Home Forums Hunting & Shooting Hunter's Campfire Prednisone

As a medical provider, I have read through this thread with interest, BOTH as a patient who relies on other's medical advice as well as a provider who is expected to give it to others... I will add a few of my own observations and impressions from both perspectives.

1. Modern medicine and the "business" of medicine keep pushing us toward a "one size fits all" and assembly line process which may work well for Model T's and boost profits for some BUT does not always pan out well for the individual patient, who is very much an individual!!! The "bell curve" mentioned earlier in this thread or the one on hypothyroidism is a "distribution" defined by '"averages" and statistical deviation from "average." Patients individually are NOT populations! Lab standards, dosing regimens, efficacy studies, side effect profiles will always apply better to a population in general. If you are very average, then you will likely do well treated with a "one size fits all" approach; if not, prepare to be confused and possibly disappointed with your care and experience.

2. Today's providers and yesterday's providers are not the same... both good and bad!!! Yesterday's providers tended to be better clinicians because that was what more of their training was focused on AND they had less fancy technology at their disposal. Most were "generalists" who were focused on the whole patient and spent a good deal of time talking to the patient as well as examining them. They were masters of observation and clinical diagnosis. My father-in-law, a general practitioner, was like this. He did it all... made house-calls, saw patients in the office, delivered babies, performed basic surgeries like tonsillectomies, appendectomies, C-sections, and even administered anesthesia for other docs in the OR. He "rounded" at the hospital at least twice a day and even formulated/dispensed some medications in his office! He was a dedicated man and revered by his patients (still is talked about today in almost "holy" terms by locals who received his care.) But, even he grew tired as technology grew, expectations increased, his family demanded more time, and he grew older. He spent the last 1/3 of his career further specialized, getting a couple more years of training and exclusively providing anesthetics.

Fast forward to today... the business of medicine and technology have exploded, providers are more "specialized" than ever, and true "generalists" focusing on the "big picture" are even more rare. They are less profitable in the current business model of health care. Specialists that order tests, and especially those that perform procedures make the most money. In contrast, talking to patients and spending time with them pays poorly... follow the money! I would say that at least 1/2 of the patients I see in the pre-op area of our hospital each morning have not met the surgeon or talked with them until right before surgery. Rather, they have been seen, diagnosed, and worked up by a "mid-level" provider in the office while the surgeon is out doing more profitable business elsewhere... not always, but usually. This often applies to non-surgical practices as well. Most physicians are not the diagnosticians they used to be AND the patients may very well not even be seeing the physician through the whole process!

3.Steroids are a mixed blessing. Chronic use vs, a brief large dose followed by a weeklong taper are two different animals. I've used the latter personally for severe reactions to poison ivy, acute back pain/spasms, and what now appear to be intermittent gout attacks (although I have never demonstrated abnormal labs or joint crystals.) Steroids have been a lifesaver in these occasional occurrences for me! I have also seen the devastative effects on soft tissue, blood vessels, and bone in those forced to rely on chronic systemic steroid use for RA, post-transplantation immune suppression, etc. Chronic use, particularly in large doses, almost always comes at some cost. Once again, one size does not it all. Every case is different!

I will finish bloviating by sharing a story of a young female patient (~42) that I was assigned to take care of as an intern as she was admitted through the ER in a larger "teaching" hospital. I did her history and physical exam after she was admitted to the floor. She had not felt well for about a week (flu-like sx of general aches and pains) and had seen her "general" provider who had also taken a history and IIRC maybe checked a few lab tests. When her symptoms had not subsided after a couple of days, he decided to put her on steroids (I do not remember whether it was a Medrol dose pack/taper or just prednisone) but it did not have the desired effect but rather just the opposite. The following day she was admitted to us. Within 2 hours of talking to me, she had destablized to being placed in the ICU with even more aggressive/supportive care, ie. intubation, monitoring lines, and pharmacologic hemodynamic support. She was pronounced dead shortly after going into cardiac arrest. Once again, an intern in my training and still a little shaken in this particular experience, I attended her autopsy early the next morning. The results were dramatic. She had experienced a bout of bacterial endocarditis, despite being healthy prior ( I do not remember whether she had a history of murmurs or rheumatic fever in her past, but she definitely was not an IV drug abuser!) It appeared as if a bomb had gone of in her heart rendering her pump useless. Her physicians efforts to treat a little flu-like inflammation had actually hastened her departure from mortality. It was not my position to place blame on anyone and I still would not today given the scenario BUT it did open my eyes to what suppressing the ability of the body to fight an infection can have in certain circumstances and I, to this day, always consider the pro and cons when administering (or personally taking) a steroid!!!

