Major surgery and a Vasovagal event

[Sumojo]

I’ve been taking 5mg pred for a while. Reduced to 4.5 and after a few weeks began to feel unwell. I told my doctor who said go back on to 5mg. I then went into hospital last week. I had gluteal reconstructive surgery. The anaesthetist suggested I should increase my pred. So I did the sick day rule and added 5. Three days after surgery I had a Vasovagal event and the crash cart was called. I had a concussion and stayed in hospital a further two nights. As I had been on 10mg for a week I dropped back to 5mg a few days ago. I’m coping well with the surgery but I look as if I’ve been in a car smash with my bruised face and arms. I feel terrible, nauseous and exhausted. What should I do re increasing pred. Is it just the aftermath of the surgery and having to use crutches for eight weeks or is my adrenals?

[SnazzyD]

Hello, given that you were feeling unwell before the op on 4.5mg and assuming 5mg helped, I would assume some adrenal issues here. Also, bear in mind general anaesthetics can take a few weeks to work out of the system. The op itself will need a lot of healing and it is exhausting, especially when people are sent home so early. The logistics of small things that we take for granted are tiring and crutch use really can be.

We don’t know how much it takes to re-suppress the adrenals in those where they were already struggling. Personally I found the 3 week rule was an over estimate. A week on 10mg might have also made them a bit dozey again. Perhaps try a bit above 5mg and the really rest and see if that works rather than going to 10mg. That’s just my opinion and others may have different ideas.

[Sumojo in reply to SnazzyD]

Hi there, thank you so much for responding so quickly. I think I might try 7.5 next dose to see if I feel better. I hate feeling like this.

[PMRpro Ambassador]

It takes weeks to recover from any surgery and normally the body would produce more cortisol to cope with the stress on the body, both of the surgery and the healing process. I do wonder if the "vasovagal event" was adrenal related - I wonder if they thought about that before plumping for v-v event which is often a "we havent a clue why, they appear to be OK now so we'll log it as that" diagnosis.

And on that basis, maybe the 10 to 5mg drop was a bit much, a bit too soon, when you have all this battering to cope with. Two weeks post-op is early days by most standards and you had the extra excitement too. Obviously 5mg was only just enough for you to feel good pre-op - it is likely to be very borderline now.

[Sumojo in reply to PMRpro]

Thank you for your quick reply. I never thought about whether the v-v episode may have been related to the adrenals. I’m feeling pretty rough on 5 so I’ll probably up it a bit for a week. Maybe 7.5? I know I caused quite a stir when I crashed. Three times they said I passed out while they were trying to bring me round. It was a terrifying experience to have all those people sticking me with needles, more cannulas after they’d only that morning taken my op ones out. Then a rushed trip to have a cat scan on my head to check for a brain bleed. Good grief, it makes feel weird just thinking about it!

[PMRpro Ambassador in reply to Sumojo]

Not surprised!!!!! See how you get on - I'd be taking what I need, hang the taper later! If 5mg is what you need for managing the PMR then it won't be hard to get back down, just you may not be able to drop straight back in one.

[Pixix]

My father had non frequent, but happening, v-v attacks. He was lucky, perhaps, could feel one coming on,& then just laid down anywhere, in the street, in shops, at home etc…& it would pass in about ten minutes & that way he didn’t get hurt, & didn’t get injured (though there was the day he passed out face first into his curry). I’ve now got orthostatic hypotension, which appears to be very similar. I haven’t learned to lie or sit when myBP drops like a stone & fell off the rockery dislocating my ankle, bashing my head it & badly damaging my coccyx. I’m sorry to reply to your post in a different way, but I haven’t found anyone else with v-v attacks…has it happened before to you, please, & how do you deal with it? Have they told you it will happen again? Did they say it was related to the surgery you’d had? I had a very bad headache from my head landing on the ground so suddenly!! I presume, but haven’t yet found out, that mine is hereditary. Horrible for you that it happened when it did, & I hope you recover from that & the surgery soon. If you feel well enough, please let me know…thanks, & sending hugs, S x

[SID3 in reply to Pixix]

I have had various vvs over the years, once in a wheelchair in hospital after surgery, several times in the middle of the night, sometimes when suffering a bug. All before PMR. Have learned to sleep with feet higher than head and to try to avoid dehydration.

[Sumojo in reply to SID3]

Thank you for replying. Interesting your events were before PMR I was wondering if they might be related. I was probably dehydrated after the op. I’ll do all I can to avoid that happening again.

[Pixix in reply to SID3]

Thanks, very interesting for me, too, as I’m having so much trouble with dehydration right now, having to use saline spray as my mouth is so dry, often! I’m getting dreadful head sweats, just like turning a tap on, pours into my eyes, ears, down my neck…it’s hard to keep hydrated. And feet higher than head, I will try that, too, many thanks!

[Sumojo in reply to Pixix]

Hello, thank you for your reply. Yes I’ve had one before again in a bathroom. It’s a terrible place to fall there are so many things to hit your head on. I’d never heard of them either until that first one and that ended up with a hospital stay for three nights with concussion and a huge gash on the back of my head after hitting the toilet.

This time I face planted and hit my head on the door frame. Two lovely black eyes and bruises Al over my arms and legs. It was probably from being in bed for a few days after the op. and nausea.

Your dad had the right idea and in future I’ll be doing my utmost to stop falling.

[Pixix in reply to Sumojo]

Thanks so much for taking the time to reply. It’s just the same as I have. I can’t sit down yet & it happened two days ago. I guess because in that situation we just fall in a blackout so have no chance to avoid anything. I felt nauseous & dizzy, but the next thing I knew I was flat on my back, my head hurt, my ankle had dislocated, & my behind is so so so bruised & sore! I think the nausea may be, may be…I’m no Dr, part of it. Dad reported nausea beforehand & I felt nausea immediately before I fell. Hm,time will tell, I hope you heal well & don’t have further attacks! S x

[Orpheus82]

I have had v-v attacks since the age of 9yrs. Fortunately I know when they’re coming so get down on the floor and wait for it to pass. My friends are well versed in coping with these as they have often happened in restaurants caused by post prandial hypotension - BP drops after eating. My piece de resistance is on long haul overnight flights and I think I’m now up to about five different airlines! Dehydration plays a large part so I have to make sure I keep hydrated to keep my BP up. Five years ago I had major breast surgery - mastectomy and reconstruction. I ended up on ITU for five days and had a dreadful crash. I had repeatedly told them that I was on 5mg of prednisolone and had been taking steroids for over two years. No one listened! I now make sure to apply sick day rules and insist that the anaesthetist gives me extra hydrocortisone. Interestingly fainting runs in my family too.

[Sumojo in reply to Orpheus82]

That’s so interesting to hear you’ve had them for so many years. Sounds as if they’re nothing to do with PMR then.

[Rosedail in reply to Orpheus82]

Thanks for mentioning “post prandial hypotension” as I will research it. I have that and I’ve had to lay down in restaurants and on city streets after meals…horrible nauseous feeling and I break out in a sweat to boot. But mine has never been diagnosed…and the episodes are not frequent as I now avoid rich meals and donating blood. When I mentioned the symptoms to my physician he was flummoxed.

[Orpheus82 in reply to Rosedail]

It can be so embarrassing when it happens in a restaurant as people assume that you’re drunk! I try and avoid heavy carb loaded meals. Like you I also feel nauseous and sweat. I wonder if my adrenals have always been a bit dodgy!