Rheumy nurses

[Treesha]

Does anybody know if specialist nurses can administer the same amount of steroid as the consultant if he hasn't authorised it? The reason I am asking is because the jab the rheumy gave me has only lasted 2weeks. The last one lasted 3months so I'm thinking she only gave me a small dose .

[helixhelix]

Don't know, but you may be right that she only gave you a small dose. The first jab I had didn't do much, but the next time Doc said she was giving me more & it worked. So definately a difference depending on dose. Px

[Treesha]

Thanks for your reply, the effects of the steroid took longer to work too which makes me think it was a lower dose.

[Gina_K]

Or she did'nt inject it into the right place exactly. Maybe? Nurses doing joint injections does'nt sound best practise?

[Treesha]

Hi gina it was an intramuscular injection. When I've had them in the past they've always been into the buttock but she put this nearer the hip??

[allanah]

Hi Treesha'

Sorry you are not getting as much benefit from the steroid this time.

As a nurse we have to work to very strict guidelines in giving drugs. Some nurses for example specialist rheumy nurses, midwifes, specialist nurses in intensive care/A&E, Health visitors, can prescribe certain drugs in certain situations which they have to undergo lots of extra training and usually more University to give these specific drugs. It is usually then they are awarded the extended nurse prescriber which means they practice in their own right but under strict guidelines and are totally accountable for that part of the practice but obviously supervised and continually updated on the practice.

Other medicines fall into a group known as PGD that is patient group directive. This is a prescription that certain types of specialist nurses in certain situations can give this overall prescription eg Health Visitors giving Baby immunisations , imagine having to go the the dr every time you wanted to give a baby imms which is your specialist area.!! So certain Rheumy nurses will be trained or under PGD for Rheumy drugs. So in answer to the above the doseage wil always be worked out by some form of prescription or training either a Doctor or highly qualified nurse specialist under guidance. However the consultants or registrars or junior doctors will also prescribe other drugs and often consult with the nurses ,who see the patients more than them, to discuss how the treatment is working. I often would give for example pain killers to one patient and they would be comfortable where the same dose on the next patient would not help them. So different people react differently to different medications and doseages.

Nurses also are trained in advanced procedures for example giving joint injections, putting people onto ventilators, defibrillating patients at arrest with appropriate training and ongoing training so it is possible ( as in my Rheumy clinic) for the nurses to be trained to give joint injections and use ultrasound, ours are hopefully starting soon they said.

Where you give an injection also is strictly done as there areas certain" triangle areas" for intra muscular injections where it is safe to give the injection eg so you dont potentially hit nerves. Also other nurses can give intravenous drugs which are prescribed. So this is safe practice for the patient.

Personally when i have had a steroid it often only works for about 6 weeks and they havent lasted 3 months and that is on the same dose so it might be a good idea to tell the nurse that the last injection did not give you as much relief and then she can "titrate" that is, get a dose or time period that is best for you and within safe practice.

I hope this makes you feel a bit better about who and what is being prescribed but if the treatment is helping maybe you could ring the helpline and explain you are still uncomfortable. I hope i have explained the system a bit better for you. Thinking of you

Axx

[Treesha]

Thanks allanah yes you have explained things very well. I'm upset because I feel my kness are starting to swell again. I really wanted to wait until June before having a steroid injection because I have a holiday booked. But I was too bad to wait, I had hoped I would be ok for a while longer. I am scared of steroids and the long term side effects.I have had 5 intra muscular jabs in 10 months. Theone I had in november was at the same time I started on MTX so it looks like maybe it is the MTX that has stopped being effective ( don't know ) my rheumy also upped my meds so maybe she was thinking that way too?

[Jan66 in reply to Treesha]

Hi, sorry things are not good with you at moment. I,too, am off on holiday next week and feel as if the MTX isn't working. I have been off steroid tablets for 3 months now BUT have a few left. I am thinking of taking some so I can enjoy my holiday without telling the docs! Good idea or not?????

[helixhelix in reply to Jan66]

NOT a good idea! It's really important with steroids that you taper the dose down slowly, and don't start & stop them suddenly. So if you only have a few left then you could cause more harm than good by just taking them for a little bit. The reason is that your body also produces a very similar thing naturally, but when you're taking the tablets your body slows production. If you suddenly stop the tablets then your body won't be ready to take over - it needs a period where you slowly reduce the artifical dose to get your own production going again. The withdrawal symptoms can be dreadful - so I really would advise you not to play around with these drugs. Take extra anti-inflammatories and painkillers with you instead. Polly

[Treesha]

Go for it were all responsibe for our own health and who knows what the future holds, live life to the full!! Enjoy your hols. What meds do you take?

[Hidden]

Allanah and Polly, Thank You for your detailed description of how meds are administered and controlled. It is scarey to know how frequently steroids are used, but to take just a few and then, none. That could be a major problem. Also, if Jan66 has a few steroids left, that means she didn't take them all as perscribed! Steroids scare me, especially being diabetic, they screw up my usually well controlled blood sugars, so I haven't taken any for 3 years.

Good to have such knowledgeable folks on this site. We have the best of medical and legal advise!! Thanks to LL also. Lxxx

[allanah]

I think a lot of people worry about steroids, but the docs are using as sparingly as possible and they often do have really good relieving effect. I put on a lot of weight with the steroids and i know i too have trouble now keeping blood sugars under control. But i think Docs are careful what and when they give them and i just check my sugars more regularly so they balance out. But yeah as Polly says its very dangerous to stop taking steroids suddenly the same as it would be to stop other drugs like insulin, i think just treat drugs carefully and follow the instructions and do what it says on the tin!!!!

I think though maybe by the hols your other RA drugs might kick in? or if you are still having trouble they may be able to give you some more steroids or maybe stronger pain relief. I now use prescribed combinations of what they tell me to use which includes morphine/tramadol/brufen and panadol and it took a while to get the one combination that suits me.And when i went on my first holiday in the sun since being diagnosed i found my joints were so much better!! ( Think i need to move somewhere warm!!) hee hee

I have also just been given acupuncture in my knees for the pain , ok they are swollen and bruised at the moment but my son commented today on how much more flexible thy are so heres hoping, might be worth asking your doc about?

Love Axx