Doc, I have low vitamin D levels. Is this deficiency dangerous?

Dr Flo,
I recently found out that I have low Vitamin D levels after a blood test.  How can one make up for this deficiency? What are the adverse effects of this lack of vital nutrients?
Alnashir Walji

Dear Alnashir,
Vitamin D is made by the body when sunlight triggers its formation from cholesterol in the skin. It is also found in small amounts in some foods like oily fish (for instance salmon, sardines, trout and mackerel), liver, egg yolk, cheese, mushrooms, fish liver oil and foods fortified with Vitamin D. This nutrient is useful in bone health, nerve and muscle function, immune function, regulation of glucose and overall health. When the levels are low, the bones can become misshapen, thin or become brittle, resulting in rickets in children and osteomalacia in adults. When severe, it may also lead to seizures, muscle cramps, bone deformities and pain, and dental abnormalities.
You are at high risk of having vitamin D deficiency if you have minimal sun exposure, if you are always covered up when outside, if you are obese or if you have a disease that interferes with absorption.
To manage vitamin D deficiency, get adequate sunshine exposure (10 to 30 minutes, between 10am and 4pm) to the face, arms and legs without sun screen, at least twice a week. You can also take vitamin D supplements, at the dosage prescribed by your doctor.

Dr Flo,
 I have been feeling pain in the back of the tongue. It all started early this year.  I would feel pain when I take cold drinks or peppered food. This  continued until I started to develop a rash at the back of the tongue. I saw a doctor who told me I had tonsils and he needed to clean and bleed out the rash. He did this, but it did not help. I have been using antibiotics, but I don’t have a lasting solution.
Secondly, I have been feeling some pain when I sit on wooden chairs typically those we use to study. I feel the pain especially in the back. The tailbone to be specific. I feel heaviness and pain when I am about to stand. What is your advice on these two issues?
Abdinassir

Dear Abdinassir,
There are rashes or bumps found naturally on the tongue, including the back of the tongue. These bumps contain taste buds, and can become swollen and painful, forming a white or red rash when they are irritated. Many times, an exact reason for the swelling cannot be found, but possible causes include taking highly acidic foods or spicy or sugary foods, stress, hormonal changes, injury to the tongue, infection (viral, bacterial or fungal), problems within the gastrointestinal system and having food allergies. It is advisable for you to be reviewed by a dentist in a proper hospital for examination and relevant tests, and then you will be advised on the way forward. In the meantime, avoid spicy, acidic and sugary foods, gargle with warm, salty water, brush your teeth at least twice a day. If possible, use a mouthwash.
About the second issue, there is a small muscle within the gluteal (buttock) region called the piriformis muscle. It helps to rotate the hip, by turning the leg and foot outwards. Right beneath it is the sciatic nerve, which is a big nerve that starts at the lower spine, and passes through the buttocks and down the leg, with branches all the way to the toes. What you are describing is most likely piriformis syndrome, where the piriformis muscle spasms (like a muscle pull), causing buttock pain. The spasms can also irritate or compress the sciatic nerve, causing pain, starting either in the lower back, or at the hip or buttocks, spreading down the leg, even to the toes.
The piriformis muscle may spasm due to injury, irritation, inflammation, bleeding or swelling of the muscle, or due to inflammation in the nearby structures such as the joints. The pain may be worsened by sitting for long or climbing, and there may be difficulty moving the hip.
You should be on follow-up by an orthopaedic specialist. The diagnosis is made from what you tell the doctor and from a physical examination because, unfortunately, there is no laboratory or radiological test to diagnose piriformis syndrome and irritation of the sciatic nerve. The treatment includes medication for pain, both oral and injections; heat or cold therapy, stretching exercises and physiotherapy, including physical exercises, deep massage and transcutaneous electrical nerve stimulation (TENS). Surgery may be done in extreme cases. You also need to get a comfortable chair and to stand and stretch, or do some exercises after sitting for some time.

Dr Flo,
What causes tonsils stones? How do I get rid of them?
Nkirote

Dear Nkirote,
Tonsil stones or tonsiloliths are white or grey balls that are bad smelling, that form on the tonsils. The tonsils are lymphatic glands at the throat and they have an irregular surface. Bacteria, mucous, dead cells, and food particles can become trapped in the folds on the surface of the tonsils. The trapped substances then coalesce together and form the bad-smelling chunks. If these chunks harden, they are called tonsil stones or tonsiloliths. Tonsil stones are more common in people with chronic tonsillitis or sinusitis and post-nasal drip.
These stones may cause bad breath, bad taste in the mouth, throat discomfort, difficulty swallowing or ear pain. Other than this discomfort, tonsil stones are usually not dangerous.
To manage them, observe good oral hygiene by brushing your teeth after meals, gargle using salty water or a mouth wash to reduce the bad breath, or you can have the stones removed by the doctor. Before brushing your teeth, remove food particles from your mouth by drinking water and by swishing water in your mouth and spitting out. It would be advisable to visit a dentist and ENT specialist so that any underlying problem can be treated.

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