Five years into my PMR journey, and many visits to my very gentle physiotherapist. This latest appointment, she had arranged for me to see her, and the spinal physio at a joint appointment. The spinal physio person asked a lot of questions, and explained a lot about spine and nerve stuff. Made a lot of sense. Then came the question, what dose of Pred are you on now. Answer 7mg, reply, Pred is very dangerous, and you need to reduce 1mg per month to zero. I explained 0.5 mg drop was easier for me. I questioned about Adrenal crisis after being on Pred for 5 years, and she said that doesn't happen. She added that if I did become unwell, just go to your GP or A&E and they will give you a very large dose of steroid. Just wondering where they acquire all of this knowledge of Pred reduction. Trevor.
Latest visit to my physio.: Five years into my PMR... - PMRGCAuk
Latest visit to my physio.
She'd have ended up with right earwigging if it had been me. Utter ignorance posing as medical information. And since you are at 7mg after a long period on pred (I assume) her advice was likely to induce an adrenal crisis ...
Doesn't happen????????? Really .... I hope I never come across her - and I would make a complaint as she could make someone seriously ill.
The mind boggles, in fact I am gobsmacked!!
Just wondering where they acquire all of this knowledge of Pred reduction.
The Big Book of Fairy Tales -or
How to Inflict Most Damage on Your Patients…
At least you can breathe a sigh of relief that she isn't your doctor or even your physio and presumably you never have to see her again. But whether she should be allowed to roam free spreading dangerous rubbish - ! And how she comes to think she knows anything: don't think pharmacology figures largely in physio training. Agree with Pro a complaint in order.
It is this physiotherapist that is dangerous. She is giving out information above her pay grade that could lead to very serious consequences for your. Your instincts are right, tiny drops slow and steady, be guided by your symptoms.
Absolutely the biggest load of nonsense I’ve read. Unbelievable that someone can give out this information, please ignore. Good luck with your journey.
As others I would seriously consider a complaint as she could cause untold damage telling others this information and they maybe taking her advice. Unbelievable!!!!
I have just read your message and recognise your dilemma. I see that you found her input and comments about your spine helpful but she has stepped into an area in which her knowledge is limited and given you incorrect information.If you don't feel able to make a complaint do you think you could consider bringing to her attention the correct way of tapering for those of us who have been on long term medium/high doses of steroids. Also to mitigate the use of the word, "dangerous" when talking to patients when you don't have a complete history.
Would it be worth you printing some of the information from the faqs section and also send a copy to her management team?
Best wishes
I completely agree with Judyliz regarding sending some info. to the physio and the head of department. If she is not corrected NOW she could do the same with a patient who might accept her advice. I am almost ashamed to admit i was a physio. but the last thing we would have done was give advice about tricky medication - that was just not our field.
Jeepers creepers!
Sending her personally a copy of relevant guidance with bits about tapering guidance and adrenals highlighted would be a way forward. If she is generally good she should take this on board and stop her nonsense.
As a physio i doubt she had any in depth training on drugs and pharmacology. I would send her some of our references re tapering and Secondary Adrenal insufficiency. CPD will be part of her on-going professional development so this would be a useful topic and help her and any future patients. Bet if you asked her what's the difference between a glucocorticoid, mineralocorticoid and an anabolic steroid she'd calm down a bit. As my Dad always said to me "a liitle knowledge is a dangerous thing".
My thoughts exactly - but she IS an HCP and there will be patients to take it on trust. She needs to be re-trained ...
Love the question: what's the difference between a glucocorticoid, mineralocorticoid and an anabolic steroid. What’s the answer?
Corticosteroids include glucocorticoids and nineralcorticoids and are produced in the cortext of the adrenal gland.
info.umkc.edu/pharmtofarm/c....
buzzrx.com/blog/corticoster...
Anabolic steroids are different - synthetic mimics of testosterone. They are legally used in medicine but illegally for bodybuilding:
webmd.com/men/anabolic-ster...
That help?
Excellent and comprehensive reply, thank you.
This now raises another issue, particular to me. Over recent months a suspicious lump, of around 3 cms has been identified on my right kidney, top and slight to the side. I chose the option of monitoring of it in 6 months time with a triple phase CT scan. Now I am curious if it may interfere with an adrenal gland. A question for my Urologist Consultant, who I see next February.
I've been waiting for someone to ask. Here goes!
Both Mineralocorticoids (MC) and Glucocorticoids (GC) are produced in the adrenal cortex of the adrenal glands which sit above the kidneys, but in different parts of the cortex. The role of MC are primarily influencing salt and water retention and can raise blood pressure via the Renin-Angiotensin system in the kidney controlled by Aldosterone. They have some anti-inflammatory effects. The most common synthetic MC is Fludrocortisone.
GC are regulated by corticotrophin (ACTH) and are more potent anti-inflammatories. Cortisol is the most important human GC and is essential for optimal functioning of the HPA axis (Hypothalmus, Pituitary and Adrenal glands). Synthetic GC are Prednisolone, Dexamethasone, Triamcinolone and Methylprednisolone.
Anabolic steroids are wholly synthetic and mimic the effects of testosterone. They are sometimes used medically for unusual conditions but less so these days. They are used by body builders and because they have serious adverse effects they are tightly controlled by legislation and hence are found on the black market.
Think our replies complement each other!!! But you wrote yours, I cheated by looking for ready-made ...
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