Pred is Just Like the Tide!

imagine a rocky shore. In the morning the tide is out, the rocks are uncovered. By afternoon the tide comes in and covers the rocks. It sometimes leaves some uncovered. Overnight it goes out again and uncovers the rocks.

The amount of rocks uncovered is roughly how much pain/stiffness I have from the pmr.

Inflammation increasing is like the tide going out. The pred reduces the inflammation, the tide comes in and reduces the symptoms.

When we talk about how much pain/stiffness we tolerate I'm never too sure whether its at its worst, in the morning, when the tide is out, or at its least worst, in the afternoon, when the pred takes effect and the tide is in.

I assume the morning.

Stable is when the tide goes in and out the same amount every day. The pain/stiffness is the same as the day before.

Stable and no pain is when the rocks are covered in the morning and the tide is going in and out the same amount each day - difficult to tell as we can't see the rocks. 

Reducing from 3.5mg/day to 3mg/day I noticed that over several days the pain/stiffness level in the morning was increasing a little each day.

As if the tide was coming in less each day, and going out further.

My fingers have been the best indicator for quite a while. Wrist pain was added, and a twinge or two in upper arms, where it all started a couple or more years ago.

Toughing it out in the hope it was "withdrawal" was really not an option once things got to the stage I couldn't peel an orange.

So. I considered a few options.

1. do nothing, wait and see some more.

2. Have a high enough dose of pred for a day or two to have the tide come in all the way and cover the rocks completely then return to the 3.5mg at which things would be in equilibrium.

3. Return to 3.5mg and see if equilibrium would be reached after a few days

4. Increase a bit until stable and embark on slow reduction again.

I opted for 2. Particularly since that had worked once before with minor shingles attack.

A couple of days of 8mg, a couple of days of 5mg, then back to 3.5mg/day. So far stable.

Returning to 3.5mg was attractive until I realised it may have been only just enough, that inflammation and pred were in equilibrium. Which would mean not enough pred to reduce the excess inflammation. The tide would come in and go out at its new level, leaving rocks still uncovered.

Increasing to 5mg and slowly reducing as in a normal taper seemed attractive until I thought of the longer time to achieve reduced pain and the longish time to taper all over again.

So, a couple of days of higher pred, to have the tide cover the rocks.

It then occurred to me that if the build up of inflammation due to pmr and the reduction due to pred were in equilibrium, that the tide was coming in and out the same every day then the best equilibrium would be where the rocks were just covered every morning, that the incoming tide would just mean deeper water over the rocks.

Just thinking out loud really. The pred dose to be pain free in the morning when pred is taken may be the same dose at which we feel the same amount of pain at the same time each day.

Perhaps including a comment from some time ago about a medical practitioner with pmr who took a lot of pred for a bit then none for a while until symptoms returned. Basically lots of deep water over the rocks which steadily becomes less each day.

Thus, there may be two parts to pred. One is whether we return to the same condition every day at the same time, that we are stable, the second is whether we have residual pain/stiffness or not.

So, for me 3.5mg may be the stable dose. But I can be stable with a bit of pain or with no pain. Its still 3.5mg/day for equilibrium.

Of course I'm really never too sure what a flare looks like. I think I'm lucky. This was more like a slow smoulder.

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