GP appt and bone scan results

slomo
slomo Member Posts: 180
edited 30. Nov 2015, 16:44 in Living with Arthritis archive
Hi all,
I seem to have been running (! ok staggering) in circles the last few days with not much to show for the energy expended, Anyway....
On Tuesday had a good appointment with my GP who seems happy how I'm progressing but isn't thinking about me going back to work yet. I can't believe I've been off sick since beginning October, me that was never off before - making up for it now! GP gave me sick line/info line to give to work, saying that I've struggled with memory and cognitive function due to illness and meds and would benefit from phased return to work. I'd told him that I didn't think boss fully understood my problems and seemed to have told OccHealth only that I was very tired and it was stressing me that I'd have to straight away explain things to them when I see them on 8/12. Sent sick line to boss.
Bone scan shows 'slight variation from the mean' (not totally sure what that means in real terms) and GP has given me calcium tablets and alendronic acid tablets. Has anyone else had that? You take it once a week and have to stay upright for at least 30mins after that. Not sure about it and haven't taken it yet. I got impression from rheumy that he hoped he wouldn't have to give me anything else. Have decided to wait till I see him on 7/12 and take it from there. It 'can cause damage (including death or loss) of bone in the jaw.' Risk is increased if you have gum disease (that's me) poorly fitted dentures (have top and bottom partial dentures and they seem to fit ok), are taking steroids (that's me again).
Have much to my surprise managed to get a dental appointment for tomorrow morning and will discuss it with dentist too.
In the meantime my boss has been it touch with a plan for my phased return to work. I wouldn't even be physically at work until 2nd week in Jan as I've got some 2015 leave to use first then he's mixed full and half days over the next 4weeks. Has he finally seen the light and is starting to understand?! Really pleasantly surprised by the plan.
So that it so far; tomorrow 1st thing - dentist; tomorrow lunchtime - blood test; tomorrow afternoon - knackered!!

hope everyone else is keeping ok, love
slomo

Comments

  • daffy2
    daffy2 Member Posts: 1,636
    edited 30. Nov -1, 00:00
    Hi Slomo, yes some of us on here know about alendronic acid. I would suggest that you look up the National Osteoporosis Society website to get answers to your questions Was it a DEXA scan you had, which will give you 2 'scores' which indicate the level of bone thinning by reference to optimum density in a young adult and by comparison to a same profile adult (sex, weight,smoking etc) . It is worth getting hold of your results as it will help you find out more about what your options are in terms of medication etc. and whether you have osteoporosis or osteopaenia.
    If you haven't had your VitD levels tested then that should be done. If they are low it can contribute to feelings of fatigue and muscle pain and also you won't be absorbing calcium properly.

    The dental issues are a bit of a can of worms, and opinion varies greatly about the risk for OP patients taking bisphosphonates,within both the medical and dental profession as most of the cases are in relation to patients with other conditions taking very much higher doses. A complicating factor is that the drug stays in the body rather than disappearing once you stop taking it(not entirely surprising as it's treating bone). I had to have an abscessed tooth extracted recently and because I had taken bisphosphonates(even though it was only for 10 weeks and 18 months ago) I had two check ups to make sure there weren't any problems( there weren't). The dentist said she has not had any problems with any of her patients but knows of dentists who have encountered delayed healing - but as she pointed out that can happen without the drug as well so who's to say whether it was the drug causing the problem?
    Bear in mind that as with so many other conditions, those who are tolerating/happy with their treatment are not likely to be posting on a forum, so comments you read are biased to the negative. My mother took AA and didn't have problems with side effects, and 2 colleagues also take it without problems. As it's only once a week the staying upright,only plain water to swallow the pill, no food for 30 mins isn't too difficult to work round. One tip from my experience - if your prescription is a large pill that's hard to swallow ask the pharmacist about an alternative brand.
    Your GP is unlikely to be clued up about OP even though it's their job to manage it so it will pay you to find out as much as you can from reputable sources so you can discuss options and make informed decisions. The good news is that there is a lot you can do to help yourself that doesn't involve drugs and doctors.
    Sorry, this is a bit of a long post, but hope some of it is of use.
  • barbara12
    barbara12 Member Posts: 21,279
    edited 30. Nov -1, 00:00
    Hello slomo
    Sorry you have been struggling , but must say you do seem to have a good GP..its makes all the difference..sorry I cant advise on your meds. but I do wish you well, and hope you will be back to work soon..but meanwhile be kind to yourself..x
  • stickywicket
    stickywicket Member Posts: 27,219
    edited 30. Nov -1, 00:00
    I can't really add to daffy's comprehensive reply. My GP ordered a DXA scan about a couple of years ago as I have several factors pre-disposing me towards osteoporosis. He suggested alendronic acid. I know one or two people (on the forum and elsewhere) who take or have taken it. I opted not to because I already have problems with my oesophagus but, if I hadn't, I'd have given it a go. I just take the calcium and Vit D supplements and exercise as much as possible.

