Prednisone and wound healing

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jauhar
New Member


Date Joined Oct 2010
Total Posts : 6
   Posted 10/5/2010 7:31 PM (GMT -6)   
Hello:
I'm new here and hope I'm not interrupting. I'm a 70 year old male with RA for20 years, significant finger displacement left hand, large nodules throughout. Rx prednisone (5mg,10 years)), arthrotec (75mg) usual vitamins. After a resection (sigmoidal) and reversal, the abdominal wounds have not healed properly (one year) and some are suggesting prednisone is the reason. I will taper to 2.5 mg and then 0mg over a period of 2-3 weeks. How long might it take for my adrenal to get back to normal and my skin to stop bruising?

Prednisone has helped with the pain and I think percocet will help with that but I'm concerned with the effect pain relievers have on bowel movements. My problems are small compared to many in this forum, but I'll appreciate any advice or comments.

SydneyJo
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Date Joined Mar 2006
Total Posts : 1354
   Posted 10/6/2010 5:01 AM (GMT -6)   
Hi jauhar and welcome to HW and the RA forum smilewinkgrin ,
You are not interrupting, its nice to have new members and I look forward to any advice and input you have to offer, as you have many years of RA experience there!
WOW 10 years on pred! I was stuck on it for 7 years and have now been off it for nearly six months thanks to Humira.
I had a bowel resection and skin cancer removal while I was on the pred and my healing was slowed up due it - my bowel healed quicker than the skin cancer scar which were both around 6+ months
The bruising (and I had skin tears as well) stopped about a month after I finished taking it. To this day. 6 months later, I still keep finding little things that are not the same as when I was on pred - my eyes are less dry, my hair is less bald (but I take MTX so I will never have thick hair again) my 'camel hump' is getting smaller and I am less 'fluidy' in the thighs and belly.
I must admit though, that on my bad days I wish I was back on pred for how good it made me feel - all that energy with minimal pain :-)
As for your bowel movements on painkillers - I have Crohns disease and am unable to take anything stronger than a Tylenol due to the havoc they play with my bowel - but thats just me - you might be different.
Good luck with the pred withdrawal - you sound like you have a good taper going on there.
Keep us posted on your progress.
Take care
Jo
Crohn's Disease, Ankylosing Spondylitis
Current meds: Methotrexate, Humira
Bowel Resection Sept. 07
 
Forum Moderator - Rheumatoid Arthritis

jauhar
New Member


Date Joined Oct 2010
Total Posts : 6
   Posted 10/6/2010 11:35 AM (GMT -6)   
Hi SydneyJo and thanks for the welcome:
I was uninsured when diagnosed with RA so Humira and other injectables were cost prohibitive. When these wounds heal (if!) I'll consider Humira. I'm too old and set in my ways to give up all my bad habits and I believe Humira has less alcohol restrictions than other injectables.
I cut back on the Pred before recent surgeries (3 the past year) and after three days the pain was significant (RA pain, not post operative). After I got home and took the regular dose (5 mg) I was amazed at how quickly the pain disappeared. On days when I need a pain killer I follow it up the next day with a laxative, a bad habit but it is what it is.
Thanks for your response
J

wearyRAsufferer
Veteran Member


Date Joined Mar 2010
Total Posts : 1547
   Posted 10/6/2010 12:39 PM (GMT -6)   
Welcome Jauhar!
Your post is very interesting! I am curious-have you been diagnosed for 20 yrs. with RA or did you find out recently that this is what its been all along?
Why I ask is you say you have some deformity- I am thinking that you did not get on a DMARD right away? It seems in the past RA was treated more for pain relief with NSAIDS, prednisone, etc.. than with MTX right away to slow or stop the disease.
That said- are you on MTX and if so for how long? I chuckled about your refusal to give up all your bad habits and that you thought Humira had a less restrictive alcohol policy- AMEN I hear you! I like to have a couple of drinks and RA has really cramped my style or MTX has anyway...
If you have been on MTX for a long period and not giving up drinking I am interested in knowing if your liver is still OK. Not that one persons experience can tell the whole tale but my doctor has me cowering in the corner with my tail between my legs since I confessed I was having a couple of drinks on the weekends. There doesn't seem to be any clear cut evidence that its absolutely dangerous and I always seem to meet up with abstainers who don't miss it because they never cared for it and they don't know how concern for my health is not enough to make me joyfully just say no to alcohol.
I was on prednisone only for 1 1/2 years. I never had any major surgeries or injuries so I don't know about healing issues. I did notice that a simple bump would cause a huge, long lasting bruise.
Welcome again- look forward to your future posts!

