Endocrinology Appointment with Dr. Szabo

Nick had an appointment with Dr. Szabo at UMASS on Friday. The purpose of this visit was to get a second opinion on Nick’s parathyroid level going up and because Nick’s other endocrinologist, Dr. Herscovici, wants to put him on Prolia because of his severe bone mineral loss. I didn’t think Nick should go on this drug, so I asked his transplant doctor, Dr. Fan about it. Dr. Fan agreed with me. I asked him to refer him to another endocrinologist about this problem (Dr. Szabo).

Dr. Szabo feels the same. Prolia should not be prescribed. First things first. Nick’s intake of calcium through diet and/or supplementation needs to be addressed. This is something that I have been working with dieticians on for a long time. He hasn’t tolerated the foods or supplements and I have dropped the supplements altogether. Thus the increase in PTH.

Dr. Szabo pointed out all of the things that contribute to Nick’s bone density loss. First is the fact that Nick has been on prednisolone for 25 years, which he needs to take for his kidney transplant. Other meds that he needs to take also contribute to it. The fact that he’s non-ambulatory. His PTH level is high. All of these things contribute to the bone density loss.

She felt that physical therapy may actually be dangerous for Nick because of his fragile state.

She said that currently, even if she thought a medication was warranted, there are none approved by the FDA that are appropriate for him. He is young, he’s in the bone-building stage. Prolia is to help bone LOSS.

So the plan is to work on calcium intake. I have already emailed his dietician, Anna, asking for her help. I also ordered Citrical Petites, which has calcium in the citrate form. Calcium citrate is the least likely to cause kidney stones.