### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Yes, please...I had a kidney transplant in July of 2012. Prior to the transplant I was on diaylis for 4 months. Sensipar helped immensely. I work for a fortune 500 company with good benefits. All of a sudden CVS mail order decided I did not need sensipar. They think that a drug company knows better than my team of doctors. I havent had sensipar for a few months and the itching has returned a long with the fatigue. I am contact our senior vice president of benefits to find out why I cant get this drug. My calcium is at 11.4% and I am really afraid.  Thanks.

### output:

Dear user, obviously you were suffering from chronic kidney disease. Secondary hyperparathyroidism is one of the common manifestation of CKD. In this condition your parathyroid gland becomes overactive and level of PTH hormone increases which ultimately raises your Serum calcium level (normal level 8.5-10.2 mg/DL). Usually patient does not have any symptoms, but sometimes he may feel itching, fatigue and bone pain due to bone loss (as seen in your case). Senior is given to suppress the parathyroid gland and lower the calcium level when patient is on dialysis. This Chat Doctor. Secondary hyperthyroidism gets corrected after kidney transplant and serum calcium come back to normal level. But sometimes it may not happen and hyperparathyroidism persists, a condition called tertiary hyperparathyroidism. Remember, Excessive use of Senior may lower serum calcium too much causing life-threatening side effects such as heart arrhythmias and seizure (convulsions), far more serious than itching and bone loss. So it needs close monitoring of serum calcium, phosphorus and PTH leveling your case I would suggest complete work up of serum calcium, phosphorus and PTH level and consultation with Nephrologist for further course of action hope I have simplified the information enough for you to understand.