Surgery and PMR dose

[Songbird69]

Hello.

I’m due to have surgery in 10 days time for a couple of hernia repairs.

I am currently in the second week of reducing Prednisolone from 2mg to 1.5mg, over a five week period. At the time of starting the taper, I didn’t know of the confirmed operation date.

So, should I continue the reduction (I assume I will be given a hydrocortisone shot before or after the op) or abhort the taper and try again once the operation had been carried out?

I have been stuck on 2mg Pred for about a year because of gastric issues (SIBO and Gastritis) so I wanted to try a taper whilst I seem to have improved sufficiently for this to be a possibility.

Thanks.

[DorsetLady PMRGCAuk volunteer]

I’d be inclined to stop taper and return to 2mg.

Get through the operation, and yes you will get hydrocortisone to help you through it.

Make sure you are fully recovered before you consider tapering again.

All the best… 🌸

[Songbird69 in reply to DorsetLady]

Thank you, DL,

I think I knew the answer really. Just annoying when I was doing so well!

🥰

[DorsetLady PMRGCAuk volunteer in reply to Songbird69]

I know it’s annoying, but you will get there… just get this procedure out of the way.. 🌸

[Hidden in reply to Songbird69]

Me too.

[Frigidair in reply to DorsetLady]

At the risk of seeming antagonistic but shouldn't questions about dosages of prescribed medications be between Songbird69 and her medical team?

[DorsetLady PMRGCAuk volunteer in reply to Frigidair]

The question was -

So, should I continue the reduction (I assume I will be given a hydrocortisone shot before or after the op) or abhort the taper and try again once the operation had been carried out?

I was merely answering that - and suggesting stop taper and return to previous dose.. nothing more…

Very often the reason why questions are asked on here is because the patient doesn’t get the advice from their medical team. In an ideal world this forum wouldn’t be necessary.

[Frigidair in reply to DorsetLady]

No question the support found here among those sharing common struggles is a wonderful service under a wide variety of circumstances.

[Songbird69 in reply to Frigidair]

I guess you haven’t been on this forum for long! I trust the advice on here more so than from my medical team, and had I asked my medical team the question about tapering, I wouldn’t have received a response before my operation anyway.

Most people on this site are extremely knowledgable and experienced. They know what PMR is like in the real world and not text book.

I wasn’t being advised on dosage. I was being advised on whether to continue my taper.

[Frigidair in reply to Songbird69]

Understood. Wishing you all the best going forward.

[PMRpro Ambassador]

I'd be inclined to just stick at 2mg until you have recovered from the surgery. The anaesthetist will provide cover through the op and maybe post-op but don't try to be heroic if you have a flare immediately after, It will settle again and you will get lower - but no point pushing your luck!

[Songbird69 in reply to PMRpro]

Me be heroic? Seems you know me too well! Oh dear ….

But seriously, thank you for this. If I do flare afterwards (please no!) what dose should I move up to and for how long do you think?

[PMRpro Ambassador in reply to Songbird69]

The crystal ball is on the blink!!! Wait and see what happens first! But basically - however much you need to deal with the symptoms ...

[Songbird69 in reply to PMRpro]

You need to polish your crystal ball then 😂

OK - thanks. That makes sense. 😊

[PMRpro Ambassador in reply to Songbird69]

It's rheumies who have crystal balls that work - according to them ...

[Songbird69 in reply to PMRpro]

You’re not wrong there!

That’s if you can get to see them in the U.K. as it seems the NHS has imploded.

[Hidden in reply to PMRpro]

I gave up on mine

[PMRpro Ambassador in reply to Hidden]

What, the crystal ball or the rheumy?

[Hidden in reply to PMRpro]

I stayed on 9mg and didn't go anywhere near reducing pre-surgery on my ankle. I didn't want too much stress on me. I had a lot of bruising appear on me post surgery :/

[Songbird69 in reply to Hidden]

I didn’t know about the op date when I started reducing!

Why the bruising? Coz of Pred damage?

[DorsetLady PMRGCAuk volunteer in reply to Songbird69]

Why the bruising? Coz of Pred damage?

Maybe some due to Pred, but having had 3 joints replaced when not on Pred, it’s quite normal… they don’t exactly treat you like a piece of precious porcelain when on the operating table 🤔….

