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kelly anne
05-19-2013, 01:51 AM
Hi All,
I 48-yr-old female and was diagnosed in February after a lung biopsy and positive ANCA. It began around Oct-Nov with "clogged" ear and progressively less hearing in that ear and a bit in the other. Also I had a rash on my arm a few times that I did not realize at the time was related. Saw ENT who prescribed several different nasal steroids that had no effect. A steroid pack in early December to my delight opened my ears...but within a week or two they closed again. We discussed eardrum incision/tubes after the holidays, which I'm glad I did not end up getting done. In early January my husband got the flu and within a few days I had the same flu-like symptoms. However, he got better within days and I remained sick. For 3 weeks I ran a low grade fever, runny nose, major hearing loss in both ears, major night sweats, low energy, scalp felt soft to the touch, and strange bumps under the skin on scalp and forehead. Then I got a constant, horrific dry cough that produced some blood. By the last week of January the joint pain kicked in. First hips, then the bottom of my feet were very sore to walk on. Eventually ankles, knees, shoulders, and even jaw became sore with use. I felt terrible from head to toe. Assumption now is that I did get the flu, which kicked the disease that had been progressing slowly and mainly only in my ears, into full gear.

During this time I was prescribed 3 different antibiotics that had no effect. Finally my husband took me to ER where they ran a chest x-ray that showed a mass. That was shocking news. The follow up CT scan showed multiple masses. For a few days, while awaiting the lung biopsy and results, I was convinced I had lung cancer. But to my relief the biopsy showed granuloma, not cancer. Then an ANCA test confirmed Wegener's, which sucks but lung cancer would have sucked worse. And no kidney involvement. I felt and still feel to some extent lucky. (Not sure that feeling will stick around the longer I'm on prednisone!)

My first question is regarding pred tapering. I went from 60 2 wks, 40 4 wks, 30 4 wks, and virtually all symptoms were gone. Other than the pred side effects, I felt good. Then I tapered to 20 and within a few days pressure in head and ears began returning, slightly diminished hearing, sinuses acting up, and have minor chest congestion and cough. After 10 days on 20, Rheumy had me go up to 25, but after 8 days of that, no improvement and a bit worse each day. I have a message in to her now, and I'm sure she will have me go up again, but I am curious what others' experiences have been with relapsing when tapering as far as how much you had to go up to be able to reduce again.

Also, does anyone know the signs and symptoms associated with cardiac involvement? Do most patients seeing Weg/GPA experts have cardiac screening even if there are no specific patient complaints? My rheumy is not Weg/GPA expert per say...

Sorry for the lengthy post!
Kelly

renidrag
05-19-2013, 02:21 AM
Welcome Kelly, happy you found us but on the other hand, sorry you had to. Pred taper is different with every patient. What other meds are you taking for WG? It is very important to have an experienced Rheummy. Where are you located.
Dale

Pete
05-19-2013, 03:06 AM
Hi Kelly,

Glad/sad you found us. You'll find a wealth of support and information from the folks on this forum. Feel free to share your feelings, symptoms, and experiences.

As for prednisone taper, many of us find that slower tapers are better. It took me 8 months to go from 20 mg/day to zero. I purposely stayed at 5 mg/day for about three months to try to avoid having a flare over the holidays. That strategy worked ok for me. I've been off pred for almost two months now. My final taper was to reduce the dosage by 1 mg/day every two weeks. I think the hold at 5 plus the overall slow taper helped my adrenal glands kick in again.

My symptoms at onset were similar to yours. The hearing in my right ear got clobbered pretty hard. I had the eardrum lanced twice and had a tube for awhile. I wear hearing aids in both ears now to compensate for wegs damage and the cumulative effects of excessive noise in the military and industry. I hear ok, but not well. Hearing appears to be stable.

Concerning cardiac involvement, my family doc keeps pretty close tabs on me (lipid panel, cbc, liver panel, c-reactive protein, and urinalysis). So far, no signs of cardiac issues. (I should mention that I'm now 66 years old.). I haven't read much on this forum about wegs attacking the heart, but I wouldn't rule out the possibility.

