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Prednisone and surgery...

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Posted 2/20/2013 2:31 AM (GMT 0)
Does anyone know about the general guidlines for these two?  Can one have surgery while on Prednisone?  Does one need to be Prednisone free for a particular length of time to have surgery?  If so - how long is a general rule of thumb?

What would you consider a reasonable length of time for a Prednisone wean that starts at 60mg a day?  I want off this as fast as I can - I have been on high dose Prednisone for nearly 8 straight months with only one 7 day remission of all symptoms. 

Posted 2/20/2013 3:34 AM (GMT 0)
I am currently on prednisone and considering surgery. The surgeon I spoke with said it can slightly increase some risks, but is not uncommon for people to be on it at the time of surgery. She also said at this point she would keep me on my current dose, give me more in the hospital and then start weaning after that. Apparently being on the steroids after surgery can help you heal? To get off of 60 mg/day of pred would take at least 3 months to do properly.
Posted 2/20/2013 3:42 AM (GMT 0)
You can be on pred for surgery, 60 mg is a little high. They will probably want you to get down to about 20mg, if possible. It's better to be on pred and not in a serious flare, but if you can accomplish a lower dose of pred without flaring that's what they aim for.
It just makes recovery time longer, and you have to stay on it after surgery until you wean off. DO NOT try to stop it after surgery, trust me, lol. Even though you are so tired of taking it do not try to do that, it will not go well for you! I learned the very hard way.
If you are going for a jpouch it may require that you have a 3 step instead of a 2 step.
Posted 2/20/2013 6:31 AM (GMT 0)
I too was on a high dose of prednisone (up to 80mg for a few days and then tapered slowly) before surgery. My doctor knew it would take me several months to wean off of it. For me it ended up being a balancing act of not getting so low that I started to flare (my surgeon did not want to do surgery during a major flare), but also not being on too high of a dose during the surgery since it can affect healing times. I ended up going into surgery on 35 mg. The only prednisone-related complication that I had was that my stoma separated from the skin a bit (called Mucocutaneous separation) due to the effects of prednisone on tissue healing. My surgeon fixed it though and it healed fine. It took me another month and a half after surgery to taper down until I was prednisone-free.

On a separate complication note... Two years after taking in my last prednisone dose, I developed steroid-induced avascular necrosis in my shoulder. For some reason that is not completely understood, in some individuals, prednisone can cause a loss of blood flow to certain joints causing the bone in them to die. It is a very rare side effect of prednisone, but it is good that you are getting off the stuff just in case as high doses or long-term use (or some unknown combination of both) are major risk factors.
Posted 2/20/2013 1:19 PM (GMT 0)
I was on 35 mg of prednisone (tapered from 60 mg) when I had my surgical consults/surgery and all the surgeons said it was OK but I would have to have a three step procedure instead of two (I was also on Remicade which may have contributed to their decision, as I know some people who were also on prednisone but were able to have two step).

I was given a 'stress dose' of IV hydrocortisone after the surgery (bumped up to the equivalent of ~45 mg pred), and then was tapered down to the equivalent of 18 mg prednisone over the course of three days while I was recovering in the hospital. My surgeon said it was safe to taper very quickly as long as we stayed above 10 mg. When I was discharged I was taking 10 mg oral pred per day. I did have bad emotional side effects from the fast taper -- I was very irritable and awful to be around... but all in all I'm glad I was able to get most of the taper done in 3 days instead of 5 weeks. After discharge I tapered by 2.5 mg per week and now I'm off completely.

I asked my surgeon beforehand if I needed to be off prednisone and if so if it had to be for a certain length of time, and he kind of laughed and said "Do you think you COULD be off of prednisone for any length of time?" and I said well, no... and he said "I'd love for you to be off of prednisone, but if you could get off the prednisone, you probably wouldn't need the surgery, right?"
Posted 2/20/2013 2:01 PM (GMT 0)
Most UCers are on prednisone at the time of surgery; it's because that is the only drug that offers some type of 'quality of life' to those that have failed other treatments.

Sue
Posted 2/20/2013 3:31 PM (GMT 0)
     I was prednisone dependent for two years straight prior to surgery, and on it numerous times during the twelve years I suffered with UP.  At time of surgery I could not taper below 20 mgm because I would go into an immediate flare.  My surgeon told me he would rather I be on the lowest dose of prednisone possible than flaring at time of surgery.  He did, however, require my cessation of Humira for at least six weeks prior to my operation.
Posted 2/20/2013 4:01 PM (GMT 0)
I starting tapering off of prednisone 3 months before surgery.  I was at 40mg when I started.  One month before the surgery, I was completely off of the Prednisone, however, even on it I was not in remission and once off of it, the flare got much worse.  So I lived with a moderate flare for the whole month before the surgery.  Still, my surgeon felt this was the best route to take and she was right because I had absolutely no healing issues afterward.  It's been 3 months now and the surgery seems like it happened years ago.

Just to be open and honest here, that last month was a tuffy.  I stayed at home 90% of the time to be near a toilet but just kept thinking how much freedom I'd have once this UC was out of my body.

As stated in a previous post, many, many people have no choice and need to be on some pred right up until surgery and even afterward and they still seem to ultimately do fine.

No regrets....No looking back.....My ileostomy gave me back my life.

