Prednisone and Surgery: I have Polymyalgia Rheumatica and need hip replacement surgery.
Posted , 10 users are following.
I just found out that I have Polymyalgia Rheumatica. They put me on 20mg of Prednisone per day, and it has eased the symptoms considerably!
I need a hip replacement surgery. The Rheumatologist says they will not do the surgery until I get my Prednisone dose down between 5-10mg per day. A three month taper from 20mg to 5-10mg is what they are recommending.
Does anyone have experience with surgery and Prednisone? I have been waiting on this hip surgery for 9 months, but now the PMR and prednisone is throwing a wrench into the whole plan.
thanks in advance!
0 likes, 23 replies
MR._BELLA LarryM
Posted
Eileen would probably be the one to give you some good answers on this. Reducing that fast is not good.
EileenH LarryM
Posted
It might be worth shopping around and don't believe everything rheumies may say about hip surgery - there are surgeons who will operate at higher than 10mg. The main problem of reducing the dose from 20 to 10mg in 3 months is that that may allow the PMR to break through and whatever else you may be able to do with PMR, mobilising with crutches post hip-op is NOT one of them unless the PMR is well under control. You may be lucky and be one of the people who needs well under 10mg as your longer term dose and so the reduction at first down to 10mg goes very well - but unfortunately they tend to be the exception rather than the rule. All you can do is try.
https://patient.info/forums/discuss/pmr-gca-website-addresses-and-resources-35316
is the link to our resources post - and there is a link there to the HealthUnlocked PMRGCA forum where we have quite a lot of people who have gone through joint replacement surgery and some at over 10mg I seem to remember.
But do look around and see if you can find a realistic surgeon who knows something about the muscle problems with PMR (two big requirements I realise!!!)
pam7653 LarryM
Posted
LARRY,
I've had 2 foot surgeries and an ear surgery while on prednisone. They always give me a hydrocortisone shot before each surgery. I've never had a flare after my surgeries. I was worried but never had an issue. I live in the states.
ptolemy LarryM
Posted
Hi Larry I am so sorry you have PMR and also need a hip replacement. I had PMR and have just had a hip replacement. Have you talked to your surgeon about the steroids? My surgeon wanted me down to zero but I negotiated 5mg. They tend not to like taking risks as pred does slow down healing and leaves you open to infection. Most surgeons are fairly risk averse as it is quite a serious operation, so you cannot blame them. It does seem they also take into account how fit you are too, so probably fitter, younger people could be allowed a higher dose of pred. I was worried silly they would cancel the op as I was in such agony.
LarryM ptolemy
Posted
Thanks Ptolomy,
Your situation sounds so much like mine! I have been in agonizing hip pain for 9 months, but the high inflammation blood markers and anemia caused them to do a colonoscopy, 2 endoscopies, and other procedures to rule out cancer, internal bleeding, etc.
Finally, 2 weeks ago I saw a rhumatologist who narrowed it down to Polymyalgia Rheumatica. He started me at 20mg Prednisone daily, and will reduce me to 5-10 through March.
You make a good point in that i need to discuss with my Orthopedic surgeon what dose of Prednisone he is comfortable operating on. I am 64, and have been in very good health all my life. I was hiking a mountain 3 times a week until March, when my left hip suddenly made it impossible to walk without a walker.
So i will take your advice and discuss with the orthopedic surgeon. Thanks! Larry
ptolemy LarryM
Posted
That sounds sensible, I saw a rheumatologist before my hip op and she was hopeless and slowed down the hip op in my opinion. I was anaemic and had a blood transfusion immediately after the hip op. Have you got a surgeon lined up? I found the important thing is to find someone who has done lots of hip ops!
LarryM ptolemy
Posted
YesI have a hip surgeon who does only hip surgeries, and has done hundreds of them.
I sent him an email this morning asking about his opinion on Prednisone dosage going into surgery.
Hope your hip surgery went well!
ptolemy LarryM
Posted
My hip surgery went brilliantly. I am sure I should have been more careful. My sister came to stay for a few days to help and decided we should go out to lunch the day after I got home. I think it was a bit OTT as I was quite tired after the op but it was nice it was all over. Let me know what your surgeon says, he sounds good.
irene_88946 LarryM
Posted
Hi Larry,
My daughter has psoriatic arthritis. She had to have a hysterectomy. Her doctor pumped her full of prednisone during surgery to prevent her condition to flare. I know her situation is much different than yours but I find it interesting that some surgeons approach our conditions so differently.
Much luck on your surgery & recovery.
EileenH irene_88946
Posted
It is the difference between being on long term pred and short term use during surgery. Long term higher dose pred may predispose the patient to several things including poor healing post-op and susceptibility to infection.
