Fight With a Star Picket......

[Louisa1840]

Three weeks ago I fell over a short star picket which was acting as the stand pipe for our garden hose. It had a jagged rusty edge. I kind of hooked onto it and fell backwards creating a very nasty wound with a flap of hanging skin, all quite deep. ARRGH. Our little 2 year old granddaughter was with us and we were about to take her home. She was so concerned and assured me it would be all right.....

We realised it was a hospital job and hurried her up to the car after hubbie had quickly dressed the wound. JUST as we were about to lift her into her car seat she announced "I've done a Poo" (just out of nappies and in "Big Girl Undies")

It's strange how, when you're in the middle of significant trauma, a calm takes over and NOTHING fazes you isn't it? Hubbie doesn't really DO toddler poos....

Anyway, cut to the chase and eight stitches later. Since then it's being seen twice a week and dressed by my wonderful GP practice nurses. It's touch and go whether it will require a graft because of the nature of the wound but most think it will be okay.

Obviously the pred will not hasten healing? Since then I have upped my pred (following Sick Day Rules posted by, I think Mrs Nails - thank you Angela). I had been down to 6mgs and feeling very proud after 3 and a half years of PMR, I had never been so low. I upped to 12 mgs but even so, yesterday, I was aching all over and exhausted so I upped to 15 mgs.

I am feeling a lot better today but wondering how long to stay up at this level and how quickly to drop? I think 6 mgs was too low anyway as I was very stiff but I may aim for 7 or 8?

Thank you to all your wonderful listening ears. I told the nurse today about this site and she says she will tell others.....

[SanG55]

Sounds quite traumatic. Really glad your practice is keeping a good eye on things. Regarding dose, I am a relative newbie and don't feel knowledgable enough to give that advice but there will definitely be others who will be able to help. Wishing you a speedy recovery and hopefully no graft needed.

[MrsNails]

Oh Louisa, that sounds awful & cuts like that do take some healing when on Prednisolone.

I think l’d be inclined to stay on 15mg for a week to give yourself chance to recover & feel better.

As you say you felt 6mg was too low anyway, but l wouldn’t want to drop too suddenly after the trauma of your leg injury. My gut instinct tells me to drop no more than 5mg to 10mg & do a taper from there but let’s see what PMRpro thinks.

Do you have a Rheumatologist or does your GP look after you? As l do think a Medical Opinion would be wise.....

I’ve only just woken up, so l’ll refresh my mind on the Sick Day Rules & copy Pro into my answer to see what she advises.

Feel Better Soon 🌸

Angela x

[Louisa1840 in reply to MrsNails]

Thanks so much Angela its so helpful to get your advice. I have been seeing a rheumy but decided not to go back after my last visit which went something like this "Your bloods are marvellous "

Me- " Well I dont feel very well"

" Never mind we'll put you on Leflunomide and next time I see you in January you'll be better because you have such a positive attitude".

I get more support from my GP and this forum than any rheumy though I will try another one if I need to.

Staying on 12 mgs for now and will taper back down to 8ish as I can.

Hope you're doing okay?

[PMRpro Ambassador in reply to Louisa1840]

Lord - at least half of us woldn't be here if it went on positive attitude!!

[Louisa1840 in reply to PMRpro]

Exactly! Thanks for the link. Very interesting. It makes sense as we all know that stress and PMR make unwilling bedfellows. We automatically assume mental stress but ANY stress..........

[MrsNails in reply to Louisa1840]

We often know exactly what we need especially after a fall/injury like that. Yes l’m picking up nicely on 13.5mg Pred & 25MTX so hopefully l’ll be successful in tapering this time. I’m going down in 0.5mg drops using a Slowwwww Taper 🙏🏼

Keep Safe & Well 🌸🌸🌸

Angela x

[DorsetLady PMRGCAuk volunteer]

Ooh..ouch!

Best to stay at 15mg for 7-10 days, and then maybe drop back down in maybe 2 steps- giving a week on 11mg, then if okay 8mg.

But see how you are at 11mg ....might need 2 weeks.

As you say, you’d gone too low, so take this as an opportunity to reset things.

Hope you don’t need further intervention.

[PMRpro Ambassador]

OUCH! My husband didn't do toddlers, never mind nappies of any variety. I was back at work and he and his mother between them managed a poo nappy - early days of disposables but they managed to get it on backwards...

It is documented that a fall can be enough to trigger a flare:

ncbi.nlm.nih.gov/pmc/articl...

You may be lucky - pred has never slowed healing for me.

[Dontwannabesick]

Hope all goes well.

[piglette]

What a nasty thing to happen. I agree with the others and just stay where you are. Out of interest I had a similar experience about six weeks ago and am still having three visits a week from the district nurse. My GP has referred me to a plastic surgeon and said there may be a long wait. I have heard nothing so it would be interesting to see how quickly you get an appointment.

[Louisa1840]

Thanks dadcue. Yes those are the sickday rules which are a pinned post. I have been on antibios since the start so that will be a month by the finish. They said because I'm on pred I would need them because of the immunopressive effect. Also because it's on my shin it's a tricky place to heal.

Anyway lots of excuses to sit and read as I'm told to keep my leg up.....

[Louisa1840]

Hi there DadCue. I think because I was on pred, the doctor in emergency decided the antibios were a good idea. I have had no signs of infection (tracking etc) but the wound itself looks very nasty with black skin. However, each time I get it dressed they take a photo and I can see a slow improvement so I don't think a skin graft will be necessary.

I am missing my exercise though - swimming is out as there would be a danger of infection through the wound portal and cycling because of the pull on the skin. Reading with my leg up is not exercise though I suppose I am exercising my mind? I might return to my Tai Chi class tomorrow and just go gently........

[Louisa1840]

A positive attitude is a must to get through life it seems to me.

I stopped taking the Leflunomide as the locum who tended my wound felt I was starting to manifest peripheral neuropathy. I was glad to because I really didn't want to be on another toxic drug. Now, it's a matter of dealing with the acute wound against the background of PMR (possibly overlying inflammatory arthritis). Hope all goes well for you DadCue.

[Karenjaninaz]

Louisa, sounds like me but I Never increased prednisone with any of my 3 jagged leg wounds. I was given antibiotics and after consulting a wound specialist cared for my own wounds. It helped I am a retired nurse practitioner. He allowed me to use medigrade honey. The wounds- one from a car door corner, another open dishwasher door corner and the 3rd the foot of a raised church kneeler were painful and took months to heal. I think I was taking about 10mgm prednisone at the time. They took months to heal and left ugly scars. I injure much less on the 4.5 mgm I am on now.

[Louisa1840 in reply to Karenjaninaz]

Thank you Oknaz you certainly went through an accident prone time! !It could be that my flare of PMR symptoms around this time is unrelated as I think my drop to six mgs was too much.

Well done for getting so low. In the meantime, patience to all......