taking steroids while undergoing surgery?

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spiceman
Regular Member


Date Joined Aug 2008
Total Posts : 51
   Posted 1/6/2009 6:10 PM (GMT -7)   
Hi, Currently taking steroids and I will shortly be due for surgery on the 28th Jan. My question is does taking steroids increase any particular dangers?
 
At the moment I'm taking 6mg of Entocort.
 
Thanks.

Medication at present 3mg Budesnoide, 200mg Azathioprine, 3000mg Pentasa.
 
Operation due 28th Jan due to narrowing stricture.


MAG102886
Veteran Member


Date Joined Jul 2008
Total Posts : 674
   Posted 1/6/2009 6:22 PM (GMT -7)   
There are many risks of surgery while taking steriods.  When I had my 2nd resection I was on 60MG of Prednisone.  I was very much in need of the surgery and my Drs and Surgeon felt that they couldnt wait for me to taper off first.  I developed a very bad abcess under the incision, and it took me much longer to heal after the surgery.  My surgeon said he was 99% sure the abcess was due to the prednisone.  Steriods also make your intestines much weaker, so say instead of them being like a hard tire rubber, they are more so like paper..making it much easier to rip or tear, also harder to sew or staple back together.  I guess tho it really depends on how much steriods your on, and how long you were or are on them.  I was on 100MG for 5 months prior to the surgery and was only able to taper down to 60MG before the surgery.  Im not sure if Entocort is the same as Prednisone, but Im sure the higher the dose and the longer youve been on it increase complications.
Dianogsed with Crohns: At 16 years old. 22 years old now.
Surgeries:2 Bowel Resections, Gallbladder Removed.
Current Meds: Humira (bi-weekly)
 

spiceman
Regular Member


Date Joined Aug 2008
Total Posts : 51
   Posted 1/6/2009 6:33 PM (GMT -7)   

Thanks Mag for the advice. I will start my taper next week and hopefully the time I have surgery I will be off steroids.

I see that you said you have had 2 resections, was those surgeries due to strictures? Did you have your TI taken? I hope your feeling better now.

 


Medication at present 6mg Budesnoide, 200mg Azathioprine, 3000mg Pentasa.
 
Operation due 28th Jan due to narrowing stricture.


belleenstein
Veteran Member


Date Joined Feb 2007
Total Posts : 1010
   Posted 1/6/2009 7:02 PM (GMT -7)   
Spiceman:

You should not change your steroid medication without first consulting with your internist and your surgeon. You are scheduled for Jan. 28. It may be ok to discontinue steroids since you are also on azathioprine but if you have been maintained on steroids for a long time, your body has become dependent and removing the steroids at a time when you will be facing the stress of surgery is just plain dangerous. In fact, you will most likely receive large doses of steroids during and for a short period after surgery to protect your body from the potential of adrenal shock.

I must repeat. Do not alter your steroid dose this close to surgery unless it is done with the knowledge and consent of both your gi and your surgeon
Belleenstein:

30+ years living with Crohn's.


dangdonkey
Regular Member


Date Joined Jan 2009
Total Posts : 22
   Posted 1/6/2009 7:03 PM (GMT -7)   
Just had a colostomy surgery in December. Was on steroids months before and upto surgery date.
According to my Surgeon, the percentage increase for issues such as MAG posted was a 2-3%.

Also had a resection in 92, and I can safely say that pain management for these type surgeries have come a very long way. I didn't feel any pain with current surgery until the epiderial was removed, 4 days after surgery. I was in the Hospital for 6 days, 4 inch resection and a colostomy.

Hope this helps.
Take care.
DD

spiceman
Regular Member


Date Joined Aug 2008
Total Posts : 51
   Posted 1/6/2009 7:30 PM (GMT -7)   
Thanks for your replies....balleenstein/dangdonkey.
 
I'm really getting worried now about my surgery. about 5 days ago I tapered from 6mg to 3mg of entocort which after a few days of doing so felt fine but today I felt very distended again so went back up to 6mg. My GI has said to taper to 3mg 1 week before surgery. Its only after I was reading on the net that taking steroids increased the risk of infection, so I thought it would be good idea to completley come off before undergoing the knife.
 
I'm now thinking to myself what would be best for the operation, be on steroids (3mg) or be slightly in pain before the operation if I was to taper to nothing before hand. I just want things to go smoothly.
 
Dangdonkey , I see you had a colostomy In December, Is it temp? which it can be reversed? I'm so worried about having a bag one day. I just wondered why some people with Crohns have a stoma and then some have multiple operations ( resections ) with out.
 
Please somebody put me at ease. Its only when surgery is starring you in the face the mind goes into overdrive..
 
Thanks all. 
 
 
Medication at present 6mg Budesnoide, 200mg Azathioprine, 3000mg Pentasa.
 
