Should I increase pred after surgery?

[Twopies]

I had outpatient surgery yesterday that went south—lots of bleeding, extreme weakness, nausea, etc., almost went to er. Hardly any sleep and no food in past 24 hours, should I increase pred a little? I’m a 6 1/2 mg. Think a mg. Or 2 might help. My body is aching all over, won’t be able to get up and about today. I’m so sensitive to everything, the anesthesia always does me in so that’s part of it too. Thanks.

[SheffieldJane]

You need medical advice. We depend on Prednisalone for our Adrenaline but it doesn’t increase at times of extreme stress like your surgery therefore it is advisable to take more. I am surprised that your surgeon was not on top of this. Ring the outpatients.Personally I would take 5 mgs extra and go straight back to 6 and a half after a week to ten days.

I hope that you feel better really soon. What was the surgery?

[DorsetLady PMRGCAuk volunteer]

As SheffieldJane says you need medical advise...either from department that conducted your procedure - you should have details on paperwork, or your GP, failing that ring 111.

[Twopies in reply to DorsetLady]

Thanks. My surgeon never heard of pmr, I could tell by the look on his face when I told him at our first meeting. the anesthesiologist yesterday said I have been on pred “for a very long time”. (Telling me he knows nothing about pmr either). My pmr treating gp says anything under 10 mg is good, he lets me self medicate. Which is why I asked for advice here.

[HeronNS in reply to Twopies]

But self treating your chronic condition is not the same as managing your cortisol level when you are stressed by surgery, particularly when the procedure ended up being physically and doubtless psychologically more stressful than expected. Definitely get informed medical advice. Hope you feel better soon.

[MrsNails]

This is extremely poor treatment, wether they know about PMR or not they SHOULD know about Long Term Steroid Use....You should have been given additional cover (Hydrocortisone) once you started excess bleeding & feeling awful with an increase for several days.

Please look at these Links

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

Please contact your GP or the Clinic where you were treated yesterday

MrsN

[Twopies in reply to MrsNails]

Thank you. I know if I call the surgeon, he’ll say check with your gp. I know my gp will say increase as I need (what he always says). I know if I ask the hospital surgical center, they’ll say check with your surgeon which is why I asked here.

[MrsNails in reply to Twopies]

Read both leaflets & adjust your dose as per the recommendations......

[HeronNS in reply to Twopies]

Don't you have a medical phone line you can call? I'm not sure how useful it would be, but here we have a line where you get to speak with a nurse practitioner. I suppose they'd probably refer you back to one of the people you've already found unhelpful. What sort of follow up care are you scheduled to receive from the surgery?

[Twopies in reply to HeronNS]

Yes, I called them last night; they contacted surgeon who said go to er if bleeding and vomiting doesn’t stop.

[HeronNS in reply to Twopies]

Well, that's helpful. Take care! 🤗

[HeronNS in reply to MrsNails]

I quickly looked at these and in the Patient article is says if patient's dose is less than 5 mg per day no extra cover is required! I know this doesn't apply to Twopies at present, but I'd question that statement.

[MrsNails in reply to HeronNS]

Me Too to be honest! Especially if your a long timer but l think they are assuming that you must have some adrenal function as you are on less than 5mg? Possibly?

[HeronNS in reply to MrsNails]

We know you still may not be able to produce enough to deal with stress. I certainly think that was what happened to me when I felt so ill after the day I hurt my knee, and that much less stressful than surgery! It does seem a bit dismissive of the potential for problems.

[MrsNails in reply to HeronNS]

That’s what happened toMy Mum - long term Steroid User 60mg a Day plus inhaled Steroids, a Brittle Asthmatic, eventually weaned off all Oral Pred remained on inhalers but had a leg ulcer & the District Nurse debrided it & Mum collapsed.....

Blue Lights to A&E but they didn’t know what was wrong with her, nobody put two & two together......

Anyway she went to the Medical Ward & a Dr l knew (from the Private Nuffield Hospital) was doing his Ward Round, saw me & came over to see what was wrong with Mum, he listened to the story & asked for 100mg Hydrocortisone, gave her the injection, carried on with the Ward Round but before he came back to see her it was like Lazarus Rising from the Dead!

He said he knew what was wrong & would speak to her Chest Consultant & then refer her to an Endocrinologist!

It was a Bank Holiday Weekend & you Never see a Consultant except on ‘On Call’ but every day a Physician went to see her, the Staff couldn’t understand why (l worked with them all at the Private Hospital 😉) but she never said anything & just enjoyed the attention.

But the best laugh she had was one day she had a visit from a Gorgeous Irish Man (GenitoUrinary) & the Staff were beside themselves - he said ‘Sure it’s just a Personal Visit, Not Medical!’ 😂

She never told them why she had so much attention but she lapped it up & DrF who diagnosed her was her favourite! ❤️

[PMRpro Ambassador in reply to HeronNS]

It would probably be true if you have only ever been on 5mg...

[USAGCA]

Try to wait it out. The extreme effects of surgical stress should be within the first 24 hours.

[Twopies in reply to USAGCA]

Well, I did increase by 5 as suggested in the replies. it made a world of difference,,,within hours I felt alive again. It’s the sickest I ever remember being after a procedure. increasing the pred helped more than I ever expected. Yesterday the aftercare nurse called; he said, “oh my gosh, yes, they should have told you to increase your pred after the procedure.” That made me feel better. It was the worry about the cortisol levels that encouraged me to do the increase. I really was unable to function. Thank you for your concern.

[USAGCA in reply to Twopies]

I assume that they gave you an extra dose of steroid during the procedure??

[Twopies in reply to USAGCA]

No! I asked!

[USAGCA in reply to Twopies]

Oh, well there’s the problem. I’m sorry.

[HeronNS in reply to Twopies]

Thank goodness you are recovering!