Parents urge their children to drink milk, in part because it contains calcium that helps build strong bones and teeth.
But a collection of calcium in the wrong place was the last in a long line of medical culprits that weakened and then killed Utah Jazz owner Larry H. Miller last week when doctors couldn't stop the calcium phosphate from leaching from his bones and into his blood.
Dr. Michelle Mueller, a vascular surgeon at the University of Utah, was part of a team of doctors who treated Miller's fatal condition, known as calciphylaxis. The rare disease occurs in only 1 percent of patients with end-stage renal failure, but usually appears only after long-term kidney dialysis.
Doctors don't know why it appeared in Miller, who had not been a long-term dialysis patient.
"It happens when you get too much phosphate in your blood. That causes the bones to leach calcium that circulates in the blood," Mueller said.
When that happens, medications are given to counteract the process and bind the phosphate in place. When that fails, the calcium "goes into the wall of the arteries in the blood vessels, so there's no blood flow to the skin or fatty tissue, and it dies."
The resulting wounds "look like dead skin, and it progresses really fast. The tissue dies almost in front of your face," Mueller said.
The type II diabetes that started Miller's health problems and eventually resulted in the amputation of his legs 6 inches below the knee was the first in a set of medical conditions that escalated over time, she said.
Amputation doesn't arrest calciphylaxis, which "can attack muscles and organs in rare cases," but always results in the death of tissue.
It's difficult to arrest the process once it begins, she said, noting that 60 percent to 80 percent of patients with calciphylaxis die. Attempts to stop it from spreading include "big excisions of skin and dead tissue," which doctors have to let heal and then do skin grafts over.
"Most patients have such large wounds they can't recover from it, and there is no known way to really treat it effectively. It's such a rare thing, it's not like there are hundreds of people for us to try these treatments on," she said, noting she has only seen two cases personally, including Miller.
"Most everybody we've seen in our division has died of it. I only know of one patient with a large skin graft who hasn't."
She said the patients' thighs, upper buttocks and breast are at highest risk, and diagnosis is difficult. "You almost can't believe it's happening in front of you. … One night you see the wounds, and the next morning they look worse."
A diagnosis is confirmed with a biopsy of the skin, which shows the calcium in the small arteries that blocks blood vessels, leaving the patients without adequate blood circulation in the affected areas.
Doctors who treat patients with kidney failure are always anxious to control the levels of calcium, phosphate and PTH in patients to prevent the condition from developing, Mueller said.
Though to some it may appear similar to flesh-eating bacteria, "calciphylaxis doesn't start primarily as an infection. It consists of not oxygenating the skin so it dies."
Miller funeral services
Funeral services for Utah Jazz owner Larry H. Miller will be Friday and Saturday.
A viewing is set for 4 to 8 p.m. Friday in the VIP room at EnergySolutions Arena, 301 W. South Temple. The viewing will be open to the public. At the request of the Miller family, cameras or recording devices will not be permitted.
The funeral will be noon Saturday at the arena. The public is welcome to attend; cameras or recording devices will not be allowed.
A private interment at the Salt Lake City Cemetery will immediately follow.
E-MAIL: carrie@desnews.com