Help! Pain returning despite upping Pred for chest infection/Covid??

[Enfin]

Hi

I’d come down to 6 mg of Pred (yay!) but then cough (which has been around for months) worsened. Nice 111 Dr said sounded like Covid, should up Pred to 10 - and could take test although 40% false negative(which raises a whole set of other questions...) Did home test, result negative...

Spoke to GP as had series of chest infections (plus antibiotics) just pre PMR- if not Covid then what? He was absolutely sure it’s Covid (quoting 20-30% false results!?) but gave my Doxycycline to prevent secondary infection.

So now cough’s improved but yesterday the old achey shoulders and arms and complete wipe out fatigue back grrrrr! Help! Should I up Pred further ? What to? Grit my teeth and hold on - nope that’s not going to work. I’ve been desperate to drop my Pred below 5 and come out of shielded group and it was all going so well..

Help!

[PMRpro Ambassador]

Getting below 5mg probably doesn't take you out of the shielded group for a few months at least. The history is as important as the current dose - and your adrenal function isn't going to return totally until well after you at a zero pred. But it all seems to change from day to day. Do you have any other health problems? High blood pressure for example.

I'm not sure I'd rush to go higher for the moment - being ill does tend to result in an increase of symptoms because of the added effect on the immune system. Whether extra pred would help isn't a given. And what goes up has also to come down. I think a few days being a poorly person and some TLC would be an idea first - and see if the 10mg kicks in, it may not happen immediately.

[Enfin in reply to PMRpro]

Thanks PMRpro,

Yes I have High Blood Pressure too.

I’ve been on 10mg for a couple of weeks - so it has had a chance to kick in?

[KellyInTexas in reply to Enfin]

Don’t forget to “ prone the patient”... can you lay on your tummy when possible? At least part of the time?

Lungs do better with pressure off of them I’m hearing.

I don’t know how this exercise ( video from early days of Covid 19, I assume it’s still considered a useful technique?) would impact your high blood pressure- would it be worth asking your GP about? I should think it could be helpful for any chest infection, Covid or not.

youtube.com/watch?v=bBkGDIe...(Not working as expected?)

[PMRpro Ambassador in reply to KellyInTexas]

Probably more use for other things than Covid - there is some dispute over it!

[KellyInTexas in reply to PMRpro]

Interesting. It was very early on this came out. Good to know.

( before the clotting was readily identified...)

This might be why it wasn’t as effective with Covid in pulmonary clotting cases.

[PMRpro Ambassador in reply to Enfin]

If you have a history of hypertension that is a risk factor. Not as simple as just the dose of pred. I think it has been shown that we are no more likely to CATCH it - no-one has any immunity, being on low-moderate dose pred doesn't make much difference. But the comorbidities do.

[MrsNails]

Maybe this leaflet will be helpful, l hope you feel better soon.

leedsth.nhs.uk/assets/be1c3...

[Jackoh in reply to MrsNails]

Thank you Angela for reposting this ( was on forum a little while back ) I had printed this off although I note that it was produced 24 April for revision 1June.

What I don’t understand- not directing this specific question to you Angela but anyone who is out there!! If this is the agreed procedure for anyone contracting COVID whilst on pred, why have our doctors or Consultant Rheumatologists not pointed us to this document, albeit subject to revision? Don’t know if this is just me?!!

[MrsNails in reply to Jackoh]

I was waiting for the Revision to pass it on to my GP but l have printed it, just incase......

[Jackoh in reply to MrsNails]

Yes I’ve got it all printed out like you Angela but I am a bit confused with the advice given. For instance if you have an infection like UTI I have never doubled my pred. I’m on 10mg and I wouldn’t increase to 20mg. I might go up to 15 mg for a short boost and then come down while I’d got the infection. I suppose disagreeing with the sick day rules per se I question the other advice. The point to double your dose is at 10mg - 19 mg. It’s a big leap from 10 mg - 20mg but if on 19mg then not such a leap. I know they have to put parameters in at some point . I thought I’d send this to my Consultant ( Rod Hughes) and ask him what he thought.

[MrsNails in reply to Jackoh]

That’s exactly what l intend to do also, it’s more the Covid Bit l was interested in, l even bought myself a red ‘Dependant in Steroids’ armband.....

My Mums GP always gave her additional Hydrocortisone when she was poorly with a Chest Infection so she knew where she was with her Prednisolone, a very forward thinking lady.

[Enfin in reply to MrsNails]

Thank you so much for that - I missed that somehow before. It’s really helpful and useful. Great to have some concrete advice and explanations.

[MrsNails in reply to Enfin]

It’s easy to miss things but l thought it was helpful even if it isn’t the final draft.

I do hope you feel better soon x

[Rache in reply to MrsNails]

Thanks for posting that link MrsN. It’s the first time I’ve seen any advice regarding steroids and Covid - worth printing out just in case!

[maria40 in reply to MrsNails]

Thank you for that, Mrs Nails. I hadn't seen the advice about increasing to 20mg a day split between a.m. and p.m so will bear that in mind. I too have the red armband. Just hope none of the preparations will be needed.

[MrsNails in reply to maria40]

Seemed like a very sensible precaution 🙏🏼