immunosupressants and surgery

Discussion in 'Laser Eye Surgery' started by Ann, Oct 17, 2006.

  1. Ann

    Ann Guest

    Does anyone know if it's likely that surgery would be carried out
    while I'm on mycophenolate? My haematologist says it probably will
    but she's only guessing. I'm due to have a dermal fat graft to
    replace a coral implant in an enucleated socket. I'm on steroids at
    the moment and the surgeon won't do it while I'm on the steroids but I
    have yet to tell her that when weaned off the steroids I'll still be
    on the mycophenolate for the next six months. Am desperate for this
    op .. have been waiting for a long time, had a date all set up and
    then due to ITP can't get it done.

    I bet nobody here knows but thought I'd try.

    Ann
     
    Ann, Oct 17, 2006
    #1
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  2. Ann

    Dennis R. Guest

    You MUST tell your doctor about the MMF (CellCept) simply because the
    surgeon cannot make an informed decision without knowing. You could also
    ask the doctors who put you on the immunosuppressants to inform your
    surgeon of your progress, actual dosages, and if they have any
    experience with your type of surgery for their other patients. Maybe
    they can assure the surgeon that it is okay at this time to operate, or
    maybe they will confirm that you should wait.

    I take it that your treatment for I.T.P. (immune or idiopathic
    thrombocytopenic purpura) will be short term, at least for the CellCept?
    No matter how badly you want this operation, withholding crucial
    information like this from your surgeon can only cause big problems.

    Dennis (Kidney Transplant 1995)
     
    Dennis R., Oct 17, 2006
    #2
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  3. Ann

    Ann Guest

    I have been asked to keep in touch but no point telling her anything
    just now as I don't have enough to tell. As soon as I know when I
    will be off the steroids and can see that the platelet count is
    holding up, I will call and explain the situation and see what she
    says. Trouble is it can change overnight as it did before when my
    platelets crashed so nothing is set in stone.

    The idea is that I be on the CellCept for a total of 6 months and then
    try to get off it but who knows what will happen. ITP is a weird and
    wonderful disorder with a mind of its own. I definitely want off the
    CellCept. Having had cancer once already, it's very scary to be on
    it.

    It's also not quite just a matter of wanting the op but I need it. If
    the socket and implant gets infected which is going to become
    increasingly likely with the immunosuppressants, then it will end up
    being an emergency op.

    I guess you have much experience with immunosuppressants being a
    transplant patient. What a bother it all is eh? Thanks for replying.

    Ann
     
    Ann, Oct 18, 2006
    #3
  4. Ann

    Dennis R. Guest

    From what I have briefly read on I.T.P., using immunosuppressants other
    than a steroid like prednisone is a new treatment option that seems to
    work better than the steroid alone. CellCept only came into common use
    in transplantation in the mid to late 1990's. Cycloporine opened the
    modern immunosuppressant era for transplantation a decade before.

    I would bet that the dosages for I.T.P. and other autoimmune diseases
    are much less than used for transplantation, and that the incidence of
    cancer and tumours post-transplant is not as scary as some rumours make
    it out to be.
    That may not necessairly be the case. It depends on the doses and other
    indicators. Within a few years of the transplant, I was down to 7.5 mg
    of prednisone daily. There are many with arthritis and asthma patients
    who take large doses of steroids for short periods of time without
    complications.

    Best wishes,
    Dennis
     
    Dennis R., Oct 18, 2006
    #4
  5. Ann

    Ann Guest

    Steroids on their own work very well with me but they don't want me to
    stay on them long term and coming off them only got me a 6 week
    remission, so we had to try something else. The CellCept takes
    several weeks to have any effect, so back on the steroids in the
    meantime. Azathioprine has been used for a long time with ITP but the
    side effects are supposed to be more severe than with the CellCept,
    although the hospital pharmacy don't like the high cost.. tough luck
    to them and thank goodness for the NHS.
    The dosage is the same I think. 2g per day but obviously for a
    shorter time. The idea with ITP is to get to a place where you don't
    have to treat. Or you find yourself in the position where the
    treatment is worse than the disorder.
    I'm now down to 30mg prednisolone (from initial 60mg) with the 2g
    CellCept per day. Cutting prednisolone is a struggle. My knees are
    hurting today and I don't sleep at all.. ho hum.

    Ann
     
    Ann, Oct 19, 2006
    #5
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