No prednisone with Diverticulitis

[Macadoo]

Has anyone with PMR had diverticulitis and was told to stop taking Prednisone until the infection was cleared up? I’m currently in the hospital and may require surgery. I was told today by the surgeon and my primary care physician that I need to completely stop taking my current 8mg prednisone today. Im very worried that I will experience an extreme flare and possible adrenal insufficiency. The doctors said they understand my concern but taking prednisone could result in a further increase in possible diverticulitis infection and lead to surgery. They said they would monitor my progress on IV antibiotics and ‘possibly’ allow me to resume prednisone in 48 hours.

[SnazzyD]

It sounds like the common thing of specialists only seeing their bit. Time to be more direct Id say. I would be asking how they would be protecting me from adrenal insufficiency given how long I have been on steroids and who will be taking responsibility for dealing with preventing and treating any adrenal crisis. Ask for a letter to give to any other other medical professional you may come across including your GP, paramedics etc so that the information is not stuck in the slow lane in some inaccessible (to others) part of the NHS. There is a reason we are told to wear a medic alert for a year after stopping Pred. Not a nice situation to be in.

[SnazzyD in reply to SnazzyD]

This reply is based on the assumption that you are sent home until it clears up. If not ignore this; PMRPro’s reply more relevant.

[PMRpro Ambassador]

If you are in hospital - they should be using hydrocortisne as adrenal cover while you stop the pred. 48 hours is not too bad as long as you are being monitored but yes - you do risk a flare of the PMR. Not sure I have heard of anyone in a similar predicament though.

[winfong]

They upped mine! And I was in the exact same situation as you - in the hospital, in the pre-surgery observation ward. Strong antibiotics took care of it, though, and I didn't have to worry about surgery.

[Macadoo]

Thank you for the replies! I was discharged this afternoon...so far, no flares but extremely exhausted.

[Bobwif]

I was in hospital in February due to a bleed which was eventually blamed on diverticulosis. I was taken off blood thinners for a few days but not Pred. Had a colonoscopy to check for other causes but thankfully clear. I’m guessing you are in US as you say in THE hospital. I’m in UK where we just say in hospital. Good luck.

[Hidden]

I get diverticulitis infection usually once a year. I learned in medical school that steroid use exacerbates infections but changed fields.PMR is indeed miserable but it never caused me to pass out from pain like diverticulitis.

I stop taking prednisone if I am on antibiotics for diverticulitis and just suffer which I assume is what my lot in life is

[PMRpro Ambassador in reply to Hidden]

That's fine - except no pred means no cortisol substitution and the potential for an adrenal crisis. Depends how long the abx are for.

[Fifelassieo in reply to Hidden]

Hi, I had a bad flare up which l now think was diverticulitis. The symptoms l had were shivering and shaking, bloated, nausea fatigue and l had weakness in my muscles and a terrible headache, l was ill for about 10 days, couldn’t eat right because of the bloating. I now realise after reading on here that it could be a flare, l have never had anything like it before. I took about a whole bottle of lactulose and l finally managed a motion, l air on the side of constipation. I was diagnosed with diverticulitis several years ago. I just wondered if these symptoms are familiar

[Hidden in reply to Fifelassieo]

Yes, the pain can make PMR flare up like a nothing burger. Mine went undiagnosed for 6months. Every time my bowels spasm it was excruciating until you blacked out. Prednisone is a blessing but comes with other issues.

Got a new Rheumy today, gorgeous Jewess and she knows her stuff. Not affiliated with any alliances that restrict her practice. She upped me from 5mg to 7.5mg and said see you in 3 months.

I need to lose weight, 205lbs 6’3” so that will be difficult with the upped prednisone.

Back to your predicament, I take temperature daily if I feel sweaty. It is usually a low grade fever, 99-100degF and the only cure is antibiotics.

Best thing is Keep your colon cleansed with diet recommended for diverticulitis and try hard to stay well hydrated. Study up on what a good stool should look like and try to get your diet to result with a long single piece that is still somewhat soft. If you are spending more than 2-3 minutes on the toilet, your diet and hydration is off.

I do periodic colon cleans that seem to help but I am not a doctor. Try to not get infections is the best advice.

I would say exercise but PMR is just miserable but that really helps with your stool.

I am listening to this gal and hopefully 7.5mg can help me get more active.

[Fifelassieo in reply to Hidden]

Thanks for the information

[Marcy47]

I had diverticulitis earlier this year, it was cleared up with antibiotics at home eventually. They had to take me off Metronidazole as that gave me explosive diarrhoea! Ended up on Mebeverine hydrochloride. Nobody suggested I stop Prednisolone.

