurologist explained the next step would be a Greater Occipital Nerve Block. They scheduled an appointment with the pain clinic for February.
What To Expect
They say “a picture is worth a thousand words” but sometimes they make the unknown pretty scary. When you picture injections into the back of your head or neck, it’s no wonder most of us react with a shiver up the spine. You can stop right there.
We showed up at the pain clinic Friday morning and were taken into a small room by our pain specialist. He quizzed Gary on the position, severity, and details of his normal pain. INR results checked since Gary is on blood thinners for life and put us both at ease with his thorough explanations.
Gary took a seat and in a few minutes was given a slow injection, one on each side of his neck, into the occipital nerve area. I watched the entire procedure with no problem.
“…an occipital nerve block is designed to stop the pain sensation traveling through the occipital nerves. There are two occipital nerves, the greater and lesser. The injection is most often used to diagnose and treat cervicogenic headaches along with occipital neuralgia and has also been shown to provide pain relief for migraine sufferers. So it has two purposes, including both a diagnostic one and a therapeutic one.”-Arizona Pain Center
The pain specialist explained Gary might feel a slight burning as the injection entered. Patients also often experience a slight deadening of the scalp and ears from the local anesthetic portion of the shot. He said most people feel some headache pain relief immediately, but it would take three or four days for the full effect. Slight pain at the injection sites would be normal after the local wore off. The entire procedure lasted less than 45 minutes mostly spent chatting.
We waited a few hours in the hospital cafeteria until it was time for Gary’s swallow test for dysphagia. Gary noted slight dizziness (apart from the norm) but very little pain from the injections themselves. We went to his swallow test and then headed out for the three-hour drive home.
The local anesthetic wore off during the trip. Gary had a full-blown headache by the time we made it back and went to bed early. The next morning the pain had dulled, but he said he could feel the injection points. As the day wore on he felt pretty good; He could tell there was an improvement.
A Brand New Day
Jump to this morning, day three, and things are looking great. The real test will be when he looks up, moves his head around, lifts something or gets down on his knees. Positional changes always have brought the instant pain. If this treatment proves a success, then we will return for injections every three months and just maybe tamed his chronic headache pain.