Operation due 28th Jan due to narrowing stricture.


randynoguts
Veteran Member


Date Joined Jan 2003
Total Posts : 6050
   Posted 1/6/2009 9:00 PM (GMT -7)   
were not drs spiceman, so each persons story is going to be differant than what you may encounter, however, having said that, the small amount of entocort your taking is less steroids than you body naturaly produces each day. . yes steroids can increase the likelyhood of infection but it does not happen spontainiously, most hospital infections are due to dr errors during or after surgery and bad hygiene techniques by hospital personel. you will most likely get some high doses of intravenous steroids while in the hospital anyway so your little amount wont matter. all these concerns should be discussed with your dr BEFORE the last minute and answered to your satisfaction before proceding..
randynoguts 



     http://www.geocities.com/randynogutsweb/


gachrons
Veteran Member


Date Joined Mar 2007
Total Posts : 4527
   Posted 1/7/2009 4:06 AM (GMT -7)   
Hi I was on 30 mgs of pred when I went for surgery so try not to stress things will be fine .I think you probably just have jitters and it is natural before surgery.Just follow what your Dr. has told you .Keep in touch lol gail
Hallarious woman over 50 ,CD ,IBS 27 years--resection,fistula's,obstructions,hemmies,and still alive.lol gail


belleenstein
Veteran Member


Date Joined Feb 2007
Total Posts : 1010
   Posted 1/7/2009 6:43 AM (GMT -7)   
Hi Spiceman:

You are wondering about ostomies and why some people get them and some with crohn's end up with multiple surgeries.

It depends alot on how your crohn's presents itself and it is not as clear cut an answer as for those with UC. Generally though, my sense is that people who suffer from primarily stricturing crohn's are less likely to end up with a permanent ostomy than do those who have primarily inflammatory crohn's. Some people with crohn's have a pan crohn's colitis. Which means wide spread inflammation, including the rectum. If this cannot be controlled through medication, surgeons will often opt for an ostomy. And my sense is, that for most patients, quality of life improves dramatically in this situation. Perhaps someone will enter this discussion who has experience.

On the other hand, if your crohn's is limited to one area, the chances of coming to ostomy are far, far less likely. I have had crohn's for nearly 35 years. I have had three major operations relating to strictures and obstructions, but have not yet had a stoma either permanent or temporary.

If you are scheduled for surgery in order to deal strictures, I suspect you have been dealing with episodes of severe pain and I suspect your quality of life has been compromised for some time. These strictures take a long time to reach the point of surgery. You have probably been living with these issues for so long you may no longer appreciate how much they are affecting your quality of life. I suspect that by the middle of March you will be relieved that it is over and surprised at the difference in how you feel.

If you are worried about the increased risks of infection, make sure you communicate that to everyone who has contact with you. Ask if they have washed their hands. If it is obvious that they haven't then politely remind them that you are at high risk and ask if they could please wash. Bring a sanitary hand wash to hospital with you. Have your family and friends use it. Do not pick anything up off the floor! Consider anything not directly related to you -- bed, wash stand, etc -- contaminated, including the curtains around your bed. Wash your own hands frequently and do not touch your incision.

Remember, to get out of the hospital you have to eat and what you eat has to come through and you have to be able to tolerate oral pain meds. So follow your docs orders and get up early and walk to get your bowels moving again. You want to get out of hospital as soon as it is medically safe to do so because, although it is wonderful that we have these institutions to care for us when we need them, they are breeding grounds for infection.

Surgery is a major life event and should never be taken lightly, but you need surgery and that is your reality. I hope you can embrace it as an opportunity for a new beginning even in the midst of your quite natural anxiety.

Aren't we fortunate to live at a time when life-saving surgeries such as intestinal resections are routine. Hundreds of thousands are performed every week and very rarely is there a major complication.
Belleenstein:

30+ years living with Crohn's.


dangdonkey
Regular Member


Date Joined Jan 2009
Total Posts : 22
   Posted 1/7/2009 7:25 AM (GMT -7)   
In my case I needed a colostomy due to the perianal fistulas I suffer from. The consensus is that the colostomy should give my rear a break and thus promote fistula healing.
I have a loop, which means it can be reversed at a future date if I choose to.
To me it all comes down to Quality of Life, if the bag gives me some sort of comfort than I have no issue with it. You will adjust if a bag is needed.

Brian

spiceman
Regular Member


Date Joined Aug 2008
Total Posts : 51
   Posted 1/8/2009 7:50 AM (GMT -7)   

Hi Bellenstien. Thank you so much for your detailed response it really made me feel at ease. You gave me some great information on fighting infection and dealing with stricturing Crohn's.

I see that you've had your fair share of operations. Hope you dont mind if I ask you a few questions regarding your operations...

1. What type of opertions did you have ?

2. How long in between from 1 to the next?

3. Did you have open surgery?

4. Anything else you may like to add.  Thank you ever so much.

Spice.

 


Medication at present 6mg Budesnoide, 200mg Azathioprine, 3000mg Pentasa.
 
Operation due 28th Jan due to narrowing stricture.

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