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Crohn's Disease Forum » Surgery » Stopping Medication Before Surgery


06-04-2015, 09:09 PM   #1
SupportiveMom
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Stopping Medication Before Surgery

I had read somewhere that the surgeons normally have you stop medication before surgery. We were not told to do this. We have another appointment prior to the surgery date (subtotal colectomy) and they may discuss this. My kid is on prednisone & I did ask about finishing the taper (she is at 10 mg) & the surgeon said no. He was worried she could start the flare before the surgery and that might make it have to be cancelled.

Any experience with meds before surgery & stopping?
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Mom of 16 yr. girl w/Indeter.Colitis Sep. 2012(age 11) Nov.2012 Crohn's Sep. 2014 Crohn's Colitis, UC Nov 2015, Crohn's Feb. 2016

Ileostomy surgery July 2015

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Previous Meds: Humira, Remicade, Methotrexate, Cipro, Flagyl, Zofran, Cortifoam, 5-ASA suppository, Questran, Mezavant, EEN (Peptamen Jr. 1.5) by NG tube, Antibiotic Cocktail (Vancomycin, Metronidazole & Doxycycline), Simponi, Prevacid, Imuran, prednisone
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06-04-2015, 09:57 PM   #2
Clash
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My son came off remicade for a bit before surgery and then started back after. But even this break was long enough for antibodies formation. Because when he started back he only made it to the 3rd infusion with a slight reaction on the 2nd and a reaction on the 3rd. His antibodies levels were tested and extremely high.

We've never saw any benefit with pred so he's was only on it right after dx while waiting for transfer to Ped GI and remicade approval. But his colorectal surgeon was adamant he didn't want him on pred before surgery so he kept asking to make sure.

I think it really depends on the severity of disease and such. C was asymptomatic before surgery so it didn't seem to anyone the is was imperative that pred be on board and the surgeon was truly suprised at the level of damage with C being asymptomatic.
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C age 19
dx March 2012 CD

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Dx May 2014: JSpA
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06-04-2015, 10:17 PM   #3
SupportiveMom
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D's Simponi is 6 days before surgery so I suspect that wouldn't need to be stopped. She still is on Imuran & prevacid along with the prednisone so if they stop something I assume Imuran & Prevacid would be it. Is the stopping to reduce the risk of surgery? Someone told me recovery from surgery on steroids can have its own set of problems.
06-04-2015, 10:41 PM   #4
Clash
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I guess surgery while on biologics is a Rusk since there could be risk of infection. I was told the same as you about surgery recovery and pred having it's own set of issues.

My husband's niece has had many surgeries. She is steroid dependent. There have been recovery issues and such with a couple of them but others there haven't been. Her CD is refractory and her doc tries to manage the risk/benefit on all fronts, just hard sometimes.
06-04-2015, 10:56 PM   #5
Maya142
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My daughter was made to stop Humira to get her wisdom teeth out. She missed three shots (she was on weekly injections of Humira) and when she started it again, it never really worked again. The antibodies test was not available then, but her rheumatologist believes she made antibodies to it. She was not on an immunomodulator such as MTX at the time.

She then flared and we had a really really bad time getting the flare under control. We've always said that it was a huge mistake to take her off the Humira (although her wisdom teeth healed beautifully - no infection or anything like that).

A wisdom teeth surgery is VERY different from having your colon removed obviously, but I just wanted to tell you our experience. It was hard balancing the risk of flaring vs. the risk of infection and I honestly wonder if we were too cautious (particularly just for wisdom teeth).

Good luck!!
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06-04-2015, 11:47 PM   #6
24601
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Before my last resection and set of strictureplasties last summer we stopped Humira and methotrexate 2 weeks before surgery. (And we resumed them 2 weeks post-op)

I was curious to see what info was out there on this and just read this article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127026/

In terms of minimizing post-op infection risk you would ideally stop any of the immunosuppressants, anti TNF alphas or steroids before having an elective surgery but obviously there can be other factors, as in your daughter's situation.

