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Q: Recovering from surgery while taking Prednisone ( Answered,   1 Comment )
Subject: Recovering from surgery while taking Prednisone
Category: Health > Medicine
Asked by: crankshaft-ga
List Price: $50.00
Posted: 10 Feb 2004 10:15 PST
Expires: 11 Mar 2004 10:15 PST
Question ID: 305429
My husband is 70 years old.  Last year he had total knee replacement. 
He takes 30mm of Prednisone daily and it is slowing down his recovery.
 We are looking for resources that can speed his healing.
Subject: Re: Recovering from surgery while taking Prednisone
Answered By: nancylynn-ga on 10 Feb 2004 17:31 PST
Hello crankshaft-ga: 

I'm sure you feel caught in a vicious cycle: the side-effects of the
Prednisone are keeping your husband from being active, which is what
he needs to be in order to recover from the surgery.


Of course, your real goal is to help your husband get off prednisone.
But until he reaches the point where his doctor is willing to decrease
-- or even suspend -- use of the drug, this book may help: "Coping
With Prednisone: It May Work Miracles, But How Do You Handle the Side
Effects?" written by Eugenia Zuckerman and Julie R. Ingelfinger. 
(Griffin Trade Paperback; 1998.)

Learn about (and if you wish, order) the book at

Here's' s description of the book: 

"When the world-renowned flutist Eugenia Zuckerman was prescribed
prednisone to combat a rare lung disease, she teamed up with her
sister, Julie R. Ingelfinger, a well-known specialist in pediatric
nephrology and hypertension at Massachusetts General Hospital in
Boston, to write the first ever, comprehensive guide for patients
undergoing this difficult treatment.

Packed with everything your doctor didn't have time to tell you,
including recipes, exercises, and tips based on personal experience,
Coping with Prednisone is an invaluable handbook for health-care
workers, caregivers, and especially for patients themselves."

You'll see numerous reviews lauding this book and, at the top of the
page and to the left see Amazon's "Look Inside The Book" feature.
Click on that to bring up:
And then you can search the book using any search word, such as
"counteract," to bring up pages from the book.

Check out the article "Prednisone: The Drug We Love To Hate" at

The article's tips include:

"Bone density loss: Supplementing a healthy diet with calcium will
help to keep bones healthy through a course of prednisone.

Diet: Reducing salt intake can prevent side effects associated with
fluid retention. Watching fat and calorie intake can help to prevent
weight gain. A nutritionist will be helpful in planning a diet to
follow while taking prednisone.

Dosage: Talking to a gastroenterologist about the best time of day to
take prednisone for maximum effectiveness and minimal discomfort could
make a big difference. Taking prednisone earlier in the day (only on
the advice of a physician!) could reduce side effects such as insomnia
or night sweats, and taking it with meals could prevent stomach

Here's an online support group for those coping with the "SIDE EFFECTS
OF PREDNISONE," at Suite 101:

Your husband may want to join in on discussions, or at least read
through the threads to gain insight on what has -- and hasn't --
helped others who take this drug.

category of "Try It And See If It Works")

"At Your Service Health Services" (the site's contributors are various
San Francisco medical practioners) has a helpful page on "Senior
Health," at:

That article recommends a "comprehensive calcium-rich supplement known
as microcrystalline hydroxyapatite concentrate (MCHC)" to "slow or
reduce bone loss."

Scroll down to:
"Who May Benefit From MCHC?" 
" . . .Other risk factors which may result in an accelerated loss of
bone include: . . . regular use of drugs such as Dilantin, Prednisone
. . . "

There's no question that Prednisone robs the system of calcium and
that calcium is always recommended for patients on Prednisone, so your
husband may want to try a high-dose calcium product -- with his
doctor's permission.

