Lab testing adrenals for surgery....???

[raw1973]

IN another thread below I explained about my situation w/ coming off cortef, six months ago, and having to have semi-major surgery.

Question is I have 10 days till surgery What's the best way to test adrenals to know that they're up to the task of general anesthesia and surgery?

I have a lab order for Cortisol A.M. and ACTH- Plasma already. WOuld this be sufficient, or would I need an ACTH stim...?

[chilln]

IN another thread below I explained about my situation w/ coming off cortef, six months ago, and having to have semi-major surgery.

Question is I have 10 days till surgery What's the best way to test adrenals to know that they're up to the task of general anesthesia and surgery?

I have a lab order for Cortisol A.M. and ACTH- Plasma already. WOuld this be sufficient, or would I need an ACTH stim...?


You will have to undergo physical stress tests, while monitoring ACTH and Cortisol levels. That's what they do at the sports institutes.

If it were any simpler they would have developed simpler tests at the sports institutes.

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Since you seem to be concerned that your medical professional advisers will not be able to provide you with adrenal hormones during surgery, should the need arise, therefore consult a surgeon who will offer you keyhole surgery.

My minimizing the size of the trauma, you tax your adrenals less.

[JanSz]

IN another thread below I explained about my situation w/ coming off cortef, six months ago, and having to have semi-major surgery.

Question is I have 10 days till surgery What's the best way to test adrenals to know that they're up to the task of general anesthesia and surgery?

I have a lab order for Cortisol A.M. and ACTH- Plasma already. WOuld this be sufficient, or would I need an ACTH stim...?

Do either Rhein 24hr urine tests or at Quest:
Cortisol, Free & Cortisone, 24-Hour Urine (37355X)
DHEA (Dehydroepiandrosterone)), Urine (38954X)
Aldosterone, 24-Hour Urine (19552X)


For interprretation you may use:
http://findarticles.com/p/articles/mi_m0ISW/is_246/ai_112728018/pg_1?tag=content;col1

or this thread:
http://musclechatroom.com/forum/showthread.php?p=16751#post16751

.
In any case, you may want to talk with your surgeon and anestesiologist and tell them about your going recently off your Adrenal support.

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My understanding is that the amount of adrenal hormones in urine is directly proprtional to condition of your adrenals.
I guess your should be at "neutral" stress level during urine collection.
.
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[chilln]

My understanding is that the amount of adrenal hormones in urine is directly proprtional to condition of your adrenals.


While it is true, it cannot be used to extrapolate what would happen if the person experienced more physical and mental stress.

What can happen is that on any normal day, JonF's adrenals will provide him with "X" amount of adrenal hormones.

When he has several of those measured via a Rheins, then his levels may show up as optimal.

But this doesn't mean that in a surgery situation, that JonF's adrenal hormones will be able to cope with the additional stress due to the trauma injuries from surgery.

Even if JonF's adrenal hormones measured OK on a normal day, they may not increase sufficiently in response to a trauma injury.

For JonF to pre-determine whether his adrenals can cope with surgery, he would need to determine how his adrenals cope with an additional and unusual amount of stress which his body would not normally experience.

One way to generate that amount of stress would be to experience a trauma injury, while monitoring his adrenal hormones - and we all know that's not going to happen.

So we need to simulate a trauma injury, and the closest thing to that is heavy duty exercise - most likely to exhaustion.

[Drew]

If I was going through your situation, I would stress dose on either hydrocortisone OR Medrol (preferably Medrol). The stress dose would depend on the severity of the surgery. If I had past adrenal issues, but had weaned off of hc, I would consider the above "insurance". But that's just me, and it's best to talk with your dr.

[Dr. John Crisler]

While it is true, it cannot be used to extrapolate what would happen if the person experienced more physical and mental stress.

What can happen is that on any normal day, JonF's adrenals will provide him with "X" amount of adrenal hormones.

When he has several of those measured via a Rheins, then his levels may show up as optimal.

But this doesn't mean that in a surgery situation, that JonF's adrenal hormones will be able to cope with the additional stress due to the trauma injuries from surgery.

Even if JonF's adrenal hormones measured OK on a normal day, they may not increase sufficiently in response to a trauma injury.

For JonF to pre-determine whether his adrenals can cope with surgery, he would need to determine how his adrenals cope with an additional and unusual amount of stress which his body would not normally experience.

One way to generate that amount of stress would be to experience a trauma injury, while monitoring his adrenal hormones - and we all know that's not going to happen.

So we need to simulate a trauma injury, and the closest thing to that is heavy duty exercise - most likely to exhaustion.
That's all true. However, we do our patients better when we are alble to provide practical care.

Simple question: how is your treatment coming along? Do you (even with your treatment) still having symptoms?

Based upon the above, it MAY (discuss this with your health care professional) be wise to bump your dose for the procedure.

[raw1973]

To answer the doctor's questions, I have come off most treatment because when on Thyroid, cortef, HCG+Test was causing anxiety,weightgain/bloat, gait problems, vision and eye problems ...and,my doctor who is held in high regard is too far and too expensive to do regular monitoring w/ bloodwork.

I came off for a few months, exercised, went back to work..dropped about 20lbs had bloodwork and everything looked good. Cholesterol, liver values, glucose all came down from being out of range. Though that infamous thyroid was worse than ever, so my primary gave me some T-4 plus a small amount of t-3 and been fine for the last few weeks.

Anyway, decided to hold off on surgery 10 weeks. IN this time I will continue to eat healthy, diet and exercise so I'm in the best shape I can be in. This will also give me time to research and inquire as to whether I will need HC during surgery.

[JanSz]

To answer the doctor's questions, I have come off most treatment because when on Thyroid, cortef, HCG+Test was causing anxiety,weightgain/bloat, gait problems, vision and eye problems ...and,my doctor who is held in high regard is too far and too expensive to do regular monitoring w/ bloodwork.

I came off for a few months, exercised, went back to work..dropped about 20lbs had bloodwork and everything looked good. Cholesterol, liver values, glucose all came down from being out of range. Though that infamous thyroid was worse than ever, so my primary gave me some T-4 plus a small amount of t-3 and been fine for the last few weeks.
Anyway, decided to hold off on surgery 10 weeks. IN this time I will continue to eat healthy, diet and exercise so I'm in the best shape I can be in. This will also give me time to research and inquire as to whether I will need HC during surgery.

This is a list of tests that I would do if I had a questions about my thyroid:

7 • Iodine Panel - (2503)
8 Selenium
9 Copper, serum
10 Zinc
17 • Iron and Iron Binding Capacity (7573X) - (356N)
18 • Iron, Total (571X) - (24984P)
19 • Ferritin (457X) - (22764P)
20 • Transferrin (891X) - (30346P)
21 • Folate, RBC & Hematocrit - (1768N)
22 • Hemoglobin A1c (496X) - (45484P)
23 • Hemoglobin, Plasma (514X) - (7211P)
27 T3, Total (859X)
28 T4, Total (Thyroxine)
29 T3 Free
30 T4,Free
31 T3, Reverse (967X)
32 Ultrasensitive TSH
33 Thyroid Peroxidase and Thyroglobulin Antibodies (7260X)
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