prednisone and surgery: I have to undergo surgery... - PMRGCAuk

PMRGCAuk
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prednisone and surgery

peanuckle
peanuckle

I have to undergo surgery on my nose to remove a cancer growth. Should I stop the prednisone a few days before the surgery. Can't ask my GP - he is on vacation.

36 Replies
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I am a physician but I have minimal expertise in endocrinology except for that knowledge which I gained from being on prednisone in treating PMR. Your in curry brings up more questions and answers for the following reasons:

1. You are being treated with prednisone for what condition?

2. What dose are you on?

3. How long have you been on prednisone ?

4. What other medications are you taking?

5. How extensive is your surgery? Is it only a local excision as an outpatient. With the above being noted I would advise you to "think like an adrenal gland" which normally would put out more cortisol when your body is under stress such as the time when you undergo surgery. Personally I have been on 6 milligrams of prednisone recently and upped my dose by approximately 2 milligrams on the day that I had an excision of a lesion on my back..... I cannot honestly tell you whether this was enough but I suffered no consequences of adrenal deficiency.... the last thing I would do is stop my prednisone at the time of surgery. This could do great harm.

peanuckle
peanuckle in reply to jbarie

Thank you so much for your reply. Have been on pred. since May 2015 - now down to 5 mg. I have PMR. I will go with your advice since the lesion will be excised at outpatient clinic. Not taking any other meds. Thank you again. This site is so great for people like me in Canada - we can't always get info on this disease.

I have GCA/PMR and am currently on 6 mg. A week ago I had a BCC removed from my leg which involved a graft (4 x 4 ins). I asked Surgeon whether he thought it wise if I increased my Pred to 10 mg and he said no as it would affect the healing process. I explained that after the biopsies 6 weeks ago at the same hospital I developed the Staff virus and had 3 courses of antibiotics to clear it. What were the chances of it developing again. He said he had been operating at the hospital for 27 years and had never had a graft failure. 3 days after this operation I became ill and was admitted to the hospital with once again the Staff Virus. Yet again another course of antibiotics. I return tomorrow when I hope the news will be good, as it is thought that only 50% of the graft has been saved. Perhaps someone on this site can explain whether taking Pred weakens the immune system and therefore leaves one open to getting such viruses as Staff.

jbarie
jbarie in reply to hwigston

There is no doubt that high doses of prednisone will weaken the immune system.... however you are not on a high dose of prednisone. A normal person usually puts out 15 - 20 milligrams of cortisol/day which is the equivalent of 4 to 5 milligrams of prednisone.Surgery would normal cause your pituitary/axis to increase your cortisol production ... not clear why your surgery resulted in a bacterial staph infection( not viral).... it certainly was not due to too much prednisone... moreover it is not entirely clear whether your immune system is impaired for any other reason.... the bottom line is that you may very well be prednisone deficient.... not enough data at this time.

Celtic
CelticPMRGCAuk volunteer in reply to hwigston

hwigston, gosh you have been going through it. Pred does reduce the activity of our immune systems and render some of us prone to picking up infections that are flying around. Some consultants do recommend a hike in steroid dose for a day or two surrounding any surgery, mainly to avoid flaring inflammation due to the trauma to our bodies. I do hope the latest round of antibiotics have proved successful and that today's news is good.

hwigston
hwigston in reply to Celtic

Infection still there. The area receiving the graft looks considerably better but infection has now moved to the 'donor' area, but I have 3 more days of antibiotics so there is still time for the beast which is lurking in my body to go to sleep. The nurse has suggested that I get my GP to carry out a full bank of blood tests to see whether it shows any abnormality. It all started 5 years ago when I contracted MRSA from my local hospital where I had an operation for suspected ovarian cancer. Prior to that I was very fit and travelled the world cycling. Did I pick up something from one of these countries? I did get Denge fever in Venezuela!!!!!

Celtic
CelticPMRGCAuk volunteer in reply to hwigston

It sounds as though your body has taken a bit of a pasting over the years what with MRSA, Dengue Fever, and the Staph bacteria, not to mention PMR/GCA, so maybe a good idea to take up the nurse's suggestion of having a full range of blood tests carried out just to ensure that there isn't some ongoing deficiency problem, other than the lowered immunity you seem to be experiencing, likely from the steroid treatment.

