Hospitals are a hell of a place to get sick

I answered a page from a hospital nurse recently one evening while having dinner with the family.

RN: "This is Lonnie. I'm a nurse at _____ Hospital. I've got one of your patients here, Mrs. Carole Simpson. She's here for a knee replacement with Dr. Johnson. She says she's taking 12,000 units of vitamin D every day. That can't be right! So I'm calling to verify."

WD: "That's right. We gauge patients' vitamin D needs by blood levels of vitamin D. Carole has had perfect levels of vitamin D on that dose."

RN: "The pharmacist says he can replace it with a 50,000 unit tablet."

WD: "Well, go ahead while Carole's in the hospital. I'll just put her back on the real stuff when she leaves."

RN: "But the pharmacist says this is better and she won't have to take so many capsules. She takes six 2,000 unit capsules a day."

WD: "The 50,000 units you and the pharmacist are talking about is vitamin D2, or ergocalciferol, a non-human form. Carole is taking vitamin D3, or cholecalciferol, the human form. The last time I checked, Carole was human."

RN: (Long pause.) Can we just give her the 50,000 unit tablet?

WD: "Yes, you can. But you actually don't need to. In fact, it probably won't hurt anything to just hold the vitamin D altogether for the 3 days she's in the hospital, since the half-life of vitamin D is about 8 weeks. Her blood level will barely change by just holding it for 3 days, then resuming when she's discharged."

RN: (Another long pause.) Uh, okay. Can we just give her the 50,000 units?"

WD: "Yes, you can. No harm will be done. It's simply a less effective form. To be honest, once Carole leaves the hospital, I will just put her back on the vitamin D that she was taking."

RN: "Dr. Johnson was worried that it might make her bleed during surgery. Shouldn't we just stop it?"

WD: "No. Vitamin D has no effect on blood coagulation. So there's no concern about perioperative bleeding."

RN: "The pharmacist said the 50,000 unit tablet was better, also, because it's the prescription form, not an over-the-counter form."

WD: "I can only tell you that Carole has had perfect blood levels on the over-the-counter preparation she was taking. It works just fine."

RN: "Okay. I guess we''ll just give her the 50,000 unit tablet."

From the alarm it raises trying to administer nutritional supplements in a hospital, you'd think that Osama Bin Laden had been spotted on the premises.

I laugh about this every time it happens: A patient gets hospitalized for whatever reason and the hospital staff see the supplement list with vitamin D, fish oil at high doses, iodine, etc. and they panic. They tell the patient about bleeding, cancer, and death, issue stern warnings about how unreliable and dangerous nutritional supplements can be.

My view is the exact opposite: Nutritional supplements are a wonderful, incredibly varied, and effective array of substances that, when used properly, can provide all manner of benefits. While there are selected instances in which nutritional supplements do, indeed, have interactions with treatments provided in hospitals (e.g., Valerian root and general anesthesia), the vast majority of supplements have none.

Comments (19) -

  • Jessica

    10/29/2009 12:25:04 AM |

    We use an EMR and recently on the online forum for the EMR, an MD posted a question about an error message he received when he transmitted an rx electronically to the pharmacy.

    He said he had written for 50,000 IU of Vitamin D (weekly x 8 weeks) and during the transmission, the comma was dropped so the pharmacist received a RX that only read "50 IU."

    The MD posted the issue b/c he wanted to know if others were having the same problem with RXs that contained a comma.

    I replied to the post and answered his technical question, but was disappointed in his choice for intervention. I didn't reply with any info about D2 versus D3 (who am I to educate a physician about medicine?) but in hindsight, I probably should have. Who knows how many other people will receive suboptimal Vitamin D treatment.

    P.S. If you need a good laugh, grab a copy of the latest AFP magazine and read the D article. Their suggested intervention for D deficiency....50,000 IU D2 for 8 weeks. Yauzers.

    I might keep the article for historical significance. My hope is that in just a few short years, we'll look back on such non-sense and be proud of how far we've come with treating D.

    P.P.S. I'm going to the Vitamin D conf in Toronto on Tuesday! I cannot wait!!

  • Anonymous

    10/29/2009 2:40:01 AM |

    The way the nurse kept asking if it was okay to have the patient take the D2 tablets, I couldn't help wonder if the pharmacist was getting a kick back for those tablets. What also bugged me was how she didn't want to "hear" or honor what you had to say even though you are the patient's doctor. Not good.

  • Dots

    10/29/2009 5:00:34 AM |

    I'd LOL if it weren't so sad.

    BTW, I've gotten two doctor neighbors and family on vitamin D and probiotics.  One is egotistical, the other grateful.  Thanks for all you do.

