so, in bed with flu-like symptoms (temp 38.8), nasty cough, feeling pretty rough. I have just read the sick day rules on FAQ. Just wondering why it suggests increasing steroid dose? My PMR symptoms are fine, do I still need to increase steroids?
Also, due to have biopsy tomorrow to exclude GCA. Should I still go ahead?
I have never increased pred unless experiencing increase in PMR symptoms. I suppose the recommendation is designed to prevent this from happening but there's no need to automatically increase pred. Personally if you're able to rest and look after yourself I wouldn't, but that's just me. Bear in mind, too, that pred reduces your immune response so....🤷♀️
Oh - get well soon. Drink fluids and rest, rest, rest! 💐
I didn’t think about it until I was at doses below 10mg when my adrenal function wasn’t back up to speed. Not sure I would go much more than 12.5mg without medical advice, especially with infection around.
I would not take your germs into a clinical setting.
It depends on the dose you are on. If you are under about 20mg the purpose is to support your adrenal function in the event of illness. When you are on higher doses of pred or lower levels for a long time, your adrenal function is suppressed and less or no cortisol is produced. Normally your body would produce more in response to being ill - or after trauma or other stress such as an operation but it can no longer do this. SDRs provide for some cover for this situation and contribute to reducing the changes of an adrenal crisis which can happen at any dose if the trauma/stress is severe enough but is more likely at doses under about 15-20mg a day.
What dose are you at currently? The usual instruction is to double the current dose up to a maximum total dose of 20mg - up t 10mg/day you increase to 20mg, between 10 and 19mg you increase to 20mg. But it isn't necessary for a minor event - a cold for example. Some say requiring antibiotics or to stay in bed needs SDRs, others are less convinced.
As for the TAB - can you call the unit where it is being done? Delaying it is unwise but they may say they can't do it if you are ill so it would be a good idea to check.
There seems to me a misunderstanding going round that if you're sick you take more steroids and this idea seems to have spread like Chinese whispers. I'm not sure it has been properly promulgated, it sort of sprang up during the pandemic when some doctors were advising people on steroids who got Covid to take more, but at the same time other doctors were trying to get people to reduce or get off steroids. It's all a bit confusing and I still don't know what the 'official' advice is. From talking to other people at PMR events, GPs don't seem to know anythig about 'sick day rules' but that's hardly surprising as they sadly often don't know much about treating PMR generally. I'd love to know what the official line is on this.
There was a recent edict issued by the ESE (European Society of Endocrinologists) and actually, they recommend more use of SDRs than we do! Related to the official Recommendations publication this leaflet has been issued:
healthunlocked.com/pmrgcauk...
You can read the actual Guidelines in full here:
ese-hormones.org/publicatio...
Thank you, very useful to know. So the key thing is that it's only for when the adrenal glands can't respond to a sudden trauma or operation or major illness, not just any old 'sick day' like having a cold. It's also useful scientific backing to reduce steroids far slower than people are usually pushed to do or even try to do for themselves
Not a cold no, but if you look closely, odd one-off increased doses are also suggested for people who get themselves into a tizwoz over things like colonoscopies.
and I remember when I was having various ops like gall bladder and cataracts, the anaesthetists said they would 'throw in some more steroids'. On both occasions I was on low steroids, prob around 5mg but can't remember now. I presumed that was because ops and such traumas provoke inflammation.
It is adrenal protection and standard for anyone on longterm steroids.
And one of the reasons we're supposed to have our 'Im on steroids card' with us at all times
didn’t do “sick day “ rules….
sick day rules. 
Sick day rules
sick day rules 
Sick Day Rules
