Has to be from the devil. Doc put me on a pack 3 days ago. I just weighed myself. Up 12lbs.

Helping some, not much, with joint pain and other symptoms I was having. But slight kidney ache and holy crap insomnia! Geez. 3 days to go.

Wait until you have to do two weeks of the stuff. It did make me feel like I was forty again.

Hurt my back once, Doc gave me a 10 day bender, it is from the devil and will cause a man to wind up on death row if not careful, i hate that shlt!

40 as in good? Some dont age well lol

To be honest, first day sucked. I got irritable and jittery. Already have a "what the fug are you lookin at" mentality. But thankfully yesterday was better.

Been on it every day for 5 years

Prednisone makes my nose polyps disappear for 5 years or so taking it for 7 days.

From 10% breathing in my nose to clear in 7 days taking a little white steroid pill?

I call it magic....

And you have kidney issues IIRC? Then maybe its not kidney pain im feelin, just muscle hopefully.

I asked my doc if he'd give me a maintenance dose. He laughed, said no fūckin way. He told me that he'd be taking it himself if it were possible.

Glad it works for ya. This is new to me for joint pain......I had other symptoms too, a lot actually, but doc wanted to squash inflammation. SED rate was really high on bloods.

It saves millions of lives every year. It makes inflammation go away and gives people hope they will be ok and makes people feel like they are ok and gives people hope they will be ok.


Its a miracle drug that, like others, needs to be used properly. It saves millions who would have died without and with organ donation.

It saves millions of people with severe, life threatening allergic reactions.

Thank you Father in Heaven, for the miracle of Prednisone.

You saying a wild man on steroids is worse than a wild man not on steroids...??

Ha!

DF

It's a steroid, not a good thing for long term use. Sister has chron's, has ripped her up.

Good, i was damn aggressive, i stayed home and shot big rifles, those sombitches kicked the meanness outta me, i didn't finish the 10 days.

Ill take your word for it, youd know better than me. So far tho, not impressed. Doc ordered cortisol test too, but results didnt come back yet. Maybe its fuggin with something there. Who knows.

Would she be alive without it?

Same here.........Good stuff. I had zero after effects.

Lordy DF, a 'wild convict' is where i was headed.

People biotch about prednisone that makes them restless and hyper. Evidently they would prefer the calmness of death. People rarely piss and moan about the misery of it.

You can get it over the counter in Mexico

Got a point I guess. But anything that puts on 12lbs in 3 days.....some nasty schit! What the hells it doin?

Last time my back went out my doc gave me a 10 day dose of it. In 4 days my back pain was mostly gone.

Take it in morning! Its a steroid. Makes you hungry and awake.

People are piseed their normal activity was upset by it. Well, that's easy to fix. Don't take it.

Just tell your doc you're tough and you will grin and bear it.

Phuq that chit. It caused kidney failure in the wife. She spent 12 hrs a week on a phuqing dialysis machine before she passed away.
Dont tell me how it's such a phuqing miracle drug.

All at once in the morning? Im down to 3 pills tomorrow. Supposed to spread out, breakfast lunch and bedtime.

I dropped my pred tablet between the seats today in the car on the way to Nashville. Said hell with it.


I wish it did make me hungry.

I can’t eat till about 2 in the afternoon, feel like I’m going halfway puke most days. Tums, zofran sweet tea keeps me alive.


I gave up trying to eat a rotisserie chicken I got from Costco. Gnawed on it 4 or 5 nights. Gave it to the barn cats.

I had a severe poison ivy reaction my Dr. gave me a shot of Prednisone and Prednisone pills to take for 10 days. The poison ivy started to itch less within hours was significantly better the next day and about cleared up within two maybe three days. I liked how I felt on it. I did eat more but slept less felt alert and awake. I’ve heard of those that don’t react well to the side effects also though.

Had a brain condition called Tolosa Hunt Syndrome years ago. Treatment was 80mg a day for 2 months, 60 for 2 months, 40 & then 20. A normal z pak starts with 20 the first day and drops by 4 each day. 80 was something you had to live to understand but it did get me through a very difficult time.

