hi everyone,
pin November I had a total hip replacement on my left hip. As I have had pmr for almost three years I have been up and down the steroids as most of you will understand. Obviously my immune system is shot so a few days after the surgery I was found to have a deep infection in the hip and had to have it taken out. I am now on a six week anti-biotic course and am waiting to go back into hospital to have my hip joint redone. I saw my surgeon a week ago and he said he was going to write to my rhemy and ask him to completely take me off the steroids as it was not good having surgery whilst having no immune system. Of course I said that it isn't that easy when I have been trying to reduce for the past three years. He didn't seem to think it was a problem, all he is concerned about is me nor getting another infection. Of course this has totally panicked me. I am now waiting for my Rheumy to contact me as well as waiting to go back into hospital. Can anyone tell me if they have the right to just take me off the pred without my say so. My Rheumy isn't very sympathetic to my pain as it is, all he ever says is that he wants me to reduce at a quicker rate than I am ready for. I am following the slow reducing schedule I have seen on here. I am on 12 mg at the moment going down to 11 mg, it's a slow process but it works for me.
sue
I suppose the basic question is as to whether he wants you to be mobile enough to do the rehab post-op. If he was going to worry about the pred level I'm surprised he didn't say BEFORE he operated.
It seems to depend on the surgeon when it comes to pred. Some refuse to operate when the patient is on pred, others just want you to be stable on your current dose. I know 2 ladies who had hip replacements done and were then able to reduce the pred steadily to zero - almost as if the removal of the hip pain had allowed the PMR to fade too.
The effect on the immune system of the pred is disputed - it doesn't leave you with "no immune system" that is a stupid statement. I have had fewer infections since being on pred, an annual cold but it doesn't take any longer to go than normal, and I know others who have had the same experience. I'll lay odds that if you investigated he's had patients with the same problem before who weren't on pred!
However, whether they can just take you off pred without your say so is a different question. The doctors can certainly refuse to write the prescription but since you have been on pred for the last 3 years at some level or other they cannot safely take you off pred overnight because of the risk of suppressed adrenal function. Part of the slow reduction at the lower doses is to allow that to return. To take you off pred in a matter of a few weeks and then to carry out a major operation seems to me to be risky in a different way. Since I assume you are immobile until the op is done they will want to it asap - but I can't see it is safe to stop the pred just like that.
I would want to have the opinion of an endocrinologist before they do either - it is hammered into us that we must not stop pred suddenly as it is dangerous. They also say that in the event of surgery being required, and accident or other infection we may need more pred to cover us. So is it, or isn't it? Do we, or don't we?
Hi Sue, ock am so sorry you had to go through all what you have been through with the new hip and then infecction, you are having a time of it. As I am still a newbie here I can't answer or advise. My first hospital appt is Thursday 8th Jan and it's Endocrinolgy so that will be interesting. The one thing I would say is to fight your case and don't let yourself be bullied by the so-called experts. It's probably easier said than done. It's your body and you are entitled to have your say. I hope things will turn out alright for you. You have been through the mill (as they say in Belfast) You take care now. All the very best.
I agree with EileenH. Prednisone does not suppress the immune system. It can mask infections because it is an antiinflamatory medication. That is why you are taking it for your PMR.
The more serious problem is that you are in a state of adrenal suppression secondary to your being on prednisone for a couple of years. It will take 6-12 months for your normal production to return. You can not go through a major operation without corticosteroid support. This is serious.Your orthopedic doc does not understand this. He just knows hammers and saws. I worked with these guys for 30 years. He is blaming your steroids for the infection when the surgeon really needs to make sure there was not a break in his/her sterile technigue. Steroids do not cause infections. They will let the infection smolder and delay its manifestation but the bugs have to get into the wound to start the infection.
Get the endocrinologist !!!
Interesting to find someone else with the same opinion! I know some lovely orthpods - but they are all a bit gungho with the drill!
But you are so right - Sue needs a multi-disciplinary case conference! They used to do such things in the dim and distant past...
Charlie,
You replied to this by starting a new discussion rather than replying here so I have deleted the discussion and pasted your comment below.
Regards,
Alan
Case conference is a good way to deal with this, suggested by EileenH in the above note. You don't see problems with major surgical cases and people you have steroid dependency if the patient gets the proper attention.
I witnessed a classic case of this many years ago when 5 doctors did not talk to each other. The patient had a straight forward mitral valve replacement. Four days post op he was still in the intensive care unit and starting to "fall apart". The surgeon and his 4 consultants finally came together and they realized that noone was ordering the steroid replacement he needed as he had been on steroids preoperatively. On steroids the patient did well and soon left the hospital.
Thanks, I pushed the wrong buttons. I wondered where it went.
Hope you don't mind Charlie, I reported it for "reassignment" to where it fitted - it just turned up all on its own as a new thread called "EileenH"!
What you did is just fine. Thanks.
Charlie 44644