PMRpro
PMRproAmbassador in reply to hwigston

High dose pred can suppress the immune system so it doesn't mount an effective response to infection but for most people on the PMR doses it doesn't generally make a lot of difference. I have had fewer infections while on pred. Nor have I experienced any healing problems either at any dose up to 20mg.

You may have taken the Staph bacteria (S. aureus?) in with you - most of them are commonly found on the skin or you may have picked it up in hospital. Always make sure anyone coming to touch you has washed their hands immediately before getting to you. With soap and water, not just a perfunctory slap of gel - which doesn't kill all known germs!

I do trust they did a culture to find a suitable antibiotic rather than just guessing - because if they didn't they were encouraging the development of a resistant strain.

hwigston
hwigston in reply to PMRpro

A course of antibiotics was given the Co_amoxiclav 500/125 mg

The swab taken afterwards result not back yet. In the past the lab has always recommended amoxicillin. I've lost count of the number of doses I've had.

No.....if anything , increase it a little.

peanuckle
peanuckle in reply to 30048

Thanks to all of you who replied to my query re increasing or decreasing the pred. before surgery. I'm so glad you are all out there - don't feel so alone and anxious.

Was the above reply aimed at me. I have increased to 10 mg for one week.

I am due to have an ablation for svt next month. The cardiologist told me to double my pred dose on the day of the procedure

I'm surprised the people who arranged the cancer excision did not fully discuss this with you at the pre op appointment. while this forum is really

excellent this sort of thing should really be discussed with the physicians dealing with your case.

peanuckle
peanuckle in reply to Dovelady

Hi Dovelady:

This cancer grew very quickly and my doctor scrambled to find me a surgeon who would do this. We have a problem getting in to see a surgeon - usually takes months. I think normally I would have seen the surgeon for a consult first but I'm going to the hospital on the 15th to have procedure done.

Interesting conversation , I might in the next couple of months be undergoing rotator cuff surgery . I am taking 12mg of Pred , I had to get as cons opinion on my shoulder I felt the first surgeon I saw was more concerned about the Pred than my shoulder . I had the same op 3 years ago on my other shoulder with no problems and 100% recovery and success. Thoughts on this , is he holding back due to the medication and will the next surgeon I see week Tuesday give me the same responded.?

I had gallbladder surgery this past August..it was done Robitic. I was also concerned about the Pred. I was on 15mg at the time. My surgeon, neurologist and gastro Dr's all said Pred needs to be increased before the surgery. It was given to me thru IV same day as surgery. Next day went back to normal dose. Everything went fine. I stayed on 15 for another 2 week, then was able to tapper down when blood work went back to normal. Good luck.

peanuckle
peanuckle in reply to bert403

Thanks bert403.

PMRpro
PMRproAmbassador

No, you must NOT stop taking long term pred suddenly except under close medical supervision. You should have an appointment with the surgeon or a nurse the week before the procedure and you should flag up the fact that you are on long term pred then - and since I've just read your comment at the bottom of the page, make sure they know when you get there. Tell EVERYONE and make sure they make a note - then they can't deny knowledge!

It used to be recommended that the pred dose be increased before such procedures but the more recent thinking is that the patient should be monitored carefully peri and post op and more pred given if required. It very rarely is.

You'll be fine - hope it all goes well.

peanuckle
peanuckle in reply to PMRpro

Thanks for your info. PMRpro. I will make sure everyone knows about the pred.

Re: medical personnel knowing about ongoing prednisone treatment. I understand that in the UK you are issued a card which serves to alert first responders if you are in an accident or other medical emergency. What could we do in the benighted Western hemisphere to similarly help safeguard ourselves?

Hidden
Hidden in reply to HeronNS

When I was blue lighted to hospital last year my steroid card was still in my handbag in my house and not with me so not foolproof! a Medic Alert bracelet which my mother used to wear would have been more useful.

PMRpro
PMRproAmbassador in reply to HeronNS

As Whisper says - Medicalert bracelets are probably even better! Google them - they keep a full medical history available in multiple languages at the end of a phone call.

Add an ICE number - In Case of Emergency - to your mobile phone contacts list though that does require you not to lock your phone so paramedics/police can have a look. There are apps available I believe ;-)

HeronNS
HeronNS in reply to PMRpro

I do not have a mobile device.

HeronNS
HeronNS in reply to PMRpro

Good in theory, but a medicalert bracelet and accompanying service

is rather expensive, I think. Although, what is life worth? Maybe I could tell the family they can give me one for Christmas and with any luck I'll only need it for one or maybe two years after that!

