Tapering after surgery

[Sorop]

Hi I have been on prednisolone since 2015 when I was on 60mg and also methotrexate and it has taken me till now to reduce to 3mg a day. On the 14th March I had a hysterectomy and pelvic floor repair. I was told to stop methotrexate for a while before surgery because it increases the risk of infection and told to double the prednisolone the day before, the day of the surgery and the day after then drop straight back to 3mg. Unfortunately there were urinary complications and I had to stay in hospital for 10 days and they kept me on 6mg a day. I rang the rheumatology department on the advice of the pharmacist as when it was safe to start the methotrexate again and how to taper the steroids. They said I could start the methotrexate and drop straight back down to 3mg but to test it out given my slow tapering in the past I took 5mg the last two days to see the response and felt completely wiped out. Advice would be appreciated on how to proceed.

[Sorop]

P.S I have also been prescribed Solifenacin which warns of drowsiness.

[PMRpro Ambassador]

And having gone home - what else have you been doing? Being well enough to discharge home isn't the same as being well enough to much more than make cups of tea and snacks. Remember you were waited on hand and foot in hospital and spent a lot of time in bed. I bet you are tired because it is still very early days in your recovery - your body has had a considerable insult. And you are on a drug that causes fatigue ...

[Sorop in reply to PMRpro]

Thank you for your reply .My husband put flowers in every room to welcome me home and has been waiting on me hand and foot so have only been taking care of my bodily functions and having a shower so certainly not over doing it. Dropping from 6mg to 5 seems to have to have caused the dip so will have to do a slower taper I think.

[PMRpro Ambassador in reply to Sorop]

I wouldn't even THINK of reducing until you are fully recovered - your body would actually produce more cortisol to help you heal and recover and it can't with secondary adrenal insufficiency because of pred.

[DorsetLady PMRGCAuk volunteer in reply to Sorop]

Agree with PMRpro - no tapering for a while -let your body fully recover from operation first…and then only a 0.5mg reduction.

[Sorop in reply to DorsetLady]

Thank you both I was following instructions from my Rheumatologist who told me to drop straight back to 3mg which I was originally on! Only dropped to 5mg and felt the repercussions.

[DorsetLady PMRGCAuk volunteer in reply to Sorop]

Hmmm…🤦🏻‍♀️

[PMRpro Ambassador in reply to Sorop]

Rheumies aren't renowned for their endocrinology skills ...