PMR, Prednisone, DSNA Taper

I do 8m one day, 8-1/2 for the next 6 days....then 8m for one day, 8-1/2 for the next 5 days, etc....the classic DSNS method. I do not know how to do the alternating days. Would like to consider it tho. How do you do it?

You just take the old dose one day, new dose one day, old dose one day, new dose one day for however long you choose to do before going to the every day new dose stage. It is an intermediate step, half way through the DSNS approach you would do that. DSNS is much slower.

Alternating days is how I taper. Has worked well for me.  I alternate for a full week before settling on the next 1/2 mg level.

This was too violent a taper for me, but I've seen others use it. DSNS works for me and I like that I can speed it up or slow it down according to how I am

Me too.  But just thinking possibly an alternating week or two in the middle of DSNS might help at low doses.  Having just spent over three months working through tapering from 3 to 2.5 it might have speeded things up by a couple of weeks had I done the alternating thing during my first attempt, maybe meaning I didn't have to return to old dose and start taper over again from beginning.  May try this next time.

You're right - a couple of weeks at alternating old/new in the middle might be a really good idea. I do say repeat ad nauseum if you feel you are sticking at a stage don't I? 

I think I will try that. I seem to be so sensitive to a drop in prednisone at any dose...it might be interesting if I can sneak the lower dose in every other day.

rather counter-intuitive, but I will give it a go😊

I have been on prednisone too long and have lost my ability to think

clearly😃  I feel that maybe I could catch a flare quicker doing the every other day method...we'll see! I do know that stress can really throw me off...and stress always comes in strange ways!

I think part of my problem is distinguishing prednisone withdrawal from PMR.

Also, denial. I seem to want to muddle thru a couple of bad days before I give up on the taper!

Kathy:

If you use the taper DSANS you are pretty much eliminating the problem of "Is this withdrawal". Withdrawal pain happens when you suddenly take a lower dose than you are used to - and the immediate answer is to go back to the dose you are used to. In the DSANS approach you are offering your body the new, very slightly lower, dose just one day at a time - you might feel a bit wobbly on that day but the next day you give your body the dose it expected so you should feel better again. Then a few days later, after you have recovered again, you offer your body the lower dose again, just for one day, then back to the old dose. I find that for the first 3 or 4 times I feel "strange" and then my body says fine, I don't need to worry so i'll accept it. You only ever feel discomfort for one day at a time. 

If you use alternate days from the start, the steroid withdrawal discomfort will be every second day and it may spill over after a day or so - and you may think you are having a flare. 

If you want speed - you'd use either every day old dose and straight to every day new dose. Next comes going straight to alternate days old/new. And if you really want to creep down the dose so your body notices it least, you would use DSANS. 

If you think your problem is in deciding which is which of a flare and steroid withdrawal you are best with DSANS. But the bottom line remains: how ever slowly you reduce to avoid steroid withdrawal pain clouding the view, you will NOT get to a lower dose than the one you need to manage your level of inflammation at present.

I spent a little time today looking back through the diary where I record my daily dose.  I remembered I'd got to 5 mg in the spring, which was about ten months after I started at 15.  Sounds pretty good, doesn't it?  I started using DSNS when reducing to 9 from 10.  Well, since April I've travelled down a grand total of 2.5 mg!  But the last reduction was in many ways the most educational for me.  I'd been at 3 for a while, probably a month since the last 4 mg dose, and started DSNS to 2.5.  Up to this point I'd always managed a full mg reduction although I did it by dropping .5 mg for the first half of the taper then sliding down another .5 in the middle.  It always worked although there'd be a few days when I'd wonder.  This time I stayed with .5 throughout, but nearly at the end I woke up one morning with painful shoulders, a symptom I hadn't felt since starting pred.  I didn't wait around, this was a more serious symptom than the ever-present "niggles" which I think most of us have.  I went up by 1 mg, to 3.5.  Four days later I felt well enough to go back to 3, where I stayed for a couple of weeks.  I've been getting low level light therapy which may be helping to reduce the production of cytokines, and I increased my treatments again, having cut back for a couple of months, and started the taper again.  This time I got further along, but one day felt really pretty awful, a sort of generalized malaise not quite as specific a symptom as the previous episode.  Pulled out an extra 1 mg. and was about to take it.  Then something in me said, give it a little longer.  I put the extra bit back in the bottle and took 2.5.  Next morning I woke up feeling like a new person.  This was a couple of weeks ago.  I've been feeling pretty good ever since.  Still on 2.5 and holding steady!  I honestly can't explain it but I think the first time I was experiencing a genuine increase in PMR symptoms, but the second time it must have been pred withdrawal.  

I have been on Pred now for over 2 years,  with a couple of flares, and I am reducing from 7.25mg to 7mg.   I have been going down by a quarter mg as I get symptoms of anxiety, restlessness, pounding heartbeat and palpitations which wake me up at night and go on for a long time, (I also take Betablockers ).  If I use the DSNS method or alternate days I dont have any good days, so my doc suggested I try dropping a quarter overnight.  It helps a little bit, but I still get the withdrawal symptoms, but not for as long.  I stayed on 7.5mg for over 5 months, 7.25 for 6 weeks.   Hopefully these symptoms will fade away the lower I go.   

My doctor says I have an unusually extreme sensitivity to all medications, especially Pred.  My son unfortunately seems to have inherited this as well.

Thank you for all the replies....so helpful! I wish Someone gave me my dose in the a.m., using the DSANS method, without me know what the dose was!!

This is timely for me tho because I got thru today with some activity and I am doing okay....so paranoid about a flare😊

i am reading these posts every day while I work thru the DSANS method.

Thank you for all the valuable input😊