Advice please

[Noosat]

Would welcome any suggestion/advice. I had my regular GP visit yesterday. My SED rate has gone from 26 to 31. doctor has been wanting it under 20. I can function OK in my daily tasks, just cannot walk slowly for longer than about 15-20 minutes. My legs become heavy and achy so I have to stop and rest. GP said I could go to 6mg of prednisone from 5, but I am not sure I want to do this. It has been a long year's grind from 20 to 5. Could the uptick in SED occur because I have overworked the muscles in the last few months? I have been going to the gym often, doing chair yoga and exercises in the machine/weight room.

[PMRpro Ambassador]

No - you really are showing all the classical signs of being at very slightly too low a dose of pred. You are well into the realm of physiological dose of pred - the equivalent amount to what your body produces daily to function well. If you are better at 6 - go to 6,

[HeronNS]

It may be your adrenal glands, in which case, only in my opinion, others will disagree, increasing the pred will be counterproductive. You want your own cortisol production to increase and taking more pred will slow down that process. I've always been a big fan of only increasing pred to deal with increases in PMR symptoms. There are other instances where an increase might be warranted, like situations of increased stress, some illnesses. But in general the treatment for fatigue and heavy legs, etc, when you're at the stage where adrenals should be increasing their function, is to "take it easy". If a twenty minute walk is too fatiguing, try two ten minute walks instead. And maybe even cut back the more demanding of your other exercises, although using your muscles is very important. But, as I say, this is only my opinion.

Me: started 15 mg 2015, on 3 by end of first year, roughly 2-2.5 subsequently and now tapering to .5. And, yes, at several stages I went through experience similar to you, mostly at about 4 mg in my case.

[SnazzyD]

Hello, sorry to say I think your symptoms are screaming loud to you to say you are either doing too much exercise or you have not enough Pred to deal with your current level of disease activity, or both. I rather suspect that you’ve got to 5mg in action only; your body isn’t ready to be there yet. I’m sure the experts will be along to advise, but to me going up by 1mg really isn’t much on the grand scheme of things.

[Blearyeyed]

It's not necessarily that the over activity alone has caused an increase in your SED rate , but that possibly pushing yourself further physically than your body was ready to cope with may well be increasing your PMR activity or inflammation.

There are possibilities , you could spend the next week to 10 days on the higher dose of 6 mg , and also scale back on your exercise classes to hopefully bring the SED back down.

Use the time around Christmas when most classes are suspended to get some well deserved rest and choose light activity and when you return to classes bypass the weight room and gym equipment , as if you are also reaching a point when Adrenal Induced Muscle Fatigue is affecting you this isn't really the best activity to do.

After the short increase you should be able to drop to 5 mg again easier , as long as when you have your SED rechecked that it has begun to decrease.

Then , start to build up exercises and classes far more gradually , as if you are getting these Pain symptoms my Physio would say you are doing too much , and it could end up slowly down your recovery rather than helping you get stronger , quicker.

[Noosat]

Heron and Dadcue have reinforced my decision to stay at 5mg. I feel quite well. I am on a year long health programme, started in September. I have lost 10lb of the 15lb I had gained, just cutting out sugar completely and watching the portions of good organic food that is my customary diet and not having any snacks between meals. Having been called an "overachiever" or a "type A personality" at various times in my life, I have to be aware that I can overdo. My exercise plan year is broken into 3 4 month periods of activity. January I am going into the second period, which is a slowing down of exercise. As these are the winter months, it is fine with me. Too cold many days to take Lily dog to park. Right now life is O.K.