[Songbird69 in reply to DorsetLady]

I don’t like to think about that part! Thank God we are not awake to witness that. Worried about my “last chance saloon” crown though. 🦷

[PMRpro Ambassador in reply to Songbird69]

I was awake when they screwed my broken leg back together! Hammers, drills ... Great fun. I had a spinal anaesthetic but here in Italy they didn't give sedation and I spent the entire time with a succession of anaesthetists arriving to practise their English. I had some amazing bruises and that was when I was a lot younger and not on pred.

The following year I had the metalwork removed because one of the screws was causing a problem. A friend persuaded me to take homeopathic arnica globules at a high potency (30) from before the op for a few days. The nurses and physios were astounded - I was up and walking that evening and not a bit of bruising to be seen. How did it work? No idea but something did something.

[Songbird69 in reply to PMRpro]

How strange! I replied to you this morning, but maybe in my rush to research arnica globules, I forgot to press send. 🤔

It must have been very strange being awake for your op. In some ways I quite like the idea of knowing what is going on , then I could tell them to do a neat job with the stitching!

[PMRpro Ambassador in reply to Songbird69]

I didn't find it particularly strange. But I do have unusual interests ...

I was fully awake for my first c-section, was really t'd off because they had the usual screen up so the patient couldn't see. So they told me to look into the surrounds of the lights - which I couldn't because I'm as blind as a bat without my specs! I was even more t'd off for the second, done in Germany. I had signed consent for an epidural but they refused to give me one and conveniently "lost" my husband on the way to the gynae theatre. Had anything gone wrong they really would have been in trouble.

For the broken leg, the anaesthetists arrived to consent me and were going through the procedure and what could happen, and then right at the end, slightly as a throwaway "or you could have a spinal". Which of course I pounced on much to their surprise. And then having the metalwork out of my leg in Scotland, they were somewhat surprised I asked for a spinal but gave it without argument. But they gave me so much sedative I was out for the count - which wasn't the idea! Usually removing metalwork causes more bruising than putting it in. The arnica stopped that - however it did it!

[Hidden in reply to PMRpro]

Sod that. I asked them to send me away with fairies.

[Sophiestree in reply to PMRpro]

I've worked on many medical programmes, one was a hernia op where it was only a local but the patient was hypnotised (can't do the hypnotherapy bit myself) and sitting up eating and drinking tea 30 mins after the op. The other was a live cesarean and then a series of operations at the Wellcome Institute. You have to find the right personnel for these kinds of programmes though... but definitely up my street.Spent a fair amount of time in Germany and Poland with Gunther Von Hagens too!!

[PMRpro Ambassador in reply to Sophiestree]

In Dundee when they removed the metalwork, I was sitting up having tea and something to eat as soon as they reversed the sedation! Until they gave me morphine as the pain returned - that soon stopped everything as my BP plunged. Relied on paracetamol after that which also amazed them all. Was that the arnica too?

[Sophiestree in reply to PMRpro]

I have never used the arnica tabs but do have arnica cream. I was told that if you start the tabs a week before an op it really helps with recovery.I wonder if you're awake they are more careful with you and not so rough as they can be if you are fully sedated. That must make a difference to recovery time.

[PMRpro Ambassador in reply to Sophiestree]

I think that is the case - pretty sure it is for colonoscopies! No sedation here and they always proceed with great care when they get to a bend! A screaming patient isn't encouraging ...

[SheffieldJane]

I should interrupt it now rather than closer to the op and ask your surgeon/ anaesthetists for on going guidance you may need more for the upset to your Adrenals. Good luck with your surgery, I hope it goes well. People have had different advice from their operating team. The key thing is that yours know what you are on.

[Songbird69 in reply to SheffieldJane]

Thanks, SJ. I will be sure to tell them. The pre-op assessment by telephone, isn’t until 2 days before the op, as they had no earlier slots. So I have had to google my meds and supplements to see if I should stop any of them earlier.

How are you doing? Did you get to the bottom of your issues? I hope so!

[Hidden in reply to SheffieldJane]

The most traumatic thing for me was wearing undies that looked like a nappy. Oh how I begged.....I lost

[Songbird69 in reply to Hidden]

Oh pleeeeeeze 😩