Sore throat - update

[Strippy]

Regarding my previous post wondering if my sore throat could be linked to PMR or pred.

I managed to get an appointment Monday to see a GP (but not my usual one) - he barely looked at my throat, which has been sore for over a month, but decided it was acid reflux during the night caused by the steroids. I hadn't noticed acid reflux but he said it can be 'silent'.

He then doubled the Omeprazole - which my usual GP had reduced to 10mg the previous week because of its effect on my stomach - and told me to buy a big bottle of Gaviscon!.

He also changed the BP meds which previous GP had prescribed 2 weeks ago to beta blockers - which I'm not sure I'm happy about as the leaflet says once you start them it a lifetime thing. My blood pressure was never a problem before but this also caused by steroids

Will give it all a try but it would be nice to have some continuity.

No sooner have I loaded my weekly pill box than I have to change it.

My poor stomach is in a permanent state of upset - the steroids make me feel shaky and some days I have no energy to do anything

Sorry - just moaning 🙄

[DorsetLady PMRGCAuk volunteer]

Moan away … why we are here. 😊

See if new meds help… you might be pleasantly surprised… 😳 ‘might’ being the operative word..

[Fatsiajaponica]

Hi Strippy, Can I ask why your original GP reduced the Omeprazol? Was the conclusion that it was upsetting your stomach? Just to say I gave up on it as it was causing awful diarrhea. There are alternatives (which I haven't bothered with, always take my pred with lots of yoghurt).

As DL says, moan away, all this is a real pain and takes a while to settle and know what works for you. Let us know how you get on with the changes. Best wishes 💐

[Strippy in reply to Fatsiajaponica]

Hi Fatsiajaponica, Yes, I had terrible wind and diarrhoea. My usual GP tried pantoprazole and then the lower dose of Omeprazole which I was getting on with much better. The Rheumatologist said I didn't need to take them at all but GP thought it better to take them to protect my stomach. xx

[Fatsiajaponica in reply to Strippy]

Such conflicting advice!! At our AGM talk from a gastroenterologist he suggested that when you are down to 10mgs of pred a stomach protector may not be necessary. How much are you on at the moment? The issue seems to be the acid reflux as a diagnosis for the sore throat. Are you on anything else, like Aledronic Acid to protect bones? That can cause issues if not taken properly. There are a number of our contributors who have infinitely more expertise and experience than me who will be along to give advice but having all the information about where you are at is helpful.

[Strippy in reply to Fatsiajaponica]

I'm currently on 20mg pred and have a plan to taper down starting in 2 weeks time. I have resisted taking the AA so far but getting nagged to take it.

I was diagnosed with PMR at end of June. GP started me on 15mg, second GP started taper to 12.5 too soon and Rheumatologist put it up to 20.

Trouble is almost all meds are upsetting my stomach.

[DorsetLady PMRGCAuk volunteer in reply to Strippy]

Have you had a DEXA scan to know if you actually need AA..if not, then next time they nag say you want one so you know if it’s required.

[Strippy in reply to DorsetLady]

Thank you - will do xx

[Fatsiajaponica in reply to Strippy]

I resisted the AAcid for months, I am only just ahead of you, diagnosed in May this year. Now been taking it for 4 weeks, it's only once per week but was eventually convinced by another professor at the AGM and latterly by my GP to take it. The GP I see also had PMR, didn't take the AA and has osteopina so he was anxious that I take it. I had been waiting for the dexa scan before taking but it seems that the referral by another GP was not made so took the plunge and started the meds. No problems so far. Eventually had my scan yesterday and the operator said my bones looked good, thank heavens for that. I assume that you are taking vit D and calcium?

I know this is all awful at the moment, I had my ups and downs and still do. Steroid induced glaucoma at the moment, blood sugar high (now controlled by diet/low carb) and the supplements seem to be protecting my bones. I am less shaky now as on 16mgs but was still all over the place on 20mgs. You will get there and eventually work out what is best for you. I like the sound of your rheumy more than the latest GP, it may be that you need to take more control of your treatment based on what your body is telling you. Also the advice on here is so helpful. Keep us updated though.