Sorry to hear

Slum, please taper off gradually to reduce risk of blowing out your adrenal glands. You really could be seriously screwing up.

The stuff made you feel like you were fine and could whip the world, right? Well you [bleep] cant!

80 mg a day for 2 months? wow

The Doc gives me some with antibiotics and have never had weird dreams or mean streak.

Says it makes the antibiotic work better.

Maybe it is the dose that is causing problems.

Seems like good and bad reactions here. Im goin to take some melatonin and close my eyes. Hopefully I can get some damn sleep and this stuff starts workin better.

Can’t quit it, part of anti-rejection 3 med component.

I have trouble taking it, and just got a prescription filled for it for a bad arm and elbow. I take it half a dose at a time, and still have trouble sleeping,

I dont sleep worth a damn, 3-4 hours and that’s interrupted by back pain, cold/hot. Go back and forth between a recliner and bed once or twice. Docs told me it would cause insomnia

I was on a daily dose of 70mg of Prednisone for 4 months along with weekly infusions of intravenous immunoglobulin (IVIg) Kiovig for a very rare type of autoimmune encephalitis I developed.. In my case the high doses of cortisteriods was to suppress my immune system. In 2016 there was a movie "Brain on fire" about a US woman with a condition very similar to what I had. Anyway, I'm all good now with a new perspective on life.

As noted in another thread, I'm on 40mg daily, take it all at once in the mornings, and I feel great with no side affects, treating a sarcoidosis disorder. Will check labs at the end of the month to re-assess dosage. After 9 months of feeling like hell, the change is very welcome.

PTL.

GOD bless you pal. Youre in my prayers, Johnny.

OP

Its the pred causing problems. Main one is its keeping you alive. You wouldn't be biotchin if you were daid.

Hope you get some relief.

I am supposing those labs will check inflammatory markers.


I’ve had a parameter that my docs pull for acute phase reaction to inflammation, a ferritin level test. I don’t fully understand it’s meaning.

Check back with us if youre able to share an update, I would be interested in what those test markers are looking at. Not being nosey, I’m just fascinated with that area of medicine

My wife gets hydroxychloroquine for early rheumatoid arth markers. Bit she is stubborn and doesnt like that med or any meds. She is just eliminating wheat and bleached, enriched and processed foods. Actually for a few years and her inflammation is technically registerable on labs but she claims no effects or symptoms.

I have charged a lot of people for saving an eye. I have never charged for keeping anyone happy while saving that eye.

I would be rich, had I.

No prob slum. I had a severe case of hypercalcemia, which led to all sorts of problems as you probably know, including below normal kidney function, digestive probs, fouled up bun, creatinine, vitamin D, loss of appetite, loss of 30lbs, etc. Lung biopsies revealed the sarcoidosis which was the root cause of it all.

Without Prednisone, allergies would be making my life miserable.

I once had gout in my ankle that narcotics, colchrys, allo, indomethacin couldn’t even touch. Absolutely horrible pain. Took 40mg prednisone at 8pm... couldn’t fall asleep because of the pain and because, well I found out it’s difficult to fall asleep when you take prednisone at night.

Woke up at 7am, but my work boots on and went to work. that’s as close to a miracle as I’ve ever experienced.

I know it ain’t good for you, and when I’ve had to take it, it’s 40mg x 4 days, 20mg x 4 days, 10mg x 4 days, and 5mg x 4 days.

I’ve taken it quite a few times over the years. For a gout flare up it’s amazing. Beats chopping your foot off with an axe which what I feel like doing when it gets bad. Also is nice to be able to breathe when asthma and allergies or lung infection kicks in. I have heard a lot of horror stories, but have never noticed anything odd myself when taking it.

My dogs, well that’s a different story. Aggression, constant drinking/peeing etc yeah absolutely.

