Reducing Prednisolone to prepare for operation - PMRGCAuk

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Reducing Prednisolone to prepare for operation

Valnvaughan
Valnvaughan

Diagnosed with PMR in July 2015. Started on 15mg Pred and reduced to 7mg . In August 2017 diagnosed with a flare and Pred increased to 15mg. Reduced to 10mg by December but visited GP with increasing mobility difficulty. Investigation revealed severe osteoarthritis in both hips. Now need a hip replacement and operation scheduled for mid May. Surgeon wants me to reduce Pred to 5mg per day before operation.

Is there any advice about the best way to achieve this reduction?

17 Replies
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How many days before OP and what are you on now?

I saw the pre-op 7 days beforehand and she clarified it for me, but for a different op.

Are you having a general or a spine epidural?

Valnvaughan
Valnvaughan in reply to jinasc

OP is scheduled for May 14th, so 6 weeks away. Now on 8.5 mg Pred per day. Do not know detail of anaesthetic yet.

jinasc
jinasc in reply to Valnvaughan

If you can find out about anaesthetic, as far as I am aware it can make a difference.

Give your GP or Consultant a call.

I would say, with limited experience, work out how many days till date of op and then go down by 1mg till you get to 5mg about 5 days before op.

Hopefully someone with much more experience and knowledge will come along and give you a much better answer.

Valnvaughan
Valnvaughan in reply to jinasc

Thanks for your input

I had a hip replacement in November 2016 and I was on 7.5mg Prednisone. I had the spine epidural and a little anaesthetic to knock me out. My surgeon and anaesthetist were happy to go ahead and the operation was a great success. One thing to note is that your white blood count can be raised with PMR but that is normal. I remained on 7.5 mg for a few weeks until I got back on my feet.

Maybe someone will be able to suggest a quick decrease: not ideal but best wishes for your operation.

Good to hear your op was a success. I will have to ask the question about anaesthetic. Thanks for your good wishes.

I have had 2 very successful hip replacements , 2016 and 2017. For bothof them the surgeon and anaesthetist were happy with me being on pred. 12mgs first op and 7.5 mgs second op. I had spine epidural as well. Would highly recommend it. I would have found it impossible to reduce to 5 as you are being asked to do and if that had been the case I would have spent the last 2 years in a lot of pain with extremely limited mobility. It bothers me that surgery is being denied like this and seems to be a lottery depending on views of who you see. Am glad you have got a date and wish you all the very best for your op.

Thanks for your comments. Pleased to hear of your successful hip replacements. I hope I will be able to walk more than a few paces after the op.

PMRpro
PMRproAmbassador

I would interview a few more surgeons if I could - and anyway prepare a statement for the current one. And I would request an early opportunity to speak to the anaesthetist who will be the person responsible for your stability peri and post-op.

There really isn't any need to get to 5mg - it is a personal preference on the part of a given surgeon - especially if all that happens is the PMR comes back and you are immobile so post-op will be hell. If you are good at 8.5 and you can manage to get to 7.5 without a flare that would be ideal probably. But forcing a reduction to 5mg in so short a time is so likely to lead to a flare that your surgery could be made so much more difficult.

If he isn't currently aware of WHY you need pred and what could potentially happen then maybe he'll think again. The stress of the surgery at that sort of dose/probably level of adrenal function could also cause a problem. If you aren't on the oral dose - they will have to supplement it anyway in that case. Swings and roundabouts methinks. And any patient with poor adrenal function who needed surgery would be on steroids anyway - where's the difference?

jinasc
jinasc in reply to PMRpro

I hoped you would pick this up.................ta muchly.

My surgeon wanted me down to zero, but I suggested 5mg. He said ‘Ah we are negotiating are we?’ You could probably negotiate with your surgeon too. They want us fairly low because they are worried about wound healing and possibility of infection. The less things they have to worry about such as weight, age, physical fitness the happier they are.

Valnvaughan
Valnvaughan in reply to piglette

Thanks for reply. The surgeon did mention the risk of infection as his reason for asking for the Pred reduction.

piglette
piglette in reply to Valnvaughan

My op was amazing, I had a spinal block not epidural and did not have sedation so I was awake for the op so I could talk to everyone and know what was going on!! It was quite interesting. You can have sedation if you want of course. The operation was actually quite fast and I felt no difference afterwards, I could not believe I had an artificial hip it felt just like my own. I was able to walk as soon as I got out of bed and when I got home I carried on as usual, although I am not so good on steps. I did not use crutches because I was rubbish with them and just furniture surfed!

I reduced 1 mg per month. I had pains & extreme tiredness for 3-5 days after a reduction. I should have been on zero now but we are overseas and stayed on 1 till return. I also have osteoarthritis and found anti inflammatory gel and pull form of diclofenac has worked miracles. Two 50mg a day and gel for hips and knees.

Valnvaughan
Valnvaughan in reply to sweiss72

Thanks for reply. I have an anti inflammatory cream prescribed by GP and paracetamol that give some pain relief.

Hi there I really would discuss this further with surgeon - I know the risks of infection and slow healing etc. on pred but I had major bowel surgery for cancer whilst on 60mg pred. I was great after op and no infections. Second op 1year later whilst on about 40mg. So don't risk major flare for sake of a few mgs. Good Luck xxx

You haven’t really got much time to reduce it was always 1 mg a month with me however I was on 10mg when I had my new hip with no ill effect.

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