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My seasonal pmr changes finally explained.

Posted , 12 users are following.

dan38655
dan38655

I've mentioned here a few times that my prednisone dosage requirement seemed to change a good deal every year between the colder and hotter months, and I'd noticed that no one else here seemed to experience the same effect.

The seasonal effect has been that during the summer months, my dosage requirement has typically been at least 50% higher than during the winter months, and which I had attributed to air quality differences.

Today I think that I finally figured out what was really going on.

I had recently received a new bottle of prednisone by mail, just as I always do, and have been using the new pred for a couple of days now.

I have been noticing that this new pred has me feeling much more energetic and with a much stronger appetite, much like my pre-pmr days.

I realize now that the mailbox where these bottles are delivered can get very hot during our California summer months, and that a bottle delivered there likely sees temperatures up around 120F (49C) or higher at midday. My own mailbox also happens to be on the top row in one of those metal "cluster" mailboxes, so would also heat up the fastest.

So I just wanted to bring this issue of "medication degradation" to everyone's attention, as I will from now on definitely be picking up my medication in person whenever I am needing to order a refill during warm weather, so as to protect it from the intense heat.

0 likes, 10 replies

10 Replies

  • nick67069
    nick67069 dan38655

    Posted

    I hope you found the cause, but have some doubt. Here is my observation...

    Now that I have been with PMR longer ( 4+ years) I can see seasonal changes. Last 2 years it just so happens that my attempt to reduce in May/June time frame resulted in "add on" to PMR ( painful hand, finger joints) that required increased pred dose during summer. It all gets sorted out by early fall. 2 years ago going below 3mg caused the symptoms; last year year was below 2mg.

    I am currently (again) at 2mg and will taper down soon. Will see what happens with warm weather.

    P.S. I hand pick my meds, so no high temp issue.

  • Twopies
    Twopies dan38655

    Posted

    i have had to go up in the summers too, but i pick up my pred from the drugstore. how do you taper back down again? i used the 84 day method so i find that im sort of not gaining any ground, tapering speaking. by the time i get back to my lowest dose, its summer and i have to increase again. seems like the heat/allergies do a job on me.

    hope youve solved your problem. keep us posted.

    • nick67069
      nick67069 Twopies

      Posted

      one alternative that I used is to go first half of taper slow and then, IF there is no any issue, I speed up second half.

  • Michdonn
    Michdonn dan38655

    Posted

    Very interesting Dan, I have not noticed any difference between summer and winter, but I always pick up my Pred at the drug store. I know that some meds are affected by heat, but didn't know that Pred was. Good luck on the rest of your PMR journey. 🙂

  • dan38655
    dan38655

    Edited

    Thanks for all the replies, as I said this is mainly my conclusion that came of my receiving a new bottle of pred last week that seems far more powerful than what I had been taking.

    All were 1mg tablets, and from the same source.

    I took a chance on taking just 1mg today, and other than not feeling quite as fully recovered from my fast, hilly 35-mile bike ride as I have over these past few days, I am doing well so far, plenty of energy. I will alternate between my former 1.5mg and 1mg for a while to see where that goes using the new prednisone.

    Nick, It seems that you have been reducing at about the same rate as me over the past couple of years, so I say we are averaging quite-steady progress year to year. 😃

    Summertime (as well as other sudden changes in the weather/humidity) does seem to affect my home's indoor air quality, as noticed when I first walk in the door after being out and about.

    For what it's worth, I have a ventilated crawl space underneath my home, which is very dry year-round. There is also a room full of bikes and inventory including tires, etc., so I keep a couple of windows cracked year-round. I have strongly suspected that air quality issues related to my construction efforts (and the former owner's smoking habit) led to my PMR episode shortly after moving in back in 2013. I have long since replaced all of the carpet, have re-painted, and even replaced the return air duct up in the attic, to eliminate odors (and this is not an old home, just 24 years old).

    My "tapering down" from a seasonal increase is simply a half or quarter-mg decrease at a time, no sophistication to it although sometimes I take a "bump" dose (perhaps an extra 1mg for a day or two) to see if I can get things back on track (as after suspecting I might have missed a day's dose).

    • nick67069
      nick67069 dan38655

      Edited

      35 miles on hilly roads - not bad for a guy with PMR 😃. I am glad that you are keeping up with exercise. If it were not for you, at the start of my journey, I would have not gone back to exercise, because just about everybody was warning me against it. I have slowed down lately though, but still bike 2x a week just under 90 min , mountain biking and swim laps once per week for an hour or so. Don't know if it is my age or change in the attitude, but I have slowed down in both sports to more comfortable level. Feels better and recovery is faster. I know I am not going to Olympics, so no need to push hard:).

  • dan38655
    dan38655

    Posted

    I'm on Pacific Time here, so just following up here near the end of my day.

    I didn't quite make it on 1mg today, so I just took another quarter of a mg before bedtime as I was feeling a bit of malaise and achy-ness.

    And I did find fault with my logic, since I was able to reduce down to 1.5mg (winter) from 2-3mg (summer) using only tablets from my old bottle of pred!

    So it's just that this new bottle works noticeably better, though apparently not so much as to allow me to reduce to 1mg from 1.5mg.

    I will try 1.25mg/day with this new pred and see where that goes (since it's not so hard to cut tablets into quarters).

    Always optimistic!

  • rosemary83494
    rosemary83494 dan38655

    Posted

    Interesting that your prednisolone comes in a glass bottle in the US. Mine is foil wrapped in strips of 14 in a cardboard box in the UK.

  • Anhaga
    Anhaga dan38655

    Posted

    Just throwing this into the mix, back in the days when I "only" had osteoarthritis I might sometimes find I felt worse in warm weather, and I think it had something to do with tissues swelling. Of course cold and damp can also affect stiffness with OA, but I do remember this effect in warm weather. Possibly similar with other "rheumatic" conditions like PMR?

    Incidently I find PMR niggles are much improved if I get really really warm in a bath and then wrap up in too many nightclothes! Go figure!

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