Hi, I’ve just returned from a holiday in the Maldives (lucky you I hear you all say!) except I’ve come back in a much worse state than when I went. I think the 11 hour flight and over 20 hours traveling have messed up my PMR. I’m currently on 9mg Pred. and on advice from the forum took an extra 2 mg the night we landed (last Friday). For the past 48 hours I’ve had dreadful aching across my upper back and shoulders. Could this be a flare because I’ve overdone things? Paracetamol helps a little bit. It’s not helped by the fact that I took advantage of a free back massage whilst on holiday. Despite telling the masseur that I had a right shoulder injury and to be very gentle she pressed very hard on my shoulder and I think I may have a tear in my supraspinatus muscle. I’ve booked a private MRI on Wednesday to confirm the resort doctors diagnosis. Do I need to up my Prednisolone for a few days? I’m reluctant as it’s taken me 6 months to reduce from 10mg to 9mg using the DSNS method after a flare last September. Any advice would be much appreciated thank you.
Is this a flare?: Hi, I’ve just returned from a... - PMRGCAuk
Is this a flare?
Oh dear poor you. You fill me with trepidation about Australia in September albeit broken up with a stop over.What did you do about the time difference? I end up with more Pred in my system by immediately moving dosing to Australia time and visa versa. Maybe that’s why jet lag is never that bad?
Check with your doctor but possibly the sick day rules are warranted ( it sounds like you’ve been beaten up). 5 mgs extra for a few days and straight back down. See FAQs. I find the Homoepathic remedy Arnica pretty good for this kind of reactive pain.
Like you I was worried about the long journey and time changes. Going out (West to East) I took my normal dose on the day we flew and the next day arriving in the Maldives (5 hours ahead of GMT) I took my dose a little earlier. I felt fine, just a little more tired than usual. On my return I took my dose at the usual time in the Maldives then when we landed I took an extra 2 mg before bed then my usual dose the next morning. I felt ok for 24 hours but now have pains across my back and shoulders. I can’t really check with my GP as I’m under the hospital rheumatology dept. If I ring rheumatology I know they won’t want me to increase my dose as they are constantly trying to get me on a lower dose! I may try the extra 5mg for a few days tomorrow then drop back to 9mg. When you say arnica do you mean the cream you rub on?
I'm sure 11 hours in a cattle class seat wouldn't have helped!!!! At least - I assume you didn't travel Business! And to be honest - really not sure pred will help that. Have you tried enough ordinary pain-killers (they work best taken regularly, not just a single dose) and maybe some muscle cream of some sort? If the resort doctor suggested a specific injury pred almost certainly won't help.
This gives advice on flares - if that's what it is - and if so, you should be able to get back down to just above current dose without too much issue. healthunlocked.com/pmrgcauk...
But if it's shoulder - as PMRpro says, ordinary painkillers may prove better option
Thank you. I’ll read it and try to decide what to do. I really don’t want to up my Prednisolone unless it’s absolutely necessary.
No can understand that, particularly as it may be more down to shoulder than PMR per se. ..Its a bit difficult to know what to do, but if you don't get shoulder pains under control it could make the PMR react adversely.....bit of a Catch22
Yes unfortunately we were in ‘cattle class’ 😩. Can a flare occur for reasons other than not having a high enough dose of Pred? I don’t think extra Pred will help the tear in my shoulder but could it help the shoulder aches and pains if I up my dose by 5mg for a few days? I’ll carry on with the regular paracetamol and try some ibuprofen gel, many thanks.
It won't if the aches and pains are due to the injury and an uncomfortable seat on the plane - which is likely.
May I just add as someone else has added they had same effect on plane apart from the tear.If I sit where there is constantly a cold draught around my neck and shoulders I get similar symptoms of pmr and on a plane you can be sat in a draft from people with their air flow on from above in front and behind you. Just a thought??
Sounds similar to me after both ways to and from St Lucia on zero Pred and remission from GCA last October without your add ons. If it were me I’d do a week’s rest with decent pain relief. Did you tear that muscle on holiday or was that a previous injury? That can cause all sorts of refereed pain if it’s just in spasm let alone a tear. I’d get advice but as I said I’d probably give it time with a cool head.
Thanks Snazzy. I already had an injury to my shoulder sustained last November after tripping and crashing into a wall. No broken bones but soft tissue injury diagnosed. I was still having some discomfort prior to our recent trip so my doctor has referred me on the NHS for an ultrasound (a 4-6 week wait). The injury has been made much worse by having a massage whilst on holiday. I told the girl doing it that I had a bad shoulder and to be gentle. Whether she misunderstood because of the language barrier I’ll never know but the first thing she did was press forcefully on my right shoulder. I actually felt something ‘go’. I was unable to swim or snorkel for the duration of the holiday, the main reason we go to the Maldives. The resort doctor gave me two diclofenac injections in my bottom. He wanted me to have a Dexamethasone injection but I refused. To try and speed up my diagnosis I’ve booked a private MRI scan this Wednesday. I have to try to get better quickly as in less than 3 weeks we are due to fly to the US to see our son and grandchildren. It’s a holiday which was postponed from last Christmas due to Omicron. We haven’t seen our grandchildren since Christmas 2019 ☹️
I don't know if this will help or not but last year I had a lot of trouble with a painful shoulder. In the end I took an increased dose of pred, and it settled. I believe the shoulder was a sort of flare, although the initial reason for the pain is uncertain and was probably a muscle strain. In any case additional pred was the solution for me, but I was not able to taper back down quickly (which is why I think it was a resurgence of PMR) and have had to resort to slow taper. If your MRI doesn't show anything specific which can be dealt with in a timely fashion, perhaps you would, like I did, find some relief from extra pred, even if it is only while you travel?