jauhar
New Member


Date Joined Oct 2010
Total Posts : 6
   Posted 10/6/2010 3:28 PM (GMT -6)   
Hi Weary:
Let me bore you with a little bio. As a young child I had my tonsils taken out (1943-1944?). I did not visit another doctor until 1995, when the sporadic and intermittent pain in my hands and shoulder, that had been occurring for several years, became unbearable. With no insurance and no primary doctor, I went to a walk-in clinic used mostly for workman's comp cases. We were on a trip to California at the time and the attending doctor gave me some pain killers to last until we returned to Colorado. There I was diagnosed with RA. X-rays showed some joint damage that was likely the cause of the earlier pain and discomfort. The rheumatologist was a Pakistani who was appalled at my drinking and smoking habits and was very reluctant to prescribe any pain killers for fear that I would mix the two. Plaquinil and Aleve were prescribed.
We moved to California in '98 and I was taken off Plaquinil and put on Prednisone (5mg), Arthrotec (75mg) and Sulfasalazine (600 mg). No medication changes since-except no more Sulfasalazine.
In 2008 I entered a hospital for the first time since my tonsils were removed on account of an acute diverticulitis which eventually led to a resection, then to a reversal, then to a hernias repair that had been caused by the colostomy and the wounds that won't heal because of 10+ years on Prednisone(?).
My rheumatologist seems pretty sensible about alcohol. I am a heavy drinker- three drinks a night for 30 years (Scotch). Latest blood-work shows liver doing just fine. He says there is no proof that liquor and MTX will do serious damage to the liver. It's just less likely without the alcohol.
I never had any medical issues until I turned 68. Now they seem to be coming in spades and that makes me reluctant to begin a more active auto immune suppressant regime.
Thanks for your post, Weary
J

wearyRAsufferer
Veteran Member


Date Joined Mar 2010
Total Posts : 1547
   Posted 10/6/2010 8:44 PM (GMT -6)   
Oh J- 3 glasses of scotch a night?! LOL- my doctor would fall down dead if you told him that! I would love to see his face! Are you on MTX then? Unless I missed something I don't see when you were put on it.

Sorry your health is giving you the business lately...that's what usually happens though doesn't it? I'm sure it will level off. I wish you all the best!

SydneyJo
Veteran Member


Date Joined Mar 2006
Total Posts : 1354
   Posted 10/7/2010 3:42 AM (GMT -6)   
Your bio wasnt boring, infact it was interesting :-)  
You have dealt with a lot the past few years!
 If you have trouble weaning off the pred I would try the Humira, it helped me slowly get off it, which I was beginning to think was near impossible.
Good luck with your meds decisions there jauhar.
Jo
 
 
 
Crohn's Disease, Ankylosing Spondylitis
Current meds: Methotrexate, Humira
Bowel Resection Sept. 07
 
Forum Moderator - Rheumatoid Arthritis

jauhar
New Member


Date Joined Oct 2010
Total Posts : 6
   Posted 10/7/2010 3:25 PM (GMT -6)   
Weary:
I've lost a lot of respect for doctors over the past couple of years and I frankly don't give a darn what they think of my life style. I don't want absolution from them I want cures. More and more I don't think they can offer either.

I never was on MTX or any other DMARDS, although I think Plaquinil and Prednisone may fall into that category -just barely. When I think of DMARDS I think of MTX, Remicade, Enbrel, and Humira. At the time those drugs were too expensive for me to consider so I was left with anti inflammatories and a misshapened left hand.

As to Jo's point regarding weaning off pred with Humira, there's an interesting predicament. At present Medicare considers Remicade treatment a covered expense because it is administered by a doctor in his office. Neither Enbrel nor Humira are covered under Medicare since the injections are self administered at home. Most prescription plans available to Medicare recipients have the famous "donut hole" provision. The long and the short of it is either Enbrel or Humira will cost me about $7,000 a year. If money were not an issue, which is most effective??? When my current wounds heal, I'll talk to my rheumy about Remicade and see what he thinks.

Decisions, decisions, decisions!
J

wearyRAsufferer
Veteran Member


Date Joined Mar 2010
Total Posts : 1547
   Posted 10/7/2010 5:15 PM (GMT -6)   
J-

Both Plaquenil and sulfasalazine are DMARDS although mild ones. If you go on the Humira website you will find that they have prescription assistance. I tried it for awhile and they paid all but $5 of my co-pay.

