Prednisone: blessing or curse?

Prednisone messes with you. It really messes with you.  
 
For those of you who aren't familiar with this corticosteroid, its works by mimicking hormones naturally produced in your body (it is similar to cortisol). When the dosage prescribed exceeds the levels naturally present in your body, inflammation is reduced, thus achieving the goal of treatment. In doing this, your immune system becomes suppressed, leaving your body open to infection and a vast array of other problems. 
 
If a person takes prednisone for more than seven days, he or she cannot simply stop taking the drug. This is because your adrenal glands have been signaled to stop producing the hormones provided by prednisone on their own; it takes time for them to return to their normal functioning. If you suddenly stop giving your body the steroids, and your adrenals are not yet producing adequate amounts of hormones, a withdrawal reaction is likely. This may include fatigue, muscle weakness, headaches, fever, hypotension, nausea and vomiting, joint pain, dehydration, mental changes, difficulty breathing, the list goes on. Withdrawal symptoms can also occur if you taper too fast or by too large of increments. Not good! 
 
Now let's talk about the side effects that come along with taking the drug as prescribed. These can vary significantly from person to person, so I'm going to speak from my experiences. In the past year and a half, I have done more than five tapers of prednisone; with each subsequent exposure, the more likely a person is to experience adverse reactions. Luckily, I have managed to avoid what seem to be commonly feared side effects: moon face, excess hair growth, excessive weight gain, acne, etc. What affected me the most the first few times I took prednisone was insomnia. Other than that, some mood swings and increased hunger was all I could complain about, really. 
 
That is, until my latest encounter with the drug. I was forced into a prednisone taper toward the end of July due to my recent flare. The first few days I felt great, mostly because my fevers, nausea, pain, and inflammation had subsided. On day four, I woke up at 2am for the day ready to go (reverse insomnia?). It's all downhill from there.  
 
For several days, I was waking up at 3am, 4am, and staying awake. To some degree, this was great, because I was able to be productive, fitting my early-morning workouts in and getting extra work done. I had energy throughout the day; some days I actually felt too energized.  
 
My body needs rest to heal, and I was not getting enough sleep that I need to function. When I tapered after being on my highest dose for seven days, the exhaustion set in. I felt as if I had been hit by a truck. I went from running on 5 or 6 hours of sleep with tons of energy to needing double that amount of sleep and feeling fatigued throughout the day. I also had headaches, felt dizzy, and had lots of blood when I went to the bathroom. Side effects of prednisone often appear or subside when you decrease your dose, so it is not uncommon for my insomnia to go away. The issue I had was with the side effects that came next. 
 
I can deal with fatigue; it is something I deal with even when I am not in the midst of a flare. What I could not handle this time was the mental changes I experienced. I felt extremely depressed, my thoughts were constantly racing, I was tearful and easily aggravated. I cannot emphasize enough how concerned I was by what was going on in my mind; I did not feel like myself and it was scary. I felt like I was not in control of my brain.   
 
When my hands started shaking and my mental uneasiness persisted, I knew something wasn't right. Long story short, I was prescribed two different bottles of prednisone from two different GI doctors for this taper: one contained 20mg pills and one contained 10mg pills. When the 20mg prescription ran out, I assumed the other prescription was the same dosing—it clearly wasn’t. I had unintentionally tapered by 25mg. The typical taper goes down by increments of 5mg or 10mg.  
 
This explains why I felt like I was losing my mind, and likely also explains why I was experiencing a lot more blood coming from places it shouldn't be. Goes to show, prednisone is a serious drug and can really wreak havoc on your body. Luckily, I had an appointment with my GI soon after this realization. We decided to increase my dose back to where it was at the beginning of my taper to combat the bleeding and adverse mental effects. By the end of that day, I was feeling better.  
 
Currently, while still on the higher end of this taper, I am experiencing pretty severe lower leg swelling. By the end of the day, my feet, ankles, and sometimes my knees are swollen, to the point that it is uncomfortable. I have never experienced this side effect from prednisone, but a quick Google search tells me that steroids can cause this. It also isn't helping that I have a desk job.  
 
I nervously tapered again this morning (by a safe five milligrams this time). Fingers crossed.  
 
If all goes well, I have only a few more weeks on prednisone, thank goodness. Unfortunately, I have a track record of complications arising shortly after I end a taper (abscesses, fistulas, extreme fatigue, shingles... yes, young people can get shingles). I'm really hoping this time is different, and, as always, am staying optimistic.  
 
What weird stuff has happened to you on prednisone?  
 
 
 

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