Do I really need to stop prednisolone before surgery?

[krillemy]

I have been informed that I need to stop prednisolone 1 month prior to surgery. I am having a colon resection due to recurrent diverticulitis. When I read the post here on the site it seems you are all upping the dose for surgery?

[PMRpro Ambassador]

How long have you been on pred? If you have been on it any length of time they could make you very very ill by insisting on that if your adrenal function is blunted and you are adrenally insufficient. In that case you need extra pred to cover you during surgery to cope with the stress effect on the body. Most of the discussion here relating to joint replacement and then the PMR must also be well managed to allow mobilisation post-op - most PMR patients would struggle if they had flared. And would flare if they tried to stop pred altogether for that long.

They are probably concerned about healing and infection post op but surgeons carry out emergency surgery on patients on pred every day so it can be done. I imagine your surgeons aren't really very up on long term use of pred and the risks posed by suddenly stopping it for a protracted length of time like that. You need to speak to your rheumatologist, an endocrinologist and the anaesthetist team who will be responsible before complying with such a draconian measure for anyone on long term pred. However - a surgeon also went to medical school and studied physiology!

[MrsNails]

Here’s some information from FAQ’s which you may find helpful.

healthunlocked.com/pmrgcauk...

Surgeons are always concerned about the rate of healing if you are on Steroids. I had Breast Cancer so there was no time to reduce my steroid dose but they asked me to stop my Methotrexate the week before surgery.

I had hydrocortisone cover in Theatre & during the night as l was very sick. The following day the Registrar rang my Rheumatologist for advice re my Pred Dose which she increased by 2.5mg for two weeks, then back to 7.5mg

Good Luck 🍀

MrsN

[piglette]

Surgeons do seem to want you to reduce for surgery. My surgeon wanted me at zero for my hip op. We had some ‘negotiation’ and ended up at 5mg.

[singingloud]

I didn’t need to go off prednisone for my back surgery. I certainly would speak to them again about stopping it.

[paintpots]

Hi,I had major neck and face cancer surgery 10 weeks ago and the surgeon put up my prednisolone for 2 days from 5mg to 8mg and back to 5mg 2 days after surgery and I continued a slow taper a week later to 4mg and feel fine. There was no discussion on stopping the prednisolone. I am now reducing to 3mg over 9 weeks.

[PMRpro Ambassador in reply to paintpots]

Hope you are doing well?

[krillemy in reply to PMRpro]

Ohh, thank you for asking. I slept through the night 8 hours straight, and I had not taken any ibuprofen ! When I sat up, it was like I had springs in my muscles I just stood up. No rolling out and easing my feet to the floor. So it is really fantastic. Best is- my fuggy head that is really so clear.I still have pain in the joints of my ankles, hips and shoulders, when using them, but I am thinking that it is due to former over use, and needs some time. I took the first 10 mg Saturday and then 15 mg.

What do you think - it fits PMR again does it not? I am planning on staying on 15 mg for 3-4 day, and only see if higher dosage is needed, then follow the EULAR protocol.

[PMRpro Ambassador in reply to krillemy]

It never didn't - did it? Unless you were in denial like your doctors!!!

[krillemy in reply to PMRpro]

Well - I have been around a lot And they all said no. But if you can´t get the diagnosis when younger that 50 and sero-negative, then that will never change. It´a circle then! :o)

[PMRpro Ambassador in reply to krillemy]

I think it will - or hope at least. PMR is finally being taken seriously including work on new drugs.

[paintpots in reply to PMRpro]

Hi PMR ProI am doing fine , the radiotherapy is ongoing but just another hurdle. Roll on the summer when hopefully I shall be pain-free and on a lower dose of prednisolone. Thanks for asking.

Paintpaint

[krillemy in reply to paintpots]

I am sorry for your illness. I hope you will feel better. I do need to talk to them again. Just started pred., so I would like to stay on it