PMRpro
PMRproAmbassador in reply to HeronNS

I really don't feel that £30 a year is particularly expensive and the cheapest bracelet is under £20. I imagine part of the value is for your family to know a parent is safe if a paramedic arrives to a collapse when they aren't around.

On the other hand - filling a set of small cards with details and making sure there is one in every pocket/handbag/purse would fulfil a similar function.

HeronNS
HeronNS in reply to PMRpro

Ah but my problem is that I don't want the cheapest bracelet!

PMRpro
PMRproAmbassador in reply to HeronNS

That's something completely different - what I said was that the basic service isn't expensive.

It's like a mobile phone - my basic one costs me about £10 a year (on an expensive year!). The phone is about 10 years old, I put the cheapest pay-as-you-go card in it and use it once in a couple of months to retain the number. That's all I need to know I have a means of calling for assistance if I need it in an emergency and for all my family to contact me on the same number I've had for 20 years. I use it in exactly the same way as a digital house phone that I can walk around with so it is hardly exotic technology.

On the other hand - I COULD have the latest iphone on a contract which I can use in every country in the world.

HeronNS
HeronNS in reply to PMRpro

The first service I looked at here starts with the basic bracelet charge, followed by an ongoing charge of $5.00 a month, and $15.00 for each update of the record. Over time that looks like a small money pit. As for the phone, I think it is possible to get some sort of inexpensive pay as you go service here, but I feel I don't need a cellphone yet.

I like the idea of a medicalert bracelet.

But how do you indicate your dosage? What if you are unconscious and can't tell them whether you are on 40 or 14 or 4?

PMRpro
PMRproAmbassador in reply to HeronNS

That is the purpose of the bracelet and your annual subscription. As well as the relevant illnesses and that you are on long term medication it has a phone number on it which connects to a database with all your medical information on it and kept secure like your medical notes. The operators are multi-lingual so if you collapsed on holiday in Spain your medical info is as available to the medical team as if you were taken ill in the next town. It is up to you to update the dosages of all your medications - but the main reason for making sure healthcare professionals know you are on long term pred is so they know that there is the risk of an Addisonian crisis which is far more serious than missing a couple of doses in PMR and getting very stiff and sore again. If your notes say GCA, diagnosed not long before, they would know you are probably in need of a daily dose of pred and in fact the database would tell them how much. But if you have a collapsed patient with certain symptoms it is unlikely that anyone would think first of all about a developing Addisonian crisis and give the relatively small dose of corticosteroid that would avert that progressing.

One or two days without your pred dose are more likely to result in a flare of the PMR/GCA than anything else since it is possible to take a double dose of pred on alternate days without any problems. A true Addisonian crisis would take a few days to build up but you would probably feel quite unwell in the meantime and if you add in the effects of an accident or infection then it would happen faster. So knowing the exact dose they are on is less important than knowing that this patient has been on long term pred and is at risk of an Addisonian crisis unless a small daily dose of hydrocortisone is given.

The other advantage of the bracelet is that paramedics look for it/are likely to find it as part of their assessment looking for a pulse. A female patient who has just been hauled out of a car crash is not very likely to have their handbag clutched in their hands so a card in a handbag or wallet is nowhere near so useful as a bracelet.

HeronNS
HeronNS in reply to PMRpro

The bracelet I'm getting comes with a one-off payment, no more charges ever. More expensive up front, but will quickly even out. Of course I wanted the gold bracelet, but put aside that covetousness and spendthriftiness....

I have told one of my sons and my husband where the calendar is where I am keeping track of my dose each day. Hubby was obviously not paying attention so I said, you know, a person could die if they are suddenly taken off this medication. I think it sort of registered at that point. But maybe not. ;)

peanuckle
peanuckle in reply to HeronNS

I made up a card with a table indicating my dose and date. It's small enough to fitting my wallet. I guess the bracelet would alert them to the fact that you are on pred. At least that's start.

You can’t just stop taking prednisone cold turkey because it could cause death. Your adrenal glands slow down producing adrenaline while on prednisone & if you just stop all @ once it could be fatal. You have to be slowly weened off the preds. I had surgery 2 weeks ago for an diverticulitis to drain an abscess in my colon & I have to have surgery again around the 1st of August to remove that part of my colon. But I thought the same thing about getting off the steroids b4 & during the healing process of my up coming surgery & was corrected by both my Rheumatologist & the surgeon....

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