Fall and increasing pred

[Buchanan16]

After my last post saying how well my mum had been despite her crp and esr rising to 15 and 34 and how we were going to repeat test in couple weeks time she had a nasty fall yesterday.She slipped on the ice putting something in the bin and gave herself a nasty gash on her shin, her elbow and bump on her head.

My dad couldn't get her up so my husband and I ran straight over and we managed to get her back into the house.

She was really badly shaken and we were advised to call an ambulance.

The paramedics were great said she required gash looked at and took her to hospital. Then resulted in 5 hour wait in a frozen A&E dept with my poor mum sitting shaking with shock and cold.

My daughter had to bring her up a big blanket to try keep her warm.

Eventually saw by a lovely doctor who gave her liquid morphine for pain and tetanus jag and after some local anaesthetic he put one stitch followed by numerous steristrips over wound.

Shes to stay of her feet for 3-4 days no shower for 7 days as to keep it clean and dry until she sees gp to get wound checked and stitch removed. Theyv given us extra dressings and steristrips and to keep an eye on it and if any sign of fresh blood or swelling or redness round it to get it checked by gp or back to A&E.

My main question is we hadnt increased pred because of ESR and CRP yet as we were waiting till next blood tests but I gave her an extra 5mg yest and doctor at hospital said I did correct thing and should probably do same for next few days. How long do you think I should stay on increased dose? Should I just keep her on 12 for next week or so then drop back down or stay there till next bloods?

My dad has his procedure today to get squamous cell carcinoma removed from his face and he was a poor wee soul yest he got such a fright and I know my mum will be worrying about that to.

We have said she has to stay in bed today while my dad's at hospital and my sister-in-law will stay with her until we are back but last thing I want is all stress and worry causing a flare and I imagine she will be in lot more pain today once morphine and shock wear of.

[DorsetLady PMRGCAuk volunteer]

oh dear sorry to hear that…

She will ok you stay at increased dose for up to 14 days without impacting on her drop back down to previous dose -so that’s what I’d do!

Same as dealing with a flare…

[Buchanan16 in reply to DorsetLady]

yes that's what I thought

[SnazzyD]

Oh no, what a trial. Depending on her bruises and wound her inflammatory markers may be affected anyway, even a few weeks away. The flare protocol is what she probably needs in the here and now.

The steristrips may well be left in place as it is the shin and healing can be a bit difficult there especially with the elderly and Pred skin. They can be left there until they fall off.

What has she got for pain relief? The aches and pains will likely emerge over the next week in places not previously expected. That is the nature of falls.

[Buchanan16 in reply to SnazzyD]

Yes that's what I thought so I've put anextra 5mg in her box for rest of this week and will do same for nexf and i will update our gp.It's just typical after her looking and feeling so well to.

She has cocodamols but they constipated her so at moment only paracetamols every 4 hours.

[PMRpro Ambassador]

Oh dear - how upsetting for her. I suppose there is no hope of getting her NOT to go out to the bin when it is icy? If it is icy I very happily don't go out because I am so wary of a fall. I'm lucky - my recycling is all on the covered bacony as is the bin bag, organic waste is just outside the back door in a covered area.

I had a nasty gash on my shin a few years ago which needed stitches - when I went to the GP to get them removed after a week or so, she said she wanted to see it healing better so it was another week. If I were you, I would ask the practice if a nurse would come and look at it rather than her going out.

Will she take the cocodamol if you give her a gentle laxative WITH them? She does need the pain to be well controlled and a laxative should be issued with the tablets really!

[Buchanan16 in reply to PMRpro]

eThey are normally careful and moved their bins so they could go out front door to them when icy but she said she didn't realise it was icy on Sunday as it just looked wet. They are both very stubborn hate asking for help and still think they are 20 years younger which is great in some ways but not in others.She did stay in bed yesterday which isnt like her and she said shes not to sore except where fash is which was stinging a bit but I did say she will probably feel worse before she starts to feel better.

Thankfully my dad's procedure went well and he is feeling good apart from 3 inch scar on his cheek so hopefully the fact he's okay will help my mum to. The consultant who did my dad's face said my mum should keep her leg elevated but have a wee walk about house every hour so that's what she will do today she said.

I'm just hoping it doesn't dent her confidence to much.

As for painkillers she seems to be managing with paracetamols but if needed we will try cocodamols.

Thanks everyone for your wonderful advice as usual it's greatly appreciated.

[PMRpro Ambassador in reply to Buchanan16]

Sounds as if she is not too bad then. Your dad would fit in the German male student fraternities well - they have sword fights and a dashing scar on the cheek is greatly valued!!

That's the trouble with good old black ice - invisible ...

[Buchanan16 in reply to PMRpro]

Absolutely he is sporting a cracker of a black eye today to.A quick question my mum was feeling bit seedy yesterday and again this morning which does pass.

Could it be with me giving her n extra 5mg pred?

Apart from that and her ankle bone being sore and wound feeling sticky as she described it she is fine.

[PMRpro Ambassador in reply to Buchanan16]

Does higher pred usually make her feel ropey? It does some people. Made of tough stuff your mum!!!

[Buchanan16 in reply to PMRpro]

Not from what I remember when she was at 12mg before but it may just be leftover fom the fall as it was only on Sunday..ile just keep an eye on it.

[PMRpro Ambassador in reply to Buchanan16]

Of course it might not be enough soon enough to get her ready for the day as cortisol normally would and she improves as the pred level in the blood rises.