Broken arm while tapering Pred

[Abykarma]

Hi all, I just have a question re "sick day" rules. I was in the slow process of tapering from 7.5mg Pred to 6.25 - going slowly between the 2 doses following Dorset Lady's rules.

On Friday last week I fell badly and broke my left arm - the humerus sheared off the ball joint and there are a couple of other fractures as well. I had surgery to fix the fractures. I told every doctor I saw about being on Pred, knowing that I could have an adrenal deficit. They said nothing about giving me more Pred, so I decided to up my dose to 10mg.

I need to know for how long I should remain at this higher dose before going back to tapering?

Many thanks for any advice.

[DorsetLady PMRGCAuk volunteer]

ouch!! Hope you soon feel better.🌸

This link contains info re surgery etc when on steroids -

healthunlocked.com/pmrgcauk...

..and this is usual advice -medicinehealth.leeds.ac.uk/...

[SheffieldJane]

oh poor you! May it heal quickly, 🌺 DorsetLady has provided the advice. Good job you are on the ball aargh!

[PMRpro Ambassador]

I would go back to the previous dose and delay any further tapering until the surgery is healing well. Give your body a chance to heal.

[Abykarma in reply to PMRpro]

By previous dose do you mean 7.5mg or 10mg which I started after the injury? I really need to know for how long I should take 10mg?

[PMRpro Ambassador in reply to Abykarma]

I suggested until you know the surgery is healing well - but I can't give a time period for that, it depends on you and a lot of other factors. If all is looking good after 10-14 days you can drop straight back to 7.5mg and stay there until you are well recovered. So it all depends on how you feel at 10 days - if you are still feeling the effects of the surgey the you may need to drop back to 7,5mg more slowly and over a few weeks.

DorsetLady sent you the guidelines for surgery - what does it suggest?

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

It’s not a clear as it could be -but implies if normal dose is below 10mg you don’t need to increase steroids post-op.

Would agree with your suggestion - and Abykarma reviews situation at the 10-14 day point

[PMRpro Ambassador in reply to DorsetLady]

That is a bit strange - below 10 is where the trouble starts!!!!

[DorsetLady PMRGCAuk volunteer]

unless I misread it -

Remember that patients receiving <10 mg of prednisolone or equivalent do not need steroid cover but should continue with their usual maintenance steroid dosage. Patients on long-term steroids do not as a rule require supplementary steroid cover for routine dentistry or minor surgical procedures under local anaesthesia.

[PMRpro Ambassador in reply to DorsetLady]

To me that differentiates between patients on short term pred and people like us. And I wouldn't say you needed to raise pred for the dentist or local anaesthetic - just if GA is involved. But it isn't at all clear is it?

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

No-glad it’s not just me….