Upcoming surgery prevents prednisone use

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?

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.

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

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.

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.

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.

I'm in a similar situation. I am having knee replacement surgery the 2nd week of August. My primary care physician had her nurse call me and suggestion I taper and get off of prednisone completely. I am at 5.5, starting 5 tomorrow. They said it slows the healing process - so them I'm thinking okay so that means every 3 days tapering down by .5 on the prednisone until 0 -- it's a bit frightening..... the Ortho surgeon recommended I be down to 5 mg last week, but my primary doctor says no completely off -- so then I'm thinking oh boy what if I have a flare before or after surgery - and how soon after surgery can I take it if needed - but then if it prevents healing..... I'm confused does anybody have any suggestions?

@ninadavis I agree - I am in a similar situation - the ortho surgeon who will be replacing my knee said I could be at 5 mg for my PMR, my primary doctor wants me off of prednisone

I had knee replacement a year ago this past March. I had been on pred and MTX since my diagnosis in 2023. At the time of my knee replacement I had tapered to 8 mg. My surgeon and rheumy discussed my case before scheduling. The surgeon felt comfortable at 8 mg to do the surgery, so we went ahead. It was such a success and no problems with healing. I would trust the surgeon’s recommendation over your primary. He is the one with the surgical experience and dealing with patients on prednisone. I am currently still on pred at 1mg. Struggling with this phase of the tapering. I’ve finally got an order for testing my adrenal function. Good luck with your knee replacement. Be patient with your body and allow a full year to feel completely recovered. I’m so glad I did it. Had a hip replaced in 2024 by same surgeon. Great success! No prednisone issues at a high dose then either.