How long does natural cortisone in body take to kick back into production
Posted , 10 users are following.
Hi
The title says it all. I am now down to 5mg pred in am and 2.5 at night. I had too much pain to do the morning only dose. Was wondering how long before my adrenal glad starts up again from being supressed by the pred . I take the doses at about 6 - 7 am and 6- 7pm so by the 4am crucial time it is probably almost out of my system. Also at what dose would I expect to see a reaction to production.
0 likes, 21 replies
pnjmj denise76179
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I've been wondering the same thing. I am now on 5 mg daily after starting at 60mg thanks to GCA with the PMR. I have heard from others that the adrenal glands start to kick in around 5 mg. I've also noticed different withdrawal symptoms at the lower levels than I had at the higher levels, more pain in hands and feet and thighs, and mental disturbances in the first two weeks. By the third week I usually feel better and can get up and around.
grannyD denise76179
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denise76179 grannyD
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grannyD denise76179
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The answer to my question about adrenals giving up the ghost permenantly, Eileen answer covers it apparently you would feel quite ill, dizzy etc and it is rare.
EileenH denise76179
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I'm sorry to sound so heartless - but that is the bottom line of PMR. It comes when it likes and it goes when it likes. Nothing we can do will change that. Five months is VERY early days.
EileenH grannyD
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vanessa66630 EileenH
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EileenH vanessa66630
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However - is the hip pain PMR? Having PMR doesn't stop you having other problems and trochanteric bursitis is common alongside PMR.
denise76179 vanessa66630
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Has anyone else read anything that may shed more light on this problem as one never knows who to believe.
EileenH denise76179
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That is the reason you should have a dexascan within the first few months of starting pred - you may already be osteoporitic anyway. You can't tell by looking at someone. Then you need another dexascan every couple of years to see if anything is changing. There is no point much more often than that because the machines can't detect small changes. IF you are osteoporitic then there are drugs that help reduce that - but I remain adamant they should only be used when you know there is a need - i.e. after a dexascan.
It is also the reason that the one add-on that MUST be handed out with pred is the calcium/vit D supplements that come on prescription - they are the right ones. Having plenty of calcium around has been seen to change something in the bone metablism and reduces the risk of osteoporosis. We ARE better getting our calcium from food but to get the sort of amount we need we'd need a lot of milk! The nutritionist is correct there - but it isn't a case of "pasteurisation destroying calcium" - pasteurisation destroys an enzyme that helps transport calcium into the body so the amount you absorb is reduced but not entirely. Just wondering where she imagines everyone could get raw milk nowadays! It is possibly for some very locally but it isn't common. And if you are on warfarin you should not eat excessive amounts of green leafy veggies. So it is all a case of balance.
denise76179 EileenH
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EileenH denise76179
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Will have to bother a moderator :-(
EileenH denise76179
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At just above 5mg the adrenal system does start to recover but it can take time. Some doctors are quite keen for patients to stay at 5mg for some months - this allows the system to catch up. MrsO's doc was of that persuasion and although she baulked at the 6-9 months he suggested, she did remain at 5mg for a few months before a successful reduction afterwards.
Using the slow reduction scheme I've posted so many times seems to avoid those withdrawal symptoms - because when you reduce by 1mg at these sort of doses you are looking at a massive percentage, way above the 10% that is recommended. But even 10% (1/2mg at 5mg) is too much for many.
denise76179 EileenH
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Cliveo denise76179
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I have only posted on this really informative site once before but this topic hit a chord with me - and if I’m honest also caused a little alarm. I’ll discuss this with my GP on my next appointment in a month’s time and post his reply back on here. Sorry I can't be of any help answering your question Denise.
EileenH Cliveo
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vanessa66630 EileenH
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EileenH vanessa66630
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The dose you are started on is one that is high enough to relieve the symptoms that are making life difficult - it used to be higher but it was decided that 15 to 20mg is enough for the vast majority of people and reduces the total amount of pred you need during the illnesss. The less pred you have to take overall the less serious the side effects are.
After that first 6 weeks or so the inflammation that causes the symptoms should be reduced so the symptoms are at an acceptable level even if they haven't gone altogether - some people never become pain-free. Then you start to reduce the pred dose to find the lowest dose that will control the symptoms - 15mg does but it is almost certainly higher than you need. Maybe 5mg is enough - and that is far better for you in the long term.
The catch is that many people find it difficult to drop the pred dose - the body has got used to it being there and protests when there isn't as much to go round. The protest is very often the same sort of symptoms that you had that meant you were given pred to deal with them! So you can't tell whether it is the PMR returning because the dose is too small or steroid withdrawal. That's why we say to reduce as slowly as possible: you are less likely to miss the lowest dose point and also your body is fooled into not noticing the change as much.
It is thought (though not known for sure) that the autoimmune disorder varies in activity, going up and down and so the symptoms also wax and wane. You might manage to get the dose down quite well when it isn't being so active - only to find the symptoms reappearing as it gets more active. Or you may be at a dose that appears to control the symptoms but it is missing a little bit of the inflammation and it increases slowly - like a tap dripping into a bucket - and suddenly overflows and you have pain again. We have often said that steroid withdrawal pain starts quickly and then fades as your body gets used to the new dose whereas the PMR symptoms returning tend to appear after some time, days or weeks, and then get worse.
Does that make sense? Say if it doesn't and I'll clarify any bits that you don't get.
Where in the hip is the pain? Is it on the outside of the thigh and does it feel tender? Is it worse when you go up stairs or walk for a long time? It could be trochanteric bursitis and that is better treated with a local cortisone injection - it will improve with a higher dose of pred but then you are on an unnecessarily high oral dose to achieve the same effect. Another possibility is that the lower back muscles are in spasm and pinching the sciatic nerve - the pain is different but it is difficult to put into words. I've had cortisone injections in my back for that - but it is also possible to deal with it using massage/mobilisation of the hard knots of muscle or using Bowen therapy.