Surgery and steroids

[lizzie47]

Advice please. In the past I have seen posts on whether to increase steroids if you are going to have surgery. I am struggling anyway right now with reducing ,I was doing pretty well getting down to 8mg after 31/2 years with GCA,however I shouldn't have been so pleased with myself as I have had to admit defeat and now increase to 13mg after a few try's at lower increases which didn't help.However I am having cataract surgery,I know it is run of the mill surgery now,the nerves not helped with Covid of course,I am not the bravest of souls anyway but feel I can't put it off as I also have AMD in the other eye! So I would be so grateful if anyone could give me advice on increasing the steroids further before the surgery.Thank you so much for anyone able to help me.Lizzie

[DorsetLady PMRGCAuk volunteer]

Increasing steroids before any surgery should always be discussed with surgeon and anaesthetist - but to be honest it's not necessary to increase for a cataract operation.

You may be nervous, but the operation is very quick, painless and straightforward.... and all necessary procedures will be in place for C-19.

By all means discuss your concerns with your GP or the ophthalmology team, but there is nothing to fear. .. and good luck.

[lizzie47 in reply to DorsetLady]

Thank you so much Dorset Lady.I feel comforted with your reply.I am the biggest wimp at the best of times! Covid hasn't helped with scardey cats like me,it has been very stressful and I wonder if the thoughts of my eye problems has impacted somewhat on the GCA resulting in my increase of steroids.I have a pre-op appointment on Friday,a Covid test on Monday and surgery on Wednesday,all at different Hospitals in Oxford. Thank you so much again. Lizzie

[DorsetLady PMRGCAuk volunteer in reply to lizzie47]

Of course you’re worried about things - I think we’re all a bit squeamish about eyes. I was certainly a bit apprehensive about having my cataract done, as the other eye is “no go” - but you have to bite the bullet sometimes.

My granddaughter had a mole removed from her face yesterday (she’s only 14) so mum and her had Covid tests on Thursday and had to isolate until yesterday. Think my son and grandson (13) had a few days ‘male bonding” until he stayed with me Monday (day and night) because dad had business meetings.

Sure everything will be fine!

[lizzie47 in reply to DorsetLady]

Thank you for your kind reply. I do hope your Granddaghter has now recovered,I think its worse where Grandchildren are concerned or in fact children no matter what age! I bet your Grandson loved staying with you. I go for my pre op appointment tomorrow so hopefully it wont be a problem I have had to increase my steroids this week .My problem last night was my car battery was flat so a son came over to jump start it and I went out for a short run and realized my eyes were not good enough to drive to pre op tomorrow and covid test on Monday as I have been shieldad for so long I havn't driven for so long! Never rains but pours! thank you again.Lizzie

[MrsNails]

Hi Lizzie

You really need to be steady on your current dose & not be actually reducing as the ‘stress’ of your upcoming surgery can impact on you.

You need to speak to the Anaesthetist & Consultant before your Surgery & they need to be aware of your underlying conditions, if necessary the Anaesthetist will give you Hydrocortisone Cover while you’re having the Surgery.

Some Doctors say Steroids need to be reduced before Surgery as steroids can impact upon the healing rates but lots of us have had surgery since we’ve had PMR/GCA so just make everyone aware. I now have a Steroid Dependant Wristband which l bought at the onset of Covid-19 just in case!

When l had my Surgery 5years ago l had additional Hydrocortisone Cover in Theatre & again during the night as l was very unwell, then my Rheumatologist increased my Pred for two weeks post Surgery from 7.5mg to 10mg

Good Luck 🍀

MrsN

[lizzie47 in reply to MrsNails]

Thank you very much Mrs Nails for your reply.I have in fact had to increase the steroids from 8mg to 13 mg this week to a flare.I had struggled hoping it was withdrawel but it became obvious it was a flare.I am going to the hospital for a Pre Op so I will discuss it all with them.Thank you so much.Lizzie

[PMRpro Ambassador]

No - don't increase them off your own bat unless you need more to manage the symptoms. Discuss it with the surgeon - he may want you to reduce if you can rather than increase.

I doubt that they will require the intra-operative hydrocortisone MrsNails mentions - but cataract ops are very short, 30-45 mins including recovery usually and done under local anaesthetic. The actual surgery takes about 10 minutes in most cases.

[lizzie47 in reply to PMRpro]

Thank you for your reply PMRpro.I didnt want to increase my steroid dose this week as I was hoping it was withdrawel but as I wrote I had been struggling on 8mg,hoping it was but it became obvious it was a flare hence increase to 13mg having tried going up 2mg,made no difference,then the same and ended up at 13mg.I am hoping they will still do it.In your opinion do you think I should try dropping down to 11mg now?My only concern is the flare hasn't been controlled with only 3 days of 13mg. I do wonder if my stress to do with the catarect surgery has impacted and caused the flare! what would your thoughts be please? thank you so much . Lizzie

[PMRpro Ambassador in reply to lizzie47]

I think you are probably quite right - you are obviously very apprehensive and that must be stressing you and we all know what stress does to PMR!! It very much depends on the surgeon - some are more laid back than others. So I think you should just wait for the pre-op and discuss it then.

[lizzie47 in reply to PMRpro]

Thank you for reply.Yes will do that,pre op tomorrow.Lizzie

[Jackoh]

I had both my cataracts done whilst on 15 mg of pred. That’s the dose I happened to be on at the time. The procedure was very quick and although I was a bit squeamish at first the operation and recovery time were minimal and the end result was so fantastic that even now, 18 months or so later, I marvel at what a difference it has made to my life.

Like everyone has said discuss this with your medical team but if you are now fairly stable on 13 mg I would stay there until after the operation. I personally wouldn’t increase any further.

It is possible that the stress of the up and coming operation has not helped your condition so to bring in extra stress by reducing again ,but not knowing how you might react or feel, I would consider might give you extra stress.

The operation is very quick, with fantastic results so I’m sure you will be fine. Also hospitals at the moment are so COVID aware your pre op , COVID test and operation will be safe.

Try not to stress and give this 13 mg a very good chance of controlling your symptoms. I personally found no increase of symptoms or effect on my GCAPMR during or after the op.

All the very best and do let us know how you get on. Best wishes x 💐

[lizzie47 in reply to Jackoh]

Thank you so much for your reply and help.I feel more confident than I did hearing your experience and other kind people who replied. I went for my pre op today and the steroid dose was no problem and I think you may well have been right in that perhaps I had got so wound up about the surgery hasn't helped the GCA,stress can cause so many things.

Have Covid test on Monday and Op Wednesday,thank you again.Lizzie

[Jackoh in reply to lizzie47]

👍👍x