1. < Polymyalgia Rheumatica (PMR)

Going back to normal life

Posted by debjohn54 @debjohn54, Feb 2 10:06am

I would like guidance on how to return to normal activity that I enjoy. I like playing pickleball and would like guidance as to how to safely return to play as well as knowing when it is safe. Does all the inflammation need to be gone? Thanks. I currently use an exercise bike and walk on a treadmill daily.

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

debjohn54 | @debjohn54 | Feb 4 1:50pm
In reply to @dadcue "Not so many precautions for PMR except for the possibility of causing a flare. Depending on..." + (show)
@dadcue

Not so many precautions for PMR except for the possibility of causing a flare.

Depending on how long you have been on prednisone, there are many precautions that should be taken. Make sure the surgeon and the anesthesiologist know you are on long term prednisone.

When I faced a major back surgery, I was told I wasn’t a good surgical risk because of prednisone. Pain was going to be the deciding factor. I wound up taking 60 mg of prednisone and the pain went away.

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So it is the possibility of flare up that I should be concerned with? I have no upcoming surgeries. Maybe that was directed to another reply? Thanks!

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pb50 | @pb50 | Feb 4 2:42pm
In reply to @lizward46 "My PMR diagnosis coincided with the need for shoulder surgery (a painful bicep tear). My ortho..." + (show)
@lizward46

My PMR diagnosis coincided with the need for shoulder surgery (a painful bicep tear). My ortho Dr told me to not begin my course of prednisone until a week after surgery. My rheumatologist concurred. I believe there could be a problem with the anesthesia interacting with prednisone. You didn’t mention what medications you are taking. It would be best to talk this over with your surgeon.

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The problem with steroids and other immunosuppressant anti inflammatory drugs isn’t a conflict with anesthesia… it is that they make you more vulnerable to infection - NOT something you want to deal with in scenarios of surgery or extensive dental work.
My Rheumy always takes me off my meds or if possible postpones procedure until my blood level is within two weeks of next infusion. ..or postpones both surgery and infusion to when my levels of immunosuppressant is lowest.

For the record, when you are on prednisone or other immunosuppressants you should take care to avoid infection - wear masks, wash hands, avoid indoor crowds during fall and winter seasons for respiratory illnesses. If you get one, the risk is that it can get away from you and be very serious.

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joan7 | @joan7 | Feb 5 8:09am
In reply to @patricianolson "I will be having back surgery for sciatica. Are there are precautions for surgery/anesthesia when you..." + (show)
@patricianolson

I will be having back surgery for sciatica. Are there are precautions for surgery/anesthesia when you have PMR?

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Definitely if you are on Prednisone. I'm finding that it depends on the surgeon. Example: I had to have my Gall Bladder removed and the surgeon was very hesitant to do the surgery when I was on 10 mg Prednisone. I had also torn my meniscus root and when I was suppose to have the surgery back in October. At that time, I was on 20 mgs of Prednisone, but that Surgeon was not worried about me being on the higher dose of Prednisone. His words, "we'll work around it", and monitor your anesthesia and vitals
.

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1 reply
DadCue | @dadcue | Feb 5 2:57pm
In reply to @joan7 "Definitely if you are on Prednisone. I'm finding that it depends on the surgeon. Example: I..." + (show)
@joan7

Definitely if you are on Prednisone. I'm finding that it depends on the surgeon. Example: I had to have my Gall Bladder removed and the surgeon was very hesitant to do the surgery when I was on 10 mg Prednisone. I had also torn my meniscus root and when I was suppose to have the surgery back in October. At that time, I was on 20 mgs of Prednisone, but that Surgeon was not worried about me being on the higher dose of Prednisone. His words, "we'll work around it", and monitor your anesthesia and vitals
.

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My spine surgeon was "reluctant" to do a lumbar fusion because of my long term prednisone use. He seemed to be most concerned about osteoporosis and wanted a bone scan done first. The surgeon was not so sure that my spine would hold all the hardware that would be needed to fuse my lumbar spine.

I had a t-score of a +5 in the area of my lumbar spine. The spine surgeon said I had a lot of bone but "it wasn't good bone."

The issue of delayed healing and an infection were other concerns the spine surgeon had because of my prednisone use. The issue of adrenal insufficiency and potential for an adrenal crisis was a concern for any surgery not just a lumbar fusion.

When I took 60 mg of prednisone and the sciatic pain went away, the criteria for the lumbar fusion was that "pain would be the deciding factor." The "emergency" lumbar fusion was postponed.

My lumbar spine is a disaster zone but I don't have that much pain anymore. I have numbness and lower extremity weakness but not too much pain. Now the surgeon says it "isn't about the pain anymore."

I'm off prednisone thanks to a biologic called Actemra. Now the surgeon says the surgery should be done sooner rather than later. I would still need to skip one monthly infusion of Actemra in order to do surgery. I could probably skip a month of Actemra but I refuse the lumbar fusion.

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1 reply
pb50 | @pb50 | Feb 5 3:29pm
In reply to @dadcue "My spine surgeon was "reluctant" to do a lumbar fusion because of my long term prednisone..." + (show)
@dadcue

My spine surgeon was "reluctant" to do a lumbar fusion because of my long term prednisone use. He seemed to be most concerned about osteoporosis and wanted a bone scan done first. The surgeon was not so sure that my spine would hold all the hardware that would be needed to fuse my lumbar spine.

I had a t-score of a +5 in the area of my lumbar spine. The spine surgeon said I had a lot of bone but "it wasn't good bone."

The issue of delayed healing and an infection were other concerns the spine surgeon had because of my prednisone use. The issue of adrenal insufficiency and potential for an adrenal crisis was a concern for any surgery not just a lumbar fusion.

When I took 60 mg of prednisone and the sciatic pain went away, the criteria for the lumbar fusion was that "pain would be the deciding factor." The "emergency" lumbar fusion was postponed.

My lumbar spine is a disaster zone but I don't have that much pain anymore. I have numbness and lower extremity weakness but not too much pain. Now the surgeon says it "isn't about the pain anymore."

I'm off prednisone thanks to a biologic called Actemra. Now the surgeon says the surgery should be done sooner rather than later. I would still need to skip one monthly infusion of Actemra in order to do surgery. I could probably skip a month of Actemra but I refuse the lumbar fusion.

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Great to have you weigh in! You are always such a great source of intel …

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