Get Ready for Preddy

Prednisone—one of the most famous drugs on the planet. For polymyalgia rheumatica, it is the only recommended treatment. Most patients, it is said, come off Preddy in a year or so, no doubt happy as clams that they no longer suffer the pain, stiffness and impaired mobility of PMR.

I refused Preddy at first. The two pages given me by the pharmacy listed only a handful of side effects: nausea, vomiting, loss of appetite, heartburn, insomnia, increased sweating, acne, muscle pain or cramps, irregular heartbeat, weakness, swelling in hands and feet, unusual weight gain, infection signs such as fever, sore throat or vision problems, coffee-ground vomit, black or bloody stools, severe stomach or abdominal pain, other pain, mood changes, slow wound healing, thinning skin, bone pain, menstrual-period changes, puffy face, seizures, easy bruising or bleeding and mood swings. Also, Preddy can mess with your blood-sugar level. And mask signs of infection. And cause false test results.

Sounds at least as safe as Russian roulette. Oh, wait…before popping a Preddy, the patient should tell the doc about any fungal infections, herpes, TB, heart problems, thyroid problems, kidney disease, stomach problems like diverticulitis, bone loss, eye diseases, diabetes, mineral imbalance, seizures, blood clots, and any mental or mood disorders like depression.

Sheesh, if everybody in those categories is excluded from Preddy’s world, who’s left to play the drug game?

Babies, apparently. Preddy passes into breast milk but “is unlikely to harm a nursing infant.” Wow, those babies are made of steel!

Doctor T called me to convince me to give Preddy a try for a couple of weeks, just to rule out the chance of GCA, Giant-Cell Arteritis, a form of vasculitis that can easily lead to heart attacks. “Okay, just for that,” I agreed, and bought some. $16.75. Cheap for something so miraculous.

I thought about the chance of Preddy causing insomnia that night and decided to wait till morning to start the drug trial. What’s the difference, after all?

The difference was the time my brain had to dredge up an old file. I awoke with the question, “What if Preddy can trigger an akathisia reaction?”

Supposedly, akathisia reactions are so rare that doctors don’t worry about them. I’ll bet that one of my docs two decades ago is still worrying about these reactions, however: I nearly committed suicide on a half dose of Prozac he had prescribed for pain.

The James's Flamingo (Phoenicopterus jamesi), also known as the Puna Flamingo, is a South American flamingo, named for Harry Berkeley James. It breeds on the high Andean plateaus of Peru, Chile, Bolivia and Argentina. It is related to the Andean Flamingo, and the two are often placed in the genus Phoenicoparrus. It is a small and delicate flamingo, approximately 3 feet in height. Its plumage is pale pink, with bright carmine streaks around the neck and on the back. When perched a small amount of black can be seen in the wings. There is bright red skin around the eye. The legs are brick-red and the bill is bright yellow with a black tip. Immature birds are greyish. James's Flamingo is similar to other South American flamingoes, but the Chilean Flamingo is pinker, with a longer bill without yellow, and the Andean Flamingo is larger with more black in the wings and bill, and yellow legs. By Pedros Szekely (http://www.flickr.com/photos/pedrosz/1955192221/) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

The James’s Flamingo (Phoenicopterus jamesi).

By Pedros Szekely (CC BY 2.0), via Wikimedia Commons

An akathisia reaction numbs your moral and social senses. You feel completely calm and rational, although in the human sense, you are not. In my case, my Prozacked brain made the judgment that I was a useless human being and should dispatch myself a.s.a.p. In another case, a guy broke into the Vancouver zoo and slaughtered 26 flamingoes. As my naturopath at the time said, “It’s like a sunyata experience that you’re not ready for.”

I’ll say. One akathisia reaction is enough for a lifetime. I wrote up my experience (see “Flamingoes” in Broken Sleep), which was published in two medical journals.

I stumbled from bed to computer and asked the question, Can Prednisone trigger an akathisia reaction?

Sure enough, one in five thousand patients. Very rare, indeed. I just don’t want to be the one in five thousand. Besides, I’m not at all sure the reportage of akathisia reactions is accurate. After all, these incidents are embarrassing and disturbing. Patients might be reluctant to report. Not only that, some researchers on multiple killing incidents point out that the shooters were on various drugs, including those with “rare” incidence of akathisia reactions. The pilot who rammed a plane with 156 people into a mountainside, for example—I am one of the few who can understand what that person’s mind might have been like and how he could have done that. Maybe I could commit any crime on Prozac…or any drug that can produce akathisia reactions. Including Preddy.

Nobody speaks out about this. Druggies are druggies—who listens to them? They’re gone from the normal world.

Maybe it’s time to perk up our ears. Maybe it’s a bigger problem than we want to admit.

I trot back to Dr. T. “No way,” I tell him. “Not unless I’m supervised 24/7.” I don’t have GCA, anyway. We’ll notice if the vasculitis heads in the wrong direction.

Belatedly, I search the Net for Preddy’s side-effects. Well, well, well…. This list is much, much longer than the brief info from the pharmacy. Two side effects blink neon at me: vasculitis and anemia—two of the very conditions we are fighting. So, if I took Preddy, how the heck would we know if my anemia was improving or just losing the battle against Preddy? How would we know if a turn for the worse in vasculitis was disease progression or just Preddy having a little fun with my mortality?

The docs can’t answer that one. Neither can I. I put Preddy away.

I think about all the people walking around in just my small city with a diagnosis of PMR, merrily downing Preddy every day, thinking they’ve got the situation under control, when all the while there may well be an underlying disease process creeping along, nudging them along to their final door.

A little later, Dr. T gives me twenty pages of information on PMR. Ten pages focus on the research criteria for diagnosis of the condition. My body meets all the criteria except two: (1) nobody has measured my ESR (sedimentation rate) because apparently in BC or Canada there’s a choice between CRP and ESR; you can’t get both; and (2) my response to Preddy has not been monitored.

So help me, the patient’s response to the only “treatment” for the condition, with all its failings, is one of the criteria for deciding that the patient indeed does “have” polymyalgia rheumatica. Talk about putting the cart before the horse!

Obviously, nobody knows nuttin’ about PMR. No matter how bad the pain gets, I refuse to get in bed with Preddy. Onward with testing the endocrines—the answer’s in there somewhere!


Featured image by Pedros Szekely (http://www.flickr.com/photos/pedrosz/1955192221/) [CC BY 2.0], via Wikimedia Commons


This post and others made possible with help from generous contributors to the Wellness 4 Wolffy campaign. If you enjoy this blog and want to see more posts like this one, please help support Wolffy in her quest to get well.

An image saying "Wellness 4 Wolffy" in blue text. Two wolves stand howling on either side of the text, and the number 4 rests over a paw print.

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