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Having surgery and wondering about pred dose

Posted , 4 users are following.

Mrs.Mac-Canada
Mrs.Mac-Canada

I thought I had posted this a couple of days ago but didn't get a response so thought I'd check and I guess it got lost in cyperspace.

I had arthoscopic surgery yesterday on my ankle.  Not a big thing just cleaned up a couple of bones that had grown extra bone and was impeding the bending of my ankle.  Dr. thinks it is a result of gout and if I keep the uric acid level managed and keep active it should grow back - at least for a good number of years.

I have been using Frau H's lol method of very slow decreasing the pred. Started pred at 20mg about 20 months ago and other than a couple of hickups (one self induced stress) was successful in getting down to 5mg then had to use the very slow, almost stop method which has been very successful.  I am now at 4mg and have been for 3 weeks  I'm not sure what to expect with the surgery and realize that we are all different but I was wondering, if the pain returns, should I increase and/or stay at the 4mg until I'm back to normal with my ankle.  I wouldn't increase unless the pain is like a flare and affects most of my body.

I'm sure many of you have experienced this and greatly appreciate hearing your stories.     Thank you,  Diana

 

0 likes, 14 replies

14 Replies

  • Oregonjohn-UK
    Oregonjohn-UK Mrs.Mac-Canada

    Posted

    Any pain from the ancle is not going to be reduced by preds and I think you will have to see if it's affected your PMR as it takes a few days to settle down.  Hope all goes well
    • Mrs.Mac-Canada
      Mrs.Mac-Canada Oregonjohn-UK

      Posted

      Yes, thankfully no pain. Hope it continues.  Dr. gave me something for it if things change but fingers are crossed.

      Also gave me some Let us,  an anti inflammatory I've never used before. I'm only on 4mg of pred and a little worried about taking it  but my uric acid level is high and I know he's concerned about that especially with the additional swelling from the surgery. Will take one today and check with him tomorrow. 

      We live just outside of Vancouver, BC so we were almost neighbour's once upon a time.smile 

    • Mrs.Mac-Canada
      Mrs.Mac-Canada

      Posted

      That would be Lertus.   Darn you auto correct!!!
  • Nefret
    Nefret Mrs.Mac-Canada

    Posted

    I had a knee arthroscopy last year when I was on 5mg Pred and I was fine.  I had permission to raise the dose if I needed to, but it wasn't necessary, I had no PMR problems at all.

    If the event causes your PMR to flare, then you might need to go up to stamp it out, but as Oregonjohn has said, steroids won't help the surgery pain.  If you don't need to raise the dose then I would suggest wait and see.

    Incidentally, here in the UK we do have some surgeons who won't operate, even in a minor way, if you are above 5mg Pred and equally we have those who insist you put the dose up prior to and immediately after sugery, whatever your dose may be!  Confused?  You bet!  I'm lucky that I am allowed to go my own way.

    • Mrs.Mac-Canada
      Mrs.Mac-Canada Nefret

      Posted

      Thanks Nefret,   I wasn't stressed about the surgery except having it in Merida, Mexico and I don't speak very much Spanish.  I had it yesterday and made out just fine.  My Dr. Does speak English well and explained everything to me.

      I had a spinal with some sleepy IV but kept waking up and asking if I could watch so I think they finally gave me a good dose and knocked me out.  Still a little groggy but absolutely no pain in my ankle and the Dr. said he removed quite a bit of the extra bone. Will see him tomorrow for a change in bandage  and a chat about what's next.  Can't wait to be up and around.  

      We are so impressed with the medical system here.  Costs are much than in Canada and I don't know many places you can drop into your Ortho office and end up with a 1/2 meeting. This is at a hospital approved for the US President and is highly regarded by friends that have gone there.  3 or 4 days 5 days to get in to surgery. Depending on the surgery and press op requirements of course. 

      Feeling good so will stay a 4 for now.

      Thanks again and good luck with your decreases. Diana

    • EileenH
      EileenH Mrs.Mac-Canada

      Posted

      Hehe! Here you get the spinal - and nothing else unless you ask for it. So when they nailed/screwed my knee and leg back together I was fully awake with headphones and a CD. Not that I ever got to listen to it as the (4) anaesthetists were desperate to practise their English with me. The following year in the UK when they removed the metalwork because it was being irritating and causing trouble I had to ask for the spinal - she was sending me for a GA - and was then given 2 temazepam so I slept through it. BORING! 

