Without the C17-aa nature, most oral steroid pills would be useless, but the obvious question is while they carry a toxic nature, how toxic is it? Different steroid pills carry varying levels of toxicity, for example, Halotestin is the most toxic of all C17-aa steroids, while Anavar is very mild. Of course, total dosing and duration of use will play a role, but on a per pill basis, most steroid pills are not as damaging to the liver as excessive alcohol consumption, and not nearly as toxic as many over the counter medications. Even so, unlike most over the counter medications, because steroid pills are taken every day when they are being used this presents a higher level of toxicity to the liver. When you supplement with oral steroids, your liver enzyme levels will increase, and this is assured. However, for the healthy adult male who does not add any additional stress to his liver, who lives a healthy lifestyle and supplements responsibly, once use is discontinued his enzyme levels will return to normal. The liver has remarkable rejuvenating capabilities, and with responsible use, permanent damage can in most all cases be avoided.
With epidural administration the drug is contained in the epidural space and acts within that space, not systemically. If I were you, I would call and talk to the Dr or one of the nurses in the outpatient procedure area where they are going to perform the procedure and voice your concerns to them. Tell them your history with these medications and tell them your fears. Be sure you do this at a time when they can sit and speak with you, not in the minutes before the procedure when they are trying to keep a time schedule. You may even want to make another appointment just to talk about your questions, yes, it is another copay, but it may be worth it! Make sure they address your concerns before you go through the procedure. Tell them that it may not be a big deal to them because they see these done every day but to you it is a big deal and you want to be sure you have as much knowledge to make an 'informed decision' as to whether or not you feel this is the right thing to do for your body. If your questions are not answered to your satisfaction then wait to do the procedure until they are. There are a lot of good references on line you can go to for information on the treatments for pain. Lets see, there is the American Pain Foundation, the American Pain Society, Natuional Institute of Arthritis, Musculoskeletal and Skin Diseases, Spine and others-google back pain and you will find all kinds of sites to research from. I tend to like the ones that are the pain assoc and foundations and sites that are "dot-gov" some sites just want to sell you some cure so be careful where you get your info but there are a lot of really good sites where you can download pain logs and things you can print out and bring to your Dr to show how your pain is day to day and how it effects your activities. One or two of those sites have these things available. Pain diaries are good tools to bring to the table. Epidurals are not without complications and you should carefully consider. Talk to your Dr about how many he does every month or year and for how long he's been doing them. Dont let anyone touch your back who does not perform them under fluoroscopy or live xray. That is the only way they can be sure they are in the right area is to do under fluoroscopy! Most do, but some dont and I would not consider someone who doesn't use fluoroscopy. I hope this helps some Cathleen. You can always send me something private if you want as well.
The physical examination, however, may be deferred until after initiation of oral contraceptives if requested by the woman and judged appropriate by the clinician. The physical examination should include special reference to blood pressure, breasts, abdomen and pelvic organs, including cervical cytology , and relevant laboratory tests. In case of undiagnosed, persistent or recurrent abnormal vaginal bleeding, appropriate measures should be conducted to rule out malignancy. Women with a strong family history of breast cancer or who have breast nodules should be monitored with particular care.