Adrenals? What now?

[winfong]

After slowly getting down to 6 mg at the end of November, I got Covid, then had a flare. My rheumy had me bump up to 20, which seemed to take care of things, then slowly try to get back to 6.

This morning, I got to 7, and just feel awful. I've never been so fatigued in my life. I'm assuming this is the dreaded adrenal deficiency.

My question is, 'What do I do now?' Stick with 7 and wait for adrenals to wake up? Bump up to something higher (and, in particular, what)?

Thanks in advance for any advice

[SnazzyD]

It’s a bit of a conundrum because you are not long out of the acute stages of Covid (5 weeks?), you had a flare and you are at what I found was a horrible neither here nor there dose. All three of those things could be at play. How far from the Covid did the flare start? What is the flare at now? What did the doc say about reducing? 7mg for me was a rotten mix of too high for the adrenal glands to feel lively and too low to cope with anything much else. The only way I could get out of that was keeping on dropping 0.5mg over a month or two and living like a shadow of my former self. I’d not like having to recover from Covid with ambivalent adrenals. You could still be hammered by the Covid even if the ouchy bits have finished. Perhaps go to 10mg and reduce more slowly while your body is still recuperating back to 7mg and see how you are from there. Have you tried asking the doc?

[winfong in reply to SnazzyD]

What I read on the internets is that 2 weeks is a typical recover time. In fact, I'm starting to wonder if it's long Covid (it's been more than 6 weeks now). Symptoms - fatigue, brain fog, some shortness of breath, headache, insomnia, heightened anxiety - seem to add up to that.

[PMRpro Ambassador in reply to winfong]

I think 2 weeks is a very fast recovery time - my healthy and fit daughters both struggled to get over Covid, especially the fatigue.

[piglette]

With the deathly fatigue it us better not to reduce, but hang on until it improves. As you have had other problems too it may be better to increase a bit to ensure that the PMR is under control. Normally with JUST the deathly fatigue you should just stay at the same dose.

[PMRpro Ambassador]

As Snazzy says - rock and a hard place really. You need to be lower to persuade the adrenals to wake up and that takes time so going back will only extend that process. OTOH - Covid at the end of November and a resulting flare says to me you are still suffering from the effects of that and maybe not ready to be back there so soon. It takes a while to recover from Covid, however mild it may have been, and the increased dose also fulfilled the function of sick day rules.

[Chrissiej]

I agree with SnazzyD also. And, from personal experience, it does take quite a while to get over the tiredness from Covid. I am 10 years older than you and had covid last year. After all the other symptoms were gone, the tired bit lasted for over a month.

[PMRnewbie2017]

Yes to all of the above from me. I caught the Christmas virus on 8th December and am still weak, tired, not myself at all. I have stopped reducing (currently on 2.5mg, though I increased to 5mg for a few days when I was wiped out through the virus and lack of cortisol). I would increase your Pred dose a little bit for around a week to 10 days then reduce slowly again. Your tiredness is probably more likely to be from Covid. The bio-equivalent dose of Pred to normal cortisol output is not strictly 7mg, it can be as low as 4mg in some people. Sadly we have to go through the discomfort in order to trigger our own cortisol output. The trick is to do this gently and slowly otherwise flares and adrenal insufficiency can raise their heads. As many have said before, the adrenal cortex does not simply "wake up". It will splutter into life one day, not the next, then produce cortisol the next few days, then less the next day. Any over-exertion or stress will use up that cortisol leaving us deficient again. You cannot rush this part of the journey nor can you rush PMR into remission.

[winfong]

Thanks for all the advice. A couple of things I should probably mention:

- I really wasn't feeling tired until I hit 7 megs

- PMR/GCA/LVV symptoms (e.g., aches/pains/stiffness) have been minimal

- Brain fog's been much higher than normal