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Rank: Advanced Member  Groups: Registered
Joined: 3/17/2010 Posts: 42
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Hi All My hospital would like to book me in for a minor op in the next few weeks, thankfully nothing to do with RA. It will be under GA and will last around 20 mins. I should be able to go home the same day. It is a routine op and the surgeon said I would have the usual risks of blood loss and infection. I told the surgeon that I am on MTX and etanercept and this would put my risk of infection as higher than the average patient. He decided to get a full blood count and then said he would check for the results of the blood test before giving me a date for the op. I asked him what should I do about taking my MTX and etanercept and he said to talk to my rheumatologist to see what they tell me to do. I emailed the rheumatologist nurse the same day and she told me that it is down to the surgeon to make the decision as to whether I should come off the meds prior to the surgery. Now I am confused.  Is it standard practice to stop taking immune suppressing drugs before surgery to allow time for immune system to get stronger or is this only done when having major surgery? I guess I should just relax and not stress too much but the surgeon did get me slightly concerned when he said that perhaps my surgery should be performed under the NHS Trust - you see he works for a company which the NHS outsources patients to undergo routine surgery. Your opinions are welcome. Agnes
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Rank: Advanced Member
Groups: Registered
Joined: 3/24/2010
Posts: 102
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I would so love it if someone medical would jump in and give advice!!!!!!!
I had understood that one should stop all RA meds prior to surgery------------------------
it would seem that - each to their own advise?????????????????
help.............
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Having just gone through this with drastic consequences the correct advice, in my area at least, is to stop Methotrexate and Enbrel two weeks before the op and restart two weeks after providing there are no complications. I was told incorrectly to restart Enbrel after the six week check with the surgeon and suffered a major flare as a result which is proving difficult to bring under control. Good luck Lyn x
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Rank: Advanced Member  Groups: Registered
Joined: 6/18/2010 Posts: 351 Location: Herne Bay Kent
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I was also told to stop medication two weeks before and begin again two weeks after any invasive procedure. I am due to have a tooth out and the same applies for that. Hope the op goes well
Sue
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 1,689 Location: Durham
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I take humira and was told I would have to stop taking it before any surgery. Kathleen x
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Rank: Advanced Member  Groups: Registered
Joined: 4/20/2010 Posts: 1,749 Location: Somerset
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Agnes.
I do have the answer as not been under Gen An. Good luck though with your quest.
I do feel people always seem to pass the buck.
Rose
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Rank: Advanced Member Groups: Registered
Joined: 3/17/2010 Posts: 42
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Thanks for your answers. It does look as most of you have had to come off the RA meds for a short while which makes sense. I will put this info to my surgeon and then leave it up to him to make a decision. It's so awful to fall between two camps.
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Just to add!! Most surgeons are completely unfamiliar with RA drugs and the importance of maintaining adequate medication to keep the disease at bay. Your rheumatologist should provide necessary guidance to ensure that the surgeon makes his decision based on facts and not just his own thoughts on the matter. Enbrel and Methotrexate both slow down the healing process so it is the interests of the surgeon to keep you off the drugs as long as possible. However the rheumatologist would argue that an absence in medication of anything more than two weeks would allow RA to become active and could lead to a flare. The surgeon needs to be aware of this, he won't necessarily know. I stopped my Enbrel at the beginning of July for an op on 15th July. I was told the orthopaedic surgeon would review meds at the follow up appointment on 3rd September once he could see all was adequately healed. I actually restarted on 20th August after a huge flare and I couldn't stand it any longer! It was against my GPs advice and the surgeon's advice. The Enbrel became ineffective due to the long absence and I'm not now sure that it is going to work for me anymore. I have since been told by the rheumatologist that I should have restarted after two weeks. Shame the surgeon and I weren't informed :( I have had a number of ops over the years and invariably received conflicting information. Best of luck Lyn x
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Rank: Advanced Member Groups: Registered
Joined: 3/17/2010 Posts: 42
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Lyn
Thanks for your reply. I will bear it in mind when speaking to the surgeon. As yet I have heard nothing from my surgeon and they have not even got in contact with me to set up an appointment for the surgery. I will try to get the two sides together so that they can thrash out a plan. If necessary I will get my GP to act as go between though I doubt that will happen. The only thing I can say it is great to have this site so that at least I can inform myself on what the general protocal should be. Without this info I would not have pushed my surgeon for an answer and I could have been booked in for an op when I was not physically ready to go under the knife.
Agnes xx
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Hi Agnes Difficult one isn't it! Hope things go well for you and if they can't sort it out between them go with your own instincts! I didn't until too late ... more fool me!! All the best Lyn x
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Rank: Newbie
Groups: Registered
Joined: 12/10/2009
Posts: 5
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Hi Agnes. I have to say you have worried me. I am under a neurologist for my Oesto Spondylosis in London and I live near Stafford. I am ment to be having an bone marrow biopsy under local aneisthetic ina weeks time I am on 50mg Metrifen and well as 5 others drugs each day. Although the hemotologist knows I am on the drugs he has not mentioned leaving them off before the op. Has anyone out there had this and what did they do? I do not have a rhumitologist as my GP says they would not do anything for my condition which is progressive since a car accident in 2006.
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Hi Bevers The problem is with drugs such as methotrexate and the anti-tnfs which can retard wound healing. I would think, and it is only my opinion, that the procedure you are about to undergo will not involve the surgeon making anything other than puncture wound. As it's a local anaesthetic job any wound will be very small. I would certainly check it out with someone who understands the drugs you are on for your own peace of mind. Most surgeons don't, as I found to my cost recently!! Good luck Lyn x P.S. What drugs are you taking?
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