It's not easy but sometimes we just have to optimize what we can - like having an elective surgery over an emergency surgery, optimizing nutrition, going with the best prophylactic antibiotics protocol etc
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Stricturing jejunoileitis dx 1996 aged 17
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Previous treatment: Humira + methotrexate
Past treatments: prednisolone, azathioprine, budesonide, pentasa, EEN (oral and NG), elimination diet, SCD, whipworms, 6mp, Remicade, anti-MAP antibiotic therapy
Surgeries: small bowel resection and strictureplasties in 2001, 2005, 2009, 2014
06-05-2015, 05:54 AM   #7
SupportiveMom
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Thanks for the link. It's much easier to digest then the research papers I was reading. I can't risk the anti tnf stopping working. There is nothing else if Simponi stops working, and there is no antibodies test for Simponi. I think I will send an email to the surgeon's nurse to ask again about meds. At least this gives me a focus to worry about!
06-05-2015, 09:34 AM   #8
Lady Organic
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I have heard that pred is no good prior to surgery, in what dosage, I dont know. Pred would make the tissues weaker and less strong to accept reconnection if i remember the story of a CD patient I met a few years back. It was not a colectomy, maybe a resection, but honestly i dont remember this detail. The post-op was a mess for her and it was due to the pred, and that all I mostly remember because she instisted on this (with lots of regret and anger). she changed medical team afterwards. Was she on a higher dosage than 10 mg , I tend to remember it was the case. 10 mg is low and prolly be acceptable. still worth inquiring more about pred.
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Last edited by Lady Organic; 06-05-2015 at 10:07 AM.
06-05-2015, 06:50 PM   #9
2thFairy
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It depends on the surgeon. Some want you to stop prednisone or biologics, others do not. I was on Remicade and a bunch of other crap before my colectomy and my surgeon didn't feel there was any additional risk of infection to continue meds, so I continued. My last Remicade infusion was 1 week before surgery. Surgeon preference.

edit: My surgeon also mentioned his belief that the risk of further flare without the meds was a greater problem than the risk of infection from continuing the meds, but again, this will differ from surgeon to surgeon.
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Last edited by 2thFairy; 06-05-2015 at 08:41 PM.
06-05-2015, 07:12 PM   #10
hawkeye
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I took my Imuran and 5-ASA until (and including) the day before surgery. If she is on Omega 3 fish oil supplements she may have to go off of those a week or 2 before as they thin the blood, or so I was told.
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Current Medications: None currently. Was on Imuran (150mg/day) and 5-ASA (3000 mg/day) as maintenance meds prior to surgery
Surgeries: Left hemicolectomy 2014.
06-05-2015, 07:53 PM   #11
lenny
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Seems like things like wisdom teeth etc. should be done prior to getting on these meds or not at all. Seems like the meds should take priority, if they're working.
06-05-2015, 08:49 PM   #12
SupportiveMom
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Well the meds working is up for debate. If they were truly working would surgery be necessary?

There is no resection, so the only connection is the stoma for this surgery but still the healing... I am concerned. I was surprised doc said 7-10 days in the hospital. My friend just had the same surgery (30 yrs old) and he was out on day 7 but no prednisone. I'm guessing the extra days is because of the pred?

Imuran is an immunosuppressive. Wouldn't there be complications being on it? In all fairness, I'm not questioning the surgeon. He is TOP NOTCH & done thousands of these. He definitely know what he is doing. I think because of her dependency on steroids her coming off before could put her in a flare and then surgery would be canceled. I just want the best chance for healing for her as possible.
06-05-2015, 08:59 PM   #13
2thFairy
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The average time in the hospital after stoma surgery is 5-10 days. Stomas can be tricky in the beginning. I was in for 12 days and was not on prednisone. It is so very different for everyone....truly.
06-05-2015, 09:06 PM   #14
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I think the time range is because you just don't ever know for sure. When they say 7-10 days, you could be out in 5 if everything goes incredibly well or 14 if things are a little slower. It's just variable.

Just to illustrate the unpredictability of it all, for my 4 resections/strictureplasties which were all open procedures, I was in hospital for 10 days (aged 22, very malnourished, no meds), 3 weeks + 10 days readmission for post-op abscess (aged 26, very malnourished, no meds), 3 weeks (aged 31, pre-op TPN, optimal nutrition, no meds) and 7 days (aged 35, optimal nutrition, no meds)

One of the most important things is choosing a very experienced and skilled surgeon that you have confidence in and you've got that box checked

While you might ideally stop meds, it sounds like he has the experience to judge what's right for an individual and wouldn't be making the decision to keep her on the meds unless that was best in her individual situation. I know it's hard not to worry about everything though
06-06-2015, 04:08 AM   #15
Grotbags
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I was on pred 10mg, Humira and Methotrexate when I went for my surgery, my surgeon said it wasn't ideal, but safe enough.
I had no infection and healed up quickly, was out in six days, I was 48 at the time.
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06-06-2015, 08:51 AM   #16
hawkeye
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I think they usually give a range of days. When I had my resection he said anywhere from 4-14 days. I was out in 6 days, but back in 2 days after being released for another week due to an obstruction.

Based on some of the folks that were in the hospital with me the 7-10 days for an ostomy seems like a good range.
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