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Taking Humira and need un-related surgery

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Posted 10/16/2016 7:17 AM (GMT 0)
I think I've asked before but for the life of me I can not remember the replies. So here is my situation:

I've been on Humira for 2 years, and 6mp for 1 1/2 years. It has been GREAT, life is pretty much normal... except for the fact that I have a really bad underbite and was told the only way to correct it would be to go to a maxillofacial surgeon to correct it. I actually went for a consultation and he said he could correct it (no problem) only issue is that I would have to stop taking Humira to avoid infection post-surgery.

My question is has anybody had surgery (un-related to stomach) and had to stop taking Humira? How long do you have to wait until you can resume Humira injections? Thanks. I'm not trying to sound vain, but I hate smiling and feel like my confidence is shot.

My concern is by stopping Humira temporarily, it will lose its effectiveness.

Post Edited (billo) : 10/16/2016 1:23:28 AM (GMT-6)

Posted 10/16/2016 3:54 PM (GMT 0)
From what I heard it's only one dose. I have a significant amount of oral surgery needed as well since my mouth is very over crowded and jaw doesn't even match up, it's the least of my problems but it hurts to eat so it's on the to do list for some day. I totally sympathize smiling issues. While I was on humira last year I was told that I had to be 100% positive that the crohns was under control since inflammation can be a problem after surgery in the mouth. I was told it would be one dose or just done right before one so while it was lowest in my system. Holding one dose for a little while shouldn't be a big deal. Unfortunately the crohns flared so I've had to hold off on surgery for it. The same goes for the remicade im on now. I have to have hernia surgery this winter if everything goes well and it will just be done when its lowest in my system. Also make sure you get a preventive course of antibiotics
Posted 10/16/2016 7:36 PM (GMT 0)
You're not being vain - it can be a source of jaw pain and abnormal wearing away of your teeth when your bite is off by that much. I have TMJD, mainly from a fairly crooked jawline, and had to wear head gear as an adult, which was a literal pain, but it was worth it to me.

Your GI and surgeon can hopefully come up with a plan that will get you through this surgery without causing a major flare.
Posted 10/16/2016 8:48 PM (GMT 0)
wow thanks for the positive news! I was under the impression it would be a couple months of no Humira injections. If its just one dose, I think that might be something I could swing.

I know it sounds silly but I see people smiling all the time and I know I dont have a great smile. I feel like it really impacts my self esteem.

Next step is figuring out how to pay for the surgery, its only a mere $30k
Posted 10/16/2016 10:04 PM (GMT 0)
Definitely talk to your GI about it and they can tell you exactly how to time surgery with the humira.
But wow, 30k!!!! Have you looked in to care credit? Not sure if balances can be that high or if your doctor excepts it but I have it for my pets and hope to use it for future dental work.
What exactly do they have to do to correct it? As I mentioned earlier it doesn't sound silly at all. My mouth has been plaguing me for ever and I can completely understand being hyper aware of it and selfconconcious. I dont even like to smile when I've had to have neurologist exams and they ask me to. I have all my teeth in decent condition (except for one or two due to prednisone use) but my mouth is way too small for a normal amount of teeth so it makes it look like I'm missing some. And has my jaw misaligned. they can't even fit the films in my mouth to take X-rays without popping my jaw out of the socket and placing the films in tilted sideways. Most people tell me they don't notice it but I don't know how they couldn't. given all the things that have gone wrong in the last year though I feel terrible taking on anything that's not absolutely necessary at this point.
You're not along in dental issues and I really hope they are able to fix it for you successfully!
Posted 10/16/2016 10:06 PM (GMT 0)
I had several surgeries while taking Simponi, an injectable anti-TNF biologic like Humira. My rheumatologist told me to schedule surgery to occur right before the next injection was due so that the Simponi would likely be at a very low level. I was able to take my Simponi again when the surgeon declared the surgical site healed. This was usually when my sutures were removed for the simpler surgeries. One time for a rather complex surgery I wasn't declared healed until 6 weeks pot-op. This was a total pelvic reconstruction surgery with multiple transfusions and bruising where the bleeding went into tissue.
Posted 10/17/2016 12:11 PM (GMT 0)
I may be dense but I'm not sure why you need to stop the Humira for even one dose. Think people exaggerate the infection risks of biologics sometimes. If a biologic was definitely working for me and I had to have surgery for whatever reason, I don't think I would agree to stop the biologic. That's just me though. I've been on everything in the past and never so much as caught an extra cold through it all.
Posted 10/17/2016 2:22 PM (GMT 0)
@ncot, I believe the risk is much higher with oral surgery because of the high amount of bacteria in the mouth and the risk of it being introduced into the blood stream. My cardiologist urged me while I was on humira to use mouth wash every day and be very careful because the immunosuppressants raise the risk of an infection from the normal bacteria in the mouth traveling and causing an infection in the heart. That was before my mother ended up with this type of infection and I found out how common they are (and she's not on immunosuppressants) so I'd use a healthy level of caution and make sure they premedicate with antibiotics.
Posted 10/17/2016 3:57 PM (GMT 0)
Labradorite - Ah okay. That makes sense. I don't know if it's coincidence, but I've been struggling with a couple of gum infections lately and I'm on 6MP. I've upped my oral hygiene routine and they seem to be slowly clearing, but I'm seeing the dentist tomorrow anyway.
Posted 10/17/2016 4:49 PM (GMT 0)
I was just asking my surgeon's office this morning, I'm having hip replacement surgery and they told me 6 weeks is the minimum and 12 weeks is ideal before I go for surgery. I am currently on Stelara every 8 weeks. I'll probably do it at the 8-10 week mark.

