Total hip replacement soon, ?pred dose

[123mossie]

Hi all, just wondering about my current pred dose with surgery coming up. I’ve tapered to 5mgm, it’s 13 months since dx, when I began on 15mgm. I’ve been on 5 since the end of October & doing well though I had a massive wobble mid November on reducing to 4.75, awful fatigue & felt ill but no pmr symptoms. Fine now though. I’ve asked the gp about the dosage, leave it to them she said. I sent a query to the anaesthetist who has said carry on. So I should be ok on 5, any thoughts? I’m having an epidural +sedation apparently. Thanks

[DorsetLady PMRGCAuk volunteer]

“I sent a query to the anaesthetist who has said carry on.”

So why the query? If he’s aware of situation and happy with dose of 5mg, fair dos. You may find he gives you extra on the day depending on how things go.

Presumably you have a date, fingers crossed for that, and just for info, I found hip operation and recovery very easy compared to knee and shoulder replacement.

[PMRpro Ambassador in reply to DorsetLady]

I understood the "carry on" to be the response to the query ...

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

OK

[PMRpro Ambassador]

You shouldn't change the dose you are doing well with just for surgery. The anaesthetist may decide to give you adrenal cover during the surgery by adding some hydrocortisone to the drip. And then you should keep an eye out just in case the surgery triggers a flare - you might need a bit more post-op but everyone is different

[123mossie in reply to PMRpro]

Thanks for the replies, I just needed a bit of reassurance. I wasn't sure whether the sick day rules applied for cold surgery. The op is the end of this month, I'm doing some strengthening exercises trying to be a good patient.😇

[suzy1959]

I totally agree with the other comments. I have had 2 hip replacements in the last couple of years ( and 2 knee replacements too). All of the ops were epidural with sedation and I was on 11mgs Pred for all of them. The anaesthetist gave me top up steroids afterwards- for each op the way they were delivered was a bit different. I did have flares after each surgery. but I was very prone to flare then due to the OA pain. As long as you do as you're told post-op, you will find you can recover very well from hip replacements and quite quickly too. Do take all the pain relief you are given. I was amazed at how well it worked considering nothing worked for my OA pain.

The doctors have some concerns regarding slower healing with pred, but my wounds healed very normally and within 2 weeks, the dressings were off. I used Bio oil to help the scar formation too.

Good luck- it will be OK!

[123mossie in reply to suzy1959]

Thanks for sharing that, its reassuring to hear you were OK through all those surgeries. I've got bio oil at home, I'll dig it out ready.

[piglette]

I have had a couple of hip ops and both were at 5mg. I had a spinal as well, but decided to forget the sedation as I wanted to know what was going on.

[PMRpro Ambassador in reply to piglette]

I watched them while metalwork was put in my broken leg - they had been delighted I wanted a spinal and sedation was never mentioned. They anaesthetists all took it in turns to practise their English. The following year the metalwork was removed in Scotland. I had to ASK for a spinal anaesthetic and they made me take temazepam so I slept through it. I was not amused ...

[123mossie in reply to PMRpro]

Haha I can imagine them all clustered round getting a free English lesson. I was quite happy to hear about the epidural, but I didn't want to listen to the sawing & hammering! So I'm ok now that I'm going to be zonked out. The usual conversations in theatre aren't aways fit for patients ears either.

[PMRpro Ambassador in reply to 123mossie]

It was an absolute hoot! Mine didn't involve too much sawing luckily. Just lot of screws. They were working in Italian - this region is trilingual and German is my preference, also officially everyone in the healthcare sector is supposed to speak both it and Italian. Then if you want speedy promotion you learn Ladin - the regional ratoromanisch language which predates both Italian and German.

[123mossie in reply to PMRpro]

Fascinating!

[Casia]

I had a total hip replacement last July with sedation and a spinal anaesthetic. At that point I was on 2 mg of pred which my consultant described as ‘almost homeopathic’ and during the op, the anaesthetist gave me dexamethasone which is a more powerful steroid than pred. (Now being used on serious Covid patients). I recovered very quickly and had no problems at all. And strangely, all my aches and pains disappeared after my surgery. The inflammation went down and I’ve been off pred for a month now. That said, I would have been decreasing the pred more before the op but the anaesthetist advised me to stay on the dose I’d been on for several months until post surgery. Your situation is of course very different but I’m sure the anaesthetist knows what he’s doing and do ask him about the dexamethasone. Good luck!

[PMRpro Ambassador in reply to Casia]

I know several people who were on low to moderate pred doses before a hip replacement and were then able to reduce steadily to zero which they hadn't before. It was as if the pain pre-op had been feeding the PMR.

Your consultant might have thought 2mg was "almost homeopathic" - however, almost isn't quite! There are plenty of people around whose doctors thought the same and forced their patients to dispense with pred quickly only for the symptoms to return within a month or two. Professor Dasgupta told us in a webinar some months ago that he often keeps patients at 2-3mg indefinitely as it reduces the risk of relapse.

[Casia in reply to PMRpro]

Very good point. I think he was trying to reassure me.

[PMRpro Ambassador in reply to Casia]

As long as it was "it's very low" rather than "why do you need it" ...

[123mossie in reply to PMRpro]

It would be nice to think that may happen. Re lack of empathy from consultants, I was reading an article about long Covid recently & quite a few medics who’d had it said one of the worst things was the comparison with their pre Covid selves, also the unpredictability of their symptoms now, how they had had to lower their horizons to accommodate the disease, reduced quality of life. Ring any bells... at least we’ve got pred.

[PMRpro Ambassador in reply to 123mossie]

As I have been saying since long Covid first came on the horizon - welcome to my world!!! I don't quite understand the excitement - it has been known for YEARS that viral infections can trigger CFS and it is now considered an immune-mediated disorder. But all of a sudden they have vast numbers of cases all triggered by the same virus - doesn't make the result any different though does it?

[betsgirl]

2 years ago I had exactly the same scenario when needing a hip replacement. It was suggested by the hospital that I increase my pred after the op but I declined and had no problems. My operation was also done by epidural and sedation and despite my initial concerns that I wasn't having a full general anaesthetic (bit scary I thought at the time!), all went well and everything was ok.

Just for information, I was diagnosed with PMR and GCA at the beginning of 2015 and thanks to being very lucky in having an excellent Rheumatologist who advocated a very slow reduction plan, (from 40mg initially), I reached 0 by the middle of 2020 (5 years duration).

I do still have my ESR and CRP checked when necessary but so far have had no recurring symptoms, although have had issues with less muscle strength as a result of prolonged use of steroids so make sure you do your exercises after your hip operation.

Hope all goes well and wish you all the best in getting back on your feet again.

[123mossie in reply to betsgirl]

Thank you betsgirl, that’s reassuring to know you managed ok without increasing the pred, also that you’ve managed to come off altogether now. As you say lucky the rheumy was on the right lines with tapering. I’m aware of loss if muscle strength, I’ve started strengthening exercises now & will be very obedient with my post op instructions. 🙂