You can order MCHC at NutriMed Lab:   
which notes that MCHC is "an extremely bioavailable form of calcium
which has been used with great success in prevention and treatment of
osteoporosis, to prevent and halt bone loss, and to restore bone

But here's information from NutriMed that your doctor needs to know if
he or she isn't already aware of MCHC:

"Additional minerals are present [in MCHC] in the natural ratios
occurring in normal bone. Boron is added because it has been shown to
reduce urinary excretion of calcium and magnesium and *significantly
increase blood levels of both estrogen and testosterone.* . . . .
.Calcium, sodium fluoride and estrogen are the only agents whose
ability to influence favorably the process of osteoporosis has been
established. *Of these, only calcium is without potential hazards.*
Calcium from M.C.H.C. and calcium citrate are readily absorbed and
utilized by the body. While other forms of calcium may halt bone loss,
only M.C.H.C. has been shown to restore bone density."

Smith & Nephew (makers of Orthopedic equipment and devices) has a
"Knee Replacement Site" at:

The page has photos of simple, but helpful, floor exercises designed
to increase strength in the knee.

Here's some more simple floor exercises from "Your Medical Source":

Doing these kinds of strengthening exercises should help your husband
reach the point where he's ready to try such recommended regimes as
using a stationery bike. (He can go pedal slowly on one of those bikes
and set the tension to low.)

Of course, his doctor will have to approve any changes in exercise
routines. But encourage your husband to try these floor exercises and
hope he soon feels strong enough to increase activity and move to the
next level of exercise.

See the article "Dangers of Prednisone, and How to Avoid Steroids," by
Dr. Joseph Mercola with Rachael Droege, at: 

According to Dr. Mercola: "But the need for this and all drugs can be
dramatically reduced over the course of anyone's life if they adopt a
healthy diet and take a host of other preventive measures such as:

*Eliminating sugar and grains from the diet 
*Increasing omega-3 fats, primarily EPA and DHA 
*Optimizing vitamin D levels [dairy products and fish are rich in vitamin D]
*Removing any excess iron from the system" 

Learn more about omega-3 EPA and DHA fats at See this
article, "The Benefits of Fish Oil," by Laurie Anderson, RN, published
April 8, 2002:{5FE84E90-BC77-4056-A91C-9531713CA348}

The term "Optimizing vitamin D levels" was confusing to me. Dr.
Mercola explains at this page:

Weight gain is always a concern with patients on Prednisone. See the
Jan. 2004 issue of "Arthritis Today"online, at:

That article evaluates several very popular diets, including South
Beach, Jenny Craig, The Zone, and Atkins.

The "pros" concerning the Slim-Fast diet:
"Certain medications, such as prednisone, can cause weight gain, says
Vivian C. Shih, MD, an attending physician at the Rehabilitation
Institute of Chicago's Arthritis Center, so reducing calorie intake by
using meal-replacement foods [like Slim-Fast] can help offset weight
gain. And if a physician calls for a temporary cessation of exercise
to rest actively inflamed joints, reducing calorie intake is a sure
way to prevent pounds from piling on."

From USA TODAY's Jan. 6, 2004 online chat with Dr. Robert Kushner, "a
professor of medicine at Northwestern University": 

Question "Chuckey, TN: What kind of diet plan is best for someone who
is taking Prednisone on a continual basis. I have gained 40-50 lbs in
the last 8 years from this medication.

Robert Kushner: There are several medications that make weight loss
very difficult. Prednisone is one of them. If you can't reduce the
dose or take a substitute medication, then focus on calorie control
with ample amounts of protein, and daily physical activity. You may
also wish to discuss with your doctor about taking a medication to
help you lose weight, such as sibutramine (Meridia) or orlistat

The Fred Hutchinson Cancer Cesearch Center's site has a page on
nutrition for transplant patients. There, I found a very helpful
"Nutrition Guidelines During Prednisone Treatment":

"Protein: A protein-rich diet and exercise can help prevent muscle
loss. Include a protein-rich food in every meal and consume 2 to 3
protein-rich beverages or snacks daily. Exercise can include walking,
bicycling, low-impact aerobics.

