Upcoming surgery prevents prednisone use

Posted by ninadavis @ninadavis, Feb 24 8:11am

I have to have major back surgery in 3 weeks (rods, fusion etc) due to severe stenosis. The doctors think my steroids were covering any symptoms. But now with surgery coming up I have to totally stop taking steroids by the day of surgery as they hinder inflammation and inflammation helps the healing process - who knew? The surgeon called my Rhummy and then he called me to tell me how worried he is about what is going to happen to me pain-wise when I go off 7 months before I would if I tapered 1 mg per mouth as he had prescribed. Today I am at 6.5. Does anyone have any suggestions? I am meeting with a PMR Rhummy at Mayo on Monday, so anyway insight you all might have I can ask him.

Just a little background - I got PMR in August and have been tapering down from 20 mg. I was at 7 a few days ago. I have been doing great PMR-wise.

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

@ninadavis

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.

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Have you talked to the surgeon yet? If the Mayo rheumatologist said taking 5 mg would be fine, do you have reason to believe you’d have to take less than 5 mg?

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@ninadavis

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.

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I think your doctors will work something out.

One thing about medical procedures is that the person doing the procedure needs to be comfortable too. You wouldn't want anyone doing surgery on you if they weren't comfortable doing the surgery.

I feel for you. I faced the same predicament when a spine surgeon was "reluctant" to do a lumbar fusion. The surgeon said surgery was urgent but said my prednisone use could cause serious complications. The radicular leg pain was so severe, I would have signed any surgical consent form --- even leg amputation.

Fortunately, the delay was such that alternatives were tried. I took the matter into my own hands out of desperation. I took a big dose of prednisone which probably wasn't the best thing to do. I was honest about it and told my rheumatologist. She was the one who suggested a better alternative.

Five years later, the lumbar fusion is still pending. I am now happy that the surgeon was reluctant. The spine surgeon still says surgery is necessary but now I'm reluctant. The surgeon is willing to do surgery because I'm off prednisone. The surgeon doesn't pressure me to do surgery and is willing to wait until I'm ready.

I sincerely hope you get some pain relief soon. A steroid injection into my spine was what my rheumatologist suggested. I had reasonable pain relief but I still have severe spinal stenosis.

Sometimes I think PMR exacerbates other problems when there is chronic "systemic inflammation." I think the inflammation goes out and finds things to inflame whether the inflammation is needed or not. Sometimes localized steroids work better than systemic oral prednisone.

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@seniormed

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.

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Arrrrrgh. Could be no issue. Could Be a bit risky. I’m worried about aggregate impact. He may feel bad He made you stop and so may load you up OnDecadron.
OTOH, 4mg is a Pretty low dose so even with a second drug, it likely won’t put you in a crisis

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Dear DadCue, I too have thought about amputation, the pain is so severe. I had the steroid injection into my spine and the pain excelearted by at least 30%. Both surgeons said that in my case the epidural would never have worked. I wonder if I went back to 20mg the pain would go away....but like you the spinal stenosis wont go away and I would be like a time bomb, when this whole thing with my back happened I tripped over a threshold at Costco and at 2AM I had to call 911 and I was in the hospital for 6 days. If I don't have the surgery the same thing could happen again. Thank you for your help.

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@emo

Have you talked to the surgeon yet? If the Mayo rheumatologist said taking 5 mg would be fine, do you have reason to believe you’d have to take less than 5 mg?

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I did talk to the surgeon but not since the doctor at Mayo sent his notes. I will call the office tomorrow and ask if he has received them, and then will ask for a conference call with him this friend who works miracles with doctor's offices (he owns a big insurance company for only doctors and lawyers so he is able to get docs to take his call). It is really important that I don't stop the prednisone - to me anyway.

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I have worked with friends accompanying them to appointments as an advocate /wingman.
I think physicians are more attentive to patient
education and questions with an advocate there.
Especially important for my senior group.

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