Normally I'd never recommend pred for this, unless I was sure it was PMR, because of its known effect of weakening muscles and making them prone to injury, but on the other hand, needs must.
Thanks. It’s so difficult to know what’s causing the pain isn’t it. I can’t tell at the moment whether it’s my shoulder injury giving me the pain or whether it’s the travelling I’ve just done or a flare of my PMR. I also have osteoarthritis in my right shoulder. I’ve had the right shoulder injury for nearly two weeks and until last Saturday the pain has all been in my right shoulder and arm. Now I’ve got pain in both my shoulders and upper back. I don’t like to experiment but If I don’t get relief from pain killers and gels I may have to resort to extra pred.
It's a difficult choice, but you may find that the recommended adding of 5 mg for a week will work miracles, and you can then taper back down to about 10. Some people need more pred than others because of their metabolism. I've always felt that I was very sensitive to pred, tapering very easily at the beginning, so I suspect I do better at the lower doses than some others might who aren't absorbing it as well.
Vacation travel can be deleterious to one's health from a dietary perspective, with restaurant fare tending to be overly rich in hidden ways. Diet-related inflammatory response is a hot topic in health-related circles and some arthritis sufferers come close to starving themselves into a frail condition because this blunts their body's inflammatory response to good effect, reducing pain in injured/inflamed tissues and (as in my case) easing all PMR symptoms.
Short-term, additional pred will likely help, and hopefully you can resume with your normal dosage quickly, before dependence on higher dosage sets in fully.
Perhaps limiting your diet to more water-bearing foods might give enough of a fasting effect to help with inflammatory symptoms within a useful time frame, while still providing healthy sustenance.
Best of luck.
Hi Dan, I totally agree that diet can have a profound effect on inflammation in the body and I’ve been looking at ways of reducing inflammatory foods in my diet. I’m a type 2 diabetic and on my holiday stayed very close to my usual diet cutting carbs as much as possible. Fortunately there was a very varied buffet for each meal so I was able to choose familiar and less spicy foods - boring but necessary. I think looking back my only over indulgence was the Prosecco!
It's so sad that we seem to have to pay with a flare for a little fun - and with that fun probably a bit limited to begin with ☹️
I agree. This was my first proper holiday post-Covid restrictions but with the rigors of long distance travel, watching my diet, injuring my shoulder, 11 hours of mask wearing on the flight, my hand luggage mostly consisting of essential drugs whilst away and swollen ankles to boot I wonder whether such holidays are worth it!
Oh poor you. When I returned from the Maldives in Early Feb I felt rough for 4 or 5 days. Exhausted, achy etc but it wore off and I felt much better….then I caught Covid! I do hope you find it wears off without having to up the steroids.
Thanks. I’m going to stick with the pain relief for a while longer before upping the steroids. I’m hoping it was the travelling and that I will feel better soon. I hope you are feeling better after Covid 🤗
I hope it’s the same for you, fingers crossed you’ll soon feel better I felt sure for me it was a combination of jet lag etc and REST to get over it, trying to fight on is dangerous! Fortunately Covid was no more than a very heavy cold but again, I’m short of energy but time will heal hopefully and this wonderful weather is so uplifting. ☀️🕶
Note my diagnosis is stills disease not PMR but I do have swollen stiff sore joints all over. I’ve learnt never to have a massage unless given from an experienced physio or relevant medic. Holiday massages are for the fit and healthy I’m afraid. After all you wouldn’t take their advice on your meds so why let them loose on your muscles.Hope you feel comfortable soon and have a better trip to see your GC 😀
Sad. We’ve visited 7 maldives islands & go for the wonderful snorkelling. We don’t dare go abroad yet due to Covid, though I’m very interested to see people with PMR/GCA travelling abroad now! But when I read all your comments it’s definitely put me off again which is probably a good thing! Sorry you couldn’t snorkel, & hope you feel better soon, very sad. S x
Hi Pixix, Sorry to put you off long distance travel. That was our 6th visit to the Maldives over the past 10 years as we too love the snorkeling. My husband and our two travelling companions managed two snorkeling sessions each day so it was only me that missed out. I was a little nervous about Covid. We had to do PCR tests 48 hours before leaving the UK and I bought some FFP3 masks which I wore constantly. The airline (Emirates) enforced mask wearing on the flight but some people still had them beneath their chins or with their noses sticking out!
It’s OK, I don’t think I fit enough for that far flung right now anyway! IF you feel up to it, I’d love to know which islands you’ve been to (by private message is better, probably)…as you know sone have great house reefs & some haven’t so always interested in recommendations, purely based on the snorkelling! We wear FFP3 if going to hospital appointments & would wear on planes & inside. I can’t imagine mask wearing in the Maldives, tbh! We’ve flown emirates nearly every time, once with Qatar airways. I think both are excellent. But we haven’t even been in a supermarket in 2 years 4 months, so I think a decision re our next Maldives trip could n be made this year, but travel next year!! Unbelievable that people still don’t understand wearing mask under nose or under chin is acceptable! Oh, & I wouldn’t fancy having somebody I didn’t know sitting next to me in Covid times, either. Think we will stick with Italy & Jersey & maybe national parks in USA this year! Thanks, S xx
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