Stopping pred before a 9:00am test

[crafty_grannie]

I've read on here before that pred should be stopped before having a 9:00am test. My rheumy said to get one before my next visit and I asked her about stopping pred beforehand. She said there was no need to do that. Not sure what to do now. Are there some tests where you need to stop pred and others when you don't? She does not like me asking questions, and I do so very politely, and she dismisses as pointless anything I suggest, like taking pred around 3:00am. What difference would it make to the result if I take my normal dose about 3:00, rather than waiting to take it after the blood test?

Thanks for your help.

[SnazzyD]

I have been advised to withhold my Pred before the test and take it immediately after on every occasion, for both the plain Cortisol blood test and the Synacthen test.

[SheffieldJane]

I have had several 9am Corisol tests and Synacthen tests. I took my Pred with me and swallowed it as soon as the test was over as advised. It makes sense that a cortisol test would be more accurate without artificial cortisol masking the results. I had no ill effects, I remember worrying about not taking my Pred.

[crafty_grannie]

Many thanks Dad2Cue, Jane and Snazzy. That is what I thought, and I think your explanation is spot on with my (fill in) rheumy. Can't wait for my real rheumy to get back. Thanks again. Don't know what I'd do without this forum.

[HeronNS in reply to crafty_grannie]

My doctor told me (for morning cortisol test) to stop for three days if I could, but certainly for 24 hours. I had the test 59 hours after my previous pred dose and took my next dose shortly after the test. No problems. Interestingly, given your situation, he didn't tell me anything initially, I had to get back to him and ask!

[crafty_grannie in reply to HeronNS]

Thanks Heron. Don't know how I'd be after three days without pred but twenty-four hours should be do-able. I think my rheumy needs to know a bit more about pred but she is very defensive. I certainly won't take my morning pred till after the blood test. Thanks

[HeronNS in reply to crafty_grannie]

Definitely don't take your pred before the test. Otherwise it will be measuring the pred which rather defeats the purpose.

I did rather wonder how I'd be, too. In fact I had no PMR symptoms, much to my surprise, but I didn't handle stress well. That was six months ago and I have only managed to taper a couple of mg. , so I don't know why getting ready for the test was relatively easy. But I think all they really need is for the pred to be out of your system and it pretty much is after 24 hours as far as I know.

[Suffererc]

That is a very uncaring doctor. They need to listen and be able to take suggestions. They are not god and working on guess work. How would we tell doctor what is wrong if they don’t listen

[crafty_grannie in reply to Suffererc]

Don’t think she sees herself as God but is pretty insecure and defensive. Probably isn’t used to patients knowing or saying anything. I’m still surprised so many people just say, ‘Yes doctor’. I was hoping she might do a bit of investigation. I’ll see how we go at the next appointment.

[PMRpro Ambassador]

You don't STOP pred, you just need to not take any in the 24 hours before the test - i.e. for most people take your morning dose the day before as usual and then delay the dose until after the blood sample has been taken. This is because the pred will suppress the production of cortisol if taken late in the day before and with the assay in the lab if taken in the hours before the blood is taken.

[crafty_grannie in reply to PMRpro]

Thanks PMRpro, poor choice of words. I did mean ‘delay’. Problem I’m having at the moment, probably for quite a while if I think about it, is that I often have difficulty finding the word I need at the time, especially if the person is looking at me and waiting ………….. I will make sure to write down the explanation so I don’t forget. Thank you.

[PMRpro Ambassador in reply to crafty_grannie]

I've heard doctors say you have to stop pred before the test - even they don't explain it well! I wouldn;t worry - I bet most of us struggle to get words at times, Happened to me with PMR and no pred, for others the pred does it.

[MaritimeMags]

Hello C_G. When I asked my new Doctor about these tests (Synacthen and Cortisol) the other day, because I have been on a low dose for a few months and wondered how my immune system was getting on, she said that such a test was not possible until I was off Pred altogether! I knew that was wrong and she needed to educate herself a bit more about PMR. Subsequently I have avoided having her for appointments!

[crafty_grannie in reply to MaritimeMags]

Hi MM, that's why I find this forum invaluable. I would be absolutely hopeless without it. Even if I could read all the information around, I find it makes a huge difference being able to hear from people who have been or are actually on the journey and know what it is like. I am most appreciative of the support.

[Anonnomus]

Care to share what the other med is?

[SunriseHope]

I have been on Prednisone for almost a year now, with monthly blood tests. Why is this the first I have heard about waiting until after a blood test to take prednisone! I have been under the care of a rheumatologist, an internist and a GP.It makes sense to do this , now that I think about it. Thank you Crafty Grannie for posing the question

[DorsetLady PMRGCAuk volunteer in reply to SunriseHope]

The test being talked about in this post is the cortisol test -to see if your adrenals are working/capable of working. If you are above physiological level (approx equivalent to 5-10mg Pred they won’t be) -see link for more info -

healthunlocked.com/pmrgcauk...

Are the monthly tests you refer to the inflammation marker blood tests (CRP/ESR)? If so, you don’t need to adjust when you take Pred for them.

[crafty_grannie in reply to SunriseHope]

Hi SunriseHope, sorry to confuse you. This relates to the test that checks the levels of cortisol produced by the adrenal glands. It isn't used till you're down to about 7mgs of Prednisone or lower. Higher levels of prednisone provide enough cortisol so the adrenal glands don't have to, but when you get down to about 7mgs or less prednisone, there is not enough cortisol from the prednisone, so the adrenal glands have to 'wake up' and start producing cortisol again.

Sometimes it takes a while for them to 'wake up' and start producing cortisol again. This particular blood test is to check whether the adrenal glands are able to produce the cortisol required.

This is just my very general explanation as I wanted to ease your concern. There are many more knowledgeable people who will respond to you with more information.

Hope you're going well on your pred journey. All the best.

[PMRpro Ambassador in reply to SunriseHope]

This is a specific blood test for adrenal function. Most blood tests it doesn't matter

[SunriseHope]

Crafty_Granny Thanks for clarifying this, I guess I did realize this in the thread, but my mind was somehow turned around when I answered with my post. Another lovely prednisone gift with me! Lol

[crafty_grannie]

Knew nothing till I found this forum Dad2Cue. Invaluable.