STEROIDS AND SURGERY

[m33ary]

Hello all. I'm having surgery in Sept, wondered if anyone had surgery recently and did they change your steroid dose before or after surgery ? Hope you are all doing well and pain free.

[PMRpro Ambassador]

It depends on what you are having done. It used to be common practice to increase the pred dosage but more recently the usual procedure is to monitor the patient closely post-op and sometimes to give a single dose of a different corticosteroid during the operation. It depends on the surgeon and his personal preferences.

As for your daily pred dose, most surgeons like you to be stable on a dose before surgery - and not to be attempting a reduction! I know a few patients who have had hip or knee replacements whilst on low to moderate doses of pred (up to 10mg) and have been able to reduce their dose post-surgery and even get off pred altogether. It is almost as if removing the stress of the pain also helps the PMR and need for pred.

[polkadotcom]

I had an arthroscopy on my knee last year, was on 5mg and didn't find I needed to raise the dose at all.

It used to be common to be told to raise the dose by 5mg approx just before the surgery and for the aftercare, but I really think it now depends on what dose you are on and how you are feeling in yourself. If you have had the pre-op assessment already then you can ring them and ask if they have any instructions, or query it at the assessment.

[guinivere]

Hi I recently had a knee replacement. and I was told by my Consultant that I had to reduce my Steriods to under 10

[metaljoints in reply to guinivere]

I had two knee replacements last year, both very successul. The first was delayed to enable me to reduce my Prednisolone to 5 mg (having had PMR for the previous 13 months - with some flare-ups, and with corresponding increased dosages which were then decreased by about 1 mg per month). That was December 2012. The second knee was done 4 months later. In each case, the surgeon and anaesthetist wanted me to remain steady on the dosage, and because of starving on the day of the operation, gave me an larger steroid dose during the course of the operation.

I am now about to undergo two more bouts of surgery - my hips this time, and following a big PMR flare-up earlier this year, I am now steady on 10 mg of Pred. During Pre-op assessments and discussions with the anaesthetist in particular, we agreed to stay steady on this dosage. I plan to do so until I am clear of all surgery (the first hip in 14 days, and the other, a revision, 3 months later), and then attempt to reduce again VERY slowly, as recommended by the experts via this website.

Good luck with your surgery!

[m33ary]

Thanks for your response's much appreciated. I had my pre op tests on Wednesday and they hadn't a clue, neither does my GP!! I'm on 10mgs at present so I will continue with that for now. I'm having hiatus hernia surgery PMRpro. It is so bad I can't eat for last 2 months!

Polkadotcom and Guinivere how did your surgery go??

[guinivere in reply to m33ary]

Not very good this time My 3rd knee replacement Had no problems with first 2 But this one I had in April I'm still in agony with.Its affected my leg, ankle, foot etc.They seem to think a Sciatic nerve been caught up.Am due an MRI next week for it.Im cracking myself as im highly claustrophobic. Got some Diazapan for this time as last time I had a full blown panic attack.Ive had every scan known I think as I have regular CT Pet Bone Scans And Bone Density scans but an MRI freaks me out.

[m33ary in reply to guinivere]

Oh that sounds miserable. I wish you well, sending gentle hugs xx

[Bagshaw]

I had a sequence of three operations on my eye following a detached retina. Each time I told the doctors I was on prednisolone, they did not comment. Post-op I was routinely given steroid drops. I don't know whether there is a connection with the subsequent raised pressure in the eye which now has me on eyedrops for life, to head off the risk of glaucoma.

Don't know if it helps, but my advice would be to stress to every nurse and doctor who takes your medical history that you have PMR and what your current pred dosage is. Good luck!

[Falkers]

HI 33ary,

I had a hip replacement when I was on 6mg a day. I think it depends on what surgery you are having and what level the Surgeon is happy with. All went well with me and I wish you good luck with your op. I stayed on 6mg for a month after the surgery, then began reducing slowly.

[jinasc]

Oh Dear, you wrote " I had my pre op tests on Wednesday and they hadn't a clue, neither does my GP!!"

I would be making sure they 'did have a clue'. That is there job.

If any medic had said that to me, the gloves would have come off. Why issue someone with a Blue Steroid Card which we are told to carry at all times if there is no issue?

[m33ary in reply to jinasc]

I so agree with you, its hard to make them understand!

[jinasc]

Firm but Fair is the way to go.

You would not let a car mechanic get away with it, so why Medics (who are body mechanics after all).

[polkadotcom]

The actual op went fine, no problems at all but it was found that the tear in my knee was not repairable, so I wasn't much better off! I did know that was a possibility, but if I hadn't given it a try I would always have been wondering if things could be better.