JanetGarrett LarryM
Posted
LarryM,
Sorry about your PMR and pending hip surgery. I am 56 and diagnose last October 2017 following many months of upper and lower pain. I just underwent emergency eye surgery 7 weeks ago prior to Thanksgiving. I was on 10 mg prednisone. I have other health conditions that make my tapering slower than most 14 months so far from 17.5 mg. Best of luck to you and Happy New Year.
Janet
LarryM JanetGarrett
Posted
Thanks for your response Janet. My orthopedic surgeon has agreed to do the hip surgery when I get my dosage down to 10mg Prednisone.
Larry
ptolemy LarryM
Posted
That is fantastic news. It is easier to get down to 10mg than reducing at the lower levels I think anyway.
JanetGarrett LarryM
Posted
That's great news Larry. Today I received a phone call from my rheumatologist office with results from my dexa scan on New Year's Eve. Today is into the new year I have a new diagnosis LOL osteopenia. Make sure you look it up and are getting the weight during exercise calcium calcium vitamin D the right Foods avoiding the wrong Foods while taking the Prednisone for the PMR. I am 56 I've only been on for 14 months. They say 50% of Americans over the age of 50 technically qualify what does diagnosis but those of us on prednisone apparently requires treatment which options do not look so hot in my opinion after researching for hours tonight. Take good care Janet
LarryM JanetGarrett
Posted
Hi Janet,
Sorry to hear about your osteopenia diagnosis!
I have had osteopenia for over 10 years. I went through Fosamax treatment In 2008- '09, and my condition had not deteriorated much in 10 years. I am now back on Fosamax . I have been on Calcium/ Magnesium/ vitamin D supplements since my initial osteopenia diagnosis. My priority is to get the hip replacement surgery so that I can get back on my feet and exercise. Being on a walker really holds me back. I will keep my attitude positive, and be as proactive as possible.
Take care!
EileenH JanetGarrett
Posted
If all you have is osteopenia it depends on the figures whether it requires "treatment". I have osteopenia, figures of -1.1 to -1.3 originally. After over 7 years of pred they are still better than -1.5. And that was merely taking calcium and vit D supplements. I know people who didn't even have calcium/vit D supplements whose BMD didn't change after 5 years on GCA dose pred.
JanetGarrett EileenH
Posted
Hello again Eileen,
Does rheumatologist is in it must be treated mode. Since the receptionist called me yesterday I don't have the figures at hand yet. This doctor is ultra conservative with the use of prednisone has told me she will not continue to prescribe she wants me off not at the lowest dose but off ASAP. I am at 9 mg. I have taken calcium and vitamin D for a good part of my adult life. I'm wondering if since the data said 50% of Americans over 50 have this osteopenia it's just normal it's just normal progression rather than the prednisone? My first rheumatologist October 2017 never ordered a dexa so I don't know what changes may or may not have happened in these 14 months. I'm very concerned about what to do Fosamax or not ? the thought of any more heavy drugs, especially when she keeps touting Methotrexate and Plaquenil, really concerns me. I don't see any way around having to find another new rheumatologist before a long like our friend Raven here. Thank you for your input. Janet
EileenH JanetGarrett
Posted
I'd be hi-tailing it out of her office. That sn't how PMR/GCA works and if she gets you off pred asap all that will happen is the symptoms return.. Why on earth diagnose PMR, for which the only realistic management is corticosteroids, and then tell the patient they have to stop taking it? The median duration of steroid management of PMR has been found to be 5.9 years:
https://www.medpagetoday.com/rheumatology/generalrheumatology/66912
http://rheumnow.com/video/dr-kathryn-dao-steroid-duration-requirements?utm_content=buffercb736&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
If it is good enough for top names at the Mayo - it should be good enough for anyone.
JanetGarrett EileenH
Posted
Good evening Eileen, thank you for your post and links . I actually printed and supplied opposed to my rheumatologist. She picked it apart because She picked it apart because of the way that the study was performed. I did however get my numbers today which I think are interesting. My T score for is an average between the two hips is -1.7. the results for my spine were - 0.0
EileenH JanetGarrett
Posted
That is sheer b£**&y mindedness - there are problems with retrospective studies but I can assure her that after being on PMRGCA charities and forums for over 10 years, those figures reflect what I have seen. PMR definitely does NOT only last the mythical 2 years they want it to last - and I know a load of top research people in the field, besides Eric Matteson and co, who agree.
With a result like that for a dexascan I would be studying Anhaga's story, it is on here somewhere but not sure where, this is a link to the same text on the HealthUnlocked forum:
https://healthunlocked.com/pmrgcauk/posts/137578304/my-osteoporosis-journey
As she says, trying that for a year got her from -2.1 to -1.6 where no intervention was required - only slightly better than you are starting at. NO DRUGS with doubtful long term effects...
JanetGarrett EileenH
Posted
Thanks for the information Eileen. I will look Anhagas story. I decided to try the K2 supplement and ordered it last night when I reordered my magnesium.