How should I prepare for surgery?

[Expert4essences]

I’m new on this forum although I have been following the posts for a couple of years. (Diagnosed in Dec 2018 and started on 20mg prednisolone. )

I am having a mastectomy next week and I would like to know if I should increase my prednisolone dose before the surgery and/or afterwards. I am currently on 7.5mg. My rheumy dept has not been at all helpful.

Many thanks for your invaluable information over the last two years .

[2013mayo]

Hi, First of all I’m so sorry you are having to go through this type of surgery, I hope it goes well.

I’ve recently had surgery, when I asked my rheumatologist if I should increase my dose of pred for surgery she said no, however after surgery I had double vision (GCA ) and the doc phoned rheumatologist and was told to double up on my dose for 5 days.

In my opinion double up for a few days, maybe start the day before and then continue for a few days.

Hope all goes well.

Xx

[Expert4essences in reply to 2013mayo]

Hello 2013mayo, thank you for your reply to my dilemma. It’s really comforting to have the support of this forum.

[piglette]

It is your surgeon you should ask. I left my dose the same during surgery as my surgeon did not want me to increase, but it was suggested I increase afterwards as my CRP went up.

[Expert4essences in reply to piglette]

Thank you for responding to my post. I will be ready for any changes after the surgery.

[PMRpro Ambassador]

You need to speak to the anaesthetist - no-one else - before the anaesthetic. After long term pred they will monitor your response to the stress of the surgery and give hydrocortisone as long as they think it is necessary, during and post-surgery. That is to replace adrenal function which at 7.5mg pred will be blunted.

You may end up with a flare - and then react with the oral pred dose. Your CRP/ESR will almost certainly rise - due to muscle damage. It will be symptoms you need to react to though rather than just blood values.

All the very best for next week

[Expert4essences in reply to PMRpro]

Thank you so much for responding so quickly to my post. I was fine about the surgery until I realised that no one was taking my steroids into account. Your advice is clear and very helpful. I will be prepared for a possible flare afterwards.

I am so glad to have this forum. It has helped me through the last 18 months.

[Thelmarina]

Just had surgery. Doubled dosage for 5/7 days then went back to original dose and was fine. Normally you would produce more cortisone to deal with the extra stress on your body but as Pred gives us a daily fixed dose we need to ramp it up. I hope all goes well with your op. Such a relief when it’s over! ❤️

[Expert4essences in reply to Thelmarina]

Thank you Thelmarina. Did you double the dose before surgery or after? Or both?

[Thelmarina]

The next day after xx

[Expert4essences in reply to Thelmarina]

Thank you. That’s helpful xx

[SheffieldJane]

This decision should be in the hands of your surgeon and anaesthetist. They need to be well aware what you do and don’t need during the op. Best wishes for the operation. I hope all goes well.