    Good luck with today's appointments.
  • elnafinn
    elnafinn Member Posts: 7,412
    edited 30. Nov -1, 00:00
    Hi Slomo

    As daffy says, google NOS. https://www.nos.org.uk/?gclid=Cj0KEQiAm-CyBRDx65nBhcmVtbIBEiQA7zm8lbkh_WgmMLIna1qv5Z6U0eWgGzup4IIlzCTEL1PlHL8aApan8P8HAQ There is a forum and you can call the helpline run by nurses. Good information on there and their leaflets too. Very few GPs know anything about OP other than the course of meds they have to offer first, second and thirdly, if they do not agree with you, plus the calceos tabs or similar. They rarely discuss with you if your daily diet is sufficient in calcium and if it is decided it is they should then offer you Vit D only on script. This is what I do which is much better than taking calcium in pill form, I think so anyway. ;) Exercise too, weight bearing.

    Yes, definitely get your Vit checked out. Very important.

    Elna
  • slomo
    slomo Member Posts: 180
    edited 30. Nov -1, 00:00
    Thanks everyone for your comments and thanks daffy for the info.
    Well I've been to the dentist and all is OK, had scale and polish and go back in 6 months. She says main issue with the alendronic acid is if you need an extraction as it can delay healing, but she's not had problems with any patients who are on it and although I've got gum disease and have deep 'pockets,' around the remaining teeth, this is all from some years ago and is under control.
    Had my blood test done and asked nurse to print off my scan results which he kindly did ( I promised to pay him in blood!).
    Had lunch out with OH who had been taxi-ing me through the horrid sleety rain.
    Have now pored over my results with help of info booklet downloaded from OP Society.
    My T scores are AP Spine = -1.9 Dual Femur neck mean = -2.3 and Dual Femur Total mean = -2.6 so I think that's osteopenia in Spine and femoral neck and OP (just, as below -2.5 is the point where its classed OP) in the femur. I'll see what rheumy says when I see him on 7/12 and in meantime I'm taking the calcium tablets. Pain levels have been really good lately but because I can move around fairly comfortably I tend to move about at my old healthy rate and end up with my heart thumping like I've run up stairs, almost like hyperventilation. Pretty sure rheumy wil reduce steroids when I see him, I've been on 15mg daily for couple of weeks now.
    Anyway thanks to OH deciding to take me out for lunch, today has been a good day and we're now chilling out with a cuppa.

    Thanks everyone, take care

    slomo

  • elnafinn
    elnafinn Member Posts: 7,412
    edited 30. Nov -1, 00:00
    Great to hear you have had a good day, Slomo.

    Look after yourself and your bones,

    Elna
  • daffy2
    daffy2 Member Posts: 1,636
    edited 30. Nov -1, 00:00
    I'm glad your dentist has been able to reassure you. As Elna says your GP will normally expect you to try the bisphosphonates starting with alendronic acid and if that doesn't suit go onto the next one - usually risedronate. It's worth bearing in mind that just because a drug is of the same type it does not follow that any side effects will be the same. I tried both and had very different side effects.
    As you say, your T scores show you hovering around the osteopaenia/osteoporosis border, which in one respect is a good thing as it means you can take steps to hopefully prevent tipping fully into the o/porosis bracket.On the NOS forum it's often referred to as a 'wake-up call'. One thing to bear in mind is that OA can cloud the issue by distorting the density readings, (may show greater density)so if you have OA at the sites where the scan is done you may need to allow for that. Unfortunately there doesn't appear to be any calculation to determine the level of distortion. I have no idea if my lumbar T score of -4.2 would be even worse if I didn't have OA in my spine as well, can't get an answer, so am choosing not to think about it!
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    I was given alendronic acid when I was using oral steroids to minimise my beginning osteopenia - I didn't like it very much and found the taking it on an empty stomach and sitting about for 30 minutes a real faff. I spent 2011 weaning myself off the steroids then had a follow-up dexa scan in 2013 (I think). My bone density had increased by 3.4% which is the only positive result I've had on anything!

    We are prescribed these things for a reason (usually a good one) and I admit I take side-effects leaflets with a very large pinch of salt because they are only warnings, not guarantees, but as you already have issues you are wise to be more cautious. I must now resume my Vit D and calcium as the darker days are here. Ho-hum, more to remember and swallow. :roll: DD
  • slomo
    slomo Member Posts: 180
    edited 30. Nov -1, 00:00
    Hi guys,
    Just a couple of thoughts on the sitting/standing around for 30 minutes thing.
    I have a work colleague who uses the time to do her ironing on a Sunday morning and my friend goes for a shower as she says that is a standing up job. Dr didn't contradict me when I said that to him so if I do have to take the alendronic acid I might just do that.

    It looks as if this week I have no medical appointments at all! This is good, strange but very good. Should try to spend the time on Christmas present deciding and buying.

    take care everyone and thanks for the info and comments. Will let you know how things go at rheumy appointment on 7/12.

    slomo
  • daffy2
    daffy2 Member Posts: 1,636
    edited 30. Nov -1, 00:00
    As I understand it the reason for the 30 mins upright bit is to get the pill moving through quickly as it might damage the stomach lining if it sticks in one place, and also to make sure it's out of the way before food gets dumped on it! The empty stomach and quantity of plain water also help speed up progress but they are more to do with not interfering with absorption of the AA. That's also why it's a first thing in the morning job as that's the easiest way to ensure lack of food interaction for most folks.
    Although a lot of people take it at the weekend as they find it easier to remember and work round it, a colleague of mine found that it was easier to rearrange her morning routine on a work day(shower and hairwashing before breakfast rather than after) than disturb the chance of a lazy Sunday and breakfast brought up by OH.