Flare after two surgeries : Hi, I’m looking for... - PMRGCAuk

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Flare after two surgeries

Tiggy70 profile image
14 Replies

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.

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14 Replies
SnazzyD profile image
SnazzyD

Goodness, that’s a lot. What do you call a flare?

Tiggy70 profile image
Tiggy70 in reply to SnazzyD

For me it’s usually aching in my hips and shoulders not helped by paracetamol It’s difficult to know with my right shoulder because of the surgeries and physiotherapy but my left shoulder has been aching a lot and my hips have recently joined in.

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer

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.

Tiggy70 profile image
Tiggy70

Thank you. I think I’m going to go for it working on the premise that it will help and not make things worse🌸

PMRpro profile image
PMRproAmbassador

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.

Tiggy70 profile image
Tiggy70

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.

PMRpro profile image
PMRproAmbassador in reply to 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.

Tiggy70 profile image
Tiggy70 in reply to PMRpro

Thanks, I don’t want things to get worse.

PMRpro profile image
PMRproAmbassador in reply to Tiggy70

Absolutely not!

hurryupharry profile image
hurryupharry

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.

Tiggy70 profile image
Tiggy70 in reply to hurryupharry

Thanks for your reply. I’m going to try an increase in Pred over the next 5 days and drop back to just above where I was comfortable before my surgeries. A year ago I didn’t increase whilst having a flare (rheumatologist told me not to) and I ended up back at square one.

PMRpro profile image
PMRproAmbassador in reply to Tiggy70

They make me SOOOO angry - wasn't his pain!

Kitchenfairy profile image
Kitchenfairy

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

Tiggy70 profile image
Tiggy70 in reply to Kitchenfairy

Thank you 🌸

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