You never know which med is going to work for you. I added Humira to the MTX because I still have daily pain upon joint usage in the 3-5 range. My doctor who doesn't live with it doesn't give it too much merit. So it only hurts with use he says and writes it off. Excuse me but do your flipping feet hurt every time you take a step or your hands when you try to pull a file folder out of a too full drawer? Do your hips and knees ache when you start to walk after you sat for 15 minutes?
Sorry I had a little vent. I was concerned with the possible side effects of Humira and I dislike giving myself shots so I put off trying it for a long time. I used it for 3 months which my doctor said was the time table to see if it worked or not. I did get relief in my hands (although not total) and no where else so I stopped. That's not to say it won't work for you.

I wish you all the best!

Bstrong
Regular Member


Date Joined Jul 2010
Total Posts : 107
   Posted 10/7/2010 11:59 PM (GMT -6)   
Hello jahuar, WELCOME to the forum!!! I've been on Prednisone for few months but didn't notice any problems with wounds healing, it maybe after longer use (?)
Sydney Joe, could you tell after what time of taking Humira you could get off the Prednisone? and if I could ask did the skin cancer occured after you were already on Humira?
I am so hoping for all the benefits from Humira - just had my second injection this Monday!!! I hope that it slow down the process of the joint corrosion and help in the long run. Side effects are scarry but that's what I've chosen. My rheumy gave me 2 choices Enbrel and Humira.
I wish you all the best jahuar!!! Decisions are not simple here but hope we will make the right ones!
Polyarthritis - diagnosed July 2010, suffering from May 2009, Sweet Syndrome

Prednisone - 10mg/day, Plaquenil, Vitamin D, Fish Oil, Isoniazid, Humira - just started

SydneyJo
Veteran Member


Date Joined Mar 2006
Total Posts : 1354
   Posted 10/8/2010 5:25 AM (GMT -6)   
jauhar - Humira is very expensive (even in Australia) Im lucky that the government subsides mine or else I wouldnt be able to afford it. I have heard that Remicade has the same benefits as Humira so if that is a cheaper option I would see how that goes. All these meds cost a fortune though, and I would love to know exactly how much I have spent the last 25+ years.
Bstrong - It took 6 months of a very gradual taper for me to get off pred. My skin cancer was a basal cell carcinoma on my face (ugh) and it was after I started taking MTX that it occured - I wasnt on Humira until 2 years later. I didnt even have a freckle or anything suspicious there before I got this sore that wouldnt heal - so hence me blaming the MTX lol. I hope the Humira works well for you, good luck and keep us posted.
Jo
 
Crohn's Disease, Ankylosing Spondylitis
Current meds: Methotrexate, Humira
Bowel Resection Sept. 07
 
Forum Moderator - Rheumatoid Arthritis

jauhar
New Member


Date Joined Oct 2010
Total Posts : 6
   Posted 10/8/2010 10:56 AM (GMT -6)   
Weary -
I've been retired for a long time so I don't suffer the pain caused by regular work day activities--only the pain caused by day to day living: opening packages, bottles, walking on terrazzo tiled floors, scratching my back, putting my hand in my pants pocket with the little finger getting hung up on the pockets edge. I have great sympathy for those with RA that have to put up with the rigors of a work environment--fortunately, I do not.

My pred dosage has always been 5 mg (10 years) and for the last 3 days I've cut it to 2.5 mg's in the hope that it will help the wound healing process. If all goes well I'll cut the dose to zero in a few weeks and then decide on Remicade, Enbrel, or Humira. When I was first diagnosed I was unwilling to risk the possible side effects of those drugs and I couldn't afford them anyway. Now, at 70, I'm going to reconsider. If my right hand goes the way of my left, my abilities will be severely limited.

As Jo has pointed out all of those meds are very expensive. If I choose Remicade, Medicare might pay all the costs-- but I have to weigh that against laying in the doctors office for two hours every 3 weeks getting infused. Otherwise, the cost will be about $7000 per year.