[Swdai]

I had operation yesterday to repair an Achilles’ tendon rupture which happened on 3/01/22& hospital ( orthopaedics dept ) were hoping it would heal naturally but after a month in plaster & 3 months in air cast boot it did not happen, referred to consultant and within 3 weeks had op. The consultant advised me to take my 10mgs pred as normal before going in : fortunately he understands PMR as him mother is victim of this condition. Ideally he would have liked me on8mgs but he said he didn’t want to waste any more time before giving me the op .

He said every consultant varies in their thoughts re pred dosage / operations but that the immune system is already compromised & recovery / infection is very much down to the aftercare .

I feel so sorry for all those out there who have consultants /GPS who do not understand PMR : I am so fortunate to have both.

[PMRCanada]

I’ve had two bouts of diverticulitis in the last year. First one last July a gastro specialist at hospital ordered a CT scan which confirmed diverticulitis and presence of a phlegdom (spelling?) in lower colon. Prescribed and took 1 week of two types of antibiotics at home which did the trick. Did not stop pred. Follow up colonoscopy cancelled 3 times due to COVID issues at hospital and my inability to get a test in the time required prior to procedure, so it didn’t happen.

A month ago familiar pain (in a bit different location) but GP off with COVID so off to our local hospital again. Attending ER dr took tests, nothing showed, so assumed it was diverticulitis again. Prescribed 2 types of antibiotics again, recovered at home. Followed bowel rest diet for 2 weeks. Did not stop pred.

Rheumy advised me to stop Methotrexate while on antibiotics. Also could not take calcium supplements, no dairy or oranges for 7 days. Told diverticulitis can be caused/exacerbated by steroids (but also caused by being overweight and genetic history…both apply as my dad needed re-section surgery for his diverticulitis, mom has it too). I was on 8mg and stayed at that dose.

My GP recently met with me to follow up and is re-booking a colonoscopy with the gastro specialist. He also said I’m on the right track lowering my pred dose and weight. I’m finding I’m getting afraid to eat in fear of symptoms returning.

Don’t think I’d survive if I was told to just stop taking pred abruptly! Wishing you the best with healing from the diverticulitis and clarification re your pred consumption moving forward.

[Carver63]

Hi Macadoo if your doc say get off then get off and ride the flare after. i had surgery and the antibiotics i was given reacted very bad with Pred. I survived the ambulance ride but there is a substantial health risk mixing meds. i was fortunate that the Relapse of my GCA only required a small increase in Pred before i was able to get back on the slide. Saying that there are meds that dont interact as badly so make sure you let the Docs know your situation and medications. Good Luck! Pred works but it sucks

[Blackcat1M]

Hi I have diverticulitis it’s news to me that it clears up!I have had it for ten years, I have to be careful that my bowels don’t get blocked and was told to eat plenty of fibre.

They even let me look at the camera to point out what it looked like.

I would be interested when it clears up for you.

Take care

[Macadoo in reply to Blackcat1M]

Once you have diverticulosis, it doesn’t heal on its own. If it becomes infected and inflamed, it becomes diverticulitis which needs to be treated with antibiotics. I’m currently on 2500mg daily of two antibiotics for 7 days and my diverticulitis is healing. Downside is significant fatigue…it’s difficult to get out of bed.

[Blackcat1M]

Oh I take 5mg pred at the moment and have never been told to not take it

[tytto]

Very suddenly I developed an abscess in the lower left area which was found to be in the diverticula -- never had any hint of a problem with diverticulosis though I knew as it was found during colonoscopy about 30 years ago (I was 85 when the infection came). I was in the hospital for 2 weeks on a liquid diet, antibiotics (IV) and pain meds. At the time I was tapering from 7 to 6 mg/day. The hospital staff kept me on 7 mg daily.It was during Covid time -- I was negative so remained in my room. Now 4 + months later the infection appears to be gone but I am Stiff as a board as I again attempt to taper to 6mg.

[PMRpro Ambassador in reply to tytto]

Then it is time to stop reducing - you aren't heading for zero, you are looking for the lowest dose that manages your symptoms. It is also the dose range that requires a return of adrenal function and that takes time at any age - and the older we are, the longer it is likely to take. Annoying but reality - things wear out over time.

[tytto in reply to PMRpro]

Thank You for the reply: That was my thought ~ not the time to taper. Time for a REAL chat with my rheumy!

[Sufferinginsilence]

I hope you're feeling better now. I really sympathise. I was diagnosed with severe diverticulitis prior to developing PMR . I'm currently in the middle of a flare up with awful diarrhea and was put on Metronidazole three days ago by my GP but no mention of stopping or increasing Pred. Just starting to feel a bit better apart from a touch of nausea and occasional 'runs' then came out in a horrible itchy rash all over my torso! So today, I've been changed to Amoxicillin and a strong antihistamine. I don't think I could bear PMR pain on top of it all!