One size does not fit all; it never hurts to get a second opinion; look out for yourself and never be afraid to ask a question; be "reasonable" in your expectations and don't let ANYONE ever lead you on to believe that medicine is a perfect science. Amen!

Great post-- Yes --- The Medical Arts.

just to add---Insurance companies have far to much say in drug therapies.


If its not on their formulary, within the ranges of those crazy labs, no coverage.

lundtroller, you have accurately described my experience over the past 9 months.....5 different "specialists' seen during that time. My pulmonologist was a joke.

It's really crazy men, the rage built in me so by the second day i called Wife at work and asked for the farm alone for the rest of that week and all weekend, we have another property over in Arkansas she stayed at, plus, it's closer to her work at the hospital, didn't want her to see me in such a state.

One afternoon i grabbed belts of ammo that included 500 Nitro, 505 Gibbs and 577 Nitro Express, grabbed the three rifles, went out back and shot them till exhaustion, bloody fingers from the trigger guards, and kicked stupid, it was a positive experience, simply kicked the meanness outta myself, came in, washed the blood, grabbed a double handful of mixed nuts, threw those in a large bowl, stole some of Wifes vanilla ice cream, used fist to mash the pile of ice cream into the mixed nuts, covered ice cream with peanut butter, got a spoon, and maintained, i oddly welcomed the ice cream brain-freeze.

And i hate ice cream, guess looking hard for some comfort at that time, maybe ETOH or Lundtroller can explain the rage/anger/aggressiveness some of us have endured.

As harmful as prednisone is to your personality & body it's the only thing that helped my crohns disease. Tried the biologics you see on tv, humira, entyvio, stelara. One was shots, the other 2 were infusions. The last med stelara nearly did me in. Had to take prednisone & a tetracycline to get over that mess. Still take 5mg of pred daily for eye inflammation.

BS. Depends on how strong it is used. 5 mg vs 100?

Temporal arteritis is medically Giant Cell Arteritis (GCA) can kill you and it can do it pretty quickly too and is often a medical emergency I have at times started people on treatment for before diagnostic tests confirmed the diagnosis.

1 to 5% of prednisone patients taking higher than 40 mg will experience 'roid' rage. body physicians don't step into mind physicians ballpark and vise versa

backtracking a bit--- review of the role of estradiol (e2) in the body in both men and women.

in old men, ever wonder why those vein seem to pop out on the back of your hand, if you whack it on something even gently the skin is so thin you start to bleed. low e2

among other things the testosterone in you body is converted to e2, which causes cardioprotection, and thickening of the outer skin cells which contain aromatase converting enzymes.

the e2 also plays a large role in the Circadian rhythm, although you will rarely read or hear about it. E2 increases the tryptophan hydrolase-2 and serotonin transport express, down regulates serotonin 1A receptor and MAO A&B

e2 deficiency cause a decline in overall serotonin, the good mood hormone and sense of well being

Vit D (remember those 100 other metabolites) activates TPH2 and converts tryptophan to serotonin in the brain. (mechanism also affected by Omega-3 Oils)

why did you go for peanut butter and nuts? --- your body knew it was low on tryptophan (serotonin)-- but you are already low on the other stuff to converting it serotonin.

Stage is set for disaster.


Prednisone starts the cascade-- ADH and Oxytocin by pituitary , and Epy by adrenal. Blood pressure goes and fight or flight syndrome is activated. Endorphins are released and you feel no pain, you feel no guilt about your rage because of the " human binding hormone oxytocin"

(I suspect also that your eyes were "tearing" from the oxytocin -- but you didn't think this was part of the package)

My gastroenterologist put me on prednisone for my crohn's also. Worked good except my back was always hurting. He said it wasn't from the prednisone. Back pain started when I started taking the pills. He basically said I was nuts.

Then they got me on humira and when I stopped the pred, my back felt better.

Then I got a fungal infection and they put me on itraconazole and had to stop humira. Back on prednisone and back pains came back. Took me off it and put me on methotrexate and back pains went away.

From what I was told by different doctors it shouldn't cause that issue but twice it happened. Don't know

Thank You ETOH, still thankful for having the state of mind not to harm others, and in a small way self preservation, i did not take Vit D3 at that time, this episode was near 10 years ago, i was about 50.

They put me on it for BellsPalsey sp. By about day four I was afraid of becoming a axe murderer.

It's a place i don't like to go either man, weird, one day at the kitchen sink throwing water on my face, the mail lady pulled up to put some packages on the porch, i usually go out with a smile and thank her, that day, stood silent, just stared, didn't move, didn't blink, just stared, not a good place to be.