I wrote on her three weeks ago regarding my situation and diagnosis of Hirdoadencarcinoma, I have had a Cat scan and the news is better than initially expected, I am to have further surgery to remove any more tumour or cells and then be monitored every three months as it is an aggressive cancer that can return any time
I have been impressed with medical team I have supporting me, apparently there was only a 5% chance that the tumour I had in my back was not a secondary, I was in that 5% and it would seem that my cancer is very rare 1 in 100000, I am trying to stay positive and hopeful for the future.
My oncologist is concerned that I am on 6mgs of Preds, particularly in light of my pending surgery and is encouraging me to reduce, as quickly as possible, but does acknowledge the difficulty, I am not longer sure which of my symptoms belong to which, cancer, steroids or PMR, I would really welcome your views. Thank you for all your support, prayers and advice it has been both helpful and warming.
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quincey1
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That really is a glimmer of light in the cloud of bad news! Hope the sun continues to come out of hiding.
I can't quite understand why the surgeon is worried about operating on a patient on only 6mg pred - that is well within the physiological dose, the dose that is the equivalent of the amount of corticosteroid your body produces daily naturally and which is essential for life. At present it is that that is providing your adrenal function and reducing the oral pred rapidly is not advisable since the adrenal glands would struggle to keep up with increasing and reliable production of cortisol - which will be essential during the surgery period, in fact, normally you would be given EXTRA steroid to cover you.
I think I would ask to speak to the anaesthetist. I never cease to be surprised at the aspects of pred therapy that surgeons seem unaware of. One lady was waiting for a hip replacement, and at her pre-op assessment the white cell count was high. The surgeon panicked and assumed it was infection - not the normal effect of pred on white blood cells. I explained it here, the lady told the nurse, who spoke to the anaesthetist who confirmed there was no problem and she had her surgery.
I am happy for you that the news was better than you expected. I am also puzzled that the surgeon wants you off the Pred. Normally we advise that Pred is a support during an operation. I wonder if your Rheumie could have a useful input, or as PMRPro says the Anaesthetist may well be able to advise on what is best. Wishing you the best possible experience and outcome for your operation. Please let us know how you get on. Bless you. This too will pass. 🍀🌼🌻
Seems like you have received very good advice here. I wonder if there is anything written, guidelines for adjusting Pred prior to surgery, that someone here can point your. It might be helpful to share with your medical team.
There appear to be a number of papers easily found through google which universally accept that a patient taking steroids will remain on them through the surgery, The only question appears to be whether additional prednisone is always necessary, implying that, as PMRpro says, normally additional pred is given as a support through the surgery.
It tends to be up to the individual anaesthetist I think. It used to be normal to give steroid cover then the thought changed to close monitoring and giving steroids if the patient appeared to need them. It also depends greatly on the dose the patient is on at the time. If they are at or below the physiological dose they are more likely to be given a boost - because their adrenal function probably isn't up to supplying the extra that would normally be secreted in response to stress.
Thank you for all your replies, I do remember in my haze at the appointment the oncologist saying she would liaise with my rheumatologist before the surgery! Her concern was also my compromised immune system, I will continue on on my current dose of Preds and hope the surgery is very soon. Your kind wishes and support are really valued and comforting x
Hi Quincey. I was on 4-7mg of pred for 5 years for PMR when I had 8 inches of my colon removed without any issues. Anesthesiologist did add extra dose of “stress” steroids which was great because I had no PMR pain post op for several days which I’m convinced sped up my recovery. Best of luck to you!
Dear Quincey. I too wish you more good news, peace of mind and Healing. Praying that you will find coping in difficult times easier and that hope is never lost but increases with every day. Bless you. xxx
All the very best Quincey. So pleased you have had some good news and pray this surgery will go well and there will be good liaison between the professionals and clear guidance what you have to do regarding the pred. Best wishes. Let us know how you get on. Jackie xx
Thinking of you and sending good wishes for the surgery. It's good to have faith in your medical team - other than this blip with the steroid dose, which I hope will be sorted out between them all!
Sending you lots of positive healing energy and if you have not seen it click on my post Relaxation, there are some gentle yoga stretches and also a long relaxation as the last track. It sometimes helps to have something to DO with a worrying brain when you are lying down. If you do NOT have a way to play it on iPhone or computer message me with your address and I will put a CD in the mail if you like.
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