Do GPs talk to consultants?

Had a call from the gp surgery today to say the prescription for my medication was ready, very efficient except I don't take any medication so it was rather a surprise. Turns out that the GP has received results back from the hospital (don't know what but I'm guessing the density scan) and has put me on (need to check the spelling here!) colecalciferol. Contraindications for taking it are kidney stones (yep) and hyperparathyroidism (another yep). So what I'm really wondering is will the gp be doing this off his own back or does the consultant communicate with him to say what I need prescribing?

I decided to rebel and said I wouldn't take it until I've seen someone to discuss it with them so going to the docs on Monday. If anyone has any advice I'd be grateful.

GPs write referral letters to Consultants - usually once for the referral and then you are the consultant's problem and not theirs.  The chance of you getting a copy of this letter without kicking and screaming are fairly remote, but you are entitled to have a copy.

Consultants write letters to GPs - usually after each consultation and the Consultant should send you a copy (but you may need to request this).  The consultant may request the GP to prescribe medication, tests, etc., which the GP is supposed to implement (but they may choose not to, especially if the consultant is private).
Normally, the consultant will have discussed medication, tests, etc., with you during the consultation.

It is wishful thinking to expect there to be any meaningful interactive dialogue between the two.

It sounds like it is worth talking to your GP first and follow-up with the Consultant (or his/her medical secretary) for an explanation.

Edwin
Sorry - posted this from Mrs Admin's account - again (Thyroid brain fog).

Thanks Edwin. It's difficult knowing the procedure, I'm so grateful that at least my endocrinologist has given me a diagnosis that I'm really scared to push in case I annoy him! Been a month since scans and latest lot of bloods done so no idea what sort of time scale is normal before I'm called back to the hospital.

GP it is on Monday then, I would say "watch this space" but that'd be rather dull:-)

Hi Meggy,
might be worth ringing consultant admin person and check this out. I was given a wrong from of vit D by registrar and had really bad allergic reaction. 

i had to write to consultant about it all ( as gp at the time didn't want to do anything ) and than got letter back, saying try something else.

i also question medication people put me on now, especially the side effects - raising calcium, etc.

if something doesn't seem quite right, than ask about it.
this is just my personal experience.
we know the communication between hospital and GP is now good.

best wishes

Lozza

Hi Meggy

That is the correct VitD supplement you have been given but what dose have they said to take ?

If it's a low dose (400-800iu) then you should be ok to take it without it raising your calcium, on the other hand if you have been given a high then you might need to keep a watch on calcium levels although it can take a while for it to have an effect.

Some of us can take VitD ok some can't so you could try it and see. I should be taking it to raise my level before surgery, surgeon would like it up to about 60 but not much chance of that. I take 800iu as and when which isn't often. Don't worry too much about those contraindications as they are there just as a precaution.

Time scale of appts is dependent on your hospital and how your Dr works, have you seen a surgeon yet ?

Over the last 3 weeks I have had, vocal check, scans and pre op this week so it's all been really quick, haven't got a surgery date yet but I assume it will be soon as they are doing the pre op.

You could ring the secretary and ask when you will be seen again.

Take care

Nelly

Hi Meggy

Same thing happened to me - GP's have all been "on the course" as to what to do if Vit D is found to be low. Trouble is GP's don't check Ca or PTH BEFORE going ahead and ordering large doses of Vit D.

My GP simply ordered tablets from the local hospital (as she had been told on the course) of 50,000 units Vit D3 (Cholecalciferol - the correct type, as Nelly says) and when they came in the post, the label stuck to the bottle said to take 50,000 iu DAILY - yes DAILY!! (I never got to the bottom of whether that was just a typo on the label or whether the GP had actually ordered that dose.)

I saw all the contraindications as you did on the pack insert, so called the hospital dispensary and told them I had high-in-the-range Calcium at the same time as a moderately high PTH. They told me absolutely not to take such a high dose with a high Ca/PTH - in fact they called both my GP and my endo at Addenbrookes and told them too.

You can imagine how well that went down! 