SnazzyD's advice re coated and Gaviscon looks like a good option.

[piglette in reply to Strippy]

Don’t take AA until it is proved you need it is my thought.

[SnazzyD]

Like Fatsiajaponica I wonder what the stomach effects were that the Omperazole was causing according to the first GP. Did the second GP say why they disagreed?

Some do find it makes them worse. If the double dose doesn’t help or makes things worse, it might be worth asking to try the ‘old fashioned’ type (H2 antagonist) like Famotidine. I found them more tolerable and effective, but for me that didn’t last and the game changer was enteric coated Pred + Gaviscon at night. What I did find was that once I’d got into a pickle it took weeks for things to settle and coming off Omeprazole when I changed lead to rebound acid for a couple of weeks. I also, suffered from not enough acid and got indigestion and food just not going down quickly.

What were the BP meds that were changed from?

[Strippy in reply to SnazzyD]

First of all Ramipril, then Ramipril with indapamide (which made me feel very unwell) , then Ramipril with Felodipine, now Ramipril with Doxazosin. My Blood pressure is all over the place fluctuating between very high and then low in the same day.

I have been told to monitor it for a couple of weeks.

[DorsetLady PMRGCAuk volunteer in reply to Strippy]

Well all of those added to ramipril can cause hypotension… so no wonder it’s up and down so much. You might find the BB are better -what have you been prescribed ?

What time of day do you take BP meds?

[Strippy in reply to DorsetLady]

The Doxazosin is the beta blocker. Just take all meds in the morning. Omniprazole first - then BP and vit D - then pred after breakfast. They all go down and fight each other! and make me feel terrible!!

[DorsetLady PMRGCAuk volunteer in reply to Strippy]

Ahh… sorry my fault should have looked it up… I have always taken my BP meds at bedtime - was on Ramipril and others many moons ago.

But after BP dipped very low after a couple of surgeries about 6 years ago, had a complete revamp of meds. So off everything for a while, but as BP crept back up a bit, now on Candesartan [an ARB].

Maybe try taking Doxazosin at bedtime - or at least during evening if it doesn’t clash with others.

[Hidden in reply to Strippy]

Doxazosin is an alpha blocker not a beta blocker..........altogether different med

[Strippy in reply to Hidden]

Yes - I am sorry - mis read it.

is it good or bad????

whatever it is it is making me pee every 10 minutes

[Hidden in reply to Strippy]

nhs.uk/medicines/doxazosin/... for prostate enlargement as well so may be affecting your bladder outlet muscles. Or are you sstill on a diuretic? Perfectly respectable drug for BP problems.

I sometimes think that doloping everyone with a wodge of new drugs all at once after diagnosis makes deciding which might be causing side effects something of a nightmare, especially since the addons can cause upper digestive problems ie AA or lower ones I.e. calcium and 'prazoles'. Folks already feel a bit odd due to the illness and the Pred.

[PMRpro Ambassador in reply to Hidden]

"I sometimes think that doloping everyone with a wodge of new drugs all at once after diagnosis makes deciding which might be causing side effects something of a nightmare"

Don't get me started on THAT!!!!!

[Strippy in reply to Hidden]

Thank you for that - it explains why I have been having to rush to get to the toilet in time!!!

And I agree - have had the conversation several times with GP - if you start or alter a whole lot of meds at the same time we don't know which is upsetting me. And I have this mental picture of them all fighting in my poor stomach 😏

[Stills in reply to Hidden]

Wodge - gave me a good giggle

[SnazzyD in reply to Strippy]

Your poor body does seem to have been at sea with all the changes and Pred. You have been on 20mg for longer than most so I’m not surprised you’re suffering. I hope you can start to come down soon. Regards b/p, Pred does make you retain sodium which can increase blood pressure and fluid retention. I had to all but eliminate it until I got well under 10mg. If you do decide to try altering your salt intake, check with the doctor regards the bp tablet you’re on.

