Prednisone for an achy wrist? That seems unusual (I have a lot of aches LOL, and have been on prednisone a lot). There is a topical prescription NSAID available called Pennsaid, that my friend is using. It is a gel that can be spread on an achy joint, and people who can’t take oral NSAIDs can often use it instead.
RA also comes to mind, if there is a consideration of severe inflammation causing pain in a joint. (is she left-handed? splinting can help but reduce mobility quite a bit)
An odd situation, RH, both wrists.There’s more to this story. I don’t think she has RA, but who asked me. I’ll mention the Pennsaid, but it also seems to have some effect on diabetes. Seems many or all steroids do.
She’s one of those tales that suggests we all keep at some exercise and reasonable eating. I predicted this decline in physical strength years ago. (I come from a genetically strong family, but all the elderly aunts who flagrantly ignored their health suffered woes.) My mother is the sort who is delighted when, eg, the eye doc says her eyes are in good shape, but would be lost, I think, without some medical issue to lean on.
The other cautionary is how some specialists aren’t up on endocrinology.
NSAID is non-steroidal anti-inflammatory, like Advil, Motrin, aspirin, etc. Here is a link for Pennsaid (if anyone else is interested too; if you or your loved one has ulcers, it might be something to think about):
http://www.pennsaid.com/
My friend likes it because it is a thin gel, so you barely rub it in, not an ointment. Some skin irritation can occur so she uses less than they say. Seems to help.
I’ve been on prednisone multiple times, not even that high a dose, and it has messed up both my mood and my weight. One of the most manic people I know (nice guy though) is on like 80 mg of prednisone per day. Funny thing is that he is as thin as a rail. And yes, not only are all doctors not up on endocrinology, but many are not up on pharmacology and side effects.
Prednisone can cause bone loss:
http://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp
Even using an electric wheelchair can be taxing on the wrists and the thumb. My FIL used a Jazzy and had trouble with his “joystick hand” (I know you mentioned both wrists though).
My dad is the opposite, he had severe cataracts and he was worried about getting eye surgery so he ignored it and was driving around with 20/80 (and 20/200 in the other eye) vision. I finally took him to my doctor and he had both cataracts removed, and now is 20/40 and 20/80. He hides medical conditions from us and constantly says “I feel GREAT!” and “I went to the doctor and everything is FINE!”. I even had to push him to get a mole looked at and it was SCC and he had it removed before significant damage was done. And then he says it was his GP who pushed him to get it looked at, and I know his GP said “it’s a wart, don’t worry about it”.
Good luck.
I have seen prednisone have nasty side effects - mood, personality, weight, appetite, ( as mentioned above)
Short term use, and weaning off may be ok, but otherwise be on alert. It’s a potent med
That’s the trouble - it’s a medication but it is really a hormone. Once you start messing around with hormones, it is like a cog in a huge system of gears.
http://rheuminfo.com/medications/prednisone-2/prednisone-detailed-information
Opinions on surgery. My mom has congestive heart failure and needs a new heart valve. The cardiologist has been telling my sister for about a year and a half that mom needs a new heart valve. At her last visit the dr told her that once she’s past the shingles he’s going to send her to a surgeon for evaluation.
There are several opinions in the family…I believe you have to balance how difficult this surgery will be on her, including time in rehab and quality of life vs how much quality time it will give her. Other siblings say we do it at all costs. Another thought is rely on the opinion of the surgeon.
She’s in very poor health overall. She hardly gets up out of her recliner and has never done anything in terms of exercise or rehab to improve. She thinks after surgery she should just come back to her apartment and have people wait on her there. She is not a wealthy woman so that’s not a reasonable expectation.
Obviously the choice is hers and she wants to do the surgery. She thinks it’s as uncomplicated as the stents, which was still a difficult recovery. She doesn’t always understand what she’s told so she does rely on us.
I posted a link from Johns Hopkins explaining different types of procedures. I think that a follow up with a surgeon may not be out of the question if she could qualify for the least invasive of the options. Does she have advanced health directive? Some questions to keep in mind: How many procedures have the surgeon done and what is the success rate? How does he measure success? Is the reason that your mom does not exercise or get out of the recliner due to the CHF or is this her normal baseline? What is a reasonable expectation of the outcome?
It seems that many elderly never fully recover once they undergo surgery using heart/bypass. The mental decline as well as other physical complications are to be considered carefully, (IMO). It’s not an easy decision. http://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/heart_valve_repair_or_replacement_surgery_92,P07975/
@eyemamom I’m mostly a lurker on this thread, but my 86 year old mom had TAVR done in May and her health improved dramatically. She did make a full recovery and has regained a great deal of her quality of life. Feel free to PM me if you’d like to know details.
An 80 year old man I know had valve replacement last winter - wife said she found only surgeon in country who does procedure using small incision and less anesthesia-
Husband has dementia so limiting anesthesia her goal.
She said surgeon is in Miami-
I see this couple doing multi mile walk each day- they were walkers before procedure.
An in law had a heart valve replaced last year, the first time he saw the doctor, the doc refused to do the surgery stating he was not in good heath. I don’t know how or why, but the doctor changed his mind and did the operation. It was a disaster, the patient has some dementia and short term memory issues, he was an ugly mean cruel horrid patient, he did not qualify for covered rehab originally. His wife has had a miserable horrible year. He is, surprisingly, still alive, but he is worse than before, many horrid months, falls, a visit to rehab after he refused all therapies, etc. Sad & tough, because who knows which person will have a good or bad recovery, though people predicted this guy’s recovery would not go well. I would ask for details about all the thing that might go wrong and make sure you are willing to live with any of those which might happen.
