Prednisone for shoulder area inflammaton and pain before tx
My regular dr prescribed a 12 day taper of prednisone to treat a shoulder injury,acturally it feels like my whole left upper back, chest and neck got it too. My pcp approved it prior to starting tx in the next week or so. I actually get hiper than sleepy when I take it. Anyone else had any expeience with prednisone and hcv?
Had a horrible experience with Prednisone and treatment. Was only supposed to take it for 10 days for gout, but a careless Kaiser doctor had me on for 30 days. Man, it turned me into a first-class *****!
prednisone is very hard on the liver...there are times when nothing else will work..
but this doesn't sound like one of them. Ask your doctor for liver friendly drugs and some physical therapy. If you pulled muscles they will take 3 weeks to heal...tendons etc take longer. But it's better to let time, heat/cold/physical therapy help the healing process than to try to rush a muscle to heal...at the expense of your liver. Just my opinion.
Most hep docs won't approve it on treatment due to studies done on liver transplant patients who were given boluses of steroids and seemed to have more difficulty suppressing hepc on their own afterwards. My doc wanted to put me on it to slow my blood loss during tx and the hepatologist said no. That said, I was on it for maybe three or four days and it didn't hurt my progress. I think mremeat (sp?) took quite a bit of it during treatment and still treated successfully.
yeah, there all always going to be exceptions...when it can work better and like with bells palsy it will reduce inflammation quickly, saving facial nerves from premanent damage....but again a muscle injury will heal...it isn't deforming permanently to have a tight muscle group where the inflammation recedes more slowly.
Steroids are kinda the drugs we all love to hate...yes they can save lives, stop rejections etc....but they can also bring on complete organ shutdown...some transplant centers have stopped using prdnsine due to these issues....and better meds available now....but so with steroids history they need to be the last, not first line of defense.
Prevalent immunosuppressive strategies in liver transplantation for hepatitis C: results of a multi-center international survey.
Gedaly R, Clifford TM, McHugh PP, Jeon H, Johnston TD, Ranjan D.
Transplant Center, Department of Surgery, University of Kentucky, Lexington, KY, USA.
To determine current immunosuppression regimens and strategies for acute cellular rejection in hepatitis C virus (HCV) patients after liver transplantation (LT), questionnaires were sent to 264 LT programs worldwide. Surveys from 81 programs were reviewed. In 27 centers (33.8%) the immunosuppression protocol used in HCV differed from non-HCV patients. Tacrolimus-based immunosuppression is utilized in 70 centers (86.42%). Triple therapy using tacrolimus, mycophenolate mofetil and steroids is the most common regimen (41%). Six programs (7.4%) use steroid-free protocols. In nine centers (11%) steroids are discontinued within a week, 56% within 3 months, and 98% within the first year. At 75% of centers, mild rejection is treated by increasing baseline immunosuppression. Moderate rejection is treated by increasing baseline immunosuppression in 38% of centers, steroid bolus in 44%, and either in 16%. For severe rejection, 46% of centers give bolus steroid, and 16% administer antibodies. Among respondents, non-US programs use significantly more cyclosporine than US programs (35.6% vs. 2.8%, P < 0.001). Duration of steroid therapy is significantly shorter in US programs than non-US (10.8 vs. 29.4 weeks, P < 0.001). There is no consensus regarding the best immunosuppressive regimen and rejection treatments in HCV patients after LT. Our results reveal the most prevalent management practices in this difficult group of patients.
PMID: 18498313 [PubMed - as supplied by publisher]
One very positive aspect of a steroid free regimen is found in this sentence:
"Regarding steroid-related side effects, posttransplant diabetes mellitus occurred in 10% vs. 45%, and wound infection in 6% vs. 31% of steroid-free vs. corticosteroid patients (P=0.003 and 0.01)"
Randomized trial of steroid-free induction versus corticosteroid maintenance among orthotopic liver transplant recipients with hepatitis C virus: impact on hepatic fibrosis progression at one year.
Kato T, Gaynor JJ, Yoshida H, Montalvano M, Takahashi H, Pyrsopoulos N, Nishida S, Moon J, Selvaggi G, Levi D, Ruiz P, Schiff E, Tzakis A.
