.....it doesn't take much these days 🙄I've been reading the info about slow tapering and adrenal insufficiency. It makes perfect sense to me. So why do GPs want a quick reduction (the rheumatologist I saw last week wanted 12mg to zero in three weeks!) 😧 I got scared and confused and decided not to go back.
So here I am, toddling along on 11mg, wondering whether to drop to 10.5 or not 🤔
I have an appointment with a new GP at my surgery on Monday and one with my endo tomorrow 🤞
Visitors this weekend, I am not looking forward to it, hey ho 😞
You haven't been on pred very long so the risk of developing adrenal insufficiency is not very high.
For most of us, we have been on pred for many months, in some cases years and the longer your adrenal function is compromised by being at pred doses above about 5mg, the more likely it is that they will struggle a bit to wake up. SLow tapering as we talk about it is also required to not overshoot the dose your PMR requires for good symptom management.
If you have to get off pred because you probably don't have PMR, you can taperyour dose down to 10mg quite fast however long you have been on pred. Then you can drop to 7mg quite safely as well. Most patients can get to 5mg quickly even after months on pred.
You only started pred in August, so less than 3 months in all. You were also only on PMR level doses, not the high doses for GCA which cause adrenal suppression very quickly.
"For example, a few days of prednisone will not produce a significant problem, but several weeks of prednisone at a dose of 10 mg will diminish the cortisol level and the ability to fight a stressful situation.
Recovery of the pituitary-adrenal response after use of a suppressive dose for more than one month will take about one month. Generally, this one for one recovery time is typical up to about 9 to 12 months, when recovery will often take up to a year or may not occur at all."
So in all, since you have been on pred for 3 months, it will probably take up to 3 months for it to recover entirely - and it will be the last few mg that will take longest. You can drop to 5mg with no problem now, you don't need to pussy-foot about dropping at 1/2mg at a time. You can safely do 2.5mg at a time down to 5mg, and every 7-10 days. Then if you drop 1mg every week or 10 days after 5mg, your adrenal function should be able to keep up and you will get to zero in the 3 months.
It is a completely different situation for you to what most people face. When I first went on pred, I took 15mg for 2 weeks, then 10mg for 2 weeks, 5mg for 2 weeks and just stopped with no problem at all. I couldn't do that now though.
Thank you so much for that straight talking common sense. I can do that, I will write it out. Just need to get rid of the Omeprazole which is causing stomach painns and upsets. What was the name of the PPI that had less problems? Is a PPI essential, my system is really **cked up 🥴
I suggested an H2antagonist if you REALLY need something for acid - famotidine or cimetidine from the chemist, But just Gaviscon would probably do if you need something - so no, a PPI isn't essential and you are probably far better off without it.
If it is at all possible could you rescue your rheumato appointment for some future date.......you might need it .Also wouldn't be a bad idea, given the Christmas appointment madness, to discuss a plan with your GP for what you might do if your original symptoms make an appearance as you taper.
I think that is the idea - to take the pred away to see what the symptoms were. There is a degree of consensus that it very probably ISN'T PMR. And there is only one way to sort that problem out.
Your reply doesnt follow on from what I said. All I'm suggesting is rescuing a follow up appointment with Rheumato in the future if needed ( LadyJane gives the impression she didn't go back to the Rheumato as originally planned) and what to do , in practical terms, over the Christmas period in case the symptoms reappear.
Oh dear Jayne, you seem to have got yourself in a pretty pickle. Have you lost confidence in your husband’s rheumatologist already? Her rapid taper schedule did sound a bit ambitious but surely she knows enough about steroid use to know that your adrenal system would be slower to respond after your time on pred. As PMRPro has said you should be okay to taper quite quickly through the higher range, from about 7mg many people find it more difficult.
Hopefully your weekend visitors will give you pleasure and take your mind off your dilemma. Just don’t try to be the perfect hostess if you are fatigued, let your guests help out. Take care, hugs.
but you’ve only been on it a very short time! I took a lot of short courses for Asthma & after weeks of the course I would go 9, 8, 7 dropping one mg each day. I didn’t hit any problems over the years of doing this, it’s what my Dr told me to do, & it worked!
In order for folks to offer the best suggestions as time goes on, it would be helpful if you could pop your original blood tests results and the ones done ( ? Were they normal when you were on Pred), from October into your bio.
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No, I don't think I want to do that, but thank you for your comments
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