Posted 2/20/2013 8:45 PM (GMT 0)
I'm still waiting for this 60mg a day to help. Yesterday I was hopeful - had less bathroom trips (but also only ate 1 banana & 2 pieces of toast all day. Today - it's ad if I'm on no Prednisone again - all my symptoms are what they were on Monday when I began it (even a touch worse)... GGrrrrrr
Posted 2/20/2013 10:26 PM (GMT 0)
A month before surgery, I also stopped the Humira and the Imuran and had just finished the prednisone.  Like I mentioned, that last month before surgery was really bad.

All that stuff going into my body everyday, and the UC was still coming out the winner.  Looking back, having the surgery was a no brainer. 

The ostomy support group I belong to has volunteers, who on request, will meet with groups or individuals of those

suffering from UC and other GI issues.  The purpose it to answer questions about the various surgeries and to try and take the fear out of what seems a very scary thing.

Hopefully, some of them will realize that there is hope for a better life.....well, for many, better than life with UC.

Posted 2/21/2013 8:29 PM (GMT 0)
     desert sun...you sound like you were in my boat.  I was 52 when diagnosed with UP.  Over the course of the twelve years I suffered, it never did travel further into my colon.  I would LIKE to think the nine Colazal a day I took all those years at least helped me in that matter! Other than that, my proctitis just kept getting worse.  The 6MP I took for seven or eight years did absoutely nothing and neither did Remicade or Humira.  The only drug which helped  somewhat was the prednisone which was slowly, but surely, killing me.  I have full blown osteoporosis.  I was almost 64 at the time of my operation.  I am now 66 and sooo wish I had the operation ten years before I did.  Oh well, my GI doctor never owned up to the fact that he wasn't helping me.  I had to seek out a colorectal surgeon online!  SOOO glad I did.
Posted 3/3/2013 3:19 AM (GMT 0)
musicmaker:

Do you play? What instrument?

As far as prednisone, me and Mr. Pred (i call him/her the "growing old drug...more on that in a minute) are old, old friends.

The first 8 years of UC, i was on prednisone on and off for flares...the last 7 years with UC i was on prednisone min. 20 mg/day....going up to 40 mg/day when things got bad....

I did not "taper" before surgery..lol! My nurses told me on the day of surgery I was given 100mg! No wonder I felt so darn good!

After surgery I went to 60, then 50, then 30 mg (each day)..kept on 30 mg. for 2 weeks, then 20 mg...then..they dropped me too fast...
I suffered with breathing, light headedness, low blood pressure, nausea, etc. for several months before I went to my general practitioner (NOT my surgeon) and told her the story....she advised me to get back on prednisone at 5 mg/day..whew! within 24 hours I felt better...she told me they had tapered me too fast becasue I was "young" and "healthy" and they probably assumed I could just deal with it....well, it was 3 more months at 5mg/day until I finally tapered off....have not been on prednisone since Jan. 2012.

So, word to the wise - be careful getting off of it!

As far as the "growing old drug.." Well, osteoporosis, bags under the eyes (will NOT go away now), cataract surgery, permanent tendinitis in both shoulders (just live with it), and who knows what else at 45 years old? LOL!

God Bless and best regards,
jimmy
Posted 3/5/2013 3:32 AM (GMT 0)
ENIGMAWRAP -

Yes, I play guitar & sing...

I don't seem to even respond to the Prednisone anymore.  Even on the 60mg a day - which was started from zero - it didn't help.  First tiem I was on it - miracle drug, but it didn't last long at all.

 

Posted 3/5/2013 11:58 AM (GMT 0)
I was on 40 mg of pred and tapered to 20 in 2 weeks before surgery. That was a very hard taper. My surgeon initially said it was ok to be on 40, but my gi said no because I'd been on it for so long.

I think they give everyone who has been on pred a "stress dose" of pred during surgery, as surgery is so stressful and if you've been on pred you can't manufacture the large amount of cortisol that you need to cope with the surgery itself.

After surgery I did a more standard taper to get off of it for good (got interrupted when I had to go back in the hospital for a complication).

I did become steroid resistant a few years before surgery.... was in the hospital for 18 days first waiting for IV steroids to kick in then trying remicade, which worked at first.... then two years later, I flared again, and IV steroids worked.... go figure.... just not well understood..... but pred worked some after that.... not great, but helped a bit....
Posted 3/5/2013 12:46 PM (GMT 0)
Hubby became steroid dependant and needed to stay on the higher doses or he flared terribly. On thing I learned from the UC forum here was a very long slow taper was the way to go. As good as his Dr was, I asked her the last time he was on it that I felt from all the advice from UCers that the taper MUST be done this way....we tapered long and slow and he finally got off it. He was better off it than on it.

Because it reacted so badly while he was on it and didn't help much, once he got off it he stayed off it. He was off it 2 years prior to the sugery.

My sister on the other hand had an emergency ileostomy performed and she was on the higher dose at the time. The major diff between her and hubby was he healed and bounced back faster and her recovery was slower but she did fine.

If you are a jpouch candidate then from what I understand it would need to be a 3 step process instead of a 2 step one due to the prednisone and needing sufficient time for healing etc.
Posted 3/5/2013 2:53 PM (GMT 0)
I went straight from extremely high doses of IV steroids in the hospital into "emergency" surgery. They had me do a very slow taper after surgery. Think the taper about 3months. They did make me have 3step surgery for the jpouch, though, because of how sick I was and the steroids.
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