Thats scary, JG. Last i saw you looked like a cross between John Wayne and Paul Bunyon.

Heres hoping it passes soon, Johnny.

Hi JG, I was diagnosed with pulmonary sarcoidosis a bunch of years ago. Unfortunately the doctors missed diagnosing it until I'd lost 42% of lung capacity, Started at 40 mg, as you have, but after the two year regime, it came back and had to do it all again. Good news is that was the end of it. Seven years on prednisone, But I've been in remission over 20 years, Sounds like you're tolerating the prednisone really well, I hope it kills those little granulomas and never comes back. Eileen Clarke

Praise and Glory be to you, Father in Heaven. Thank you Father, Lord God Almighty. You were right, Father, by your Grace, we did do miracles..

Have taken it multiple times as an adult for allergy issues.


The old WWII era sawbones we had as a kid handed it out like candy.
Sinus issue, you got an envelope of "sinus" pills.

Know it's the same thing, I recognize the taste.
Can't believe no one has mentioned that.
Phuggin things start to resolve the instant they touch your lips.
Can't avoid it, and it doesn't go away fast.


Last time I got them pur normal pharmacy was closed.
Those ones must have been coated. Not too nasty to take.

I take 5 mg every other day for the residual inflammation in my lungs from Covid. I think it has helped.

I have a scrip for emergencies when I feel a COPD attack starting. Big blast then 12 days decreasing every third day. In January I put on 20 # in those 12 days. Lost about 10# of it since, but had to hit it again this week. Glad to be able to sleep most of the night without waking up trying to catch me breath every 2 hours. I noticed dull headache toward the end of the treatment. Oh well. It beats the alternative.

G5
Remember this for the next time you have a back injury.

Dexamethasone (Decadron)

Ask your doc about it. I’ve used it twice for back problems. PFM, it is.

I had a small bottle of them for severe hay fever when I was roo shooting, one tablet fixed the issue and for the next several years every time I twisted an ankle or tore muscles I popped one, the one would take away the inflammation and allow me to keep working.
That was a bottle of 25, I am not sure if they are that effective for everyone but they certainly worked for me, and with no side effects.

Taken it several times for poison oak and other skin conditions. Never had noticeable side effects. Sure does help with poison oak though.

Im supposed to be cutting back on it. I tried to cut back about a month ago and ended up with a very stolen and painful foot and ankle. I thought I had finally got the flare calmed down and to night its back with a vengeance. I don't want to be up all night again so I'm going to take 20 MG now. I've gained weight on it but it's bought me some serious pain reduction. I wish I'd did have bad side effects because it really helps my spondylitis.

Bb

. . . but Lordy, the dreams! Yikes.

I got into a life-changing event back in '91. The doc started treating a bad chest cold with pred and theophylline (anti-asthmatic). It kept getting worse. He kept upping the dosages. I finally woke up in a local Oncology ward with my lungs filling with fluid, and ranting like a lunatic. Prednizone psychosis. I invited the nuns in for a demonstration of levitation and stigmata. They didn't know what I had, but they knew it was serious.

It took months before a thoracic specialist suggested I get off all the meds. I turned out I was allergic to the theophylline. I got weaned off everything, and gradually got back to normal. The pred-related stuff went away in a month. The coughing lasted another 18 months.

It took another couple of years before I met a 2-digit liver recipient who'd started the local self-help group and he started explaining the effects of steroids on your noggin. He'd been one of the first couple dozen liver recipients and they'd had to experiment a lot on him to figure out how to keep his body from rejecting the liver. He'd suffered tremendously.

My Dad had a somewhat similar reaction to Pred in high doses when he got a bad rash. Luckily I'd had the experience and was able to tell him he wasn't going insane.

Taken it in some dose 4-5 yrs. Only take 5 mg a day now. The higher doses I took caused cataracts. Gained 40 lbs which I have now lost, have thin skin. It caused bad insomnia, and I stayed angry all the time. It's good for short duration, but not long term at high doses. I've heard it called the devil's tic tac. The stuff is great to get you out of trouble, but try to find another plan for long term.

