Hi again, please excuse my apparent ignorance, probably brought about due to poor or insufficient advice from the Medical profession.
I have two questions:
I have been told by my GP to have a Cortisol blood test. The only information given to me is to have it done at 9 am. I asked him if I should stop taking my Prednisolone 24 hours before and he insisted that I didn't need to. I am currently taking 20mg per day.
Secondly, I am booked to have spinal Surgery on 16 September. I believe that the sick day rules apply, along with a "plan" to deal with my diabetes (3 insulin injections per day). I cannot obtain any confirmation that this is in place, only a comment from the surgeon's Secretary that I might need to stop taking steroids before my operation!
Needless to say I am not filled with confidence.
Any help and advice would be appreciated.
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maxxgarry
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Thanks for reply. Due to various problems I have already had my pre-op. There doesn't seem to be another opportunity to speak to anyone before admission.
Ring the person who arranged the pre-op number should be on your bit of paper.
If this fails contact PALS and ask if they can help. NHS hospitals have a Patient Advice and Liaison Service. Worth a couple of calls to set your mind at rest.
In the US I have gotten stress dose steroids so I didn’t take my 7 mg. In the am. The stress dose depends on the surgery I.e. seriousness and time. I take steroids now for adrenals. Anesthesiologist has the answer.
Hi, please don’t take at face value a comment from anyone other than a Medical Professional. I presume you informed your Surgeon of your Steroids & other Medical Conditions.
You don’t usually see an Anaesthetist at the Pre Op Clinic but rather on the day of your Procedure.
At every opportunity tell everyone you are on Steroids & what your current dose is. They ask you your name & DoB at every point along the way on the day so repeat
‘l AM ON PREDNISOLONE 20mg DAILY’
You never stop any Steroids before Surgery & the Anaesthetist will look after you in Theatre & you will be give Hydrocortisone accordingly to ‘Cover You’ - you should be advised as to if you need to increase your dose Post Operatively or not. But is actually worth a phone call to your Rheumatologist before you go into hospital for his advice.
maxgarry Please see my Revised Answer Below - double check with your GP but if the Test is at 9am & you are still on a high dose - is he looking for something specific?
Re the Cortisol Test - take your Pred with you & take it after the blood had been drawn - presumably you take your Pred in a morning?
For a Synacthen Test you need to stop the Pred for 24hours & they don’t do that test until you are under 5mg.
You don’t usually see an Anaesthetist at the Pre Op Clinic but rather on the day of your Procedure. Did not know that, 2 ops and at both pre-ops saw Consultant Anaesthetist and on the day. Now wondering why - but won't lose any sleep over it.
Hi, often the Pre Op Clinics are running at the same time as the Anaesthetists are in Theatre. Many Anaesthetists Work On a Rota so they usually prefer to see the actual Patients themselves in the day.
Some Surgeons work with only one or two Anaesthetists so it maybe easier to organise for them to see the Patients in advance.
I’ve only ever seen the Gas Man on The Day - you must be ‘Very Special’ 😉 but we know that anyway.
The Pillow is still standing up to Angela Treatment 👏🏼👏🏼👏🏼 Thank You 🙏🏼
Cortisol test ? Why ? On 20mg my understanding is that you are way too high on the dose ........ but someone will correct me pretty rapidly if I am misunderstanding the issue.
They’ll just be looking at ‘random’ CortisolLevels - not the same as a Synacthen Test when you need to be under 5mg - when they are looking for an Adrenal Response.
We can tell you our experiences and point you to articles on the subject, but we are not medically qualified so it is a good idea to go back to the professionals in this case with the questions that you have.
You do not take the pred in the previous 24 hours before the test - otherwise it is totally pointless. If you take pred in the mornings it doesn't matter though - just take your dose as soon as the blood sample has been taken.
However - if you are on 20mg pred there is absolutely NO point having a cortisol test - that is way over the level at which the production of cortisol by the adrenal glands is suppressed.
You may have had you pre-op - but you SHOULD see the anaesthetist on admissiopn and I would specifically ask to speak to them before they knock you out. As long as they know your steroid history they will know what to do,
Such great advice . So at what level - eg 5 mg / 7.5mg would they start testing morning cortisol And would you expect it to be low < 50-100 at those levels . ? They don’t really talk about this part when you start off on the higher doses . 😊
I think most endocrinologists would say no point above 5mg, at 5mg MIGHT be worth it - perhaps as a baseline so you can see what happens over time and dose reduction. Synacthen tests are usually not done until at 3mg or less. I think SheffieldJane had a poor result at 5mg, much improved at 3mg - and then she went back up because of LVV/GCA. I'm sure others may have similar experiences.
The anaesthetist will see you on the day of your op not before. That is the time to discuss all of your medication and any information regarding previous procedures if you had any effects from the anaesthetic then. They will take it on board and act accordingly. Not sure why on earth the GP is sending you for a Cortisol test???
I have had a recent 9am cortisol test and had to stop my pred for the previous 24 hours. However, I am on only 4mg, so it was to give my Rheumatologist an idea of how my adrenals are at this low dose.
Hi Maxxgarry.
Like you, I was diagnosed by my GP to have PMR. He’s not an expert but has done his best. Also, he is retiring and I have no GP at present. We have recently moved to a retirement community and I had major back surgery 2 weeks ago. Lots of changes in my life. I’ve been quite blessed to have a friend with PMR who has shared so much valuable information to get me on the right track. This blog is invaluable to me. I am writing to share my surgery experience. Just a few days before my initial surgery date, the surgeon’s assistant called to say I needed to be off Prednisone for a month before my back surgery and set a new date 6 weeks in the future. It was a very hard month. By the time the surgical date arrived, the pain was so severe I couldn’t use my hands. However, the PMR was held in check by the surgical pain meds afterward. Now my future is a mystery. Has anyone else had this experience? Good luck with your surgery and your PMR.
My local doctors (Virginia) said I must stop prednisone before hip replacement surgery. I then saw a rheumatologist at Duke University Hospital in North Carolina. She said I could continue taking 15 mg through the morning of the day before surgery. I was given a stress dose of steroid by the anesthesiologist. The day after surgery I continued with 15 mg. I had horrible pain and swelling during recovery because I am allergic to warfarin (Coumadin). After two weeks when the doctor saw that the incision was healing well, my dose was increased to 20 mg to help with the swelling. The steroids did not appear to slow down the healing.
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