I think it’s going to depend on co-morbidities, the rest of what’s wrong with her that may put her at risk or affect recovery. If you google there are positive reports for over 80. But.
http://www.sts.org/news/people-older-80-fare-well-after-valve-replacement-surgery It’s a small study, but, “They found that octogenarians have excellent survival, but may do better when discharge to a care facility can be avoided.”
Sorry, but I’m not a fan of prolonging an older person’s diminished life just because technology can do that. Tough decision. If there can be marked improvement- physically and in quality of life, maybe that’s different. My mother did well after triple bypass, felt so much better. But what did it amount to? She refused cardio rehab (the exercises and counseling) and after the first year, went physically downhill to the point where she not only uses an elec chair, she can barely walk to the bathroom. She didn’t use the gift medical technology (and Medicare) gave her. Sorry if I seem tough.
No, you don’t seem too tough. I happen to fall in line with your opinion. I know she won’t do rehab and if we’re talking a year of recovery how much gain is there really to be had? Of course no one can answer that. If I’m recovered enough myself I’m going to try and go to this next appointment. The problem is my mom does not want to hear or know the information. I don’t happen to believe you preserve life at all costs, but perhaps easy for me to say since it isn’t me.
If someone is on blood thinners, those ben-gay type gels for topical pain relief can cause complications!
Having done cardiac rehab (and I still go there for my exercise because I like the routine and they know what to do if I were to have an issue), I swear by it. But I’m not in my 80s. However, I also see a goodly number of seniors there who go through the motions in Phase II (post-op rehab) and quit ASAP when that is done. The cardiac rehab folks tell me they are good at picking out who will have a recurrence. I would take a good hard look at the senior’s current quality of life and get a sense of whether or not they are willing to do the hard work of rehab. (And it IS hard. There are 85 yo guys there who don’t look a day over 60 who are running and and 60 yo men who can’t walk on the treadmill. )
That said, my dad had a bypass at age 73 and said he won’t do that again (he’s 78) now that my mom has passed away and he no longer has to provide her nursing care. He has laid out (in writing, thank goodness), what he wants to have done, and that is mostly NOT having things done.
I read an article about LVAD a couple of weeks ago (left ventricle assistive device – which is basically a sort of artificial heart that does the pumping work of the left side of the heart) and it sounded so cumbersome and limiting that I drew a line in the sand for myself about whether I’d do that it it were necessary. First time I had found a specific situation in which I’d just say no.
Maybe get a second opinion?
Well crap. My mother passed the CA drivers license test. At 83 she passed the vision test after her cataract surgery Then passed the interactive laws test online. Without getting in a car she’s now licensed for a decade behind the wheel. At which point she will be well into her 90’s.
RE: the heart valve. That is a tough call. Remember that every day in the hospital bed after you lose about a week’s worth of conditioning. My mom was a (otherwise) healthy 73 year old and had a valve and aorta repair done. At that time, there was a 10% morbidity rate from the surgery alone. She was in the hospital 16 days and very very tired for weeks after. I think it was almost a year before she was back to her old self.
LF - does your mom have Type 1 or 2 diabetes? Prednisone does affect blood sugar a lot. And I find with my dad, the older he gets the more irregular his sugar is. Plus, we can no longer tell by looking at him or his behavior when he is going low. Pain also can affect blood sugar too.
I cannot believe they do not have a diabetic menu. Actually they don’t need a “diabetic” menu, but they do need to make sure they offer things that are not carb-heavy. Alternatives to a big pasta meal or a bagel at breakfast etc.
Good for her! Now if they can get everyone else tested every 10 years. NJ has vision only testing every ten years, but I have yet to see it applied.
Heart valve is a tough call - yes, it could make quite an improvement, but honestly some people do not want to go through pain and trouble of rehab.
I would say that if her insurance is good, and she wants to do it, and there is no sign that she has Alzheimer’s or dementia, let her do what she wants. But I would sternly warn her, that part of the surgery is the rehab afterwards, and you and your siblings don’t have the training or the time to help her with rehab at home.
“Preserve life at all costs” is not the same as “she wants the surgery done but I don’t think she is considering all the details”…
I also want to mention that my dad delayed cataract surgery for years and had a tougher time of it due to crystallization of the lens, so he had two surgeries on each eye instead of one (but now is seeing pretty darn good). I don’t think waiting will help anything.
Me, I’m going to become part-robot if I have to - my uncle always made an off-color joke about having a pig heart valve and “good thing I’m not Jewish”, sigh…
Type 2. Cropped up maybe ten years ago. She was always one of those who took her meds and ate what she wanted (not a great idea.) Also overweight and sedentary. Apparently everyone should know Prednisone is trouble, supposedly there are package warnings. This, from the Joslin Diabetes Center, “In fact, another name for corticosteroids is glucocorticoids in honor of the powerful effect they have on glucose metabolism.”
My issue with her is a lot like what we all face: our good ideas and intentions, info and awareness we have, then some stubbornness on their parts for whatever reasons. Add that she never came to terms with her own childhood and if I press too hard, she feels victimized. Same rollercoaster a lot of us face.
At last she likes her place,the staff and neighbors.
A valve replacement is pretty major surgery. Remember, there will be coumadin/warfarin (blood thinner) checks following for the rest of her life. These are weekly at first and minimum monthly once stable. I feel if her diminished health is due to a bad valve, that’s a good reason to do it. But, if her valve is not a problem now, but may be in the future, it is not a good reason.
Dragonmom, I feel for you, my dad managed to pass his test a couple of years back. Fortunately, my mom didn’t.