Upcoming surgery prevents prednisone use

I agree. I was just mystified by my dental surgeon saying no to prednisone (I’m not on it routinely) in lieu of Decadron. It’s not as if Decadron isn’t a steroid and as such suppresses immune response.

I had a synovial cyst removed and bone spur removed from L5-S1 in December12, 2023. The prednisone was helping with my inflammation of the cyst and pressure on my sciatic nerve. I was on 12.5 mg prednisone. Back surgeon and rheumatologist did not want me to stop because of my PMR diagnosis. I stayed on and did fine with healing and recovery. Did taper down to 10mg in January in a 7.5mg AM and 2.5mg PM. Not further issues from the cyst.

Very interesting!

I have severe lumbar spinal stenosis worse at L4-5. I also have a long history of inflammatory arthritis. I was off prednisone when a large synovial cyst formed and caused a resurgence of back pain so severe I had to go back on low dose prednisone. Low dose prednisone didn't really help that much.

I know synovial cysts are usually caused by inflammation. The surgeon who wanted to fuse my lumbar spine speculated that severe osteoarthritis due to aging caused the synovial cyst.

I resisted doing the lumbar fusion because I'm fearful about the pain the surgery would cause. I also feared autoimmune flares because I probably would need high doses of prednisone on a long term basis again.

What is interesting - At the time the synovial cyst formed, I was off Actemra, a biologic that was treating my PMR. There were supply chain problems. Actemra was in short supply because it was being used to treat seriously ill patient Covid patients.

When supplies of Actemra improved, I resumed my treatment with Actemra and my back pain improved. I stopped prednisone again. My neurosurgeon didn't really believe me and "strongly encouraged" me to do the lumbar fusion. However, she didn't want to pressure me to do surgery if I wasn't ready. I said that I wanted to wait.

A year later another MRI was done. The second MRI showed the synovial cyst was gone so I had more space in my spinal canal. The neurosurgeon agreed that the lumbar fusion could wait but she didn't know for how long.

I'm inclined to believe the synovial cyst was caused by autoimmune problems when prednisone was stopped. The severe spinal stenosis didn't go away ... only the synovial cyst did.

I interviewed two surgeons and one was ortho and one was neuro, the neuro said no need to go off prednisone. The ortho, who I am going with, is adamant. It's a terrible fix to be in.

The neurosurgeon that wanted to do a lumbar fusion said I would need to be off prednisone and Actemra for a month before and a month after surgery. The neurosurgeon said I would be given corticosteroids only "as needed" for adrenal problems but otherwise not. Pain would be controlled with conventional narcotics as needed after surgery.

A month after surgery, I could resume treatment to suppress my immune system again but that would be decided by my rheumatologist ... not the neurosurgeon. I haven't done the lumbar fusion yet.

I had knee replacements done a long time ago while on prednisone. The orthopedic surgeon said I didn't need to stop taking prednisone but he said precautions would be taken to prevent an infection and reduce the risk of an adrenal crisis. I got IV steroids during surgery and after surgery until I resumed prednisone again.

I had "aberrant healing" after my knee replacements but no infections. My prosthetic knee joints "look good" but the soft tissues that surround the joint don't. The orthopedic surgeon advised me not to have surgery again unless absolutely necessary.

The orthopedic surgeon blamed my "deranged immune system" for the aberrant healing.

My docs had extensive discussions regarding my long-term steroid use prior to my TURBT on Jan. 26. My internal med doc, who had to sign off on surgery, consulted my rheumy and my oncologist (I have Smoldering Myeloma also) as they discussed actually increasing my Prednisone use temporarily to 20 MG (was on 15) to prevent my body going into shock. They decided not to. While I was in surgery, they actually gave me an additional low dose of steroids in the IV solution for this purpose. But I wasn't dealing with an my inflammatory situation complicating healing. I had shoulder surgery a few years ago, this issue never came up and I healed normall.

I tore my meniscus root in my left knee in August, 2023. After my consultation with the surgeon in September, I was scheduled for surgery in October. After 3 1/2 years of being very sick and somewhat bed ridden the last year, I was finally diagnosed with PMR a week prior to my knee surgery. Because, at the time, I was experiencing double vision and headaches, they scheduled me to have an emergency bilateral temporal artery biopsy (for possible Giant Cell Arteritis) two days before my knee surgery. Because the knee surgeon was not comfortable with putting me under anesthesia within a couple of days of being put under for the biopsy, my knee surgery was cancelled and rescheduled for November. At no point did the surgeon express any concern about me being on 20 mgs of Prednisone or my recouping from the knee surgery. He said they would adjust the anesthesia accordingly. I am 61 years of age.

I was also having Gall Bladder issues since May 2023, but the General surgeon told me in May he would not do the surgery, because he said he only did it when people were in severe pain not in discomfort, even though my GI doctor recommended it (I was very upset & told my GI doctor). As luck would have it, in November, I became very sick because of my Gall Bladder and could not eat, etc. I had to have another emergency surgery for my Gall Bladder this time. I called the knee surgeon and he recommended that I have the GB surgery done first before my knee surgery. Surgery for my knee was once again cancelled. It took me a while to recoup. Call it bad luck, I call it crazy. Then in February, I rescheduled my knee surgery again. Happy to say I am scheduled to have my knee surgery in three weeks from today. I am now down to 5 mgs of Prednisone and doing well, but going down from 7.5 mgs to 5 mgs was extremely painful for several days. By the third day, I took 2 Advil I felt better within an hour and within 2 days the pain was gone (could have been a reaction to coming off the Prednisone). I'm going to talk to my Rheumatologist after my surgery and see how she wants to wean me down off the Prednisone now that I'm on 5 mgs. I'm currently seeing a new PA in the Rheumatology group because my original PA is out on leave. The fill in PA goes strictly by blood work inflammation numbers and my old doctor went by the numbers and by how a person feels. I am leaning towards weaning by only 1 mg per month from the 5 mgs, since I never want to experience that level of pain again (on a scale of 10 it was a 12).

So 6.5 mgs does not seem like a lot to me, but it depends on whether the doctor is willing to do the surgery. I have heard that some doctors won't even consider surgery if you are on Prednisone. So it all depends on the surgeon. Luckily my knee surgeon was ok with surgery at 20 mgs so he'll be fine when I'm at 5 mgs. However, my Orthopoedic Surgeon is and has been the surgeon for a major Pro-Football team for a long time, so I'm sure he has a lot of experience dealing with various injuries and situations.

Hope this helps. Let us know how you make out today at Mayo!

I met with Dr Abril at Mayo today, he told me that by going off prednisone I will have the GCA risk. He told me that at Mayo they routinely operate on patients who take 5 mg. prednisone. He sent his nots to my surgeon, I hope they convince him. I just wanted all of you who have helped me to know.

Although I consider myself a rule follower except for the speed limit, I am contemplating not going lower than 5mg and not telling (lying) to the surgeon. Not my style but I am in so much pain that having my 87 year old mother drive me to different surgeons to interview may be beyond what I can handle.

Best to let the anesthesiologist know that your adrenal response may
be suppressed from prior steroids. They might actually give you decadron
or hydrocortisone if they are concerned about perioperative stress.