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Oral Steroids, Buto at Paggaling

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How long-term steroid tablets affect bone, wound healing and surgery, and why they must never be stopped suddenly.

Mga tabletang steroid sa tabi ng isang buto.
Ang pangmatagalang pag-inom ng steroid tablets ay nagpapahina ng buto at nagpapabagal ng paggaling — at hindi dapat itigil nang biglaan. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Kung ikaw ay umiinom ng steroid tablets, ang pahinang ito ay para sa iyo. Ang mga gamot tulad ng prednisolone, prednisone o dexamethasone ay mahahalaga, at kung minsan ay essential na mga gamot: pinapakalma nito ang pamamaga (inflammation) at ang sobrang aktibong immune responses, at tinutulungan nito ang mga taong may asthma, COPD, at malawak na uri ng inflammatory at autoimmune conditions na mamuhay nang maayos. Wala sa mga susunod na impormasyon ang dahilan upang itigil ang pag-inom ng mga ito. Ngunit ang mga gamot na ito ay may ilang epekto na mahalaga kapag ikaw ay sasailalim sa operasyon, at ang kaunting pagpaplano ay ginagawang mas ligtas ang lahat. Ang pinakamahalagang bagay na maaari mong gawin ay simple: sabihin sa iyong team na umiinom ka ng steroids: alin dito, anong dose, at gaano ka na katagal na gumagamit ng mga ito.

Ang ibig naming sabihin sa "steroids" dito

Ang salitang "steroid" ay ginagamit para sa ilang magkakaibang bagay, kaya mahalagang maging malinaw. Ang pahinang ito ay tungkol sa mga corticosteroid tablet (ang mga karaniwan ay prednisolone, prednisone at dexamethasone) na iniinom nang regular para sa isang kondisyong medikal.

Ang mga ito ay hindi katulad ng steroid injection sa isang joint o tendon, na isang one-off, local dose na ibinibigay upang pakalmahin ang isang partikular na masakit na bahagi (mayroon kaming hiwalay na pahina tungkol sa corticosteroid injections). At iba rin sila sa mga anabolic, muscle-building steroids na minsan ay ginagamit sa sports, na isang ganap na magkaibang uri ng gamot. Kapag nagtatanong kami tungkol sa "steroids" bago ang operasyon, ang tinutukoy namin ay ang mga tablet na regular mong iniinom.

Ang mga Steroid at ang iyong mga buto

Isa sa mga pinakamahalagang pangmatagalang epekto ng mga steroid tablet ay sa skeleton. Ang pangmatagalang oral steroids ang pinakakaraniwang medikal na sanhi ng osteoporosis, isang pagnipis ng buto na nagpapataas ng posibilidad na ito ay mabali. Ito ay mahalaga sa isang surgeon dahil ang mas matibay na buto ay mas mabilis gumaling at mas maayos na humahawak ng fixation, at dahil ang fracture ay isang bagay na mas gusto naming maiwasan.

May ilang bagay na mahalagang malaman, dahil ang mga ito ay nakakapagbigay-katiyakan gaya ng pagbibigay-babala:

  • Ang epekto ay nakadepende sa dosis at oras, ngunit kahit ang katamtamang pang-araw-araw na dosis na iniinom sa loob ng maraming buwan ay maaaring magsimulang magpahina ng tibay ng buto.
  • Ang pinakamabilis na pagkawala ng buto ay nangyayari nang maaga, sa unang ilang buwan matapos magsimula, kaya naman ang proteksyon sa buto ay pinakamainam na isaalang-alang nang mas maaga kaysa huli.
  • Ito ay malaking bahagi na maaaring mapamahalaan. Karamihan sa mga taong gumagamit ng pangmatagalang steroids ay dapat nag-iisip tungkol sa proteksyon ng buto bilang isang rutinang bahagi ng kanilang pangangalaga.

Karaniwan itong nagsisimula sa mga pangunahing bagay: sapat na calcium at vitamin D. Para sa mga taong may mas mataas na panganib, maaaring magdagdag ang iyong doktor ng gamot na nagpapatibay ng buto (tulad ng isang bisphosphonate). Kung ikaw ay regular na gumagamit ng steroids at walang sinumang nakipag-usap sa iyo tungkol sa iyong mga buto, ito ay isang napaka-makatwirang bagay na itanong. Ang aming pahina tungkol sa bone health and osteoporosis ay tumatalakay dito nang mas detalyado.

