Tapering, GP and Rheumatologist

[Palgeo]

Both my gp and the rheumatologist I last saw at NNUH want me to speed up my tapering. They both want me to reduce my Prednisolone dose by 1mg every four weeks.

I'm at 5mg and starting the 5-week taper to 4.5mg. This is the fastest I feel comfortable with.

However, I've recently had bowel surgery and do not know what lies ahead. So I am anxious. I have experienced some depression recently, as anyone in my circumstances would, but at the back of my mind I am also wondering if the depth of depression was a symptom of adrenal insufficiency from which I have recovered. I am feeling more stable but I expect to see my bowel surgical team for a follow-up soon. So things will change, either for the better or the worse.

During surgery, I had to be treated for "leaky veins", stated to be the consequence of my "steroid use". I have yet to find out what was meant by "leaky veins" (probably obvious). But, if I have to have more surgery, it would be better if my veins were less "leaky". So a good reason to speed up the taper.

I'm so mystified by the pressure to speed up the taper. Both my gp and rheumatologist, separately and together, and before I had surgery, made it very clear that this was what they wanted me to do. Can anyone throw any light on why this is? Thank you.

I don't know what steps to take, questions to ask, who to ask what, etc!

[PMRpro Ambassador]

A common response to any suggestion something might be due to pred - got to stop it NOW. The trouble is - you have been on pred for some time, you can't stop pred NOW, you need to taper off it slowly. And 1mg a month at this level isn't always slow enough as you well know,

Can I ask which rheumy team you are under at the N&N? Because I can imagine who might be behind such a steep reduction after you have been on pred for less than 18 months.

[Palgeo in reply to PMRpro]

The rheumatologist I spoke to was Dr Coath. I had not seen her before.

[PMRpro Ambassador in reply to Palgeo]

She was at Southend - didn't think she was that much in a hurry there, Southend and Norwich are both part of the East of England Integrated Care Service so maybe they move around.

healthunlocked.com/pmrgcauk....

[123-go]

Hello, Palgeo. I was under Dr Coath before she moved to Norfolk and can honestly say that I never felt pressured to taper faster than I felt comfortable with. I found her very approachable and open to questions. I hope she would explain her reasons for her tapering advice if asked- confidence in your management plan is important.

[Palgeo in reply to 123-go]

Thank you.