Hi, I’m looking for some advice please. I’m just over 2 years with PMR. I’ve had two shoulder surgeries in the past 10 weeks. The first was extensive surgery to repair 3 rotator cuff tears and remove bone spurs and the 2nd, 3 weeks ago was a revision to wash out the shoulder because of healing issues. For the past 8 weeks I’ve been on a maximum dose of antibiotics (Flucloxicillin) which I finish today 🤞. During this whole period I’ve been on 8.5mg Pred but suspect I’ve been flaring for at least a month. My orthopaedic consultant has been adamant that I don’t increase the Pred because of my healing issues. I feel the time has now come to increase before things get really bad. I saw my rheumatologist at the end of October (prior to my second surgery) but he wasn’t happy for me to increase to more than 10mg and then only for a short time. The last time I had a flare was last August whilst trying unsuccessfully to reduce to 8 mg. At that point I increased to 13mg for 3 days and then 10mg for 2 days before dropping back to 8.5 mg. It seemed to do the trick. Should I try the same regime again? I don’t like taking things into my own hands but trying to appease both the rheumatologist and the shoulder consultant has been very difficult. Just to add to the mix I had my Covid booster 2 days ago and I’m due a flu jab on the 10 December. We’re due to fly to the US on 20 December to spend Christmas with our grandchildren and I’m hoping to feel a bit better to cope with the travelling. Your advice would be much appreciated, thank you, Tiggy70.
Flare after two surgeries : Hi, I’m looking for... - PMRGCAuk
Flare after two surgeries
Goodness, that’s a lot. What do you call a flare?
Certainly sounds as if you need up get things back under control as soon as possible….a month of flare building up plus the stress of recent effects gphasnt done any favours..
Your suggested regime is in line with the usual advice we give for dealing with a flare - so think you need to go for it and hope it works, but perhaps stop at 9mg rather than 8.5mg. ..and don’t even consider any further tapering until you’ve had a good period to recover from your trip.
Thank you. I think I’m going to go for it working on the premise that it will help and not make things worse🌸
Seems to me there has been a decided lack of consideration of Sick Day rules. The injury itself was one thing, then the surgery and then the protracted course of abx
addisonsdisease.org.uk/newl....
says
If you are prescribed antibiotics, continue to double your dose until you finish the course or feel completely back to normal.
I'm not suggesting you follow it - but your doctors need to think about it.
Hi, thanks for your reply. I very much doubt that neither my Rheumatologist or shoulder consultant have ever heard of sick day rules. Neither of them have mentioned it to me. I feel like that horse has bolted now. My shoulder consultant actually told me following my surgery that I needed to be off the steroids as I they were slowing down my healing 😫
Do you think I should increase my Pred as outlined in my post? I finish my antibiotics tonight so could increase my Pred tomorrow. Thanks, Tiggy70.
I think you need to - and see how it works out. If it works - great.
I also think that surgeon needs some education on working with long term steroid patients.
I would definitely follow your plan to increase your dose. Last year I had a couple of ops to remove tumours, the anaesthetist gave me additional 10mg at op time. After the first op everything was fine I returned to my then normal dose, 5mg at the time. After the second op I was really stressed, pmr symptoms returned at full volume. My gp, who is very good, gave me a prescription of 40mg for a week. I thought this was a bit too much and so took 10, that didn’t seem to help so took 20 for 5 days, which was a relief, then went back to 5mg. I had to settle on 7mg but I was then able to start on the DL five week cycle of tapering by 1/2 mg.
When I had a hip replacement I was told to double my dose. On returning home I was given a schedule for tapering, and was back to my original dose within 2. weeks. No problems at all. I would think the stress alone ,which we are told to avoid,would warrant an increase in your dose. Good luck x