Steroids, paghilom ng sugat at impeksyon

Ang mga steroid ay gumagana sa pamamagitan ng pagpapahina ng pamamaga (inflammation) at ng immune response, na siya mismong dahilan kung bakit nakatutulong ang mga ito sa maraming kondisyon. Ang kapalit nito ay ang parehong calming effect na maaaring magdulot ng mas mabagal na paghilom ng mga sugat at maaaring magpataas ng posibilidad ng impeksyon sa sugat. Sa paglipas ng panahon, maaari ring manipis ng mga steroid ang balat, kaya ang mga taong sumasailalim sa long-term treatment ay madalas mapansin na madali silang magkapasa o nagkakaroon ng skin tears mula sa maliliit na pagkakauntog.

Hindi ibig sabihin nito na hindi maaaring ituloy ang operasyon. Ibig sabihin lamang nito ay mas masusing babantayan ng iyong team ang sugat, at mahalagang maging maingat sa balat sa paligid ng naghihilom na incision. Gaya ng paninigarilyo at alak (tinalakay namin ang mga ito sa kani-kanilang mga pahina), anumang bagay na sumusuporta sa paghilom ay mahalagang gawin sa mga linggong nakapalibot sa isang operasyon.

Steroids sa panahon ng operasyon — dalawang mahalagang punto

Ito ang bahagi na nakagugulat sa mga tao, kaya mahalagang ipaliwanag ito nang malinaw.

1. Huwag biglang itigil ang iyong mga steroid. Kapag regular kang umiinom ng mga steroid tablet, nararamdaman ng iyong katawan na may sapat na steroid sa paligid at itinitigil nito ang sarili nitong produksyon. Kung ang mga tablet ay biglang ititigil, maaaring mawalan ang iyong katawan ng parehong source sa loob ng ilang oras, at maaari itong magdulot ng malalang pagkakasakit. Kaya maliban na lamang kung partikular na sinabi ng doktor ang kabaligtaran, ipagpatuloy ang pag-inom ng iyong mga steroid hanggang sa araw at pagkatapos ng iyong operasyon.

2. Maaaring kailanganin mo ng kaunting karagdagang "cover" sa panahon ng operasyon. Ang operasyon ay isang pisikal na stress, at karaniwan ay tumutugon ang iyong katawan sa pamamagitan ng paggawa ng extra na sarili nitong steroid. Dahil pinatahimik ng mga regular na steroid tablet ang natural na tugon na iyon, ang ilang tao ay nangangailangan ng top-up dose ng steroid (madalas na ibinibigay sa pamamagitan ng drip) sa panahon ng operasyon upang punan ang pagkukulang. Tinatawag itong stress-dose o steroid cover, at pinaplano ito para sa iyo ng iyong surgical at anaesthetic team; hindi mo kailangang mag-ayos ng anuman nang mag-isa. Ito ay isang routine at naiintindihang bahagi ng pag-aalaga sa isang taong naka-long-term steroids.

Ano ang ibig sabihin nito para sa iyo — ang praktikal na bahagi

  • Sabihin sa iyong team na gumagamit ka ng steroids, at maging espesipiko: anong gamot, anong dosis, at gaano ka na katagal gumagamit nito. Kung mayroon kang steroid card o alert bracelet, dalhin ito.
  • Huwag na huwag ititigil o babaguhin ang iyong steroids nang mag-isa. Sundin ang mga nakasulat na instruksyong ibinigay sa iyo, at magtanong kung mayroong hindi malinaw.
  • Magtanong tungkol sa iyong mga buto kung hindi pa ito nababanggit: calcium at vitamin D, at kung minsan ay gamot na nagpapatibay ng buto (tingnan ang aming pahina tungkol sa bone health).
  • Tandaan na ang pahinang ito ay tungkol sa mga steroid tablet, na naiiba sa steroid injection sa kasukasuan (joint) at naiiba rin sa mga muscle-building steroids.

Kailan dapat humingi ng tulong

Karamihan sa mga taong gumagamit ng steroids ay nalalagpasan ang operasyon nang walang problema. Ngunit mahalagang malaman ang mga babalang senyales, dahil madali itong gawan ng aksyon:

  • Kung mayroon kang nakaligtaang dose ng steroid (halimbawa dahil sa pagsusuka o sakit) at nakararamdam ng matinding pagkapagod o panghihina, pagkahilo o paghimatay, o nagsusuka: maaari itong maging senyales na kulang ang iyong katawan sa steroid. Humingi agad ng tulong medikal, at kung mayroon kang emergency steroid plan, sundin ito.
  • Sa paligid ng sugat, bantayan ang mga senyales na ito ay hindi gumagaling nang maayos o maaaring may impeksyon: tumitinding pamumula, pamamaga, init o sakit, paglabas ng likido o nana, sugat na bumubukas, o lagnat. Ipaalam ito sa amin.
  • At gaya ng dati: kung hindi ka sigurado kung ano ang gagawin sa iyong mga steroid bago ang operasyon, magtanong sa amin kaysa manghula. Mas gusto naming sagutin ang iyong katanungan.

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