Upcoming surgery prevents prednisone use

I’m sorry about having to juggle both the back surgery and PMR, but that’s great that your surgeon and rheumatologist are collaborating, and you have an upcoming appointment to discuss. It suggests they’re both taking it seriously, which isn’t always the case.

Hopefully, the rheumatologist will be able to guide you. That’s not something I know about in detail, but at least from my experience with PMR (I am a caregiver for my father who has it), I would also be very concerned about stopping the prednisone cold turkey. I wonder if it’s really necessary to stop it though? You’re on a relatively low dose of prednisone already.

My dad was diagnosed with PMR two weeks before he had a severe stroke =( At the time, he was on a dose of 30 mg prednisone, which he continued while in the hospital even after vascular surgery to clear the clot. Neither the neurosurgeon, neurologist, hospitalist, nor rheumatologist at the hospital questioned this (and neither did I—I didn’t realize it could be an issue). They were actually more concerned about finding a way not to interrupt the prednisone while he couldn’t take medication orally.

In the 6 weeks he was hospitalized between the acute hospital and acute rehab facility, he had two PMR flares with his ESR shooting up to 100 or more. I think the severity of the PMR flares did more to hinder his rehab and recovery than the prednisone. It was agonizing to see him at the same time trying to recover from post-stroke/post-surgical pain and PMR pain.

I know there are alternatives to prednisone. But most rheumatologists don’t like to change up medications if a person is already stable since everyone can respond slightly differently. It sounds to me like your care team needs to find a way that they can manage both.

I’m wishing you all the best!

Very helpful information.

Well I’m confused about the “inflammation promotes healing” theory. It is part of the healing process but not necessarily a productive part. As a matter of fact, I’m having jaw surgery in the near future and the dental surgeon wanted me off Prednisone “because it suppresses the body’s ability to fight infection …. we will give you decadron to control swelling”. Proving only that this surgeon knows nothing about steroids. Decadron was also given routinely when I was in the OR during surgeries like Harrington Rod implants. To control swelling that increases pain.

Here’s some data from Science Direct for your reference. I would maybe have your Rheumy ask your surgeon what they plan to use to control swelling and whether that could be prednisone.
https://www.sciencedirect.com/science/article/pii/S0022202X15332917#:~:text=Indeed%2C%20in%20experimental%20models%20of,predisposes%20tissue%20to%20cancer%20development.

I agree—it’s a really broad, generalization. Inflammation does promote healing in the right amount, but excessive inflammation causes problems! And prednisone doesn’t quash all inflammation; otherwise no one on it would ever heal from the common cold or a paper cut (not to minimize surgery).

It’s all about weighing the pros and cons, and sometimes it seems non-rheumatologists are very hesitant about prednisone use and at such high and long-term doses because in other specialties you’d want to avoid it… But with PMR, the steroid use is warranted and a PMR flare isn’t exactly a minimal risk. While my dad was in the hospital, I was so stressed out because he had his stroke over a holiday weekend so everything was taking longer: Finding a rheumatologist to consult on his case, getting someone to write an order for IV steroids because he couldn’t take oral meds, getting a pharmacist to do a conversion of his dose into the IV steroids. He was off it for almost two days and has a huge flare anyway!

It may be that Decadron will do just do just as well to suppress the PMR pain- I know it’s strong because I was on it to reduce swelling when I blew a lumbar disc and was on home traction. But it would be a high wire act to transition from one to the other I would think.

Anyway - doc to doc chat I think is necessary

Wow, that is an amazing article on wound healing and I am so glad there are not enough lizards at this time of the year to collect their dung. I am memorizing some of the larger words so I will sound like I know what I am talking about when I argue for at least a small dose - such at 4mg. during my healing.

I’d start at 20 and taper down to 4! 🙂

The really interesting paragraph as someone whose quality of daily life is largely dictated by my inflammation levels, was this one:

Experimental studies established the dogma that inflammation is essential to the establishment of cutaneous homeostasis following injury, and in recent years information about specific subsets of inflammatory cell lineages and the cytokine network orchestrating inflammation associated with tissue repair has increased.
Recently, this dogma has been challenged, and reports have raised questions on the validity of the essential prerequisite of inflammation for efficient tissue repair. Indeed, in experimental models of repair, inflammation has been shown to delay healing and to result in increased scarring.

I too was scheduled for a hip replacement last September but since I was on Prednisone (20mg) my surgeon did not want to proceed because of the increased risk of infection. Thankfully my hip is not causing me too much pain, probably because of the Prednisone so I was ok with not doing it.
I’ve just started Kevzara and will hopefully be able to taper down more quickly. I’m currently on 10 mg and able to do most things with relatively little pain.

It is complicated to prep for non-emergent surgery when we are on long term steroid treatment.
Will it be necessary to wean off prednisone completely
or is there an acceptable lower dose? Is there a cut off
point for lesser risk of infection and healing problems?
The surgeon is the ultimate arbiter of the go ahead decision and it will depend on their experience.
The anesthesiologist is also part of the equation and needs to be concerned with perioperative adrenal support. The doctors involved may need to confer with input from endocrine and infectious disease colleagues.
Team consensus may take time and planning by group effort with patient involvement.

.

I had a hip replacement while taking 2 mg. of predisone and I recovered much faster than most people my age from the surgery, but I am very active and eat an exceptionally healthy diet (whole foods, organic, primarily plant-based, high in anti-inflammatory foods). I had a very mild case of PMR to begin with and started on 10 mg. It took me about a year to taper off of it.