Back again....the saga continues on.....

[Kern1410]

Hello all!

Hope you are having a lovely summer. After getting back from trip - I needed a break from my health problems. I have tapered down from 50mg pred to 40mg. Doing ok. Well today at work I broke a tooth. I went to the dentist - they can do a crown tomorrow. I told them I was on prednisone but he did not seem concerned. I called my Rheumatologist but he did not call back. I’m worried about my anxiety and adrenals. I upped my pred tonight back to 50mg and was going to take another 10mg in the morning with a Valium to keep my nerves calm. Does this seem like a reasonable plan of attack? Any suggestions?

Thanks for your help!!! 🌸

[SheffieldJane]

My young, squirrel bright, dentist said that he would administer Novocain without Adrenaline because of my Pred. Might be worth a query. Personally I would be wary of increasing an already high dose of Pred for this treatment. Ensure you tell your dentist what you’ve taken. The Valium (5 mgs maybe) is probably a good plan. I did not find having crowns fitted, too bad at all. It made me feel more normal somehow. These diseases make you brave. Good luck!

[Kern1410 in reply to SheffieldJane]

Thanks! I will not take any this morning except the Valium. See reply to DorsetLady! I am not a fan of dentists! 🙁

[DorsetLady PMRGCAuk volunteer]

I wouldn’t really recommend taking even more Pred, you’ve already added in an extra 10mg. That’s not what it’s designed for, and too much make make you more anxious rather than less. And why are you worried about adrenals, they are not doing anything, the high doses of Pred have made them redundant for the time being.

I can understand the Valium if you are anxious, but you need to talk everything through with dentist before he starts working on your tooth .

[Kern1410 in reply to DorsetLady]

Going to the dentist gives me a pretty high dose of anxiety. I already use the numbing agent without the epi. This will be my third time at a crown. But since I’m so nervous I burn through the numbing agent and Valium and can’t stay numb for more than 10min. I’ve requestwd to be put to sleep - but insurance won’t cover it.

I’m also confused about the adrenals? (And they have been one my mind a lot) I thought if you were on predisone and in a stressful situation - you increased to compensate? I thought that is why you tell your doctor or if you go in an ambulance? Maybe I’m confused? Need a tutorial?

But regardless - no increase - take a Valium and hope for the best! Crossing fingers it works this time! 🤞

[DorsetLady PMRGCAuk volunteer in reply to Kern1410]

Quick explanation-

Once you have been on steroids for more than 3 weeks and at a dose higher than 7.5mg (which is equivalent to normal cortisol production by your Adrenals- called the physiological level) they temporary stop working because the artificial cortisol in your body (Pred) means they don’t have to.

That’s means in a stressful situation where they would normally go into overdrive to help your body they don’t - that extra boost has already been superseded by the constant level the Pred gives (hope that makes sense) So you don’t get that extra burst of energy to help you out of a dangerous (stressful) situation - the fight or flight phenomena!

You tell medical people you are on steroids so they don’t suddenly stop them - that could cause a steroid insufficiency problem and your body would really struggle.

That why when we get low levels (around 7.5mg) we need to reduce very slowly to nudge the adrenals into working again.

So please don’t worry about your Adrenals at the moment - they are having a rest and letting the Pred do their work!

Sorry about all your problems with the dentist - I wasn’t being flippant- but he is best person to discuss your anxieties with. Hope the extra you took last night helps - but no more!

[Kern1410 in reply to DorsetLady]

No flippant! 😀 lol! I’ve been so focused on getting my diagnosis that I have been in denial about the adrenal problem that I’m facing on the back end. It has me really worried! So they really won’t kick back on till you are under 7.5mg? What if they never come back on / wake up or are compromised for life? Should I be doing anything for them? I need to get tested to see what’s going on if anything?! Any links?

🦋

[DorsetLady PMRGCAuk volunteer in reply to Kern1410]

There is nothing you can do at the moment - so stop worrying.

There is no need for them to work until you get below the level that your body would normally produce cortisol - and that’s around 7.5mg - not necessarily exactly that amount for everyone - but an approx figure.

Once you get to around 10mg then ask the same question- and we’ll give you information you need - if you have it now you’ll only forget it!!

For the majority of people they do start working again - although it’s not like switching a light on - one day they’re asleep next day they’re awake! It takes a little while to recover all function. But there is a test to see if they are capable of working , but most doctors won't sanction that until you reach 5mg Pred.

For a few they don’t work properly, so that means a low dose of Pred for life. Much like diabetics needing insulin. But it’s quite rare.

As I said don’t worry about that yet - it’s some way in the future - just concentrate on the here and now!

[Kern1410 in reply to DorsetLady]

Thanks for the info!

[PMRpro Ambassador]

I have had an extraction, root canal treatment and ceramic inlays done while on pred - no problems at all. I also request local anaesthetic without adrenaline - but I always have done as they make me ill. But I don't necessarily take any more pred.

At such a high dose as you are the adrenal factor is redundant - you are already on way more than the body would produce in reaction to stress. You don't need more. The adrenal question only arises at much lower doses, especially below 10mg. As I see DL has explained.

[Kern1410 in reply to PMRpro]

Thanks for the info! I did successfully complete the crown!! So I can scratch one more thing off my list.

BTW - is there a list or link of supplements I should be taking?

[PMRpro Ambassador in reply to Kern1410]

Not that I would suggest other than calcium and vit D and possibly vit K2 (which I don't take myself). Otherwise, only as required ...

[Kern1410 in reply to PMRpro]

Thank you!

[Gennyh]

Seems reasonable. Good luck. It’s not easy, I know.

[Kern1410 in reply to Gennyh]

Thanks! 🌸