This

+2. It gave me anger issues I didn't know I had.

What a surprise. A drug works for some and some have the bad side effects out weight the benefits.

Maybe they should put warnings on a label?....

Nothing new here. I’m deathly allergic to ancef, most of you get/have gotten doses after surgery .

Are bone density problems an issue???

Doc rx's me Pred for gout when nothing else will touch it. 40 mg burst dose, then down titrate from there usually taking 6 days. Did the same for a severe swollen poison oak/ivy reaction. Works well in those applications. And yes, I get 'roid rage from it. Wife and kids give me wide berth when I'm on a Pred bender.

Mom was on it 7 years for PMR trying to keep SED rates down. It worked in that regard, but destroyed her bones. As we speak, she's bedridden. T3 is gone - like not there. T2 and T4 are swollen with compression fractures, and T5 is extremely hot - ortho's words, not mine. Ortho showed me the MRI.
The bone is so brittle and weak that there's nothing to screw into - like punky wood. Can't do the injectable cement either because there's nothing there to attach it to. Ortho said it's the years of taking Pred and an otherwise healthy lady is probably going to die from it.

My wife gets on it periodically, give her dreams, rage, it’s awful, but it works!

Really sorry to hear that...
I've done the treatment three times, once for gout and twice for bronchitis. The second time with bronchitis my MD wouldn't give me any antibiotics, she won't for a viral infection. A few days after the week of prednisone the bronchitis came back with a vengeance. I skipped my MD, went to RediMed. That doctor uped the doseage and extended the treatment to two weeks, also gave me a Zpac. That knocked the cr@p out of the bronchitis. My MD never said a word about me doing an end around.

Miracle drug for my gout. Can't take NSAIDS.

Thank you very much Eileen. I have hope my situation will turn out like yours.

I have taken Prednisone many times for chronic hives that nothing else would work..I had an open prescription but I found a combo that worked as well and quit taking Prednisone..Prednisone is often prescribed for MS..Nasty stuff to some,it never bothered me much....


Jayco👍

Get off that schitt. Take anti-inflammatory like curcumin and cod liver oil.

I wouldn't call it an end around so much as advocating for your own health. With Pred you usually see results quickly. Viral infections and bacterial infections are 2 different animals. Doc shoulda done a culture and figure out which one you had. That Z-pac is an anti-biotic and that's what knocked that infection down. Good on ya for making the call to see someone else - more people should.

Pred has probably saved my life a couple of times, but as I said earlier, it can really open up the gates of hell. I would be the last one to tell someonenot to take it, but watch out for yourself and for others. One of the best things that ever happened in my life was the relief I felt when a doctor told me: " It's the Prednizone that's doing it." Once I knew it was a drug reaction, all the weird stuff became much easier to handle.

The liver transplant guy gave me a lot of good advice. According to him, Pred puts you on a roller coaster. Your adrenal glands are pretty well shut down. The Pred tells them there's an excess of adrenaline in your system, so it shuts down adrenaline production. You're now dependent on the "fix" of fake adrenaline every so many hours. When you're up, you're on top of the world. However, when you come down. . .

"Your body takes the sincere lack of adrenaline and a sign that you're dying," George said. "We go our whole lives, basically feeling well, because we have adrenaline in our systems. When that disappears, it mimics the body shutting down in preparation for death."

There are some things that are locked up in your head on the level of Jungian archetypes that trigger. I had dreams of death, decay, really morbid stuff. It can be real Fright-Night stuff.

Bottom line: If you know someone on cortical steroids, be a buddy and let them know this stuff can really send them for a loop. Often times knowing it's just the drug that's doing it can be a huge help. Since my run-in in 91, I've probably helped half a dozen people by broaching the subject.

shaman, advise is spot on. Pred is akin to what I would think that Meth would be like if I had ever taken it. I never got any REM sleep the whole time I was on the Pred...I hope I never have to take it again. I talked to the Dr about it, and there are stronger and weaker versions of the Pred.

