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Date Posted: 16:37:39 01/15/07 Mon
Author: becky
Subject: withdrawal symptoms or not?

Maybe those of you with more experience can shed some light on this dilemma. My mother who is 82 years old and has numerous health problems including Congestive Heart Failure and COPD had a stent placed in August of 06. The hospital stay exacerbated her COPD and well to make a long story short - for one reason or another she has been on and off prednisone since last August. She usually starts out with 40mg for several days until the COPD is better and then tapers down 10 mg every 3-5 days depending on how her breathing is until she is off. In November however we went on a family trip and she was well enough to go too.......so she stayed on 20mg every other day throughout the trip and did not taper down as usual. This lasted about two weeks. When we came home she tapered to 10mg every other day and then 10 mg every 3rd day and then off. This took until the end of November.........Suddenly about 3 days after she stopped the pred completely she began to get a bad backache. The nurse thought it was her kidneys but all bloodwork was normal. It continued to get worse and about a week after stopping the pred completely she went into horrible severe back spasms - so bad she could not walk and just screamed with pain. We took her to the ER - where many tests were run (bloodwork, xrays and CT scan of upper/lower spine)......all her cardiac workups were normal (for her anyway as she has a pacemaker) her CT and xrays did not show any new compression fractures (which they had feared as she has one that is a couple years old) bloodwork only revealed a slightly low Potassium. I brought up the Pred withdrawal but all docs seemed unfazed by this......... Sent her home with Davocet and Flexeril diagnosis a "pulled muscle" which I was suspicious about. Which did seem to help some but not a terrific amount. However about 2 days after being home she developed another COPD flare (from being in bed in the hospital - happens every time) and therefore began the Pred again at 40 mg daily. Within 4 or 5 days she was much better and steadily improved over the next 2 weeks. She was on the 40 mg daily for 5 days and then 30 mg daily for 4 days and then 20 mg daily for 4 days and then 20 mg every other day again for a week. By this time she was doing great...........breathing good, getting around good, stent has now healed and generally doing well. So now the drop to 10 mg every other day and about 5 days into this and ready to quit completely she tells me she is very fatigued, aches like the flu and headaches etc... The doc says we can go back to the 20 mg daily in case it is from withdrawal and this time not go to every other day to taper. Within 2 days of back on 20mg daily she is feeling good again - out shopping one day - really did more than normal for her. By the next day she is complaining of a bad backache again......over the next couple of days the backache progresses to spasms coming once in a while again. So pred upped to 40mg daily. No change - in fact - now the spasms become nonstop 24/7 and she cannot sleep, hardly crawl to the bathroom etc...... We had started using the Darvocet and Flexeril again to try and stop this - but it was not doing a thing this time. So on New Years Day back to the ER. More tests - all okay - this time an abdominal CT - check organs, all fine - no aneurisym etc......bloodwork all normal. Sed rate even okay. In the hospital she is getting morphine IV - but even it is not stopping the spasms which will wake her up from sleep! Finally Tylenol with Codeine starts to help after a couple days and she is released on that medication and no other extra meds - told to stop Flexeril and also to stop her Requip in case it was an unusual rxn to the Requip. For a few days on the Tylenol/Codeine she is sort of okay then here come the spasms again. All this time she is on 40 mg /day pred (probably 5 days) - it does not seem to be helping her muscles at all but it is helping her COPD - (which had flared again in the hospital of course) Goes to her Neuro who was treating for the compression fracture - he reviews case and bloodwork and also agrees it is a "muscle problem" think it is due to severe arthritis that is inflamming the muscle fibers? Switches her to Hydrocodone plus tylenol.......better than the codeine for her COPD and bowel problems (she gets blocked with codeine)........first couple days it works okay too (by okay I mean she tolerates sitting in a chair to watch tv for a few hours a day - rest of time in bed - not anywhere near normal)then the spasms start again.....she is also being tapered on the pred again - got to 30 mg daily then the doctor was going 30mg/20mg/30mg/20mg - I thought I noticed much more severe pain on the 20mg days but who knows at this point. We are at our wits end - she has been in bed now with only walking to the couch or to the bathroom since just after Christmas........what is going on? I am not buying a "muscle pull". So my question is can this be prednisone related? Can it be from too much and she now needs to taper off and it will eventually quit? Or is this a withdrawal that she just has not ever stopped by going back on it. I would have thought that the first time since she stopped the back spasms almost immediately after restarting the pred...........but this last time they continued right through the increasing of the dose back to 40mg daily for 5 days - though they did finally get some better and just about that time she was lowered to 30mg and they started all over again........

I am frustrated because the doctors don't seem to think these kind of excruciating muscle spasms can come from the pred - either from the dose itself or withdrawal. But I have read differently. And she has never done this before - and this fall is the longest/most pred she has ever had for her COPD. So right now I am at a loss as to whether she should go back up on her dose for a week and see if it makes a difference or continue tapering down?!!

Could this be related to the pred and if so any tests that could shed light on that fact? (check cortisol levels, etc) If it was withdrawal related should she have gotten better again the second time we increased her dose? And so if she did not get better on the 5 days of 40mg daily then is it NOT withdrawal?

I do believe the aches and flu like feeling and headaches were withdrawal as they went away in one day on a dose increase..........but it is the debilitating back spasms (she claims she cannot even breathe right - they are in her thoracic area and come around her chest/ribs) that are the worst and which I do not know if there is a link to her pred dosages or not.

I am so sorry to take such a long post - but I am very frustrated right now and very worried that if this keeps up we are going to have a major complication due to her other health problems and lose her!

Thanks for any help you can shed!
Becky

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