Has it started? What to do?
Posted , 10 users are following.
I contracted Polymyalgia about four years ago. A high dose (30mg) of Prednisone made symptoms tolerable but I was pretty sore and stiff in the mornings. With a few ups and downs I have slowly recovered and gradually tapered down to zero about a month ago. However, I have recently been suffering from stiff legs and pain in the mornings. Initially I thought this was normal stiffness (although I never suffered from this before PMR) from exercise as I had been doing quite a lot of cycling. But I'm now stiff with sore muscles in my legs with no real exercise the day before and I'm wondering if it is PMR returning. It is nothing like a full blown attack but a bit worrying nevertheless. I am not sure whether to take some prednisone, and if so what dose. I was thinking of 5mg to see what happens. Things are further complicated because I am going for a knee replacement operation tomorrow. A doctor friend of mine who has followed my case since the beginning told me that the anesthetist will probably give me a dose of prednisone anyway, given my history of PMR. I don't know if I need to remind him of this or how important it might be to have or not have prednisone before a major operation.
1 like, 7 replies
Anhaga hugh79987
Posted
Your medical team needs to know you were on long term pred as it may mean you need to be monitored to see if you need a bit more of a top up if your adrenal function is still a bit sluggish - you need more cortisol in stressful situations as the operation is. If the operation is tomorrow, why not wait until afterwards to decide whether or not you need to go back onto a low dose of pred? Although it does sound rather as though you should.
All the best for the operation!
BettyE hugh79987
Posted
I was down to 1mg. (it had taken more than four years ) when I had a hip replacement. I was pretty uncomfortable with the hip problem but didn't think it was PMR. Not sure if it's always the case but my pre op consultations included one with the hospital pharmacist who said to maintain my pred. until at least six weeks after the op. As Anhaga says, any operation is stressful. I didn't need to increase it but would have done if PMR showed signs of returning
I had an epidural and sedative rather than GA and would do so again if given the choice. Don't know what is offered for knee replacement. Very best wishes for speedy recovery.
carol_ann35477 hugh79987
Posted
Hi Hugh, you definitely need to let your surgeon and anesthetist that you have been on a long term dose of Prednisone and have only been off it for one month. Personally I would not take any at this time until I discussed it with my rheumatologist. Surgery is a stress-or for your body and your surgeon or anesthetist may feel it is necessary to give you some during surgery.I recently had a knee replacement, was still on Prednisone daily and they topped that up during surgery.I had no problems and the surgery has been very successful. Good luck.
EileenH hugh79987
Posted
I do have to say that if I had been expecting surgery in the near future I wouldn't have tapered off that last couple of mg. It will be a case of wait and see - but you must tell the anaesthetist at least of your history of long term pred use as you may need cover while in theatre, And I would have thought it is unlikely to be prednisone - much more likely to be hydrocortisone but one never knows these days.
Good luck
hugh79987 EileenH
Posted
Hi Eileen,
Thanks, as ever, for reply. I think its been almost 2 years since we last communicated, which has to be a good thing in a way. When I got down to 1mg of pred, which was quite a while before the operation, my surgeon seemed pleased and said that there should be no problems as i was on such a low dose. I thought that it would be a good idea to try and get down to zero, which I did about a month before the op. When i saw the anesthetist, I did tell him that i had been on pred for several years, but he didn't say anything about giving me something during the op and I haven't seen him since. Anyway, I had the operation a week ago and I haven't been aware of any PMR symptoms afterwards so all seems good. Mind you, I've been so drugged up I wonder if I would have noticed! One interesting thing that the surgeon said afterwards was he was pleased that there did not seem to be any damage to the bones from long term prednisone use (he had also given my a couple of cortisone injections directly into the knee). This was not something he had mentioned before, maybe not to worry me. Although I was pretty debilitated when I started PMR , I have been pretty active and maybe this has helped to keep my bones in good shape.
All the best
Hugh
EileenH hugh79987
Posted
Wasn't the PMR that concerned me but the potential for an adrenal wobble due to the stress of the surgery!! And that persists for at least a year after stopping pred altogether.
Glad it went well - and I do like it when I don't hear from people for years 😃
BettyE hugh79987
Posted
Good to have that behind you and do hope the pain eases very soon. Everyone says that knee replacement is much more painful than hip. Hope I never have to find out.
Interesting about your bones. Eight years of Pred left me with " amazing bone density for your age" ( 81 at the time ) I wonder if Pred. is sometimes unfairly blamed and perhaps individual differences my partly explain it.