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Post by angela on Mar 4, 2009 20:41:42 GMT -5
I am going to be scheduled for spinal surgery on my sacrum in the next couple of weeks. I posted about the fall I had on Dec 18...basically, I have pseudomeningocele that is getting bigger.
And just to make things interesting....I am 22 weeks pregnant.
To those who ask....no, the surgery can't wait until after delivery. I have cried many tears over this and we are praying for the Lord's mercy and grace (sorry if the religious reference offends anyone).
Anyway, the surgery entails a 2-3 day hospital stay and 10-14 days bed rest at home.
I am currently taking 30 - 32.5 mg hydrocortisone per day. I will get the Solu-Cortef during surgery. How do I proceed after the surgery? I don't want to suppress my immune system or prevent healing.
I don't have an endocrinologist -- my family doc is taking care of my hormonal issues, but this is new to her, too. I would appreciate any input.
Thanks so much,
Angela
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Post by justaustin on Mar 5, 2009 7:22:33 GMT -5
Hi Angela,
Congratuations!! 100mg IV solumedrol will not suppress your immune system. Your body would easilly produce this much (if it was functioning properly) with surgery/stress/illness.
They need to give you 100mg IV solumedrol every 8hours until you are eating/drinking and able to resume your oral HC. If you are having post-0p nausea/vomiting, you will not be able to take your HC. If you receive this stress dosing for two days or less, then you can go back to your regular dosing with out weaning. IF stress dosing for more than 2 days, you will need to wean.
Once you return to regular dosing, (if you receive IV solumedrol for a day), your body might tell you that you might need more HC. Pay attention and listen to you body.
The only thing that might negate all of this above is this: Find out if the docs(is this a neurosurgeon doing the surgery) will be giving you decadron/dexamethasone post op. Sometimes they do to decrease swelling. It is very powerful. IF so, you might not need to take your HC. BUT DO FIND OUT!!
Laurie
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Post by Lethal Lee on Mar 5, 2009 8:03:23 GMT -5
Hi Laurie,
Could you clarify for me?
Wouldnt SoluMedrol be a lot more than Adrenals would produce? I agree SoluCortef 100mg would be fine. But SoluMedrol would be 100x5 = 500mg HC equivalent? I understand some estimate the Adrenals (if healthy) can produce up to 200mg daily under extreme stress.
If you were given SoluMedrol you would need it repeated at a much longer interval than the SoluCortef too wouldnt you? If you had SoluCortef what would be the interval?
I ask because I would like to know not only for the benefit of posters but also myself. I am about to ask my Doc for RX for SoluCortef emergency injection kit. I am about to order an medical ID too & want to be clear on exactly what to put on it.
I also am going to need a Wisdom tooth removed under general sometime this year. The tooth has crumbled to gum line & will have to be cut out...ouch!!! Strangely no pain though & this has been going on for a year!!
Sorry for sort of hijacking your thread Angela. But I think we both need to know this!!!!
I hope everything goes well for you & baby.
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Post by justaustin on Mar 5, 2009 8:17:44 GMT -5
Hi Lee,
WOW!! Thanks for pointing that out. I know solumedrol is stronger than IV solucortef. But, didn't realize the difference!! When I first started HC, my doc stressed IV solumedrol be inscribed on medic alert should I be in trauma/ unresponsive. HUM!
***************** This is From Chris' sticky of two worst cases of hypopit he's seen. This is the second case...
"This second story is about a woman who lives in Europe. To protect her identity which she guarded and didn't want her name out there, (very private person, posted a few times but not on RTH or STTM that I know of), I will call her by a made up name, Jill. Her best friend who even if I could remember her name (I'll call her Sue), I also couldn't say here, contacted me in email that Jill was on her death bed (do not recusitate order or DNR) in a hospital ICU because she "accidently" took too much morphine from the pump. Jill was shown how to do this to cause a fatal dose if the pain got too much for her. Jill's nurse did not know about the DNR and so she revived her. Jill was in a coma and doctors gave her days to live at best.
The docs had earlier identified that Jill had adrenal insufficiency, but because of absorption issues which had caused a stroke, Jill had to be put on solucortef IV instead of Cortef. Sue brought me into the picture 2 days after Jill's morphine overdose and acted as a go between for Jill's husband and me.
I poured over all Jill's labs which included several hormone tests. I was also given some medical history which included severe hemorrhage during child birth. Some of you might have a red light go off as I did.
Could Jill have Sheehan's syndrome, a form of hypopituitarism caused by severe blood loss. I scrutinized her labs and found she had low pituitary hormones including dirt low ACTH. She also had dirt low cortisol as well as secondary hypo. I don't remember what the numbers were or what the other pit hormones were, I was to worried and focused on her almost non-existent cortisol level. I told the friend Sue to tell the doctors to try Jill on solu-medrol as I suspected solu-cortef would not be strong enough for her and that I thought she had Sheehan's Syndrome.
Sue emailed me the next day to tell me that Jill woke up about 2 hours after she was put on solu-medrol and was doing real good. There seemed to be no damage from the morphine. Later, Sue told me the doctors diagnosed Jill with secondary AI and Sheehan's only because I suggested it.
The doctors also treated her secondary hypothyroid condition later on. Her improvement was quick and one of the more remarkable I've seen. She is no longer in pain from I assume was fibro, but I didn't ask at the time. I assume she's still doing ok since I haven't heard anything for over 2 years.
I didn't write this to impress you all. There are many people who can recognize that Jill likely had Sheehan's and needed Solu-medrol. I'm glad I was there to help. I wrote this and posted the first story primarily to remind you all that there is always someone worse off, but also for educational and interest value. "
********** So, perhaps IV solucortef would be fine every 6-8hours until eating/drinking. IF you are not responding, they should try solumedrol. Perhaps that's the learning point for Chris' sticky. It would be great if he could comment on this.
Neurosurgeons use decadron alot post-op. So I would definitely get that squared away.
Laurie
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