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Old 11-22-2006, 03:20 PM   #1
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Adrenal Insufficiency and Meds Adjustment

Hi.

I've just recently been diagnosed with adrenal insufficiency. (In July.) I am still in the process of working on a meds routine. Some days what I have works, other days, not so much. What really confuses me is when and how much extra to take on unusual days.

For instance, I suffer from chronic pain. On some days that pain is worse than others. Am I suppose to up my cortef on days like that, or just take more if I'm feeling crappy?

Another example is that a few weeks ago, I came down with a bad chest cold. No fever or anything, but I was having to work through it and was feeling pretty bad. I upped my cortef by a small amount simply because I was having to take it every three hours or so, because I felt so crappy. So I would take an extra 2.5 in the evening, since I had taken my third dose so early in the afternoon. Then, even after I got better from the cold, it seemed to take around a week and a half for me to get back to where I was, being able to wait 4 or 6 hours between cortefs. Is this normal?

Anyway, sorry to ramble. I'm rather sleepy today, but wanted to see if anyone had any input.

Thanks,
Caat

 
Old 11-25-2006, 11:02 AM   #2
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Re: Adrenal Insufficiency and Meds Adjustment

I was hoping someone else would have some input for you. Seems most just read.

Please tell us how much Cortef you take. What time of day & how much for each dose?

If you feel you are just not doing well you could try Hydrocortisone, the generic for Cortef. The Hydrocortisone works better for me, but many use Cortef & do just fine.

It is hard to know how your cronic pain is affecting your replacement. I know it eats it up. It is not good to increase frequently. It is hard to figure out when you really should increase & how much.

The book says to only increase for a fever. I "totally" disagree with this because of my own experiences. When I get a cold I try to avoid broncitis or pneumonia, so I double for 2 or 3 days at "first sign" of a serious cold. I split the extra amount of a daily dose between a.m. & noon doses. The evening dose is kept at the amount I always take. We can double for 3 days & go right back to our normal dose.

 
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Old 11-26-2006, 09:30 AM   #3
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Re: Adrenal Insufficiency and Meds Adjustment

Quote:
Originally Posted by WandaB
Please tell us how much Cortef you take. What time of day & how much for each dose?
Hmmm. I thought it would show up as a signature. My doses are:

Predisone: .5 am
Cortef: 7.5/5/2.5
Florinef: .5 am

I usually take the first around 8am when I wake up. The next, on a good day, is between 12:30 and 1:00, the evening dose can vary, since I work evenings, but usually around 4:30 or 5:00. (Maybe 5:30 or 6:00 if I'm not working.)

It seems as though, when I had the cold, I couldn't make it past 11:30 for my second dose, or past 2:00 for my third, so I was just taking an extra 2.5mg in the evening. That lasted for almost a week after my cold went away. I'm now just getting back to feeling like I can do a my regular routine.

I usually do better on brand than generics. I can't say in this situation, but as a rule, I try generics first and usually have to switch to brand. I am on generic prednisone, and I will be seeing my doc this week for the first time since I started that. I don't know if she'll have me up the dose or not. We're going the route of starting small and working up rather than starting with high doses and working down. I didn't want to do that.

I do tend to wonder about the chronic pain though. I did have shingles a few months ago, and called my doc, but she said not to adjust for that. So I don't really know. Because *that* was painful, I can tell you that.

Caat

 
Old 11-27-2006, 09:35 AM   #4
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Re: Adrenal Insufficiency and Meds Adjustment

Caat,
What mg is your prednisone tablet that you are taking half of...5,10 or 20mg?

I think your doc is wrong. If I got shingles I would take extra for 3 days when most severe to see if it helped. A normal persons cortisol would release automatically if needed. By finding all the people you can to talk to about their experiences you will learn much more than from any doctor.

The hard part of addisons is getting used to possibly not feeling exactly like you did before & pacing your self daily. I was diagnosed in 1998 & this still bugs me. Many of us have good days & bad days. I sometimes get lots done & some days nothing but what is necessary. I don't increase for anything except ""extreme"" tiredness, lack of sleep (less than 4 or 5 hours) if I can't rest during that day, feeling very cold (sign of low cortisol for me), injury or illness. Oh & when I have visitors for a week or so I add 5 to 10mg daily for the really busy days. If I don't I will go downhill & have to sit in a chair!

Let us know how your appointment goes.

 
Old 11-27-2006, 02:27 PM   #5
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Re: Adrenal Insufficiency and Meds Adjustment

Wanda,

When you increase your meds, do you find that when you go back down to your normal dosage that you experience feeling different, like headaches and such by having to re-adjust to the dosage again? Also do you see any weight gain with the increase in meds at all? I have only been diagnosed since April of this year and have noticed small weight gain recently and I'm afraid to increase when I'm feeling ill because of that. I'm on Cortef 12.5 in the morning and 7.5 in the pm.

Thanks,

Cruiser8892

 
Old 11-27-2006, 02:43 PM   #6
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Re: Adrenal Insufficiency and Meds Adjustment

Quote:
What mg is your prednisone tablet that you are taking half of...5,10 or 20mg?
Literally 1/2 of a 1mg tab. That's why I'm curious to see if she will up it on Thursday. I started out without taking Prednisone at all. I just started on it a couple of months ago. I also just got my Synthroid upped from 75 to 100mg, and got bloodwork today to see how that is going.


