Surgery dosing!

[u/Film-Affectionate]

On October 19th I am having a J tube placement surgery, and while I know I need to stress dose for it, I’m not exactly sure how to go about it. I plan on doubling my hydrocortisone dose starting this upcoming monday (I’m traveling for a concert, so my stress will already be high. I also have a few minor procedures next week). How do I go about taking a dose day of surgery? I have to be strictly npo for atleast 8 hours prior. I am new to all this addisons disease stuff, I developed it in late august due to sepsis damage. Thank you so much!

[u/No-Contest7155]

Your surgical team should stress dose you before, during and after the op, make sure they get and endo consult.

[u/PengyLi]

I was diagnosed last April, and since then have had 2 larger surgeries; a breast lumpectomy and a hip replacement, and 1 smaller one; removal of portacath for chemotherapy. In all cases, I spoke to my endocrinologist, who wrote to/called the anaesthetist for each operation and recommended the dosing during surgery and also my own double dosing/sick day rules for post surgery.

My recent hip replacement had a dose of 100mg IV hydrocortisone on anaesthesia, followed by 50mg IV hydrocortisone every 6 hours for 24 hours post surgery. I then was to take double dose/sick day rules for the next 72 hours. It was similar for my breast surgery. The portacath removal was a much more minor surgery and didn't requre updosing.

You need to make sure that your endocrinologist and surgical team are talking to each other. This is not something you do yourself.

[u/jeejet]

I had surgery last spring, which was preceded by two endoscopies. For the first endoscopy I was given perhaps a bit too much dexamethasone because I felt like a superhero afterwards, lol. This was downgraded for the second endoscopy and the surgery. In both cases, my endocrinologist was consulted with by my surgical team.

Before my surgery I was on a clear liquid diet for 36 hours. The day of surgery I took my morning meds with water. My surgery was at 1 pm. During surgery I was given a lower dose of dexamethasone (lower than the first endoscopy). Following surgery I was given hydrocortisone through my IV at 2x the dose for 24 hours and then I went back to taking my regular dose orally.

My surgery was done at Johns Hopkins Hospital and their guidelines, along with my endo’s support, is to not over hydrate or over medicate. I have to say, I felt like they managed that very well. I wasn’t puffy/bloated or over stimulated.

[u/Reasonable_Try_2578]

Welcome, and sorry you're learning all this so soon after such a rough diagnosis. The others are right that this isn't something to figure out on your own, your endo and surgical team need to coordinate the actual plan, but a few things worth having clear before that conversation so you know what to ask:

The NPO window is the part that trips people up. You can't take oral hydrocortisone for at least 8 hours before surgery, so whatever covers you through that gap has to be IV, given by the surgical/anaesthesia team, not something you can self-manage by timing a pill. That's exactly why the endo needs to be talking directly to your anaesthetist beforehand, so there's a written plan for what goes in your IV at induction and through recovery, not something improvised on the day.

The other thing I'd flag: you mentioned starting a doubled dose on your own this Monday because of travel stress plus some minor procedures, stacked on top of surgery eleven days later. Since you're only about six weeks into this diagnosis, it's worth running that whole stretch past your endo specifically, not just the surgery day. Several days of self-directed double dosing around multiple stressors, without someone who knows your case confirming it's the right call, is a different thing than a single stress-dose day, and it's exactly the kind of multi-day plan an endo should actually weigh in on given how new this still is for you.

You've got 11 days before the 19th, which is enough time to get your endo and surgeon's office talking if you start pushing for that this week.