  • Mark K. Sprengel

    10/29/2009 5:25:16 AM |

    So they needlessly increased her costs? Great :/

  • moblogs

    10/29/2009 10:31:29 AM |

    You know, I don't bother telling doctors exactly how much D3 I'm taking. I just get them to check my blood levels and they see no problems with the results. But they would probably balk at the fact I take 10k per day.

  • Helena

    10/29/2009 1:38:59 PM |

    I am a bit disgusted about this whole thing. This shows ones again how stupid the whole industry is… I was just recently at my doctor to take a few tests after some horrible years on the birth control pill Yasmin (it had basically taken me 7 years to put two and two together because no doctor would believe my symptoms well at least not connect them to the birth control). He asked me why I was taking all these vitamins and supplements – Preventive maintenance, was my answer. No comment back except for a smirk. Well yesterday they called me to tell me that everything was ok, but didn’t understand why I wanted to see my own lab results… the woman I was speaking to almost questioned my motive for wanting to see it. What the heck is wrong here… ???

  • Anonymous

    10/29/2009 1:54:06 PM |

    Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop
    The National Institutes of Health (NIH) Office of Dietary Supplements (ODS) is sponsoring the Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop on Wednesday, December 16, 2009 at the Bethesda North Marriott Hotel & Conference Center, Bethesda, Maryland.

    Workshop Summary
    Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.

    Serum concentration of 25(OH)D is the best indicator of exposure to vitamin D from all sources. It reflects vitamin D produced cutaneously and that obtained from food and supplements. There is considerable discussion of the serum concentrations of 25(OH)D associated with deficiency (e.g., rickets), adequacy for bone health, and optimal overall health. In fact, different assay methods are used to assess 25(OH)D. The methods themselves vary and there are considerable differences among laboratory results even when they use the same method.

    Given the uncertainties in vitamin D measurement, the NIH/ODS will host this one-day workshop to evaluate the state of analytical methods. The intent of the Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop is to develop strategies for resolving inconsistencies between results obtained following quantitative determination of selected nutrients in biological materials such as serum when different measurement techniques are used. The desired outcomes of this meeting are to identify strengths and weaknesses of analytical approaches available for the quantification of the nutritional biomarker of Vitamin D status, circulating 25(OH)D in biological samples and to discuss analytical methods, including criteria for selection of method(s); role of reference methods and samples; sample preparation and interpretation of results.

    The workshop will consist of a series of short, focused podium presentations interspersed with open discussion sessions on the currently available analytical methods and interpretation of findings. A final session will summarize the discussions, identify knowledge gaps, and suggest a research agenda for future studies.

    Space is limited and will be filled on a first-come first-served basis. There is no registration fee to attend the workshop. To register please forward your name and complete mailing address including phone number via e-mail to Ms. Tricia Wallich at Ms. Wallich will be coordinating the registration for this meeting. If you wish to make an oral presentation during the meeting, you must indicate this when you register and submit the following information: (1) a brief written statement of the general nature of the comments that you wish to present, (2) the name and address of the person(s) who will give the presentation, and (3) the approximate length of time that you are requesting for your presentation. Depending on the number of people who register to make presentations, we may have to limit the time allotted for each presentation. If you don't have access to e-mail please call Ms. Wallich at 301-670-0270.

    Workshop Details

    Meeting Location:

    Bethesda North Marriott Hotel & Conference Center
    5701 Marinelli Road
    North Bethesda, MD 20852
    Phone: 301-822-9200
    What profit is there for one to gain the whole world yet lose or forfeit himself? Luke 9:25

  • Adam Wilk

    10/29/2009 5:17:57 PM |

    Dr. Davis,
    Great post, I enjoyed the way you wrote the dialogue between you and the nurse at the hospital--very, very realistic, and kind of spooky at the same time.  Unfortunately, this is just the tip of the iceberg--from my own personal experiences with my type 2 diabetic father in the hospital, getting insulin right is a total nightmare.  They use this arbitrary sliding scale which in some cases is totally ineffective and makes for unnecessarily high sugars--I remember how my father was merely 2 days post-op and was sitting there furious because the staff thought it was okay for him to be lying there with sugars in the low 200's, based on their scales and protocols.  
    You've got to stay out of hospitals.
    Great post.

  • Anonymous

    10/29/2009 9:57:08 PM |

    Well good luck getting anything "health promoting" while in a hospital!

    Last year, while hospitalized for a bout of Takotsubo syndrome,  they wouldn't let me use my own: fish oil, Vitamin D3, Vitamin K, multi-vitamin, compounded bi-est or progesterone, and so on...

