My father seems to be tired a lot, has very little energy and is short of breath. He is seeing a heart specialist who diagnosed him with a fibrillating heart. He never had heart problems before the prednisone. Could the medication have caused his heart problem?

DEAR READER:
Prednisone is an oral corticosteroid and is not an appropriate treatment option for trivial colds. It can, however, be given for severe bronchitis, pneumonia, asthma, arthritis and other inflammatory conditions.

Because you do not give specifics about the dosage of your father’s prednisone I can only give general information. Prednisone comes in 1, 2.5, 5, 10, 20 and 50 mg forms, therefore, you father could have been taking anywhere from 8 to 400 mg of the drug daily. While I highly doubt he was taking anything higher than 40 mg a day, I cannot be sure.

Prednisone has many side effects including muscle weakness, potassium loss, high blood pressure, thin skin, headache, seizure, adrenal unresponsiveness, glaucoma, congestive heart failure, and more. Of these, both low potassium and high blood pressure can be associated with heart rhythm abnormalities such as your father’s atrial fibrillation. This is NOT to say that his symptoms and difficulties are due to the prednisone, but they may be the result of one of the side effects.

Atrial fibrillation simply means that the heart is not beating normally. He has appropriately seen a cardiologist who is the best resource in this situation. While you do not say, I assume that you father is on treatment to reduce his cholesterol (if it is too high), lower his blood pressure and using an anticoagulant, such as warfarin or aspirin to reduce the chance of clots, heart attack and stroke.

I cannot say if your father’s heart problems are directly related to the prednisone if it is mere coincidence that it happened shortly after taking it. Speak to his cardiologist about the possibility.

I should also mention, that prednisone can cause the adrenal glands, which produce natural corticosteroids, to slow or stop production leading to symptoms of adrenal failure. To prevent this frightening, uncomfortable and potentially serious consequence, prednisone taken for more than three or four days should be tapered off slowly until the medication is stopped or a maintenance dose can be reached (such as for fibromyalgia, lupus and others).

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Sarcoidosis occurs when inflammation causes tiny lumps of cells (granulomas). The granulomas can continue to grow and clump together to form larger lumps or groups of lumps. If many form in an organ, function is affected.

Sarcoidosis can occur in nearly any part of the body but most often affects the lungs and/or lymph nodes. Other commonly affected areas are the skin, eyes and liver. Very rarely, sarcoidosis can be found in the thyroid gland, kidneys, reproductive organs and breasts. More than one organ is involved in nearly all cases.

Symptoms vary according to what organ is affected. Besides organ specific symptoms some general ones include fever, night sweats, uneasiness, malaise, fatigue, sleep problems and loss of appetite or weight.

Diagnosis is usually suspected during a thorough medical history and physical. If the doctor suspects sarcoidosis, he or she may choose to order testing. There is no diagnostic test for sarcoidosis so all testing must be ordered according the area of the body the doctor suspects is affected.

Treatment will vary according the organ or organs affected, but most cases can be treated with prednisone. If symptoms worsen or the disease progresses, other options are available. If the diagnosis were made during testing for another illness and symptoms were not present, most cases do not need treatment and recovery takes place in time. However, some organs must be treated, regardless of symptoms or a lack of them.

Your son is on appropriate medication and should be followed up regularly by his doctor.

For others interested in learning more about sarcoidosis, I recommend the National Heart, Lung and Blood Institute’s sarcoidosis webpage. It can be found at www.nhlbi.nih.gov/health/dci/Diseases/sarc/sarc_all.html.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I have sleep apnea. During my sleep test, they discovered my restless legs syndrome. I now take Mirapex and Clonazepam and that is controlled.

Would massage therapy be helpful in reducing my pain and stiffness? Also, I’d like to know if there’s a support group I could attend in my area with people who have these same symptoms.

DEAR READER:
Polymyalgia rheumatica (PMR) is an autoimmune disorder that causes stiffness and pain in the muscles of the hips, neck and shoulders. The disorder occurs most often in women and in the elderly.

If you are willing to try prednisone again, I suggest you first discuss the dosage you were on with your primary care physician or rheumatologist. Cut the dose and perhaps you will benefit from the modification.

Massage therapy will certainly make you feel better and is worth a try. I suggest you find a therapist who has worked with other PMR or fibromylagia sufferers. You may wish to experiment with acupuncture. Be sure to find a certified individual who practices in a clean office and uses sterilized needles. If you don’t wish to be stuck with pins, you may prefer acupressure. This is similar to acupuncture but doesn’t involve needles, rather the therapist uses his or her hands to apply pressure to certain areas of the body believed to relieve pain, increase circulation and more.

Relief may be found with acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) that reduce swelling and pain. Unfortunately, most individuals do not respond well to this therapy and require prescription pain relievers such as Lyrica and steroids such as prednisone.

Modify your diet to include garlic, nuts, grapes, curry, cherries, omega 3’s, and green tea. All these items have been purported to relieve some forms of arthritis pain.

Formulate a plan of exercise. You might even ask your physician for an out-patient referral to a local physical therapy group at your nearest hospital or sports medicine center. By obtaining professional assistance, you will not overdo, but will be able to incorporate what will work best for the degree of PMR you have. Should you have access to a swimming pool, fitness center or YMCA in your area, water therapy is an excellent indulgence for individuals with arthritis pain. Water aerobics provide gentle range of motion exercise and provide relief for several days following therapy. You might consider a whirlpool mat in the bottom of your own bath tub where you can do limited exercise right at home.