Quote:
Let us know how your appointment goes.
Will do. Thanks for your input.

Caat

 
Old 11-27-2006, 02:50 PM   #7
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Re: Adrenal Insufficiency and Meds Adjustment

Quote:
Originally Posted by cruiser8892
Wanda,
When you increase your meds, do you find that when you go back down to your normal dosage that you experience feeling different, like headaches and such by having to re-adjust to the dosage again? Also do you see any weight gain with the increase in meds at all? I have only been diagnosed since April of this year and have noticed small weight gain recently and I'm afraid to increase when I'm feeling ill because of that. I'm on Cortef 12.5 in the morning and 7.5 in the pm.
Weight gain has been a really depressing issue for me. A couple of years ago I worked really hard and lost about 15 lbs. I was right where I was comfortable. I started on the steroids and within 2 months put it all back on. I'm so unhappy with my weight now.

I do think that it was because I was a lot hungrier when I first started on them, and now that's sometimes leveled out, but I've been so busy at work I've had a hard time getting back into an exercise routine because I'm working odd hours this quarter.

Also, I notice that if I've been under a lot of stress, and I increase my meds (which I increase by *so* little) but when I get to a point where I'm sort of getting back into the med routine I'm used to, I get hungrier again. It seems like an uphill battle. I'd really like to get to a spot where I know what my med routine should be, but I guess I just have to be patient.

Caat

 
Old 11-27-2006, 06:00 PM   #8
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Re: Adrenal Insufficiency and Meds Adjustment

As always it is best to ask your dr about any changes but I had one dr tell me to double my cortef if I had a cold and felt like going to work and to triple it and make an appt with them if I felt too sick to go in. I am on 20 mgs cortef in am and 10 in pm. I was told to make it by 8:00 in the am and 1:00 in the pm. Always with a meal to make it easier on your stomach. I also take one florinef a day. Good luck!

 
Old 11-28-2006, 06:46 PM   #9
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Re: Adrenal Insufficiency and Meds Adjustment

Caat,
I never increase for more than 3 days so don't see a difference when back to normal dose. I have to be pretty sick to do a 3 day increase.

At the moment my lungs/asthma is giving me trouble so I have switched to all Prednisone for a few days. Trying to stay at the same dose as when on Hydrocortisone.

My endo started me on the max dose when I was diagnosed & the weight went on quickly. I didn't know any better at the time, but learned from others to taper to a lower dose. The hunger caused by the steroids is very real & a big problem.

The best thing we can do for our addisons is to get rid of any stress.

 
Old 11-28-2006, 08:30 PM   #10
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Re: Adrenal Insufficiency and Meds Adjustment

Cortisol is an immune system inhibitor so taking more isn't the best idea. You should only increase meds when you have a fever or severe physical trama, otherwise you are actually slowing down your immune system. Some bacteria actually produce toxins that stimulate high cortisol levels thereby fooling the body into not attacking the it

Adrenal insufficiency means you have low DHEA. Low DHEA is associated with poor immune system response, asthma, difficulty breathing, low exercise capacity, poor sexual response, memory/concentration problems, higher mortality and muscle/joint pains.

Colds that last weeks and long recovery times are a sign of poor immunity. You should be adding be adding DHEA, zinc, selenium and vitamin C and E; all of which work to improve immune response by various mechanisms.

Last edited by orion; 11-28-2006 at 08:40 PM.

 
Old 11-29-2006, 09:13 AM   #11
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WandaB HB User
Re: Adrenal Insufficiency and Meds Adjustment

Orion,
Thanks for the reminder.....I will increase my DHEA & add more zinc for awhile to see if it helps the asthma. Always take lots of vit C. I normally only take 12.5mg DHEA every other day to avoid symptoms of over replacement.

We have the 3 day rule for increasing to avoid immune system problems. I have to increase for a chest cold for 2 or 3 days or I get "very" sick. Thankfully it has been about 2 years or more since I've had one.

I haven't seen much of you Orion. How are you doing?

 
Old 11-29-2006, 09:59 AM   #12
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bigcaat HB User
Re: Adrenal Insufficiency and Meds Adjustment

Quote:
Originally Posted by orion
Cortisol is an immune system inhibitor so taking more isn't the best idea. You should only increase meds when you have a fever or severe physical trama, otherwise you are actually slowing down your immune system. Some bacteria actually produce toxins that stimulate high cortisol levels thereby fooling the body into not attacking the it

Adrenal insufficiency means you have low DHEA. Low DHEA is associated with poor immune system response, asthma, difficulty breathing, low exercise capacity, poor sexual response, memory/concentration problems, higher mortality and muscle/joint pains.

Colds that last weeks and long recovery times are a sign of poor immunity. You should be adding be adding DHEA, zinc, selenium and vitamin C and E; all of which work to improve immune response by various mechanisms.
I take 25mg DHEA every day. And I do take vitamin C, but I should look into the rest, as well. I also heard Echinacea was good.

It seems as though whenever she bumps me up on meds, I feel okay for a while, then they just don't seem to work as well. Maybe that's the process, I don't know.

Today, I'm really tired. And I just took my meds a little over an hour and a half ago. Maybe once I get on a meds routine that works for me, I won't be questioning upping my meds for things like colds.

Caat

 
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