After holding well and steady at 6mg of pred for months, I inched down to 5.5mg a week ago. On the 6th day I awoke with mild right shoulder pain. This particular ache was a precursor to my wonderful introduction to PMR early this year.
On the assumption I was not going to get away with this reduction, I took 7.5mg yesterday, hoping to balance the books back to an average of almost the 6mg that has been working well.
This morning my shoulder appears unwilling to let bygones be bygones, and has amped up the pain to presumably teach me some kind of lesson. Am I correct to assume that I must up my dose far more to something around 10mg for a couple of days to wrestle the beast back under control?
Of course if I do this, my cumulative dose will far exceed the attempted reduction, presumably reminding me yet again that no good deed goes unpunished.
Or do you think I can just go back to the 6mg dosage plus a one time .5mg top up? That would balance the books as though I hadn’t dared tempt fate.
Might the shoulder mellow out in a few days, or has a flare been sparked by that tiny drop of less than 10%, now requiring the firefighter approach to flood it hard and fast?
And how the heck am we ever to know when it’s safe to plan any further reduction? This situation reminds me of Mike Tyson’s quote: ‘everyone has a plan, until they get punched in the face’.
Ouch!
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MikeVanBC
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Plus you have to consider that 6mg may be "your level" at the moment, won't always be, but it is for now - and it's always more difficult to reduce in cold weather - and I guess that's what you have in Canada at the moment...
so maybe once things back under control , sit tight for a wee while longer....
I moved 1000 miles south to Florida in the US before I came down with PMR and currently it's still warm here at near 80 degrees. But if I was still living up north then I'm sure I would be experiencing the cold PMR effect in addition to just hating the cold which is what prompted us to move here.
As PMRpro's says - plus more stress on body for everyone - not just those with PMR/GCA -you only have to look at hospital admissions etc in winter months for all sorts of ailments...
Follow Dorset Lady's advice and then when back down - stay put till winter has gone. Better to slow down than yo-yo. Less cumulative dose in the long run.
I don’t think I’ve done anything unusual or overly strenuous over the last week, but it is conceivable moving some reasonably heavy groceries down our 32 stairs from the garage to the house just might have tweaked my shoulder. Although it’s also something I do weekly, or more so now, while my wife is in pain waiting for a hip replacement.
Assuming for a moment this is a flare, I hate the idea that I’ll end up having to ingest even more prednisone than I would if I hadn’t tried a minor reduction.
I shaved just half a milligram off a 6mg dose for 6 days, for a 3mg overall reduction. If I must now jump to a week at 10mg, that’s a 28mg overage (7 days at 4mg more than normal).
After subtracting the 3mg I shaved off the the 6 days prior, I’m left with a 25mg prednisone penalty!
As the math proves this can be such a losing gamble, and the needless pain is a further negative bonus, how the heck do you know when a reduction is even worth trying?
Thanks DL, but I thought I was listening to my body, because it did feel right when I made the reduction. So it’s obviously proving difficult to for me to discern.
I think you probably have tweaked something - it doesn't take a lot, I know!!!! Next time, use smaller bags and walk up and down a few times!!! Mercifully I have a lift as an alternative to the 40-ish steps but even so, I have a sack dolly
I'd do the increase but possibly ring the GP to get the shoulder checked as well . You never know you could have just pulled or strained something or have some other non PMR type of inflammation that needs rest and different treatment .Did you try anything else like Paracetamol, or heat or ice?
Did it help?
Rest and don't be tempted to try and kill yourself off for Christmas. If you and your wife are suffering at the moment it's not worth trying to do things as " Festive Normal" and find you are paying for it for months afterwards.
You could return to your 6 mg after a week , but then give up on the taper until the end of the first week of January when Christmas and the possible extra Happy Stress and activity is behind you.
It's never a good idea to start a new taper in the weeks before , during or the days after Christmas and New Year.
Flares come and then your progress tapering slows down anyway.
Get your body ready for the next steps with nutrient rich food , hydration , relaxation and a little gentle exercise instead.
Thanks Blearyeyed, I started this ill-fated plan at the end of November, thinking I had plenty of time until Christmas. Turns out that PMR got the last laugh. Ho Ho Ho. And I feel like the turkey.
Just hope the family won't be pulling your legs off and fighting over the best bits like they do to the turkey. Perhaps you could try and find one of those long handled trolleys that will go up stairs to get your shopping up the steps . Gosh , now I'm just trying to remember when my gift list started to lose all the interesting treats and got filled with lotions , potions , health aids and fluffy socks , funny gloves and heat pads .... At least I still get my Giles Annual so I can laugh about it.
Although it's a bit like the Christmas edition of , 'The Good Life' , at my house when the family can come. We even have to take the snaps out of the crackers and shout "Bang!!!" , as my Tachycardia can't cope with loud noises even when I know it's coming !
Oh , the joys of it all!! Ho! ho!oh!oh! oh!ow! ow! ow! ooww!!
wondering if this one-sided pain could be bursitis. PMR can cause it/make us more susceptible...high doses of steroids mask it..so sometimes the pain breaks through when you drop the dose...we can't take ibuprofen for the pain...but see if paracetamol works (if it does then you will know it is not PMR pain). Resting the shoulder helps (ice is sometimes recommended...but i find a very warm bath with Epsom salts helps). You will also find some gentle exercises online. If it gets worse there are steroid injections. Probably a one-off injection is better than long-term raised oral pred. But do try rest and paracetamol for a couple of days. See if it helps. Good luck!
Thanks for sharing your thoughts agingfeminist, but I am not inclined to believe this is a coincidence. What are the odds that bursitis would show up for the first time on the 6th day of a pred reduction? From all I’ve read on this forum, isn’t that almost precisely when the prime suspect is a flare?
Rather than jump to 10mg for a week, I’ve taken 7.5mg for the last 2 days to try and minimize my ‘penalty’ for daring to try and reduce. My shoulder feels no worse this morning, and I like to think even a bit better, so I’m going to take 7.5mg again today. If it mellows even the slightest by tomorrow I hope to go back to 6mg where I was perfectly stable the almost 2 months prior.
I shall try to limit my Christmas exertion to online shopping 🐵
It might be bursitis. This is exactly what has happened to me when trying to taper below 7.5. Have had the shoulder scanned and it is bursitis. Assuming the pain is masked by the pred at 7.5 but not 7
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Pain several days after first reduction
Right hip and shoulder pain
Beginnings of a flare?
What a dope! Mucked up my pred and I feel awful
