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View Full Version : Medrol Pack - How long until it works if your pain is inflammatory



JanW
08-10-2010, 04:41 AM
My doc started me on the standard medrol pack to attempt to see whether or not my ongoing ankle pain is due to any inflammation (PT has been getting it better, but really slowly, and we both decided to at least try a limited course of pred to see if I notice a difference). Of course, he told me that if I felt significantly better by tomorrow, we would know it was working, but how common is it to notice a difference in 24, 36 or 48 hours of the first dosage? I've never been on this for anything except my (misdiagnosed) asthma, so I don't have a clue. He did say that if I'm not at all different by the end of the pack, we need to remain with the 'mechanical problem' theory.

All of my inflammatory markers are now normal (yeah!).

pberggren1
08-10-2010, 04:42 AM
I'm not sure what a medrol pack is? Is it like Solumedrol or Pred?

JanW
08-10-2010, 04:48 AM
sorry -- oral steroid -- methylprednisolone. It's a step down pack with the most on the first day, and reduce each subsequent day for six days. It's 21 tablets total, 4 mg each.

elephant
08-10-2010, 05:03 AM
Been on those Medrol packs many times before diagnosis. I noticed within 24 hours, but everyone is different. Is there damage done to the ankle JanW? When was your last x-ray of your ankle?

JanW
08-10-2010, 05:08 AM
I don't think there was any damage to the ankle. Dx on both MRI and ct scan was unexplained bone edema, which certainly sounds inflammatory to me. On the other hand, as my podiatrist points out, it can also happen with injury. It is possible that from my foot pain I managed to injure my ankle with my gait.

elephant
08-10-2010, 07:37 AM
Keep us updated on the Medrol pack. Hope it improves! That would be great!

Sangye
08-10-2010, 11:16 AM
Jan, I don't think it's a simple mechanical injury theory at this point. You've been limiting your activity and getting PT. If it were just an injury it should be healed by now.

When I hear ankle pain in a Weggie my antennae go up. It's such a common symptom and one that seems to be routinely ignored even by the Wegs specialists. Last year Dr Seo attributed my ankle pain to a mild sprain, even though I knew I hadn't injured it. It was a red flag that the Wegs was building. I even wound up hospitalized from it with a diagnosis of severe cellulitis. It became quite swollen, turned wine color and was excruciating. The Wegs flare became apparent 2 months later. All that time my inflammatory markers were totally normal.

elephant
08-10-2010, 11:23 AM
Sangye your" antennae's go up."..another good one. LOL!

JanW
08-10-2010, 12:36 PM
Well, I hope I'm just putting the wegs dog to sleep rather than having it wake back up on me! Already my ankle feels better though, so I'm thinking we have an answer. His solution if it is inflammatory is to move my mtx up to 20 mg, which is still in the standard dose range, according to the mayo rheumy that spoke at the conference.

jola57
08-10-2010, 02:37 PM
JanW I will be monitoring how you are getting along with the recovery because my ankle has been in constant pain since the dropped foot almost 2 years ago. I had it xrayed and it showed up normal. I was on 60 pred and cytox and now I'm on 4mg pred and 10mg mtx. There was no significant change in pain between the two meds. I have finaly been so fed up with my docs not doing anything about it that tomorrow I am going to my family doc and request a visit with a podiatrist. I agree with you Sangye, docs realy pay no attention to this problem. I seem to be doing great in my blood work just my anca is high and it is only that one left ankle that is giving me greef. It is because of it that I use a cane in long walks. It swells up sometimes and is so puffed up that it looks like a scotch haggis in a sandal. When I sit or lie down it hurts even more before slowly relaxing. Simetimes it takes an hour before the pain is managable enough for me to go to sleep. Please keep me posted on how you are doing. Was your original xray ok or did you have to have CT and MRI before it showed the bone edema?

elephant
08-10-2010, 07:20 PM
JanW, so glad you are feeling better. Keep us updated. Janw my sister took the highest dose of methotrexate 25 mg and then now she is on 18 mg of methotrexate. When she was taking 25 mg of Methotrexate it caused her more nausea. She is doing great on the 18 mg.

Sangye
08-10-2010, 11:13 PM
Well, I hope I'm just putting the wegs dog to sleep rather than having it wake back up on me! Already my ankle feels better though, so I'm thinking we have an answer. His solution if it is inflammatory is to move my mtx up to 20 mg, which is still in the standard dose range, according to the mayo rheumy that spoke at the conference.