I was also told that I'd have to be careful with dental work for 2-5 years and have to take antibiotics prior to any dental work but that's because of the hip replacement and not biological.
Posted 10/17/2016 10:24 PM (GMT 0)
Hmmm this is a very interesting discussion. I had a root canal while on Humira. I was taking it weekly and asked the endodontist if I should stop, he said no. Well post root canal an infection came back where the abcessed tooth had been and bad. I ended up loosing the tooth and often wondered if I had stooped the Humira or done a different prophylactic approach if I wouldn't have lost the tooth.
Posted 10/19/2016 3:28 PM (GMT 0)
Usually IBD patients take a higher dose of the biological than some of the other patients; I wonder if we need to wait even longer than a Psoriasis patient.

I'm going to ask my surgeon the question just to make sure that they aren't overlooking the larger dose of Stelara that I am taking.
Posted 2/14/2017 5:35 AM (GMT 0)
Billo, did you ever get this surgery? I just went to the Orthodontist today and was told I would need multiple major surgeries including palate expansion surgery to correct the mouth and jaw issues I've been having.
Posted 2/14/2017 8:56 PM (GMT 0)
I have not.

My situation is my bite/smile is not that great. I first need to wear braces to straighten my teeth, then I would need to get the surgery to correct my underbite.

I asked my GI about possibly getting off Humira for the surgery but he said, "nah, its a sterile environment"...

thats a little weird right?
Posted 2/16/2017 9:04 AM (GMT 0)
If you have gum issues rise with warm salt water 2-3 times a day. It reduces inflammation and kills bad bacteria .
Posted 2/16/2017 1:16 PM (GMT 0)
Yeah, that's weird and misinformed of your GI to say. Any surgery in the mouth is considered "dirty" and while the surgical team still preps and drapes in a sterile fashion just like any other surgery, the mouth is dirty.
Posted 2/17/2017 1:26 AM (GMT 0)
Actually, I don't think it's all that weird in some ways. Both of my c-sections were while I was on Remicade, and each case I got my infusion within 48 hours after the c-section.
Posted 2/26/2017 3:59 AM (GMT 0)
thanks for the replies!

scifigal2k- thats a GAME CHANGER for me. I have such a bad smile (underbite and teeth not properly aligned) I also need braces. If I'm able to get the surgery w/o having any real interruption in my Humira, I would be OVER THE MOON happy!

*I find my smile causes me to be shy in social situations and rarely do I smile. My teeth aren't terrible, but the underbite is such a bone of contention for me. My last dentist said I have the smile of a pit bull *****???
Posted 2/26/2017 11:29 AM (GMT 0)
Oh sad!!! What a rude dentist. sad I know mouths are a bit different than stomachs with regards to infection. They always give me a one-time shot of antibiotics with a c-section as a preventative measure, but they do that with all c-sections, not just immunosuppressed ones. So maybe ask if you could have some antibiotics for just a couple of days after the surgery until the wounds are closed up? And follow all directions exactly. I wonder if they have an antibiotic mouthwash.....
Posted 2/27/2017 4:58 AM (GMT 0)
I had a cervical discectomy and fusion and had to be off Humira for 4 weeks before surgery and 4 weeks after.

I went home day of surgery and was admitted to the hospital 7 days after surgery for a septic UTI from the catheter they used after surgery.
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