Jittery as fug this morning! 2 more days, thank goodness. Joint pain is down, thats a plus. Geez tho this stuff messes with ya! Gonna go for a walk here in a bit and see if that helps. Feel like I gotta keep movin.

Glad it helps a bunch of you folks, really am. But seems to fug me up. Wish the doc woulda give me a little more heads up.

Prednisone, Prednisolone and analogs are synthetic replacements for the natural cortisol or hydrocortisone already in your body and released by the Circadian rhythm in your body during the sleep cycle particularly about 2 am.

The strength of the various analogs are due to differences in the metabolic route, hence duration, not strength as such.

The dreams and nightmares are caused by disturbances in the subconscious re-arranging of the Archetypical Jungian symbols, which becomes your reality on awakening.

Adrenaline (epinephrine) is not the main player , duration of action is far too short, Aldosterone, and ADH, are trying to regulate your Na, and blood pressure. (Renal fatigue) which are also made by the adrenal gland.

The glandular secretions are pulsatile or wavelike in the frequency of release. The secretions are trying to co-ordinate to the secretions of thyroid t4 (which comes too little and too late, ) and testosterone (why the Succubus visits you every morning)

Tumerin an Cod liver oil are excellent ideas and anti-inflammatories.

Also getting on a short course of hydrocortisone for renal fatigue.

Before i started the D3, Z Sulphate, K2 and one Hydroxychloroquine a week i normally got severe viral bronchitis about every fall and spring.
Used to have to getbon ABs to knock it.
Then a lung specialist had me start 50 mg Pred in AM every OTHER day when i started getting it.
Normally i only had to take 3 doses over 6 days before i was well and never had to get on the ABs for several years by doing that.

By skipping every other day it doesnt knock your own adrenal gland cortisol production out and no need to taper off Pred if only used for a short time.

Your comments on this would be appreciated Charley and Etoh.

Important to understand that D3 is a hormone, not a vitamin (vitamin= vital amine, , D3 is cholesterol derivative with no amine groups. )

also that adrenaline is not a hormone, only called that because most is made in the adrenal. It does contain an amine group, and by convention fits into the vitamin group .

most of the nomenclature is so outdated its hardly usable.

allosteric , the attachment of a protein, enzyme or group to a receptor site to activate------

most important aspect of biochemistry. not only are the time constants different for the same person in different places of the body,, for the same reaction, there are thousands of different ones.

and as the state of the physiological envoirnment is in a different allosteric state in each person . When compared to mathematical physiological modeling, rocket science is kids play.

the plural of anecdote is not data.

one of the most important systems to get back on line, that covers a broad category of issues is the melatonin -Circadian system.

Melatonin is not a sleeping aid, it is a HORMONE-- call it the happy hormone.

it is part of the tryptophan , serotonin -- neural communication system of your body.



first thing in any evaluation is a complete medical history.

What can one do to get it back online and up and running well

start t3 and t4 , which are components of thyroid, get separately , biological half life is different for both,
start Testosterone cream 200 mg daily --- standard dose
2000 mg fish oil 3-4 times a day
D3 at least 5000 units daily
melatonin, 5 mg at nite
L Tryptophan 250-500 ( when you see L or D in front of drug or food supplement it refers to the optical enantiomer= short version on the L forms are biologically active)
TTumeric 1000mg 2 times a day. increase blood flow by helping with nitric oxide.


this is a good start, and will help regardless of current medications taking (will not interfere) or previous pathologies

look up compounding pharmacy in your area and they will line you up with a Bioidentical Hormone Replacement doc.

Don't take synthetic thyroids. Armour thyroid is the only one to take.

Too much T3 in pig thyroid for some folks, im a prime example.

This is incorrect.

Armor and others of this type are desiccated products from pigs, that are extracted with malt solutions.