Department of Surgery, University of Miami School of Medicine, Miami, FL, USA. ***@****
BACKGROUND: Due to the known high recurrence rate of hepatitis C virus (HCV) among orthotopic liver transplant (OLT) recipients who receive tacrolimus+corticosteroid maintenance, use of steroid-free induction was considered. METHODS: OLT recipients with HCV were randomized to receive tacrolimus+daclizumab (steroid-free) vs. tacrolimus+corticosteroids during 1999-2001 and then tacrolimus+mycophenolate mofetil (MMF)+daclizumab (steroid-free) vs. tacrolimus+MMF+corticosteroids during 2002-2005. Patients in the steroid-free arm of both periods received no steroids except for treating biopsy-proven rejection. Primary objective was to compare mean fibrosis stage at the 1-year protocol biopsy, between the steroid-free and corticosteroid arms, stratifying by period. RESULTS: No noticeable differences in mean fibrosis stage between the two treatment arms, either averaging across periods (P=0.99) or during either period (P>0.35) were found. Occurrence of acute rejection during the first year was the only factor associated with a significantly increased fibrosis stage at 1 year (P=0.0003); stage > or =2 was seen in 63% (17 of 27) vs. 19% (8 of 43) of those with vs. without rejection. In addition, MMF use was associated with significantly fewer patients experiencing acute rejection during the first 6 and 12 months posttransplant (P=0.006 and 0.046). Regarding steroid-related side effects, posttransplant diabetes mellitus occurred in 10% vs. 45%, and wound infection in 6% vs. 31% of steroid-free vs. corticosteroid patients (P=0.003 and 0.01). CONCLUSIONS: OLT recipients with HCV tolerated the steroid-free protocol with fewer side effects; however, its use had no apparent impact on hepatic fibrosis progression. Occurrence of acute rejection was strongly associated with increased hepatic fibrosis at 1 year, and MMF use appears to have significantly reduced the rejection rate.
so it sounds like with diebetes the prednisone may be a plus...but then, some anti-rejection drugs cause diebetes...so that may be more a function of what won't work at all given proclevities vs. what will.
speaking of such stuff Mike, Dr T. Starz is part of the new weaning trials I was reading about last week. Did I recall he's your doc??
I thought the research and clinical trials here and in Spain on weaning look promising.
Wasn't it DR. Starz that pioneer P35 20 years ago and improved rejections by 80%?
my memory is a little fuzzy here, but I think it was Philly and UCLA that got the ball rolling on the anti-steroidal arm of OLT tx.
I don't know much about prednisone, but I do know that it is a steroid. So I hope that in headshops case his doctors have weighed all other options. As I've been told steroids are not to be given to a person with HepC or a bad liver, that is what I've heard from some doctors. A liver transplant is a different issue as supposedly the person who just rec'd a new liver is what it is. A new uninfected liver, so there's room for slack with that issue. They're has been ongoing debates of steroids being safe and other things as well for years. So all I know is what I've heard. later
My regular dr prescribed after I tried a chiropractor for 5 days, then my hep dr approved after a 3 day wait. Hope I don't have to take anymore, the only time it hypes me up is when I have about 3 hours sleep underway at night. It is helping though. It also makes me hot, don't need that.
I read the article to say that diabetes is increased with a steroid vs steroid free regimen - 10% vs 45%. I know from experience that steroid use is associated with diabetes so I would think my reading is correct.
No, Dr Starzl isn't seeing patients or doing surgery any longer. He is still at the clinic however. He was the guiding force behind the approach at weening of anti-rejection drugs. I had my dose drastically reduced back in April 2006 and ran into some problems. I think the dose reduction was too fast and when I get some courage I will speak to my surgeon about tying it again with a more gradual approach. I was told by my surgeon that it is trickier with HCV SVR patients like me but, that is a long and involved subject that likely wouldn't interest too many members.
Dr. Starzl is a true visionary. Organ, and particularly liver transplantation, wouldn't be where it is today were it not for him. Aside from being absolutely brilliant he is also a kind and compassionate man and a delight to be around.
Can Predsnisone make feel flush, hot. Chiropractor noticed I was not just a redneck but red and flush looking. My temperature is elevated to almost what they call normal, 97.8 and feel hot.
I feel better though than a few days ago!
I can only tell you that I have been on prednisone since beginning of 2002 along with Imuran. I also took 40 wks tx for hcv & finished in July 2006. I will be on the prednisone it looks like for my entire life but everything is going great. I do have to admit the tx mixed with the other meds made me pretty ill for the entire 40 wks I was on but am fine now & still svr & all shows good.
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