Additional meds from my GP?

[Hopingsail]

Hi Everyone, First to say I am pleased to have just about survived the first Mothering Sunday since my wife Sue's death. Not only the Mum of our lovely 3 kids, but she 'mothered me' too, and I miss it - (as our youngest kindly commented on my Fbook "You were her biggest challenge Dad!!).

Also pleased (courtesy DL's 5-weekly plan and the amazing support on this Forum) that I have got through 11>10 Pred reduction and commenced on 10>9. (Some slight aches but not bad) First question: After 9mg the reduction to 8 will be more than 10%; I seem to read that after 5mg then half-mg reductions are wise - how about the stages 9>5?

Secondly: I finally got a long conversation with my GP (who was working from home with Covid). This was chiefly to talk through management of an intended prostate (sorry Ladies - boy's bit!) biopsy on a "small lesion" revealed by MRI, but which is on hold for 3 months following the DVT and consequent blood thinners. (The Urology Consultant said she didn't want me bleeding to death on her watch - for which I was duly grateful.) My PSA count is only slight raised btw.

The GP then went on to say that as I was 75 yrs and had been on 10+Pred for a year now, he would like me to take bone meds. He has prescribed: Adacal-D3 (1500mg calcium carbonate and Vitamin D 10 microg); also Alendronic acid 70mg (1 tab each week). I'm reasonably sanguine about the Calcium (although I already drink a couple of litres of milk weekly with cereal and Pred) but, having read the leaflet re the Alendroic Acid, not so much. The latter seems to have the potential for upsetting the system - and what with the PMR reduction plan being my main priority I'm not sure I want an extra strain on the poor old body. Any thoughts / advice / experience welcome please.

I should add that I'm reasonably big-boned - never had a break - and keep active with walking and some sailing planned too I am delighted to say! My meds are: Fosinopril 30mg daily (BP control for last 25 years); Rosuvastatin 10mg; Pred 10>9; Apixaban (blood thinners 2x5mg daily - due for review end of May).

Many thanks!

[paulst955]

Hello, As a 71 year old male I understand your concerns, re Alendroic Acid I was prescribed that by my GP but had terrible pains every time I took them as I was already on calcium tablets +D3 from the Doc as well I asked for a bone density scan that came back all ok ( doc took some persuading to get me a scan) so I stopped the Alendroic Acid, I don't see the point of extra pain for not needed drugs. I only took the Alendroic Acid for a couple of months. You can get get 2.5 mg pred tablets so you go down 1/2 a mg at a time by mixing the tablets up that's what I do. Go slow with reducing faster means pain.

[PMRpro Ambassador]

My line is no dexascan, no AA. And there are alternatives.

You should have been on calcium and vit D (at a decent dose) from the start of pred and unfortunately, a history of decent-ish diet and exercise isn't a guarantee you have good bone density. But you are male - a positive!

My husband had early prostate ca, indicated by a slightly raised PSA and confirmed with biopsy. His biopsy was carried out while he was on longterm anticoags, by then it was no longer warfarin but apixaban I think. There was no problem with the biopsy - but he did later develop rectal vascular inflammation as a result of the radiotherapy, surgery wasn't an option and he wouldn't have accepted no action and watchful monitoring. THAT caused major problems because the practice of not monitoring the NOACs/DOACs means they miss overdosing and bleeding is a problem. He'd not been told he should not take a particular heart drug and the anticoag at the same time, they needed to be separated by ar least 2 hours. As a result the anticoag reached 10x the level it should have been.

[Hopingsail in reply to PMRpro]

Vitamin D - yes been taking the rda in Cod liver oil capsules for a couple of years. I’ve heard a few horror-stories about the prostate biopsies. … I’ll see how the PSA count goes I think. I really want to get my Pred down and any major shock is likely to play that up.

[PMRpro Ambassador in reply to Hopingsail]

I don't think he found the biopsy too bad at all - these things are relative! Was walking like John Wayne when I picked him up! Remember that it will be a bit like childbirth in that all you hear are the bad experiences.

In retrospect - I should have tried to talk him round to watchful waiting or asking for hormone treatment. But his medical hisotry was a very different one to most.

[Hopingsail in reply to PMRpro]

Thanks for update. Spoke to GP again: he’s authorised a dexascan. Also monthly PSA tests for next few months.

[PMRpro Ambassador in reply to Hopingsail]

Excellent!!!! If you don't ask ...

[DorsetLady PMRGCAuk volunteer in reply to Hopingsail]

Good…

[DorsetLady PMRGCAuk volunteer]

You can start the 0.5mg whenever you like -don’t have to wait until you get to 5mg -I started about 7mg. It’s how you feel really…and as stated easy enough to achieve-Plain white 1mg can be cut or mix and match with 2.5mg.

If your GP wants you on AA, ask for DEXAscan to see if it’s necessary. Doubt if it is,but you never know.

“First” special days of any kind are difficult following bereavement-well done on getting through yesterday.

Obviously can’t help on your prostate personally 😊, but hubby was on meds, which kept everything under control. Fingers crossed for you.

[singingloud]

Do you take vitamin K2 with your calcium? It helps you absorb the D3 and calcium into your bones.

[piglette]

Have you had a Dexascan that shows you have osteoporosis? If not why do you need a bisphosphonate like Alendronic Acid? My GP keeps saying that I should take AA too and I have had endless arguments. After my last Dexascan the hospital told him I do not need a bisphosphonate so he has not said anything since!

[Hopingsail]

Well thanks for all the info kind folks! When I’m next in contact with my GP I’ll ask for a Dexascan. Meanwhile I’m glad my instinct, beginning to be honed by the wisdom here, was not to start on the AA!

Take care everyone x

[squashie in reply to Hopingsail]

I found that .5 mg at a time was fine once I got below 10mg. Have now (fingers crossed) been off pred since October last.

Given the high potential side effects of prostate surgery, and the statistics that show many more men die with prostate cancer than from prostate cancer, I took the personal decision (at 80) to not have PSA tested any more. Both my excellent GP and my Renal specialist were quite comfortable with that decision.

[PMRpro Ambassador in reply to Hopingsail]

What I forgot to say earlier was that although I don't know the set up in the UK, try to have discussion/input from all sides of management. My husband only really saw a urologist and, as a urology surgeon, he was very pro surgery which wasn't really an option for OH. For us it was difficult to get unbiased opinions about the alternatives.

[Francesbarbara]

Just like PMR Pro, I refused Alendronic acid unless my GP arranged a Dexa scan. After some muttering, he agreed and happily the result was no bone problems whatsoever. I'm glad I stuck to my guns. Good luck with your scan.

[AyJayBass]

I had a Transperineal prostate biopsy three years ago. I'm pretty sure I discontinued the anticoag for a couple of days. It was all very straight forward and any soreness cleared up quickly. This was well before PMR. My PSA recently was just over 1.