Asking GP for a referral

[Songbird6]

Hi, hoping someone can give some advice?

I have PMR, currently managing at 4mg Prednisolone and recently had an Xray on my thoracic and lumbar spine, which has shown wedge shape fractures, I don't know how many or exact areas. My GP prescribed in advance of my Xray, because it took so long to get the results, Risedronate 35mg, Huxley D3 and The ical 1000mg to strengthen bones etc. I am taking Gabapentin, the Diazepam and Morphine Sulphate 10mg/5ml as required when pain is bad! I have a MRI scan booked or 29th October so hopefully by then I will be able to lay on my back for the scan without too much discomfort, which worries me!

Should I ask my GP to refer me to a Rheumatologist or to an Orthopedic consultant, which would be best? My family think I shouldn't just be left to manage on pain relief and bone strengthening meds alone and neither to do I. All my GP has said was to let him know how I am getting on/coping!🤷🙄🤨

[123-go]

No! You shouldn't be relying on pain killers that only mask the pain: they don't treat the underlying condition. Yes! Contact your GP. He/she may be waiting for the results of the MRI before referring you to a particular specialist but you've been told to ring with an update so please do that for your health record.

Try not to worry about the MRI. The radiologist will make you as comfortable as possible for your scan: they are used to dealing with patients who are in pain. All good wishes going forward.🤞🏼

[Songbird6 in reply to 123-go]

Thank you for your reply and advice 😊

[PMRpro Ambassador]

I fear there is very little to be done except painkillers if the compression/wedge fractures are stable. They are the same as any other fracture, you have to wait for them to heal.

I'm not familiar with the calcium supplement you mention - but calcium supplements should be in smaller doses - the body is unable to absorb more than 600mg at a time.

[Songbird6 in reply to PMRpro]

I wasn't absorbing the Calcium and vitamin D enough, according to my Liver function tests, not sure why or if that's the reason for higher doses 🤷

It makes sense what you've said about stable fractures having to heal, not thought of it like that. That has made me feel a bit more confident about my issues and I am taking less pain meds throughout the day so healing is happening. Thank you for your help.

[PMRpro Ambassador in reply to Songbird6]

I suppose that having more sloshing around might mean you absorb more. does that mean you are taking 1000mg twice a day?

That sounds as if your blood calcium is low - but I'm far from sure that only means you aren't absorbing calcium, there are other reasons. And you ARE taking your calcium and pred at least 2 to 3 hours apart aren't you? If you take them together, calcium interferes with absorbing pred from the stomach and pred interferes with absorbing calcium in the gut.

[Songbird6 in reply to PMRpro]

I am taking 1000mg 880 iu calcium Vit D per day but had no idea it should be taken well apart from Prednisolone dose!

[DorsetLady PMRGCAuk volunteer in reply to Songbird6]

see my link further down -healthunlocked.com/pmrgcauk...

[Songbird6 in reply to DorsetLady]

Thank you for this 🙂

[PMRpro Ambassador in reply to Songbird6]

AND in 2 doses!

[Songbird6 in reply to PMRpro]

Risedronate 35 mg, I take once a week and the same with Huxley D3, 20.000 unit capsules, 2, once a week

[PMRpro Ambassador in reply to Songbird6]

Was your blood vit D level very low?

[Songbird6 in reply to PMRpro]

I can't remember off the top of my head but it was low enough!

[PMRpro Ambassador in reply to Songbird6]

A PS - what level of vit D are you taking? The amount in usual supplements is nowhere near enough for patients on pred in particular. I take 4000 IU a day to keep my blood level in the acceptable range - combined calcium supplements rarely have more than 400 IU/tablet. Nowhere near enough.

[montebello in reply to PMRpro]

So you take 4000 iU vitamin D and 600 mg calcium per day, 2 to 3 hours away from your prednisone dose?

[PMRpro Ambassador in reply to montebello]

I take 4000 IU vit D daily. I used to take 2x 500mg AdCal - which is the correct way to take 1000mg calcium - but no longer do so as it caused me to have bladder problems (like a lot of others). Our basic rule for pred and calcium was pred for breakfast, calcium for lunch and dinner! All are absorbed better when taken with a small amount of fat from a meal or snack. Even tea with milk is probably enough for the average Brit

[montebello in reply to PMRpro]

Okay. Thanks. So to be clear, you no longer take any calcium, right? And does it matter when you take vitamin D?

[PMRpro Ambassador in reply to montebello]

I don't take calcium supplements - just dairy, especially cheese.

No, vit D doesn't interfere with anything but is better with a bit of fat somewhere to aid absorption across the gut wall so I take mine with my dinner. Also reduces any risk of upset - some people find it causes an upset stomach

[montebello in reply to PMRpro]

Great. Thank you

[DorsetLady PMRGCAuk volunteer in reply to montebello]

see this -

healthunlocked.com/pmrgcauk...

[montebello in reply to DorsetLady]

Thank you!

[Songbird6 in reply to PMRpro]

Okay, I will throw that ball in the GP's court then! Thanks.

[moonieboy9358 in reply to Songbird6]

If your fractures ate more than 90 days old. Then kyphoplasty in many instances will not be too promising. What was the cause of your fractures? If the fractures were from osteoporosis. Then they wont do kyphoplasty. The proceedure will weaken the vertebrae above and below your fractures. My suggestion is to wait until your mri resultsvate in. If you have not had a bone density scan done. I would ask for one

[Songbird6 in reply to moonieboy9358]

Think it was the high dose of Prednisolone in March this year for suspected GCA but also that my GP never prescribed any Calcium or Vitamin D from the start of my diagnosis for Polymyalgia in March 2021!

[Songbird6 in reply to moonieboy9358]

Thank you

[Songbird6 in reply to moonieboy9358]

Kyphoplasty, doesn't sound that promising from what I've just read up on it! Think I'll get MRI done and results back before reading up on possible procedures, if any! 🤷

[moonieboy9358]

I was taking calcium and vitamin d even prior to my fracture. I was never told to take calcium. Steroids can be a double edge sword. Steroids can have a cumulative effect on bones an in as little as two months of steroud usage even without taking them prior demineralizes bones. Despite my 5 fractures and stopping oral steroids previously. Recently, my labs went wonky. In turn. The rhuemy started me on injections of medrol. I decided i am not having anymore. I had side effects from the first injection