After my hip operation: PMR quiet (thank goodness) while everything else goes mad

[calibriel]

caftan’s recent post about their upcoming hip operation prompted me to write this. I read the post, and the responses, to see if there was anything I could add, but there wasn’t. I’m 73, and my op in early Feb went really well; I’m now almost as active as I expect to be. My pred dosage has been managed without much change, and my PMR symptoms have been quiet. It’s just everything else that went to fertiliser.

First I had a very stubborn bout of cellulitis in my lower leg (where I’ve had it before) which only shifted after 3 weeks of 3 different antibiotics; but the worst and most long-lasting thing is that I seem to have become intolerant of something which gives me urticaria (very irritating nettle rash), and angiodema. For those who don’t know, angiodema is an alarming condition where parts of the face (including the tongue and throat) swell up intermittently. I have since become a regular at the local A&E, starting to recognise some of the staff. The probable culprit is a blood pressure med which I had been on for a long time. This was stopped a month ago, but I still had symptoms. My antihistamine prescription has since been upped, and I have been given steroid cream for the rash. These seem to have helped, but not cleared it. I still have mild symptoms. Review tomorrow.

The hip and the PMR, on the other hand, are not giving me any trouble at all; and my bp seems to be ok 🙄🤞

It doesn’t come alone, does it?

[DorsetLady PMRGCAuk volunteer]

Just be thankful it’s not all bad😊 .. but it does become a bit wearing at time…

Pleased about hip etc.

[PMRpro Ambassador]

"I have since become a regular at the local A&E, starting to recognise some of the staff."

It's time to worry when you are on first name terms, recognised elsewhere in the hospital or out in the street (even worse) AND by the ambulance crews as well! And a few weeks ago, another (younger) member of the Seniors club in the village said she'd looked after me on the orthopaedic ward - that must be 12 years ago. I KNEW I knew her from somewhere!

But on the whole - that is sounding better rather than worse. Onwards and upwards ...

Which BP med was it? I was "lucky" in that the reaction to the ACE inhibitor I was started on began while I was still in hospital! Ward staff ignored my pleas, antihistamines did not much and as it worsened, even less. Then the weekend duty consultant reacted out of the starting blocks and it was stopped immediately - classical signs of an allergic reaction and it was progressing. The last offering by a nurse had been a cold wet flannel!!! ACE inhibitors are now flagged large and red on my notes along with i.v. diazepam - a/fib and HR IRO 200.

[calibriel in reply to PMRpro]

It was Enalapril. It’s fortunate I come from a medical family, because it doesn’t alarm me when professionals aren’t sure, or actively disagree. On the day of my first reaction, I had some saying Enalapril couldn’t possibly be the problem, because I’d been on it so long; others saying they’d previously seen just that. It was initially replaced with Losartan, but when the symptoms continued that was withdrawn too. I’ve been monitoring my bp ever since, and it seems to be back where it was before, so presumably I didn’t need the second drug at all 🙄 (I’m still on Atenolol)

[PMRpro Ambassador in reply to calibriel]

I sometimes wonder if some doctors sleep through some of their lectures!

coastalallergyasthma.com/al....

says "Diagnosis of an ACE Inhibitor Allergy

An allergic reaction can happen on the first day of use, or even ten years later. There is no timeline on when reaction can occur. Upon the first set of symptoms, it is essential to end the use of the ACE Inhibitor and speak with your physician. To ensure a proper diagnosis, the physician must rule out other factors, such as an insect sting or food allergy. Once the physician knows that the ACE Inhibitor is the cause of the problem, the physician can give a proper diagnosis and can begin treatment and finding the best alternative medication."

More likely after 10 years than on day of course - since you have to be exposed to the allergen to develop the problem!

Its strange because I was on 2 drugs for some years and then they discontinued the Losartan but left the other stuff the same and there was no change.

[calibriel in reply to PMRpro]

In my case, I don’t remember exactly when I was put on Enalapril, but I estimate it was at least 10 years ago - probably more like 15. Interestingly, it was the consultant in the hospital who got it wrong. He said that it was unlikely to be the drug after all that time. The paramedic, who was the first person to treat me, got it right. He was convinced from the off that it was the drug. He said that he had seen a patient develop a reaction after 20years. Of course, although trained to a different level, the paramedic had effectively become a specialist in emergency medicine

[PMRpro Ambassador in reply to calibriel]

There are some things where I'd rather have a good paramedic than a mediocre doctor! I'm biased of course - my younger daughter is an ECP in Emergency Medicine now after 10 years on the road as a paramedic.