They have incredible problems standardizing the doses, (check on the FDA recalls if you don't believe me). manufactures assays are off all the time.

also the ration of T4 to T3 is for pigs , are you a pig? the dose of which is in micro milligrams not milligrams,

T3 or/and T4 can be combined in any ratio that is tailored for that person, then encapsulated using micro cellulose. (pharmaceutical grade.) to very accurate assays.

This statement is also inaccurate.

T4or levothyroxine is not active and is converted by the cells on site to T3 (liothyronine ) and rT3, rT3 is not active and competes with the site along with regular and active T3. This conversion process has a bio-logical half life of 6-7 days.

T3 has a 1/2 life of 4-6 hours and allows the person to tailor the dose to their rhythm

pig has a ratio of 20/80 T3, T4 of which only 1/2 the T4 is active.


Ever wonder how many people fall "asleep" at the stop light , caught in that mindless gaze--- zoned out Low T3

It was previously thought that T4 was needed because it crossed the blood brain barrier, and was converted there, but it has been shown (NCBI) that T3 is present in spinal fluid .


So as an example a dose in the morning, and say one about 2 o'clock when your cortisol level go to hell

So you came around finally?????

Thanks Etoh, but i have heard Melatonin should be taken several hours before bedtime to start its affect by bedtime.

No, its not. You stated desiccated thyroid has a 4/1 ratio ...correct. Whats a humans ratio? 14/1. Shot my free t3 and rt3 through the roof. t4 bottomed out. Again, some folks can handle it, I couldnt.

Recently (1 to 2 years ago) I had to take Prednisone for a condition called temporal arteritis. Symptoms were severe ongoing headaches, could barely open my mouth to get a spoonful of food in. At first I though the problem was an infected tooth. When I finally went to my doctor she diagnosed me in about 3 or 4 minutes even though I now understand the condition is not common. Under the worst conditions, if untreated, I understand it can lead to blindness.

The doctor prescribed prednisone and within hours the headaches disappeared and I could open my mouth to eat again. I was on a prednisone treatment for several months and then gradually tapered off. Not pleasant to take but it surely worked for me.

What scared the hell out of me was the thought of maybe going blind if it hadn't been caught. I had a phone call from a specialist
doctor in a major Toronto hospital yesterday who informed my I am now considered cured and it would no longer necessary for me to drive into the city every 3 to 4 months for checkups.

In my case I am truly thankful for it.

Jim

Can be taken then, but some folks will be put to sleep before they get to bed.

Its inaccurate to extinct is doesn't differentiate that the ratio is established by the extraction process and not in vitro real time pig or human value.

human ratio has no standard, different in each person

I did have to deal with two worlds, the academic and government, neither one cared what the other calls stuff, but if your participation requires one to use the correct jargon.

Vitamine D in and of itself is not a hormone, but it is converted in the body to calcitriol which is referred to as a steroid hormone...which regulates calcium and phosphorus is the body.

Which makes it a prohormone. Call it whatever the fug ya want, ill continue to call it a hormone.

And if one has severe liver or kidney problems you can call it what you want, but it won't be turned into the active hormone metabolite.....It will just sit there as Vitamin D...

Correct

Sorry when I say Vit D its D3

As it is a cholesterol based chemical there over 100 metabolites, and only a few have been studied in some depth. To what extent and amount is open to conjecture.

the cholesterol/steriod pathways are not closed. and the steroids can be rerouted to that pathway and vice versa.

It has it's uses. You should see how it clears up a bad case of poison ivy!
Dr told me it's like using a firehose to put out a match.

As noted above, depends on the person. My wife HATES prednisone. Keeps her awake, jittery, puts on excessive weight QUICKLY. OTOH, I love prednisone. Sleep like a baby and after 3 or 4 days, get up feeling like Super Man. Positive Mental Attitude out thru the roof. I will clean out a refrigerator in less than a day. But stay active enough when I am on it to burn off the calories.

Daughter is an FNP. She has older patients who crave prednisone like a junkie craves meth or crack.

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.