In the end, I agreed with another GP that I would take 2,000 iu twice daily and have regular Ca/PTH/Vit D blood tests to see that the Ca didn't rise any further.
In fact it peaked at 2.73.

So, I'd be a bit wary of taking large doses (yours might not be as large) of Vitamin D as prescribed only by a GP, and if the instruction comes from an endo I would make sure that you have a baseline Ca/PTH/Vit D level to refer back to before taking them, and get regular blood test request forms from your GP to monitor this. It is a very sensible idea to want to speak to someone about this.

Have a look at the Vit D pages on www.parathyroid.com. There is important information there that is different to the view on Vit D deficiency taken by our UK medical establishment. Vitamin D is often low in people with HPT, but it is not deemed to be the cause of the HPT. It is like a bystander at a car crash - it happens to be there (and low) but it is not the cause of the accident. Dr Norman at parathyroid.com states that the body itself tries to keep Vit D at a low level in the body when calcium is high so as to prevent Vit D doing one of its jobs which is to ensure more calcium is absorbed from food, as the serum calcium is high enough already. Isn't Nature wonderful?!

If my HPT brain has made me make any errors in this, I'm sure someone else will chip in here.

Keep us posted on how things go trying to discuss this with your GP! They will probably say, as mine did, that your high Ca and PTH is CAUSED by the Vit d deficiency. Have a look at the Vit D pages on www.parathyroid.com before you go and see what you think.

Love from Tigerlily xx

Thanks everyone, no idea of the dose yet just that it would have been one capsule 3 times a week which seems low hopefully. It's been a month since scans so waiting to go back to endo, he did say surgery but I've not been referred along there yet but I'd be the last to know, letters really slow to be sent out and I've been finding out about appointments because I've had a reminder text first! GP on Monday:-)

Hi Meggy,
It sounds like your consultant has reviewed your results and decided you need a course of Vitamin D, they usually write to your GP and ask them to prescribe it for you.  I sincerely hope that you are offered a surgery date soon.
Hugs Sue

Thanks Sue, how did your appointment at Lincoln go? (And if you've already posted it somewhere else sorry, I read all the threads and then it blurs into one - brain fog bad at present!)

Hi Meggy,
I saw endo at Boston mid May, very nice etc, got him to refer me for surgery, asked to go to Hammersmith with Mr P.  Saw rheumie straight after who has decided he does not need to follow me up further as endo now taken over.  Found out referral would be delayed due to backlog and holidays so was concerned re lump on neck and waiting longer.  Went to see Mr P privately who decided my urine calcium was on low side and wants me to take Vit D then redo 24 hr urine, thinking possible FHH, wants it ruled out before considering surgery sigh.  He also felt lump on neck and thought it was not an adenoma and to go get it FNA'd so am now back to waiting for next endo appt mid July to start all this. 
Saw orals last week, they are going to do FNA of lump on neck so am waiting for an US appointment.  However this locum is going away for a few months so they need a locum to cover the locum.............. So I have no idea who will be doing it.  There is still a stricture in salivary duct but no mention of what is next to sort it.  I keep getting earache and pressure in my ears and all they say is yes it is all connected.  So now just waiting........
Had my Dexa a couple of weeks ago and I think I got your Mr Dishy  doing it too.
Thanks for asking, Sue

Now I'm confused, thought you'd been referred to Lincoln? If Mr Dishy did the scan did he remember all the bits? I had to go back the next day cos he'd forgotten to do my arm - mind you, with guy that gorgeous it wasn't a problem;-)

Hi again,
I did ask to go to Lincoln as the waiting time at Boston was 3 and half months in the hope of being seen earlier, but there were no cancellations etc.  This endo only visits one day a week I think so his clinics are always full, he at least was honest when he said see you in 6 weeks but I will tell you I know the clinics are full so it will be longer.  Letter came and it is 9 weeks, which is why I would have preferred to go see him in Lincoln.
Mr Dishy did remember to do my arm and I've not shrunk yet, however the dreaded scales were not my friend that day
Hugs Sue