Slightly complicated query

[marionofnorwich]

Hello PMR Brains

I am currently three and a half weeks post op from an unplanned hip replacement. Prior to this unfortunate tripping over a wall, I was on 4.5mg having just gone back from 4mg as I felt the PMR creeping back (I also had a cold virus about 6 weeks ago).

In hospital they upped my pred to 9.5mg for a few days and then back to 4.5mg which I continued after I got home until a week or so later ( a week ago) when I tested positive for Covid. As I had a really bad reaction when I got Covid in 2022 (and didn't know about Sick Day Rules) I upped my pred to 10mg for a couple of days and then 7.5mg for a couple more. Today I have gone to 6mg as I don't want to have to start tapering from scratch. Covid has gone now (tested negative on Thursday).

I have recovered well from the hip replacement but now wondering if I was artificially buoyed up by extra pred. I am feeling stiff and achey again, more so than at the beginning of the week but not sure whether to keep reducing quickly back to 4.5mg and just put up with the stiffness till I level out again or stay on a higher dose. Not sure if it is properly a flare or just readjustment after the op and Covid, plus general stiffness from being less active. To make matters worse, I have pulled a muscle in my side (opposite to hip replacement) either from sittingup awkwardly or crutch use, or a bit of both.

At the beginning of the week I was feeling pretty well in spite of having Covid and now have gone backwards. Any insights anyone? Please and thank you

Oh, my question really is what should I do about my pred dose at this point?

[SnazzyD]

Hello, it’s really helpful when you bracket comments to aid the reader to work out when something was happening relative to now.

So, just a basic thought. Since your recovery has been a bit chequered, have you suddenly upped your activity level having felt a bit better or been protecting your pulled side by making the other overwork?

[marionofnorwich in reply to SnazzyD]

I think I pulled my side abdominal muscles sitting up to get out of bed. I have been 'swinging' my legs over and then pushing my self vertical to sit on the edge of the bed but I have realized that if I don't support well enough with my arm on the way up I think it can pull that muscle. Either that or crutch used on that side. I def didn't do anything dramatic not have been over active although have been doing the recommended exercises and walking around the house on flat surfaces. Think it is just a bit of a perfect storm of different muscle uses and COVID added to the op and underactive adrenal glands. I always knew the PMR would complicate what is a relatively straight forward op. The real query is how best to deal with it as last time I was ill I didn't deal with it at all ( through ignorance) with bad consequences

[SnazzyD in reply to marionofnorwich]

Whilst I’d say don’t underestimate new movements that the body isn’t used to, the flare protocol seems sensible because the picture certainly is muddy!

[Longtimer in reply to marionofnorwich]

I can relate to your problems getting out of bed! I couldn't swing my legs out so had been turning on my side then pushing hard with other arm on the pillow. It gave me so much pain I had to go back to Rheumatologist, (Max Yates) he diagnosed bursitis, got me a steroid injection very quickly, it worked quickly too. I have become very weak, and have had to have Occupational Therapists round, very helpful, they got a metal thing (don't know the name!) which slots at side of bed, I can grip easily on that now to get out.....Hope th ings ease for you soon.this Norwich weather isn't helping!!

[DorsetLady PMRGCAuk volunteer]

I think to be on the safe side I’d treat as a flare - you’ve had a lot of different things going on.

Follow the protocol we suggest.. so up to 10mg for at least a week -although 10-14 days would be better. So long as you stay no longer than 14 days you can drop back down to 5mg or probably better 6mg with no issues m.

Whatever dose you drop down to, stay there for a month before you consider next taper.

Had you stay st 10mg for longer previously it might have sorted things out -but then hindsight is great isn’t it? 😊

[marionofnorwich in reply to DorsetLady]

Ok I will go back to 10mg again and then back to 5mg I think and work back down from there. I feel that anywhere between 3 and 5 mg is fair game while I am trying to knock my adrenals into shape. My last 8am cortisol was 238 so my consultant advised staying on 4mg for now (prior to tripping and breaking my hip). I have also emailed him for the advice but a bit wary of yo yo ing about but also wary of big drops in one go hence dropping in stages

[DorsetLady PMRGCAuk volunteer in reply to marionofnorwich]

Following a flare the big drops are okay.. but as I said you have had other things going on which may have muddied the waters... Hope things settle for you... and the side might be DOMS - so paracetamol might help.

[Bcol]

Nothing really to add to the comments from DL but it may also be worth contemplating that although you have tested negative for Covid, it and its after effects, could still be grumbling along in the background adding to your problems.

[marionofnorwich in reply to Bcol]

Yes I think that is what I am wary of as I know that COVID can have random effects but I am not sure whether or not pred is the protection from these as not so sure about the way that the immune system works especially these auto immune situations

[Bcol in reply to marionofnorwich]

The Pred won't "cure" it but going up to sick day rules for two weeks will give your body an extra boost to help counter the symptoms/inflammation.

[calibriel]

I can see you’re dealing with a complicated situation here, and I’m sure you should listen to the wiser heads than mine above who suggest you should proceed with caution and treat it as a flare. However, having recently had a (planned) hip op myself, I know that the pain from the op itself takes a while to go away, especially if because of the COVID you weren’t able to do your recovery exercises. Just a thought. I hope you feel better soon

[marionofnorwich in reply to calibriel]

Thank you calibriel . Luckily the Covid wasn't bad, just cold symptoms and eventually a little cough, although some lower back ache I attributed to the hip was probably Covid and I could do my exercises (and still can) and in fact the hip is now propping up the side with the pulled muscle. The PMR is the real wild card and possibly the impact that the Covid virus has on my immune system, especially as I know that my adrenal glands are under par. I guess just doing a little bit of everything and take it easy! I hope that your hip is recovering well too

[calibriel]

Yup, but like you I’ve had secondary issues 🙄, although the PMR has been quiet so far🤞. Just thankful the hip went well. Hope you begin to see your way through it soon too

[marionofnorwich in reply to calibriel]

Well, it is good if you haven't experienced a flare as a result of the op, which has been my greatest concern. Covid is the other wild card. But I am hoping that by taking it easy but still doing the exercises (and walking round the house) I will head off the complications

[PMRCanada]

Have you tried Tylenol, and if so has it helped? Your dose has been swinging up and down (necessarily given your illness and operation), so your body may be responding to the up and down pred doses. Establishing the lowest possible dose that meets your needs for an extended period may help to settle things down.

Also are your inflammatory markers accurate? If so you may want to hold at your dose and get bloodwork done (ESR and CRP). It may help rule out a PMR flare. A chat with your doctor may also provide some guidance and direction.

I wouldn’t be tapering at this stage until you can better determine the cause of your current symptoms (and tapering while experiencing painful symptoms is not advised).

Could it be pred withdrawal symptoms from dropping from 10 to 7.5 to 6? This too can present with body aches, weakness and joint pain. The challenge is that so many possible causes have overlapping symptoms.

Bottom line I hope you get relief one way or another.