I'm scheduled for a temporal biopsy on August 6 and the pre-op nurse told me I'd need to stop taking the Prednisone one week before the procedure. My surgeon wants to biopsy both sides and since I'm still not feeling well, suggested we do it in the hospital operating room with "happy gas" so I'd be more comfortable (instead of her office). I'm at 20 mg and can't imagine stopping cold turkey like that.
What is your experience with this situation? I see my GP tomorrow for updated blood test results and will discuss this with her. Thoughts?
I have no idea what the nurse is talking about - there is no reason not to start treatment with pred before a biopsy to look for GCA if a patient's sight is at risk so anyone who has been put on pred for that reason should NOT stop taking it as if they DO have GCA a week without pred is going to put their sight at risk. A TAB should be done as early as possible - taking pred does reduce the chances of getting a positive result which is only about 50/50 anyway. A "negative" result doesn't mean you definitely don't have GCA, all it means is that they didn't find giant cells in the sample in front of them and that isn't the same thing. If the symptoms are typical they are more significant - GCA can affect many arteries, not just the temporal artery, it just happens to be easy to access, cut a bit out and look at it.
What is the nurse's reasoning? Is it because she believes you won't heal? I think she is totally ignorant of the nature of GCA and the reason for you being on pred in the first place. It must be explained to her - the surgeon should be well aware.
Kitty, as the others have said, that nurse is obviously not familiar with the treatment of GCA with high dose steroids. It would be foolhardy to just stop the dose for any length of time without putting you at risk of further problems, not least with your vision. She may be getting confused with the fact that once you are on steroids for more than a week or two, a biopsy is unlikely to reveal the large cells they are looking for as they should have been dealt with by the high dose steroids.
OMG....the only thing I can think of is that the nurse mixed up and meant to say that aspirin should be stopped for a week before surgery as this is the general practice. Maybe she just misspoke. I know that they like to do the biopsy within two weeks to insure the accuracy but they should NOT stop it.
There is no way you should stop taking Prednisone without a taper. it is very dangerous. I am sure your doctor will clear this up for you. The temporal biopsy should be done as soon after GCA is suspected as possible, but you should start prednisone right away. If you are already on prednisone because of PMR the normal protocol is to increase the dosage to 60 mg or higher immediately. If you are not already on prednisone, they will start you immediately at 60 mg or higher (weight dependent). This will greatly decrease the possibility of vision loss due to blocked blood flow to the eye optic nerve connection. GCA can still be positively identified for a while after you start the prednisone, but the steroid will mask this test if you don't get it done right away. The clumped blood cells that are characteristic of GCA will be gone and you will get a false negative on the biopsy.
I am surprised you are on a relatively low prednisone dose for GCA. Usually it takes a higher dose to mitigate the symptoms. I would ask about this. We have found that Rheumatologists. are more familiar with these disorders than primary care doctors. Also, there is a great deal of information available online. Good luck with your biopsy and the GCA/PMR.
I was on 60 mg of Pred and within 10 days I had the biopsy. Like all the previous replys, do not stop the Pred. I think that nurse needs to go back to nursing school. Good luck
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