Discontinuing medicines - Pre-Op

[BowelMeOver]

My husband is scheduled for surgery to remove his colon and rectum on Sept 6th. Since May, he has been taking 200mg of Imuran daily and Humira shots biweekly.

In meeting with the surgeon to discuss the procedure, we were advised to discontinue the Humira 30 days prior to surgery, and the Imuran 2 weeks prior. Also, because my husband had been on Prednisone from March till early July, they will be starting him on a low dose prior to surgery, and perhaps for a bit post-op.

My concern is that discontinuing the medicine will make him vulnerable to another flare, and I'd hate to have him go for surgery in such a state. He has actually been feeling the best ever these past few weeks, which I know will only benefit him in a smooth recovery.

Have any of you also been advised to stop medications, and did you magically not feel any horrible side effects? Please say yes! :shifty:

 

[nogutsnoglory]

I can understand your fear of a flare but think about it this way, they are removing the area he would likely flare in anyway. He may feel lousy a few days before surgery but after he is healed up he should be a new man.

I usually get advised to stop taking meds a week to 10 days before surgery. I never notice any withdrawal and feel fine. The only time I had an issue was I stopped Prozac and never went back in since I felt good. Depression came rearing its ugly head. That was my fault though for not resuming after surgery.

My experience may not be applicable to your husband because coming off or even tapering of prednisone is not a joke.

 

[Jennifer]

The reason for stopping these medications is to reduce the risk of infection post op as many can impact the healing process in a negative way. Although I'm curious about the Prednisone as that also affects the healing process. I don't recall what dose I was on at the time of my resection but I believe it was over 20mg if not still at 50mg (I don't recall when the taper was as that was 14 years ago) but it did cause complications with my healing and I did get an infection. Both my GI and surgeon said it was because of the Prednisone. I haven't done any recent research on steroid use and surgery so I'm not aware as to why they'd want to put him on Prednisone unless they feel it would help with any possible flare but be low enough to not affect the healing process.

For me I had both scar tissue and active inflammation when I had my resection. They removed all of that which put me into remission for 14 years. I did start back on some of my meds following surgery though (6MP and Asacol and continued the taper off of Prednisone and Entocort). I don't recall feeling horrible before surgery, possibly because I was hospitalized and on a liquid diet while there (only for about a week though at most).

I'm going to tag Afidz as she's dealt with having to stop medication before surgery (yet her surgery wasn't a resection).

 

[BowelMeOver]

Thank you both for sharing your experience with me.

As I understand it, the surgeon will be putting him on Prednisone prior to surgery in the event my husband's adrenal glans have not returned to full function yet, since he just tapered off it completely in early July. Surprisingly enough, especially with all the posts I've read about nasty withdrawals from Prednisone, my husband actually had none whatsoever. Perhaps this is a good sign that he will also not experience any when he stops the other meds.

And you're right, NGNG, what's a few days of potentially feeling miserable, when he'll be feeling good as new soon. Perhaps it will even make him more accepting of the surgery.

The waiting is definitely the hardest part, as it gives us too much time to contemplate the "what if's"! :ybatty:

 

[afidz]

I was not instructed to stop Humira before my surgery, my surgeon only said to skip the next dose as it would be the day before my surgery. I had a horrible infection because of this and since then have not been able to heal correctly.
I think I can understand why they want him on prednisone. They don't want him to go into shock while on the operating table. But I may be wrong on that.
Humira, especially if you have been on it for a long time, gets so built up in your system that he may not flare or flare badly while not on it. My last dose of humira was before the surgery mentioned above in 2010, I stayed in remission until last February, not taking anything. He may feel good, he may not. Just take it day by day

 

[UnXmas]

You're right BowelMeOver - It's definitely better for him to be on pred when he has surgery if he's been on prednisone at any point during the last year or so.

Prednisone can shut down the adrenal gland because it takes over the adrenal glands' job producing cortisol - and you need that if you have an operation because of the physical shock to your system caused by surgery that requires higher levels of stress hormones. If your system is shocked by surgery and you still have adrenal insufficiency from previous prednisone use, you can have an adrenal crisis which can be life-threatening. So being on prednisone ensures that it doesn't matter if the adrenal glands still aren't working because the prednisone takes their place. Most people still have functioning adrenal glands even after being on prednisone, but there's no easy way to test whether that's the case beforehand so they give prednisone anyway, just in case.