How does the body use prednisone and should the dose be split?

Unfortunately the state of health care in the US in a nightmare. Greedy ins. companies pretty much determine what the doctor will be paid. They will ask for a lot, but often get about half of their asking price from the ins. company. Sort of like a barter system & let me tell you the docs are very unhappy campers. Many only work three days a week & have nurse practitioners as stand ins. Hopefully with Obamacare more & more will be able to afford health care in this country. It's really a disgrace.

I grew up in Chapel Hill, NC, but live in Santa Rosa, California now & even if I don't feel like it try to manage to get out every day.

Another question. My vision is terrible. Suddenly have to wear distance glasses. I have been taking calcium, D, E, A, C, fish oil. Is it a good idea or a waste of time?

Thank you so much for sharing you knowledge....this looks like a rocky road for me.

Not "excretion" cc23145, "secretion" - excretion means getting rid of something via the kidneys.

For a simple explanation of the adrenal glands try googling Howstuffworks "The adrenal gland"

The sites I recommend in this post on this forum:

https://patient.info/forums/discuss/pmr-gca-and-other-website-addresses-35316

provide info aimed at the patients rather than the doctor, but all checked for accuracy. The forumup PMR forum has a section of simple explanations about various aspects of PMR and GCA (Eileen's Input)

You were put on 60mg of pred for GCA in an attempt to reduce the swelling in the arteries that was stopping proper blood flow to the optic nerve. No blood flow means no oxygen supply and the cells are damaged, may even die. It's like a stroke or heart attack in that sense. The higher the dose, the more effective the action.

PMR isn't life or vision-threatening, 15 or 20 mg will get a good result but without the side effects of 60mg pred, which can be considerable in the short term and the more pred you take the worse the overall effect long term. The lower the dose you can manage with the better.

But once vision is lost in one eye in GCA the other often follows soon after whatever is done - and once it is gone, that's it. No going back. So very high doses of pred are used.

Changes in vision with pred are not uncommon.However, you need to get your occular pressures checked as a baseline and then annually at least - much the same as for glaucoma - as pred can cause increases in pressure and it needs to be found and treated if it does happen. Pred can also speed up the development of cataracts. Make friends with your ophthalmologist! In the UK an optician can do the checks - I live in Italy and have to see the eye specialist, don't know about the US.

You do need calcium and vit D. Not sure whether the others are worth it or not - careful with E and A, easy to overdose and too much of anything is as bad as too little! MrsO on here eats oily fish3 times a week and a generally antiinflammatory diet and notices the difference when she doesn't for any reason. Can you get a dexascan? That tells you accurately about your bone density - pred CAN lead to osteoporosis but it doesn't always. My bone density is fine and still the same near enough after 4 years of pred.

Oh yes - I have my opinion about US medicine - probably not too bad if you are rich and not chronically ill. But a bit risky given their preoccupation with CT scans at the drop of a hat. Glad I don't live there.

All excellent suggestions & will make appointments accordingly. One other question. I usually have an occasional migraine, but have had a whopping half dozen in the last week. Quite disturbing on top on everything else. Any reason you can think of?

US medicine....don't get me started. The whole system is currently not unlike dealing with used car salesman. How did it come to this? Lessons to be learned.

Can not thank you enough for your help.

Mary

Mary: Are you sure they are migraine? What sort of symptoms? Are they identical to your usual ones? Anything extra or different? Is your scalp tender, are your temples sore/swollen? I assume all the usual PMR stuff!

When you have PMR you are at a higher risk of developing GCA and for that you would need a much higher dose of pred to avoid losing your sight.

The fact your feel your eyes have changed and bad headache would have me at the ophthalmologist/neurologist/maybe rheumy like a shot! They can examine the back of your eye and see if anything is affecting the optic nerve as well as consider any other signs or symptoms.

They seem like the ones I have always had. My peripheral vision is distorted & I get auras & can't see well. I have had them all my life, but not too frequently. Usually go away within a half hour or so. Would it be a good idea to email my rheumatologist? You don't always get an answer back, but maybe worth a try. Takes 6 weeks to get an appointment. Bah humbug.

Mary

If they get worse, you have any different visual symptoms or you have temple/scalp/jaw pain please go to the ED if you can't get to another doctor quickly.

GCA is a medical emergency - not a "you can have an appointment the week after next" sort of thing. I know it is very difficult to tell if it is a migraine or not but if your migraines normally go away after a short time and these don't - ask someone. It is better to ask once too often than not enough.

I'll look to see if I can find more about pred and migraine - all I can find at the moment is stuff from people saying their migraines improved on pred!

Thanks. I did email my rheumatologist....we will see. As Gilda Radner would say......"it's always something". I had done quite a few searches the other day & came up with nothing.

Yes - what a brilliant way of summarising PMR/GCA! "It's always something!" Lovely!

I don't want to scare or worry you - I just want you to be aware of what CAN happen. Too many don't.

Have good day! I'm going to bed soon ;-)

Night. Thank you so much for your help.

That's what the forums are for - sleep tight!

Mary,

The list of symptoms below were taken from the Mayo Clinic Web Site. I had all of these symptoms and pretty much in the sequence listed. I was lucky in that when I lost vision in the right eye it returned after about 10 minutes. The loss was temporarily and occurred 9 times over a period of 5 days. The jaw problem only allowed me to open my mouth about half way. The blood test is simple, they just look for elevated CRP and SED/ESR. Fortunately PMR/GCA is only diagnosed in approximately 13000 people a year so not many Doctors have heard of it. The internet and forums such as this one allowed me to self diagnose this problem while laying in bed in Cairns, Australia.

signs and symptoms of giant cell arteritis include:

Persistent, severe head pain and tenderness, usually in your temple area

Vision loss or double vision

Scalp tenderness — it may hurt to comb your hair or even to lay your head on a pillow, especially where the arteries are inflamed

Jaw pain (jaw claudication) when you chew or open your mouth wide

Sudden, permanent loss of vision in one eye

Fever

Unexplained weight loss

Pain and stiffness in the neck, shoulders or hips are common symptoms of a related disorder, polymyalgia rheumatica. Approximately half the people with giant cell arteritis also have polymyalgia rheumatica.

Eileen, I will release my frantic grip on this site and check out the one you mentioned earlier.

So, here is the answers to my questions!

How does prednisone work?

The exact mechanism of how prednisone works is not known.

Taking prednisone properly:

Unless instructed otherwise, prednisone should be taken all at once with breakfast. Prednisone is not to be taken randomly during the day. This minimizes the risk of adrenal gland suppression and atrophy. (When high doses are required, the dose may have to be split between morning and evening doses for short periods of time.) In some patients prednisone can be given at twice the dose every other morning. This doesn't work for everyone, but when possible, allows your system a brief, yet helpful, reprieve from the drug.

Is should be are!