LOL-- I'm starting to think like a Wegs doc. I can hear the entire Chiropractic profession groaning in the background...:D

I was thinking that's what they'd do--bump up the mtx a bit. It doesn't necessarily mean the Wegs is building, it might just mean that your current dose is subtherapeutic.

Sangye
08-10-2010, 11:18 PM
JanW I will be monitoring how you are getting along with the recovery because my ankle has been in constant pain since the dropped foot almost 2 years ago. I had it xrayed and it showed up normal. I was on 60 pred and cytox and now I'm on 4mg pred and 10mg mtx. There was no significant change in pain between the two meds. I have finaly been so fed up with my docs not doing anything about it that tomorrow I am going to my family doc and request a visit with a podiatrist. I agree with you Sangye, docs realy pay no attention to this problem. I seem to be doing great in my blood work just my anca is high and it is only that one left ankle that is giving me greef. It is because of it that I use a cane in long walks. It swells up sometimes and is so puffed up that it looks like a scotch haggis in a sandal. When I sit or lie down it hurts even more before slowly relaxing. Simetimes it takes an hour before the pain is managable enough for me to go to sleep. Please keep me posted on how you are doing. Was your original xray ok or did you have to have CT and MRI before it showed the bone edema?
Jolanta, can you see a chiropractor? I'm not sure a podiatrist is going to be much help. An MRI would be a good idea at this point, just to rule out some other issues. My ankles do the exact same thing. I've only been able to wear the same pair of sneakers for the past 2 years because of it.

BTW, bone edema is a non-specific sign that usually just indicates developing osteoarthritis.

JanW
08-10-2010, 11:40 PM
My original xray was just fine. The MRI and CT both indicated areas of bone edema. The ankle got progressively better with PT, but certainly hasn't completely healed, and it is, as you know very frustrating. Thank goodness I have no pain at rest, only with movement. Before PT I would also have pain with weightbearing, but that's all gone now. It's continuing to improve with pred, so obviously it's at least somewhat inflammatory.

My podiatrist had no problem ordering a MRI, and later, a CT, because there was no improvement after he casted it for five weeks to rest it. I agree with Sangye that there's little that a podiatrist can be of much help -- he can send you for imaging, or prescribe PT, but there's probably little that he can do to improve the actual pain.

Did WG cause the dropped foot?

JanW
08-11-2010, 11:49 AM
Well, the medrol pack is working gang! Not even quite two days dose and my range of motion has improved dramatically. Things that would have had me wincing/screaming in pain (frex stepping on a very uneven surface) now ar dully painful but completely tolerable. So I think we know what I need to do. Hopefully an increase in mtx will have the same effect.

Of course, the downside of the pred is that while I love the way it makes hurty things stop hurting, I hate the anxiety that comes along with it. I've already spent 10 minutes in the mirror looking at my nose, convinced that the bridge is collapsing down in front of my eyes (normally I only spend a few minutes looking at my nose per week -- it's not like you make a saddle nose any better by looking at it). I'm obsessing about my daughter's tooth extraction tomorrow (it just didn't fall out and duh, she's had this done before and it didn't even hurt) and my son's red eyes (that I'm taking him to the doctor for on Friday, and is not painful, pus-y or anything -- and yes, did I mention he's in the pool everyday and has allergies? I am convinced he is losing his sight and will have to have surgery and be unable to go to sleepaway camp on Saturday). Ah, pred.

At least I knew what to expect. To paraphrase Rick James on Chappelle Show: "Pred...it's a powerful drug!"

JanW
08-11-2010, 11:52 AM
That's interesting what you said, Sangye. I've been wondering if the dose was subtherapeutic (although my numbers went down dramatically), or that this inflammation was subacute and yet because of where it was located, extremely painful. I'm not sure if the distinction makes any difference. Is it important to treat subacute inflammation? Theoretically you could have it all the time, and without pain, and never know it.

Sangye
08-11-2010, 12:08 PM
The entire time I was on a subtherapeutic dose of Cellcept my inflammatory markers were in normal range. I had terrible joint pain despite my lovely blood work!

Yes, it is very important to treat subclinical inflammation. Painless inflammation is at the root of many of the most deadly conditions and diseases. Heart disease is a good example. By the time the inflammatory markers increase, the heart disease is already quite established.

I'm glad you're feeling better (minus the hideous pred side effects) and will now know exactly how to deal with it.

katarzena
08-11-2010, 08:05 PM
I'm on medrol. When I was diagnosed my pain was gone after a few days on it. (3-4 days)

elephant
08-11-2010, 08:28 PM
JanW, that is good news. You will be straightened out in no time.