Jo - you said it took you about 6 months to taper off. What was your dosage when you began, and were you taking anything to ease the taper?
Bstrong- here's hoping that Humira is the right solution. Let us know how the process evolves.
J

wearyRAsufferer
Veteran Member


Date Joined Mar 2010
Total Posts : 1547
   Posted 10/8/2010 8:45 PM (GMT -6)   
J-
Do you find you get much relief from 5 mg prednisone?
I started out on 40 mgs and took that for about 2 months. It took me about 1 1/2 years to taper to 0. The drops were large when on the high doses. Always every 2-4 weeks depending on how the pain levels went. When I got to 12.5 I no longer felt like prednisone was doing anything for me. Yet the taper would make me feel worse for a few days until it leveled off. I pushed through. At 10 it was slow- I was only allowed 1 mg drop every 2-4 weeks. I wasn't really getting pain relief but had added weight gain, tummy bloat, etc. from it. I couldn't wait to get off completely. I hope I never have to go back on.

I wish you all the best with your taper

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 8265
   Posted 10/9/2010 1:42 PM (GMT -6)   
If you can, find some vitamin E capsels, and if you can pop it open with a pin and apply
the vitamin E on the wound, or go ask your doctor about an over the counter vitamin E lotion you
could get to help the wound...yes prednisone can make things take longer to heal...
My mom was told to use vitamin E on her scar a couple of weeks after her knee surgery...
Vitamin has wonderful healing properties for scars...
Hope this helps, it's the only thing I could think of...
((((((((((((((((((((((((((((((Jauhar)))))))))))))))))))))))))))))))))
healing hugz
**********************************************
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc (Lower Lumbar S1-L3 and Cervical C5,C6, C8 and T1), Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's, Ocular Migraines, mild carpel tunnel, ect.... "Would be nice if we could use the edit button in real life"...

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jauhar
New Member


Date Joined Oct 2010
Total Posts : 6
   Posted 10/11/2010 3:53 PM (GMT -6)   
Weary-
I've been wondering about that ever since I read your question- 'Did you get much relief from 5mg prednisone'. I now think the answer is no. The decease has gradually worsened and the pain along with it. The pain usually appears about every 4-5 days and goes away after a nights sleep. I rarely use pain killers except in extreme cases. I've been on the taper almost a week and so far I haven't noticed any difference--which may speak volumes about the efficacy of 5mg prednisone.

You took about 1 1/2 years to taper to zero. I presume when you were on 40 mg's you had "thin skin" and bruised easily. At what point were you able to notice a more normal skin and a less likelihood of bruising? My colostomy (9/20/09) resulted in an incisional hernia in my stomach. My skin around the protrusion is paper thin and may have an impact on this wound thing I'm dealing with. That's the whole reason for my taper--to get my skin back to normal. And after you raised the question I wonder why I've been on it these past 10 years.

For the past year and a half my RA has taken a back seat to other health issues but as these other health issues come to resolution, I'll get on Humira as soon as. Can I inject it someplace other than my stomach?

Chartreux--Appreciate the good thoughts and the suggestion. As soon as the wound heals, and produces a scar, I'll try it.
J

SydneyJo
Veteran Member


Date Joined Mar 2006
Total Posts : 1354
   Posted 10/11/2010 4:11 PM (GMT -6)   
J - I was on a maintenance dose of 20mg and then dropped to 15mg for a month, then 10mg for a month and from there it was a taper of 2.5mg till I got to 5mg and then 1mg down to 1mg till I stopped - hope that makes sense.
My skin tearing and bruising was the first thing that I noticed went away - which was in the 1st month.
Jo
Crohn's Disease, Ankylosing Spondylitis
Current meds: Methotrexate, Humira
Bowel Resection Sept. 07
 
Forum Moderator - Rheumatoid Arthritis

wearyRAsufferer
Veteran Member


Date Joined Mar 2010
Total Posts : 1547
   Posted 10/11/2010 4:58 PM (GMT -6)   
J-

Like SydneyJo I was off of prednisone entirely before the side effects like easy bruising, bloated belly, etc went away- I think I noticed it after 2 months. At least thats when the belly went away- it was what was bothering me the most.

I did notice extra pain during my taper that would be for maybe a week but then level off. But as far as feeling benefit with prednisone- that ended at 12.5 mgs. That's what was so frustrating about the slow taper. I wanted OFF! All I had from prednisone was bothersome side effects and the fastest I was allowed to taper was 1 mg. every 2-4 weeks!

You can inject Humira in your thigh if you prefer. I felt more comfortable in the belly where I have some fat- my thighs are pretty muscular. I wish they would come up with a biologic you didn't have to inject or infuse!!!
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