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[Potmaker]

I am an 86 year old man, after a bad fall two weeks ago suffering now with PMR. Doctor given me predisimol this week advised to take three 5mg tablets together for a week before returning to him for update. Past two days took three tablets after breakfast but found that by middle of night awake again with pain. Today I have taken two tablets at breakfast and will take one this evening, is this a wise move? Prepared to experiment with spreading taking the allocated three each day if this is possible, any advise will be gratefully received, thank you.

[SnazzyD]

Hello and a warm welcome to the forum where you’ll find knowledgeable people who will reply. Some people do split their dose though. I’ll just start with a question. Though PMR can certainly appear after a shock or trauma, what made the doc decide it was PMR just 2 weeks in and not musculoskeletal issues that would certainly still be about if the fall was a bad one?

[Potmaker in reply to SnazzyD]

Potmaker, Hi, SnazzyD I had blood tests while in A&E and apparently they pointed to the symptoms, I am due to see the doctor next week, further consultation and hopefully some strategies on what next, will ask further info about diagnosis.

[123-go in reply to Potmaker]

I would certainly query the diagnosis, Potmaker. Besides the blood test, did you have any other tests or X-rays?

[SnazzyD in reply to Potmaker]

Ah, did you have symptoms before you fell?

[SheffieldJane]

You might need 20 mgs of Prednisalone to deal with your inflammation. A lot of people do. You could try the split dose, I didn’t find it very successful, particularly in the early days when my symptoms were rampant.If you are awake at 2 am that has been shown to be the optimum time to take Prednisalone. At about 4-4.30 am the body sheds cytokines ( inflammatory substance) if you zap it with your whole dose at 2 am it doesn’t get a chance to take hold.

I am sorry to hear about your fall and the consequences. Please don’t let doctors rush you off Prednisalone too quickly ( I am assuming that is the drug you are on). There is very useful tapering information in the pinned posts on the right of your screen. Symptoms always rule, even if your bloods are normal.

Stick with us Potmaker. There is a wealth of information, experience and support to be had on here. All day ( and night) every day. Welcome!

[Potmaker in reply to SheffieldJane]

Potmaker Thank you for the information, it’s so good to know that there is good help out there, I shall take full advantage of it, thank you for your help.

[YuliK in reply to Potmaker]

Mr Potmaker

You have arrived to the right address by coming here.

There are a really lovely group of advisers with top knowledge of PMR.

Sorry to read you had a fall. Pretty nasty shock at our age.

Welcome to the PMR fold. 👍

[DorsetLady PMRGCAuk volunteer]

As discussed, you may find that 15mg is not enough for you....and if it’s not, it not.It is recommended that Pred be takes in one dose and in the morning.....if it’s not working, then when you back to GP you tell him so.

I understand you don’t want to be in pain, (and I’m not advocating that) but if you start chopping and changing then maybe you won’t be able to give GP a true picture of what’s happening....and TBH a week is not long in the great scheme of things.

[Potmaker in reply to DorsetLady]

Potmaker. Thank you so much for your reply, I was so unsure about taking the 15mg in one go, and now regret not sticking to the recommendation today. I shall follow your advise and take the 15mg in the morning so that a true picture of the progress is available to my my GP. I am most fateful for you advise, thank you.

[Potmaker in reply to DorsetLady]

Potmaker. Dorsettlady, Thank you so much for your advice. It’s 3am and I am up unable to sleep, waiting for a normal breakfast time when I can take the 15ml Pred in one dose, I am paying for my silly mistake yesterday. Of course the wise thing to have done was to stick to my doctor’s advice, I shall no doubt get scolded when I see him in a few days time. I have read much of your open advice to others and shall follow the guidance from now on, and be patient.

[PMRpro Ambassador in reply to Potmaker]

There really is no need to wait - if you are awake and unable to sleep, go and get the pills and take them. The ideal time is 2am - but the earlier in the morning the better, less inflammation has developed for the pred to mop up and so it will work better and quicker.

[Bcol in reply to Potmaker]

Morning Potmaker. I take all my Pred around 02:00 every morning, with some Greek Yogurt and a banana and it lasts me happily through the day.

[PMRpro Ambassador]

The primary thing is whether it works well to start with - and your doctor is using the pred as part of the diagnosis. The inflammatory substances that underly the symptoms are shed in the body about 4am - and a whole new load of inflammation is caused. Is that the sort of time you are waking with the pain? In some people the antiinflammatory effect of pred lasts a full 24 hours. in others it is less and for them the pain returns in the night, especially if they need a slightly higher dose of pred to start with.

Had you had any symptoms before the fall - even if they were quite mild? A fall is known to be enough to cause a flare or worsening of the symptoms and a fall often makes something called myofascial pain syndrome that can be part of PMR a lot worse as your muscle respond to the shock of trying to save yourself as you fall.

[piglette]

As PMRPro says it sounds like your doctor is just testing the diagnosis of PMR, as sadly it is not easy to diagnose. It is quite normal to ask people to try steroids for a week and see if it works. Normally people take all the tablets at once but some find it works better splitting the dose. 15mg may be a bit low and perhaps your doctor will try 20mg (4 x tablets) instead. Do the steroids help during the day?

[Telian]

Hi Potmaker and sorry you’ve had a fall. My hubby‘loves’ them ( I’m being facetious) and can lead to other problems. I would follow your GP’s advice on dosing to allow him to get a correct diagnosis. You probably need a higher dose and really need to let him how you’re suffering. Have you used pain killers? As they won’t ease PMR so another thing to try and tell your GP. If you’re suffering too much don’t wait for your next appointment. Also GPs like to manage PMR but it might be worth asking to see a Rheumatologist if only to get the correct diagnosis then the GP can manage it. If it is PMR it’s important to get it under control as it can develop into GCA which can affect your eyesight. Best wishes.

[Jan_Noack]

as PMR says, if you wake in pain anytime after say 1.30am in the night..take the lot. it should help the pain and let you get back to sleep if it's PMR.As they say, the best time is like 2 or 3 or 4am to take the meds..but they tell you first thing in the morning and food helps protect your stomach..so they say with brekkie. some have a bite to eat or yoghurt or something with meds at 4am

[Susieblu]

My heartfelt sympathies for your pain . I am nearly 85 and had a bad fall just over 2 weeks ago. I find I am waking in the early hours in pain which I am sure is due to laying in one position on the bruising I suffered in the fall. What I wondered is , have you tried taking paracetamol or paracodol ? It may not be all down to PMR. I don’t think we can get over a bad fall in two weeks at the best of times.