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Questions for GP

Posted , 7 users are following.

lbh
lbh

I'm going for my 2 month review at GP this evening. I want to make the best use of my appointment. Although prescribed alendronic acid, I decided not to take it so I intend to ask for a bone scan and calcium supplement. I was also prescribed omeprazole but am rarely taking that because the 5mg and 2.5mg are coated - only 1mg is not. (is there a 1mg coated available in England?)

I'm wondering what other routine checks I should be having? Glucose check because of diabetes risk? There is a 3/12 average test isn't there? Any other recommendations/suggestions please?? Don't think I need any inflammatory markers checking as I am at the very end of a taper from 11mg to 10mg which I'm pleased with.

Thanks for your help.

0 likes, 8 replies

8 Replies

  • BettyE
    BettyE lbh

    Posted

    Hope the review goes well.

    I was not able to take AA and just had Calceos ( Calcium and VitD ) for the whole of my eight years on pred. All was fine and hip op showed bone density was "amazing" so surgeon said!

    I always took my pred. with a couple of tablespoons of natural yoghurt ( Yeo Valley if you're in UK ) and never needed coated tabs.

    I must have eaten quarts of the yoghurt over the years since a nurse recommended it when I had to have an endoscopy because my gut was miserable. ( I don't have shares in it, honestly )

    Not qualified to answer your other queries.

    but some who is will be along.

    • lbh
      lbh BettyE

      Posted

      Thanks BettyE. I've now been prescribed a calcium supplement. That was about my only success - no to bone scan, no to enteric 1mg and no to blood sugar blood test. Oh well, I tried. Better luck next time. 😀

  • EileenH
    EileenH lbh

    Posted

    Yes - 1mg enteric coated pred has been available in the UK since August 2016:

    https://www.medicines.org.uk/emc/product/2077/pil

    although a lot of doctors and even pharmacists don't know!

    The 3-monthly diabetes test is the Hba1c - reflecting the average BS level over the past 3 months. BP and weight usually get a mention - but all these things should have been done since Day 1 of pred, as should provision of calcium/vit D supplements. If they get antsy about the AA - did they check your calcium and vit D levels before saying you should take AA? They should - says very clearly in the prescribing information. AA won't work unless they are both right and vit D very often isn't.

    You probably need a general blood screen - ESR/CRP probably don't matter if you are feeling good although that is also a good time to check how low it has gone with all inflammation under control. That is how you find what is YOUR personal normal level - mine is low single figures. And full blood count - red cells, white cells, differential etc should be checked at least every 6-12 months.

    But although I say this - I don't get much checked here where I live! 😉

    • lbh
      lbh EileenH

      Posted

      Thank you Eileen for your comprehensive reply. I didn't do very well! Asked for enteric coated 1mg - no, he says because it doesn't actually protect your stomach, it just means it is broken down later in the digestive system so keep on taking the omeprazole (which I do sporadically!) Also a 'no' to bone scan - he says it's not indicated and wouldn't be of any help. Take the AA now so that I don't regret not taking it when I'm older. (I've just turned 64) Also a 'no' to BS test - he suggests that is done at yearly intervals (I'm guessing it must have been done initially - end April). Success - he has prescribed a calcium supplement. Turns out that it wasn't prescribed initially because my vit D was slightly low, so I had a 3/12 course of vit D only, with which calcium is not indicated.

      I find it hard to counter-argue what a GP tells me with such certainty, and I work in the NHS in a clinical role. Oh well, at least I'm pleased with my successful 11 to 10 taper and maybe my GP has the same mindset as your Italian - after all, he is called Dr. Fernandes.Thanks again.

    • EileenH
      EileenH lbh

      Posted

      And it being broken down lower in the gut doesn't help protect your stomach? There are 2 components to it...

      The BSR recommendations for under 65s include a dexascan and calcium/vit D supplements. AA if indicated by the dexascan. showing a t-score of worse than -1.5

      http://www.pmr-gca-northeast.org.uk/assets/pmr_resource_9.pdf

      I had been on pred for over 7 years at my last dexascan and there has been no significant change in density - still no AA.

      I just state my opinion and back it up - and most of them given in... I've had the "you need AA" and statins and the rest. Still not taking any. I gave in and tried methotrexate - for 4 weeks. I wasn't sticking that for months to see if it might do something!!!!

    • BettyE
      BettyE EileenH

      Posted

      "I just state my opinion and back it up - and most of them given in..I just state my opinion and back it up - and most of them given in."

      I'd like to be a fly on the wall!

    • EileenH
      EileenH BettyE

      Posted

      😃

      It is always very civilised! One rheumy/rehab doctor I had to see to get physiotherapy approved asked if she could have my original dexascan results as she needed to consider what to do over bisphosphonates. I did give them to here and got a copy in return but merely said she could save her time as nothing would induce me to take them anyway - ESPECIALLY as my BMD had barely changed in 7 years on pred...

      My real rheumy is very amenable - says he always learns something about PMR/GCA from me ...

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