Barring unknown medical problems, the above suggestions should work toward relieving the pain and suffering you are experiencing.

Because I am not familiar with the community in which you live, I recommend you contact the Arthritis Foundation toll free at 1-800-283-7800 or go online to www.arthritis.org to determine the nearest support group in your area.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My over-the-counter drugs are a one-a-day multi-vitamin, calcium 1000 mg plus D daily, and calcium citrate 315 mg with 200 IU of vitamin D.

Years ago I noticed hair loss and attributed it to the metoprolol. The problem keeps increasing and, in fact, if it continues, I will need a wig in another year. I mentioned the problem to my doctor and her reply was that all medicines make people lose hair. Would I be wrong in asking my doctor to take me off the metoprolol and prescribe another medication for my high blood pressure? I showed her the drug information provided by my pharmacy indicating hair loss as a side effect.

I recently changed primary care physicians since my first doctor wasn’t concerned at all about my hair loss. What can I do?

DEAR READER:
Let me begin with some general information. Medications must go through several clinical studies before being approved. This is done by giving thousands of people a drug, while others are given a placebo. During the studies, no participant knows if he or she is taking the real thing or a placebo. An adverse consequence in more than 1% of the people studied in both categories is referred to as a common side effect, while less than that amount is referred to as rare. Once a drug is approved, it is no longer studied.

Now for the bad news. You are on lisinopril, metoprolol and prednisone. Rare side effects of all three drugs list hair loss as a possibility. Steroids are known to precipitate hair loss in men, yet all women have some male hormones. Therefore, of the prescription medications you take, all three share a similar consequence. The good news, according to my resources, is that the hair loss is generally reversible once a drug is discontinued.

It could be difficult in your situation to determine which drug might be causing your hair loss, unless you kept meticulous records indicating when the pattern began. As we age, we suffer wrinkles, heart problems, hypertension, arthritis and more. It’s difficult enough dealing with the problems over which we have little control. We shouldn’t have to deal with balding when it might be preventable. I recommend you speak with your new primary care physician who might be able to prescribe different medications in each instance without such an emotionally devastating side effect, no matter how rare it might be.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Polymyalgia rheumatica is an autoimmune disorder that causes muscle pain and stiffness in joint areas. Relief is achieved by reducing inflammation with over-the-counter medications or, in severe cases, with oral steroids as the mainstay of treatment. PMR can be a disabling disorder requiring aggressive therapy in an attempt to reduce the body’s immune response. Unfortunately, the treatment is not without risk.

You apparently have progressed from over-the-counters to prescription medications, and I cannot advise you which drug to take. That decision depends on your response to each medication. Methotrexate is, in my experience, less troublesome than prednisonebut still has its own side effects.

Although some PMR patients suddenly improve after many years, PMR typically is permanent and incurable. Therapy to treat symptoms is extremely effective but must be taken for years.

I believe that you are in good hands; your rheumatologist has made sound decisions thus far. I urge you to stick with the recommendations provided. Periodically review your health issues with him or her and try to get by on the smallest amount of medication that controls your pain.

My 50-year-old daughter has developed an allergy that causes a very itchy rash over her entire body. Tests have not determined the cause. She has been on prednisone and is now being weaned off. She has extreme pain over her entire body, especially her feet and is having trouble walking. She has been told that this is a side effect of going off the medication but that other tests cannot be carried out until her body is clear of the steroid.

Is there anything that can relieve the symptoms of withdrawal? Her job requires her to be on her feet most of the day and she is having a hard time functioning efficiently at work.

DEAR READER:
Severe itching can be caused by an allergy, but it can also reflect kidney disease or hidden cancer. Therefore, I suggest that your daughter have further testing performed once the effects of the prednisone have disappeared. To the best of my knowledge, prednisone withdrawal symptoms only occur if the drug is stopped abruptly or is tapered off too quickly. If her doctor is removing the medication too quickly, it could explain her pain. I suggest she speak to him or her and voice her concerns.

As an aside, the pain is a result of cortisol withdrawal. The body makes cortisol naturally until medication, such as prednisone or other corticosteroids, are introduced. Because the body makes only minimal amounts, the adrenal glands (which produce cortisol) shut down in the presence of the medication. It takes time for the body to resume its normal functioning . It can one week to several months to wean down properly from corticosteroid therapy.

Rarely, some individuals will not return to normal function, especially if the dosage and frequency are high and long. If this occurs, medication to replace the missing cortisol must be taken to avoid symptoms. If it is not, serious illness and death occur.

I suggest your daughter have blood work to test the function of her kidneys, a potassium level and certain cancer markers (available for breast cancer). A high potassium level (often caused by kidney disease) may be the culprit. If this is the case, I suggest she be examined by a nephrologist (kidney specialist). If her cancer markers come back abnormal she should be examined by her gynecologist or an oncologist. On the other hand, if everything appears normal, she should continue with the allergist.

If your daughter is having severe pain and side effects, she must be weaned down more slowly. If her physician is unwilling to do so, she should find a new one. Good luck and let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report “Allergies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.