PART 2: Aftercare
Following on from our article on surviving a stay in hospital in the last issue, we present some tips on coping with life AFTER surgery... Being well-prepared and educated yourself, enables you to calmly and firmly state your requirements when hospitalised. The NADF information gives you credibility and authenticity, for your stated needs, (as do the references to your G.P. and endocrinologist). However, once you have managed to communicate your requirements for an I.V. of Hydrocortisone and saline for an emergency situation, or procedure requiring an anaesthetic, you need to cope with aftercare.
Because you are an
individual, you will be on a specific dose of steroid replacement, (as
well as any other drugs you normally take).
Most operative procedures suggest that the I.V. remain in place until the
patient is able to take their ordinary steroid dose orally. (N.B. There is
no problem switching from Hydrocortisone to Cortisone acetate or
Prednisone or Dexamethasone, as long as the dose is equivalent or lower,
than that in the I.V.).
Problems can arise a day or two later, as the body tries to adjust itself,
recover from the trauma of surgical procedure, and continues the healing
process. Many people have no problem dropping down from 200mg HCz in I.V.
one day, to their regular steroid dose the next. Others will experience
nausea, dizziness, weakness and lowered blood pressure.
Instead of heading home, you may find yourself back in the High Dependency
ward, or left feeling rotten in your current ward, while everyone else on
your surgical list goes home.
If this has
happened to you before, or you have a body that is highly sensitive to
steroid levels, then you probably should taper the decrease in steroids
more slowly, over several days. Be prepared for this possibility, and
prime your endocrinologist, G.P., and specialist about it before you go in
to hospital. This is a very individual issue. Some patients drop to double
their normal dose for two days, then drop down to the regular dose.
Others, perhaps with more serious surgery to recover from, remain on
double or triple their usual dose for several days, then slowly drop down
to double the dose for another few days, and then return to their usual
dose. The process can take up to two weeks or more.
The main concern is to get you, the individual, back down to your normal
oral steroid replacement dose as soon as possible, without compromising
your recovery time. If you make repeated visits to the same hospital, your
particular requirements will be noted, and referred to for future visits.
You and your medical support team need to be appraised of dosages and
effects for your steroids, and any other drugs you may regularly take.
Make a clear note of poor outcomes, and interactions with anaesthetics and
other drug combinations, so that your needs are easily made known, and
have greater chance of being met, while in hospital. Your health is the
responsibility of yourself, and your medical support team.
Be your own advocate. Be educated, communicate clearly, and don’t hesitate to “bring in the reinforcement cavalry” of G.P. and endocrinologist, when necessary.
Robyn Atwood
(Email her here)