Are you also reducing your carbohydrates in your diet, particularly the white ones like pasta, potato, rice, sugars, bread etc? Pred makes your blood glucose fluctuate, particularly making it go high after meals. If you have lots of sugar in the blood, you will have more fluid in the blood which increases the volume which can increase blood pressure too until you wee it out. This requires your kidneys to be working well. Have they checked your HbA1c for blood sugar average?

[Strippy in reply to SnazzyD]

Thank you for that

I don't have much salt at all as I don't add it to cooking and don't eat any UPF .

I am trying to cut down on carbs - but have put on half a stone since starting steroids - whereas I used to enjoy salad and fish or chicken for dinner - I now crave something more 'solid'

At the last blood test blood sugars were normal - and I do check my blood sugar regularly - its always under 5

Never before been overweight - or had high blood pressure . It like my body has fallen apart in the last few months

🙄

[SnazzyD in reply to Strippy]

I know the feeling of needing more solid. I just ate loads of protein and cooked veg. Constant salad that feels too ethereal wore a bit thin. After 3 years of very low carb diet while on Pred, carbs now feel like a tasty garnish rather than the bulk of the meal, even 4 years after stopping Pred.

[PMRpro Ambassador]

Seems a fair moan to me - and I'd like to bend the ear of the second GP. Very unprofessional that.

However - the main reason that it says "lifetime" is that hypertension is usually a lifetime problem. You take the tablets, your BP goes down to normal - but that doesn't mean you are cured. If you stop the tablets, your BP will go back up again - it is, like pred for PMR, a management strategy. If in the meantime you were to (say) lose loads of weight or start running - your BP might fall as a result of that lifestyle change and then the dose of whatever BP meds you were on could be reduced, even stopped. But betablockers do have several positives - don't worry about them too much.

I had a sore throat from the start of PMR symptoms - it isn't uncommon. It might have been reflux but it certainly wasn't due to any medication - long before I was offered pred!

And it is always worth experimenting a bit with timing of meds and not taking them all at the same time.

[Stills]

hello, please note that my diagnosis is Adult Onset Stills Disease and I don’t have PMR. Stills manifests as rheumatoid disease with many symptoms similar to Lupus and PMR hence I value what I learn here. The very first symptom for me was an extremely sore throat and in the 45 years since diagnosis I have always had a sore throat. I took steroids etc until my mid 20s. A sore throat is recognised as a leading symptom of Stills and I take OTC relief and have had several scopes to check it out. Mid afternoon is worse along with the Stills fever and feeling of collapse and this is when I have a lie down. A recent bout of unexplained symptoms starting with GI issues and rapid weight loss prompted a script for Omeprazole but this caused such debilitating headaches I only take it when absolutely have to but I admit the GI issue also made my throat much worse and silent reflux was mentioned. Anyway just sharing my sore throat information and that my rheumatoid condition is a known cause. Warm salt water gargle gives some relief.

[Sophiestree]

I don't have PMR, rather LVV, but one of my significant symptoms was a permanent sore throat, glands and very sore stomach, as soon as I started prednisolone it disappeared overnight. I think GPs who have such differing opinions perhaps need to have a chat with each other. How is a patient supposed to be able to judge with such conflicting advice. I would have been really cross about that and would be writing a letter to the practice.

[Broseley]

Hi Strippy, I replied to you before regarding the sore throat, that I had the same issue, was referred to ENT. One of the things he suggested was silent reflux. But I was already on 20mg omeprazole so all he did was prescribe Diflam to gargle with. But I can reassure you that as soon as my pred dose was lower, the sore throat went. So it must be caused directly by the pred. Try the advice above and take it with lots of yogurt. Good luck.

[Strippy in reply to Broseley]

Thank you x