Oral prednisone

I am gradually developing a feeling of unease about the fact that my neurologist prescribed oral prednisone for my optic neuritis.

I initially refused it on our first visit because my ophthalmologist had advised that I probably didn't need high dose IV steroids because my vision loss wasn't too severe and that oral steroids would have no benefit.

Then on the second visit, because my eyes were still not improving, he strongly suggested oral prednisone again and I relented, thinking it was worth a try to make my eyes better because I don't want permanent visual loss and it was implied that it would increase my chances of regaining my vision.

So I took the treatment over the last few weeks with no noticeable improvement.

But now I keep reading EVERYWHERE that it SHOULD NOT BE PRESCRIBED. And it bothers me.

It's possible that he's just never read the ONTT or forgot that detail though, right? But is that a red flag?

He is really incredibly nice and writes such detailed case notes that I am otherwise totally inclined to think he's capable. It's just niggling at me.

[jensequitur]

I took oral prednisone for my flare, and it helped a little.  However, with optic neuritis they say that IV steroids are more effective, and will prevent flareups.  It sounds like IV steroids are more effective overall in dealing with symptoms and reducing the flare's length.  

However, nothing's a cure-all.  It sounds as if your neurologist is a keeper - the detailed case notes and bedside manner are unusual.

[Salamander2]

I had a flair (of my as yet undiagnoised illness) and was given oral Prednisone.   I have felt  better this week than I have in a year.  Numbness, coordination, fatigue and spasms all much improved.  My husband says I am my old self.  I would take it again in a heartbeat.   Give it some thought.  

Good luck, and do consider what your Neuro recommends.

Blessings,
Sally

[novakf]

The reason I am concerned is that oral prednisone is contra-indicated for optic neuritis specifically - it is fine in general and I am not even worried about adverse health effects from it for myself. I have already taken the course of steroids quite happily.

I am probably just being silly, worrying about stupid things. You're quite right, Jen, he's a keeper, I wasn't even considering otherwise. I am just anxious and potty. :)

[Quixotic1]

I also find this concerning.  But, to be totally honest, I don't believe that oral steroids are actually contraindicated in ON.  The ONTT did seem to indicate that treatment with oral steroids did seem to be associated with more occurrences of optic neuritis - but it did not show this as a hard fact.  In terms of the ultimate outcome of optic neuritis - the preservation of vision there was not difference between no treatment, IV steroids and oral steroids.

But, if your neuro is really clued into the current literature, he would be giving you courses of steroids IV.  That is felt to be the recommendation.

But, he seems good and considerate and compassionate and conscientious.  Perhaps you could just aks him, mentioning that your friends in a support group all received IV treatment for ON and mentioned the ONTT.  What was his opinion.

That way he can explain his reasoning or possibly be educated on the topic.  It doesn't sound like he has the kind of ego that would take offense at you bringing it up - unlike mine..  :((

"potty"????  unknown expression to me  (nutty?)

Quix

[novakf]

Google search tells me potty is an Australian expression - it's surprising how often that happens! I always think something is a totally normal thing to say and then someone will call me on it :)

Yes it basically means nutty or nuts - you say "he's gone potty!" when someone is acting strange or "she's just a potty old lady".

It also means a small child's toilet (those little plastic things that kids use). hehe.

Thanks for your advice, maybe I will ask him about it. + your reasoning about the oral steroids makes sense, it is definitely hard to understand why it would be actively bad for you if IV steroids are good for you, maybe just not as effective.

[Lulu54]

Novakf,  
I figured you had a British background when you said this was niggling at you - potty clinched it.  I have a good friend in the UK and we're always comparing language notes.  She was very amused when I suggested she get a fanny pack. ... are you laughing? ( It is a pouch that you can wear around your waist - not that pouch that British women have between the legs!!)

Good luck with the ON - I hope the steroids kick in and help.
Lulu

[novakf]

Oi, who you calling British? :)

Mind you I did live in the UK for a few months and there were miscommunications there as well - like the time I was talking about my boyfriend having a hole in his pants, people gave me some odd looks.... a bit later I realised that in Britain "pants" means "underwear", and what I call pants, they call trousers. No wonder the weird looks!

Fanny pack, hehe. I was always really shocked (or confused if a man said it!) when I heard Americans use the expression "I fell on my fanny"!

Thanks for the well-wishes!

[Quixotic1]

This is funny.  Yes, we use potty to refer to the toilet in a childish way.  Cursing is often referred to here as "Potty mouth."

Back to the oral steroids.  Here in the MS literature, oral steroids are not generally approved of, but the grounds on which they are basing this are not solid.  There seems to be indirect evidence that oral steroids leaves the person open to more frequent episodes of acute optic neuritis.  Oral steroids have NOT been shown to confer a worse ultimate outcome.

Quix