Where to begin……….

[jaycee444]

A month ago I had a total hip replacement - in and out on same day which seems to be a policy with many hospitals now. Stayed a week with my sister then home alone…. Was on 4.5mg Prednisolone but for ease of management have been taking 5 mg ever since. Have had a pretty stressful period with a lot of pain, sleepless nights, loss of appetite and weight loss. Feel like Im getting nowhere even though my new hip not painful but just about everything else in my body hurts although doesn’t feel like PMR flare. Sciatica and aching joints are a problem I think due to altered gait. (Had leg length added with this hip). The latest problem for me is stomach pain leading to loss of appetite and weight loss.

I have never taken a PPI and not had problems because I take my pills with yoghurt. They wanted me to take Lanzoprazole when I was discharged but as I was not on aspirin I refused so I am literally taking the same medication as before my surgery. Not sure why this stomach issue has arisen but it is very uncomfortable. In the meantime with all thats going on I have really forgotten the fact that at a low dose of Pred I could be struggling with my adrenals? Could this be the cause of come of my problems?

[SnazzyD]

Once upon a time people used to be in hospital getting daily physio and advice on correct gait so that issues didn’t arise with weaknesses that crop up due to initial guarding and changing of balance and muscle usage. Are you getting any physio at all? Did your issues with pain develop or ramp up from the start?

Gastrointestinal issues are something that have been noted after joint replacement. It was rare but we used to look out for lower intestinal sluggishness or diarrhoea and gastric bleeds after these ops. There isn’t much detail in your post though. When did the issues start in relation to the op? Were you given oral non-steroidal anti inflammatories for a few days? Regards this pain, Where exactly is it? People say stomach when in fact they mean bowel or across the middle sometimes. Is there a pattern with time of day or eating? What makes it better and what makes you not want to eat? Do your poops look the right colour? Is your weight loss due to not eating or in spite of eating?

Change in gut habit and weight loss needs to be addressed by a doctor but it is worth looking at the details so that when you see them, you get the right information in before your time’s up with them.

With everything that’s going on, it may be your adrenal glands aren’t keeping up with the increased demand for cortisol. Feeling nauseated and abdominal pain can be a symptom. Have you experimented with a mg or two of extra Pred for a couple of days?

[PMRpro Ambassador]

The stomach pain is probably because you didn't take the PPI and I would start. Here it is always given with broken bones that require surgery as that in itself can cause stress release of acid and stomach pain. I broke my leg skiing here many years ago and when I mentioned stomach pain to the consultant post-op he asked why I wasn't on a PPI and explained the link to me. It doesn't always happen but it can. I also required it recently for a non-stomach related procedure as protection.

And yes - I think a bit more pred in line with Sick Day Rules post-op might be a good idea as you have ongoing op-related pain and problems.

[jaycee444]

Stomach pain - definately stomach…. And turned up suddenly about 5 days ago. Have taken on board PMR Pro’s suggestion to start the Lanzoprazole. Instructions are to take 1 per day for 42 days. Bit concerned as I am on another medication that is slow release and PH dependent so should work when it’s in my gut (more alkaline environment apparently). Not sure if the PPI is going to make my stomach more alkaline and this would affect my other (gut) medication. I have Ulcerative Colitis. Have looked up on a drug interaction website and there are no contra-indications. Dont want to risk a flare up of my UC.

[PMRpro Ambassador in reply to jaycee444]

Budesonide I assume? Shouldn't be a problem. This says

pubmed.ncbi.nlm.nih.gov/153...

An increased pH obtained by gastric acid inhibitory drugs, such as omeprazole, does not affect the pharmacokinetics of budesonide.

It seems to suggest prednisolone has an effect on budesonide - but it is far from clear and you are obviously doing fine on the mix so I assume that was taken into consideration.

[jaycee444 in reply to PMRpro]

No it’s Pentasa (Mesalazine) granules. Have done a bit of checking but cant really see anything adverse. Will take the granules very first thing then leave it a couple hours before I take Lanzoprozole. By that time I think the granules will have passed on down.

[PMRpro Ambassador in reply to jaycee444]

sciencedirect.com/science/a...

There seems it could be a problem. Once you take a PPI for a long time the change persists through the day but by 24 hours I imagine it is certainly less.

However, it is said that the mechanism isn't affect by H2 antagonists

pubmed.ncbi.nlm.nih.gov/109...

which says "This release pattern does not appear to be affected by food, diarrhoea or the simultaneous use of H2 antagonists. "

So I'd say not to the PPI and ask for famotidine, cimetidine or one of the others of the same group.

[Chocolateluver]

Hi, I have now been totally off pred since July 2023. Problems started when I went from 3mg to 2mg and are still ongoing. Did have a test to check my adrenals were working and the Dr says yes. Been to my hospital appt in Feb and consultant tells me it is not unheard of for me to have achy joints and muscle pain even though my adrenal test was OK. Apparently all part and parcel of steroid withdrawal (was on them for 9 yrs). Never had any problem with my stomach or weight loss, nausea etc, though. It does sound to me that your adrenals may be struggling. I suggest a morning blood test to check.