Calcium: Consume a calcium-rich diet and exercise daily to minimize
bone loss. If your calcium intake is low, take a supplement of calcium
carbonate (such as Tums) or calcium citrate (such as Citracal).

Sugar (carbohydrate, glucose): If your blood glucose level is above
normal, discuss with your dietitian or doctor whether dietary changes
or insulin therapy are needed....

Potassium: You may need more potassium in your diet while taking
prednisone. The following are good sources of potassium: bananas,
oranges and orange juice, cantaloupe, Instant Breakfast, beans (chili,
kidney, refried, etc.), potatoes, Sustacal, Boost, tomatoes, tomato
juice, V-8, winter squash, ScandiShake (Your dietitian can give you a
more complete list.)

Salt: A high salt intake can worsen fluid retention caused by
prednisone. Avoid salt and salty foods such as canned, instant, and
frozen soups and entrees, soy sauce, cured meats, and packaged sauces
and seasonings. In general, processed foods contain too much salt."

I realize your husband must feel defeated by the Prednisone:
exercising and trying to eat right may seem downright overwhelming as
he copes with the drug's side-effects. It's a Catch-22 in that he has
to try watch his diet (even though Prednisone *increases* appetite)
and get some exercise, even though he's fatigued.

But he is going to have to try some of the diets and, just as
importantly, the strengthening exercises.

The fact is, dealing with knee replacement and a drug that is
well-known to be both a miracle and a nightmare rolled into one is a
lot to handle. If you think he's depressed from all this, therapy
should be a consideration.

If your husband won't try the strengthening exercises or dismisses the
idea, talk to his doctor about the possibility of your husband going
to an outpatient program at a local rehab. (I'm sure he's already had
rehab post-op, but some facilities offer programs for people who need
additional therapy. Some even have low-fee programs for patients who
have already used up their insurance allotment for rehab.)

Or, if the doctor feels your husband is ready for exercise, he or she
may approve a local exercise club or a personal trainer who comes to
your home. In either case, with your husband's permission, the trainer
working with your husband can consult with the doctor in order to
design an appropriate workout.

If you live near an indoor pool (or someplace where it's warm
year-round), his doctor will likely approve swimming, which is almost
always recommended for people who've had knee replacement surgery.

According to Medicine Net's page on knee replacement:
"Swimming is the ideal form of exercise, since the sport improves
muscle strength and endurance without exerting any pressure or stress
on the replaced joint."

Your local YMCA may even have a water therapy or "water exercise" class.

Search Terms:

"prednisone slowing recovery from knee surgery"
"efficacy AND 'MCHC supplement' "
"counteracting prednisone"
"prednisone side-effects"
"exercise AND nutrition AND prednisone"
"diet + Prednisone"
"nutrition AND Prednisone"

I hope my research is of help to you. Please post a "Request For
Clarification" if you need help navigating any of the above links, or
if you need me to clarify any of the information I've given you.


Clarification of Answer by nancylynn-ga on 12 Feb 2004 06:15 PST
First, my thanks to Pinkfreud for recommending CoQ10, an excellent supplement! 

Your husband may also want to consider taking a magnesium supplement.
Magnesium helps keep muscles and bones strong.

An added benefit: if the steroid is leading to constipation problems,
magnesium will help counter that.

See the article "Magnesium plays important role in building strong bones,"
by Alicia Di Rado, at the University of Southern California's "Health
Sciences" site:
Subject: Re: Recovering from surgery while taking Prednisone
From: pinkfreud-ga on 10 Feb 2004 21:13 PST
I'd like to add a personal perspective to nancylynn's excellent answer.

I have twice had the experience of slow healing after surgery because
of steroids. The second time, my physician suggested that I try taking
a substance called Coenzyme Q10 (available at health food stores and
vitamin shops). The surgical wound healed faster, and I regained my
strength and energy much better with the CoQ10. I cannot be certain
that the CoQ10 was responsible, but it was the only factor that was

Here's a bit of info on CoQ10. Your husband might want to ask his
physicians whether it might be useful in his recovery:

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