I am having joint replacement on my ring finger in a month. Am taking 7.5 mg of pred & was wondering should I stick with that & not try to decrease until after the surgery?
Mary, sometimes it's necessary to actually increase the dose when undergoing surgery. Certainly don't consider decreasing it at this time as any surgery can place stress on the body. Also don't attempt to decrease the dose for a good week or two following surgery. Make sure those treating you are aware that you are on long-term steroids. Hope it all goes well for you.
Thank you MrsO. Good advice. That is what I will do. Hadn't thought of increasing a bit, but feeling slight shoulder pain so may increase 1/2 mg. before surgery. I had the surgery on the other ring finger a few years ago. Kind of weird that it should happen on both ring fingers. I didn't have PMR then or if I did I didn't know it.
Mary, a lady on another forum recently underwent some surgery for which those treating her said they didn't think she needed to increase her dose - if I remember rightly she was on a similar dose to you. She began to feel unwell during the surgery but luckily was able to suggest that she needed some more steroids - they obliged and all was well.
Your present dose of 7.5mg is about the equivalent of natural steroid (cortisol) that our bodies produce when well, but that production will have been suppressed by the higher dose streroids. At this point that natural production has to start kicking in again which is why it is always recommended that we reduce very slowly from this level, otherwise we will have a shortfall of cortisol in our bodies until the natural production catches up. Therefore, any stress placed on the body at this time for some people on steroids, such as surgery, could mean a higher steroid dose to cope. That's why it is necessry for your medics to be aware that you are on steroids.
MrsO - The lady you mention had 2 eye operations in close succession and the second was far bigger than the first - it was almost certainly the strain of 2 together that caused the problem. The thought of one eye op makes my toes curl a bit - 2 just seems plain greedy 
Mary - It is essential to discuss it with the surgeon and the anaesthetist and make sure they know you have been on long-term steroids as well as telling the nursing staff so they are aware if you are poorly afterwards. It depends on the surgeon, some like to give pred during the procedure while others work on a wait and see approach. It used to be normal to increase the dose over the period of surgery but then it was decided it wasn't essential and it is usually done on a case by case basis.
But certainly, I wouldn't go about a reduction just before surgery. It is best to be stable on a dose that you know you are OK on.
Thanks Eileen, I see my rheumy today & will address the issue. It's only a finger & an outpatient surgery, but still. I am having a heck of a time reducing from 7.5 anyway. Did bllod work a few days ago & the numbers are good, but when try to reduce shoulder pain seems to want to return. Not bad pain, but pain. Maybe I should try a little harder? Not sure. Been on pred for a year now.
To be down to 7.5mg after a year is pretty good. And no - trying to force a reduction will just have you back to even more because of a flare.
Thanks Eileen. I always go with a "don't poke the bear" kind of attitude, but I think my rheumy would like me to reduce a bit more. It's helpful to have your input. I think I will stick with the dose I am on now until well after the surgery.
I was due to start reducing sometime when I was due for day surgery so stayed at 12 mg - at that time Dec14 - it saw me thru' surgery but I did stay at this dose for another month after.
Three days ago I had an extraction of a tooth, I upped my reduction (or more precisely delayed) it for a few days before continuing the slow reduction period. I did wake up on the day I was due to 'visit' the dentist with a slight neck and shoulder ache but it went off in the afternoon after the stress of the 'visit' was over. Didn't do my Tai Chi that morning either!!
Thanks, yes it makes little sense to encourage a flare in any way. Tai Chi hmmmmmm maybe that is what I am missing. I keep telling meyself I will start doing yoga again, but procrastinate.
I'm not into any mystical aspects of Chinese but as a very gently exercise. I also find it very relaxing - it is claimed to reduce stress.
Yes, there will be no turning myself into a pretzel or anything like that, but the stretching is very useful & stress reducing. I even have a tape. Just need to do it.
MrsO swears by tai chi - she credits that and Nordic walking with her sense of balance improving.
Hi Mary,
Hand surgery is usually an in and out the same procedure. Probably do not have to increase you pred before surgery, You may have to increase your dose for a short period post op becuase of stress. That is your decision. Either the surgeon or the anesthesiologist will give you a "bolus" intravenously of corticosteroid usually in the operating room. Ask what they give and how long it lasts.
If your are nauseated post op ask for medicine in the recovery area. There are good iv meds available.
Don't forget to take your notes with your questions.
Charlie 44644
Thanks Charlie, yes oddly enough, I had to have it done on my left ring finger two years ago, but wasn't taking pred them. Went to see rhuemy today & said the type of swelling in my finger would not be associated with PMR so wants me to have an MRI before surgery. Just FYI I thought it very interesting he thought of it. Also in the US medicare is changing so it now has to be done in a hopsital as opposed to an outpatient clinic. Will be more costly for ins. etc. Pretty sure the surgery will happen anyway.
Mary,
Are you saying that Medicare requires that the surgery has be done in a hospital setting or the MRI has to be done in a hospital? I am covered by Medicare.
Charlie 44644
I am saying that the surgery has to be done in a hospital now, which a few years ago was done in as outpatient surgery & not in a hospital setting, which I very much prefer. No biggie, but just something that needs to be noted. It's way more expensive for ins. to do it in hospital. It just seems like a strange change.
Hi Mary
The hospitals have been losing a lot of there surgery to independent surgery centers , especially the Orthopedic groups who, in my area, have their own day surgery centers. Sounds like a deal between the Feds and the hospitals.
Charlie 44644
Oh very interesting. Yes, that is exactly what is happening here. These orthopaedic surgeons did have their own surgery center & I was surprised to hear it was no more. Hospitals losing too much money & surgeons getting more than their share perhaps.
It may be there have been problems requiring hospital admission - day surgery in a hospital shouldn't cost significantly more than it being done in an office-based practice with the advantage that emergency care is there on-site if required so no emergency transport would be needed. My husband had hand surgery done here in Italy recently and ended up needing to stay overnight - since he was in hospital anyway it was no big deal.