Doctor follow up

[Janann25]

Quick recap: in hospital with pneumonia and Pred increased to 10mg (from 4.5mg). Saw GP on discharge and was prescribed 10mg for 4 weeks. He also cancelled my repeat prescription so he said to go back in 4 weeks.

So, yesterday I saw another GP to renew my repeat prescription. Immediately I was asked why I was on Pred after 6 years. You can all probably imagine my reply 😉. She then said I should start alendronic acid, to which I explained that I’d had a Dexa Scan last year which showed no change in bone health, which had already been good five years ago. She still wasn’t satisfied and said she needed to do her own calculations. So, we had height and weight taken and BMI confirmed as good. She asked about fractures - I’d broken my arm when I was about 26 - then asked what fractures my parents had had!! I just said, none that I know of! She then started on calcium intake. She used a questionnaire on Google to calculate this and couldn’t fault my diet. She then started on Vit D and said I should be taking it and again seemed offended when I said I’m already taking 1000iu. Eventually she told me to taper 1mg per month until I’m off them and to come back in 6 months time. I’ve just checked the prescription on the NHS App and she’s prescribed 100 x 5mg, 100x1mg which can’t be ordered until 10 August and, although I’ve had enteric coated for the last 6 years, only uncoated ones this time!!! Honestly, you couldn’t make it up😡. Luckily I still have some 5mg and 1mg but I now have the challenge of getting the new prescription changed.

Sorry for the long rant but I just had to let off steam😤

[SnazzyD]

😖. She might have used the FRAX tool to check your risk, hence the questions.

[Janann25 in reply to SnazzyD]

But why, when she had a copy of the Dexa Scan on her screen!

[SnazzyD in reply to Janann25]

Doing her “own calculations”?

Here is the tool and it shows that you plug in the DEXA result amongst the other bits. I used it to make my case for no meds back in the day.

frax.shef.ac.uk/FRAX/tool.a...

[Janann25 in reply to SnazzyD]

Thank you for that - that’s exactly the format she used.

[PMRpro Ambassador]

Pity she hadn't spent a bit of that time reading your notes!!!!

I got the grilling from our local osteoporosis guru - she wouldn't believe me. I did win. Then the next time I saw her, with the results of the next dexascan, I was actually expecting it again because I thought the readings had dropped but she just said "brilliant result, just keep doing what you are doing - I have never seen such a good result in a patient on long term steroids"

[DorsetLady PMRGCAuk volunteer]

Grrr....😲good luck with changing 'script!

[PMRnewbie2017]

Having the uncoated tablets may not be such a bad thing? If you're now trying to taper below 6mg you will need to cut the tablets to achieve the small increment reductions necessary to maintain the "no more than 10%" rule. You cannot split the enteric coated ones. Unless you have a prior history of gastric ulcers or chronic GORD you may be fine on uncoated Pred and use of Gaviscon, or OTC Famotidine or even nothing. Some of us have never had to use any gastro-protectives whilst on Pred, even at the higher doses.

PS: Her reduction schedule of 1mg each month may be a bit of a challenge, so watch out for re-emergence of PMR symptoms or Adrenal Insufficiency raising it's head. AI is a medical emergency and your GP should know this.

[Janann25 in reply to PMRnewbie2017]

As I have an hiatus hernia, I have been on coated Pred since the beginning - 6 years ago - and had reduced to 4.5mg before pneumonia struck so I’m well used to juggling 1 and 2.5mg Pred!! If ever I get to 1.5, I’ll just have to deal with it then😉

[borednow]

You rant away Janann25. Sounds to me as though you're perfectly entitled. Good Luck

[Jackoh]

She seems like the GP from hell. Well done that you kept your cool and perspective. 💐