      Get well soon!

  • EileenH
    EileenH Mrs.Mac-Canada

    Posted

    Definitely stay at the 4mg until you are sure the stress of the op hasn't prodded your PMR into greater activity. 

    It used to be said that the dose should be increased a bit if you were ill, whether that was infection or trauma, and if you were to undergo surgery they often gave a higher dose for the few days around the procedure. More recently it has been decided that isn't necessary - the fear was of an adrenal crisis and really that is so rare they decided it wasn't worth upping the steroids, just observe the patient for any signs.

    However, the effect of stress on PMR is a different matter altogether. Even overdoing it for a couple of days can lead to a minor flare and whatever you have done it is an insult to the body. How do YOU feel? I had a stress ECG done a couple of weeks ago that involved using drugs to put stress on my heart - I felt decidedly strange, achey and wobbly for a day or two but I didn't need to up my pred dose. If you have been stable for 3 weeks I would think you are probably OK but you can never tell. If you do feel "flarey" you could take 5mg for a few days and then go straight back to 4mg afterwards. Even a few days at a higher dose shouldn't pose a problem with returning to 4mg.

    • Mrs.Mac-Canada
      Mrs.Mac-Canada EileenH

      Posted

      Hi Eileen or do you prefer Frau Hsmile

      Thanks for your advice on the decrease back to a lower dose after a few days bumped up. I never knew quite how to handle that. Going to give it a bit and see how it goes before I make any changes.  My hubby is waiting on my every need so may as well enjoy. What a sweetheart he is

      I don't know about drugs used in stress tests.  Is that used to see if you are tolerating a new treatment?  Kind of scary to me....

      Thanks again and hope your heart is OK

      Diana

      ..

    • Nefret
      Nefret Mrs.Mac-Canada

      Posted

      How times have changed!  I had an op to remove extra bone growth on my foot, oh 20+ years ago now.  Plaster casts, non-weight bearing for 6 weeks and total confusion when my foot absolutely rejected any kind of cast!
    • Mrs.Mac-Canada
      Mrs.Mac-Canada Nefret

      Posted

      It really is amazing  I will be on crutches for 2 or 3 weeks and not supposed to bear weight for a few days but will get all that confimed tomorrow.  There was a time when I wouldn't consider this surgery and now it seems so easy (so far!!)  The Dr. said I will start physio soon and he knows I am going back home (Brrrrrrr...) on Dec 12th.

      We have come so far with so many medical procedures and diseases and now it's time we figured out about this or these auto immune diseases that mystify us. 

    • EileenH
      EileenH Mrs.Mac-Canada

      Posted

      I'd take great advantage of any offer from a spouse to wait on me hand and foot! Not going to happen here any time soon though ;-)

      One way of doing a cardiac stress test is to stick you on a bike or a treadmill and see what your heart does while you are exercising via an ECG. They did that and the ECG was not entirely normal. So in this case they used drugs to make my heart pump much harder so they could use a fancy ultrasound machine to see what the heart was doing and how the blood flow was. All normal - not going to have a heart attack and need a stent anytime soon, that will be written on the notes so when they do an ECG and see "OMG, there's a suppression of the ST segment..." they won't panic next time because it is because I'm female - we women are different. But we know that... 

    • Nefret
      Nefret EileenH

      Posted

      Hmmm...........Eileen, just as well I don't have any heart problems at the moment........I couldn't sit on an exercise bike if I wanted to (believe me, I don't).

      And I am with you........anything which renders me immobile is going to create an instant menu of soup and toast.  

    • EileenH
      EileenH Nefret

      Posted

      That is the purpose of the drug-induced stress test! The first was done on a bike - I gave up just before the end as the legs just gave out on trying to cycle up the mountain! But anyone who can't do the physical version should be tested with the medication version. For me I assume it was so it made it possible to use the ultrasound - he wouldn't have been able to get the image if I had been moving on a bike.

      I remember someone on one of the forums being sent for a stress test and told off roundly for not trying when really it it was a case of "can't because of (physical condition) ..." and she should never have been sent for an ordinary one. 

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