" CHINESE LADY ASKS WHY FACE & FINGERTIPS HAVE PINS & NEEDLES SENSATION?"

“My mom had her thyroid removed so they have to take a lot of other supplements. One of the supplements is calcium. They originally have to take 4 pills (500 mg +D per pill) 2 times a day but it doesn't seems to work for my mom because once in a while, her fingertips and face feels the pins and needles sensation. When she spoke with the endocrinologist, he didn't bother to think of any alternatives but to increase her intake of pills. which means she would have to take additional 2 more pills each time. So my question is should she still take the additional two pills and wont it affect her her kidneys or even makes her constipate?”  

(Ms. Lin, New York City)

  

Hi Ms. Lin,

After visiting with you this past week, your mother presented with “fingertips and face feels the pins and needles sensation,” a term in medicine called paresthesias.  Based on your mom’s past medical history, your mom’s paresthesias have an unknown etiology which must be identified by the doctor.  Specifically, in the medical paperwork you sent me, your mother’s Hemoglobin A1c level was 6.1 (normal <5.7), an indication that her blood glucose levels are likely running much higher than normal.  Why is this important?  Diabetes mellitus could cause paresthesias.  She must work with her doctor to reduce high blood glucose levels, which will help rule out diabetes as a cause of the paresthesias.  In addition, your mom, every day, has been taking 4000 mg calcium (four 500 mg calcium pills morning and night) for the past two years; yet, on the blood test, her calcium level was below normal at 7.1 mg/dL.   Low calcium can cause paresthesias (especially of the face).  Your mom’s doctor recommending she take two additional 500 mg calcium pills morning and night should be followed, if only to increase blood calcium levels back into the normal range (8-10 mg/dL).  Once your mother’s calcium levels have returned to the normal level, hopefully, her paresthesias will disappear. 

However, you are correct, hypercalcemic states, could lead to constipation, kidney stones…etc; however, since your mother had a total thyroidectomy in 2012, the body’s ability to regulate calcium levels became greatly diminished.  Normal recommended daily calcium consumption for adults is 1000-1500 mg/day.  The higher than normal calcium intake might be the new norm for your mom, a value that must be monitored by her physician, and discontinued or modified, if hypercalcemic signs or symptoms occur.

You might suggest to your mom’s physician to run a B12 level, which is also a potential cause of paresthesias.

I will address your brain tumor question in a different post.   Thank you for your question and trust.  God Bless you, God Bless China, God Bless New York, and God Bless New York City.   Stay in touch, and remember, “Always walk in peace.”

Respectfully,

Dr. Roshin








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           "PHILIPPINE MAN HAS PSA TEST DONE.  DOES HE HAVE CANCER?"

“Hello! Doc, busy? My husband Doc. on this coming tuesday he has a check up again. Can I send you a result of his ultra sound? He feel that he has a frostate enlargement but I said to him you need to go to the doctor to make medical check up, then he noticed that he has a milk calcium syst in the left kedney!” (Ms.DD, Philippines)

Dear Ms. DD,

The last time we visited, you had sent your husband’s sonogram report which confirmed a benign, renal milk calcium cyst.  In addition, I mentioned the following statement to you and your husband (Pepe), “since your husband “feel he has frostate enlargement,” I suggest that your husband ask his doctor to perform a digital rectal exam and run a PSA test (prostate specific antigen) test.  The PSA test results provide a snap shot of potential prostate conditions including benign prostatic hypertrophy, and along with a digital rectal exam, this test will help rule out prostate cancer.  We should make sure that the prostate is not evolving into a future, serious problem.”

Subsequent to our discussion three weeks ago, your husband had a PSA test completed, and you forwarded a scanned picture of the result.  Your husband’s PSA result was a 0.435 ng/ml, a value well within the normal range of 4.40 ng/ml.  Since this is your husband’s first prostate blood test completed, we have no previous reference number to gauge whether Pepe’s symptoms mirror the test result found.  However, he should rest peacefully tonight knowing that the 0.435 result, at face value, does not appear to reflect any pathology or condition of his prostate gland.  My recommendation, is to ask that your husband repeat a PSA test one year from today.  When that result is in hand, please contact me, as a means to guide further treatment if needed.

However, if your husband experiences worsening symptoms including 1) frequent urination at night, 2) urgent need to urinate, 3) difficulty urinating, 4) weak urine stream, 5) a urine stream that repeatedly starts and stops, 6) blood in the urine and or 7) the inability to completely empty the bladder during urination, your husband should have the PSA redone in six months with urgent consultation with his doctor or a urologist to include a prompt digital rectal exam.  The symptoms mentioned above could reflect a worsening prostate condition even though today’s PSA blood test result indicates otherwise.

I am deeply humbled by your trust in me.  Although we are miles apart, do know that I care about the health and well-being of all people who inquire medical assistance.  You all are, in essence, my patients; however, my advice is never a substitute for seeking professional medical services from a doctor or health personnel within your locale.

God Bless you, God Bless Pepe, and God Bless the Philippines.

“Always, walk in peace.”

Respectfully,

Dr. Roshin

Philippine Man Has Kidney Milk of Calcium Cyst & Family Asks If Harmful

“Hello! Doc, busy? My husband Doc. on this coming tuesday he has a check up again. Can I send you a result of his ultra sound? He feel that he has a frostate enlargement but I said to him you need to go to the doctor to make medical check up, then he noticed that he has a milk calcium syst in the left kedney!” (Ms.DD, Philippines)

Hello Ms. DD,

Thank you for sending your husband’s kidney sonographic report on Facebook.  After viewing the ultrasound report, the radiologist documented “the kidneys are normal in size,” and the “rest of the bilateral renal parenchyma are homogenous.”  Put simply, your forty-seven year old husband, Pepe, has functioning, normal kidneys.   However, “a 1.3 cm cortical cyst with milk of calcium is seen in the left kidney” was also reported by his physician. 

Similar to kidney stones, milk of calcium cysts are composed of precipitated, calcium salts (oxalate, calcium, and phosphate).  These cysts form due to stasis of urine in urinary tract cavities with suboptimal drainage.  You mentioning that “He feel that he has a frostate enlargement” is a potential cause of decreased urine flow; however, kidney stones have serious symptoms not limited to blood in the urine, nausea, vomiting, pain on urination, urinating small amounts of urine, fever, chills, and pain that spreads to the groin.   When I asked you if your husband had any symptoms, you said no major complaints. 

Thus, the renal milk of calcium cyst appears to be an incidental finding on your husband’s ultrasound exam, and to answer your question “You know what is the milk calcium syst? In left kedney? It is need a surgery doc?” my reply is no surgery is needed. 

I am deeply humbled that you contacted me, and I value your trust in my opinion.  Thus, since your husband “feel he has frostate enlargement,” I suggest that your husband ask his doctor to perform a digital rectal exam and run a PSA test (prostate specific antigen) test.  The PSA test results provide a snap shot of potential prostate conditions including benign prostatic hypertrophy, and along with a digital rectal exam, this test will help rule out prostate cancer.  We should make sure that the prostate is not evolving into a future, serious problem.  Thank you for your question and faith in me.  God Bless you, God Bless Pepe, and God Bless the Philippines.

Respectfully,

Dr. Roshin