    They did manage to have Armour thyroid available to dispense to me.  Instead of the bi-est and progesterone they offered me Prempro... shudder, and these two meds could be had at the hospitals nifty pharmacy prices.

    So 4 days without the vitamins probably did no harm... but the hormones???  Yikes, by the 2.5 day mark my husband was forced (by me) to become a criminal and smuggle the compounded meds in to me during the night.  What could they do to me that would be worse than hormone withdrawl on top of Takatsubo syndrome?  HA... don't answer that!

    I got better as quickly as I could, and got the Heck out of there.  BTW, I don't think anyone on the nursing staff understood the difference between a heart attack and Takatsubo syndrome... BIG difference!

    Oh... and I got rid of the "precipitating event" that caused the whole thing, and that has greatly de-stressed my life.

    My advice: stay away from hospitals if at all possible... unless you are a doctor, nurse or hospital administrator.


  • Jim Purdy

    10/30/2009 6:13:46 AM |

    Great post, and great comments, especially this one from Helena:
    "Well yesterday they called me to tell me that everything was ok, but didn’t understand why I wanted to see my own lab results… the woman I was speaking to almost questioned my motive for wanting to see it. What the heck is wrong here… ???"

    That sounds so familiar. If I could just go directly to a lab without doctor's orders, I would almost drop completely out of the whole doctor and hospital system.

  • renegadediabetic

    10/30/2009 1:07:45 PM |

    I hope I never have to go in the hospital.  They will probably feed me the standard "diabetic diet," low fat-high carb, and send my blood sugar into orbit.

    They do seem very reluctant to tell you the numbers.  After my last blood test, the nurse called and said my cholesterol was "high" and the doctor prescribed simvastatin.  I had to pry the numbers out of her:  LDL - 128, trigs - 55.  I consider the "high" LDL to be a case of skewed freidenwald and haven't bothered with the simvastatin.

  • JPB

    10/30/2009 4:49:49 PM |

    Note to Jim Purdy:  You can get your own tests. (I think the .com is correct but not sure.)

  • Rich S

    10/30/2009 6:53:22 PM |


    Try these self-directed lab test companies:


    I've used both of them a lot.  PrivateMDlabs even gives you a 15% discount on top of their reasonable lab test prices.


  • Lacey

    10/30/2009 8:19:41 PM |


    You make a good point.  In most states, it is possible for people to go directly to labs.  However, I want to point out that a few states, including NY, prohibit people from dealing directly with labs unless you are a licensed medical practitioner. New Yorkers can't even participate in the Vitamin D project.  It's infuriating, and I think it encroaches on basic liberty.

  • Red Sphynx

    10/31/2009 1:24:19 PM |

    Any guess on how much the hospital charged the insurance company for that single pill of second rate Vit D?

  • Rich S

    10/31/2009 2:09:21 PM |

    Living in New Jersey, I too suffer from "nanny-state" laws which prohibit me from getting my blood drawn for direct-to-consumer testing in New Jersey.

    However, it is perfectly legal to order the tests and get the labwork done at a Labcorp (usually the draw site used) in a neighboring, less-restrictive state.

    I am fortunate to live in southern New Jersey 20 miles from Philadelphia, so I get my lab draws by going over the bridge to Pennsylvania.  BTW, the other nanny-states which restrict direct-to-consumer lab tests are New York and Rhode Island.

    New York even restricts "blood-spot" testing (finger-prick) done at home and mailed in, which can be used for HbA1c, vitamin D, and other tests. To get around that, folks have had the tests mailed to friends or family in other states, who then forward it.  Our politicians are truly moronic.


  • Helena

    11/1/2009 12:17:41 AM |

    Jim, I am right there with you... and Rich - thanks for the links I will be taking a look at that since I want to make sure I stay in good range without over doing my supplements.

    Thanks Dr Davis for a great post, once again.

  • Ursula

    11/3/2009 6:46:33 PM |

    I'm a little concerned (as an RN), that the RN and the Pharm were under the impression D affected coagulation. Working in managed care, I see a ton of misconception. Im always astounded at how much a non issue nutrition is, with the exception of diabetics, renals, and your bariatric surgery patients. The only places that get it are centers like Memorial Sloan Kettering, taking a whole body approach. But even there, wrong MD on your case, and your sunk. Do not get sick, and if you do, don't try to heal in the average hospital.

  • kc

    12/5/2009 6:04:03 PM |

    I'm allergic to corn so I live in fear of having to be hospitalized. You can't even imagine all the ways they could make me sicker. The worst part is that my own doctor has told me that I couldn't possibly be reacting to a corn derivative because all the corn protein had been processed out. I can almost guarantee that they wouldn't have a medicine to treat me that didn't contain corn.