I also would encourage you to find a wegs/Vasculitis specialist. You can find a list on the Vasculitis Foundation website. I go to Cleveland Clinic, and others on this forum go to Mayo Clinic or Johns Hopkins among others.

Hope this helps. Good luck and better health!

Dirty Don
05-19-2013, 03:19 AM
Welcome Kelly...you are now officially a Weggie! What?! Please do as Pete suggests...it's the best. Go to the Vasculitis Center site for info on who is closest to you for WG expertise/experience, very important. Some docs think they can help, but without actual experience, at best they are reading from a book...your docs need to at least consult with experts if you can't physically get to one. Best to you.

Alysia
05-19-2013, 03:57 AM
Hi kelly,
welcome. if you are a "weggie" here is the best place to be in.
pred alone is not enough. it was a mistake of my docs, and it "costs" me with a saddle nose. you should take also immunosupressive meds.
In tapering pred I didnt listen to the doc but to my body. I have enough pills at home, so Im tapering in my way. but since you are "new" in this, you will have to learn what fits you and ask your doc to prescribe what you need.
I hope you will soon feel better.

kelly anne
05-19-2013, 04:26 AM
Sorry, I forgot to mention that I am also taking MTX 15 mgs weekly. I am in South Florida where there are no Weg specialists that I know of. The closest is in Jacksonville which is 5 hours from me. I am mostly happy with the rheumy I have, but am planning on talking to her about consulting at my next appt. Even though I have read this advice over and over on this site, I have been apprehensive...not wanting to seem...I don't know, can't put it into words. Particularly since my condition is not as bad as many.

Thanks for everyone's warm welcomes and suggestions.
K

Dirty Don
05-19-2013, 05:13 AM
My condition is 'limited', but still have benefited greatly from having the correct docs with the correct protocols. Part of your stage right now is denial...do I really have this? I don't want this. I don't deserve this. And on and on and on...we've all been there...some remain there...hard place to be. With good help and advice and a strong support system, you will get thru all this and back to a more normal life soon enough. Just gotta keep a good attitude and know that you can do battle on fairly even ground with this crappy little disease...always could be worse...hmmm, still looking for MY cup 'a coffee...

annekat
05-19-2013, 01:28 PM
Welcome, Kelly Anne. What I learned about prednisone from reading this forum is that after being on 20mg. or above for more than 2 months, your adrenal glands will have shut down. Then when you try to taper down past 20mg. and especially below 15 or 10mg., the adrenals should start to "kick in" again to make up for the drop in pred, but may have a hard time doing so. That is why most of us have more trouble tapering at the lower doses than we ever did at the higher doses, assuming that we were on pred long term. So that could explain your resurgence of symptoms at around 20mg. Your rheumy is probably experienced in the use of pred, but since she isn't a WG specialist, I'd encourage you to ask her about consulting with one, just to make sure all the bases are being covered. I know what you mean, though, it is awkward. But since there are some in your state, it seems like a logical plan. For one thing, since you have lung involvement, that could suggest you should be on CTX or RTX instead of MTX, or at least a specialist might have an opinion on that. I also have a less severe case than many, but it did include lung involvement as well as the sinus and ear stuff, and the joint pain. I was put on CTX for several months until the lung stuff cleared up pretty well, and then I was switched to MTX.

In general, it sounds like you have a pretty good handle on what WG is and how to deal with it. Being on this forum is a great place to get your bearings! Good luck, and keep us posted.

mishb
05-19-2013, 04:47 PM
Hi Kelly,
Welcome to Weggie World, where life and symptoms are different for everyone.
Don't go to close to the weggie rollercoaster at Weggie World........it is one crazy ride.
I think I like to stay on the merry-go-round, where it is a much gentle cycle.

Pred is a strange little white pill. It's one that we all hate with a passion, but love because without it, we would be mush.
It is a little wonder pill and it is so quick in making one feel that their symptoms, are no longer so bad.

I think it is a big cover-up. It likes to lead us in to a false sense of security. We think the symptoms are under control and then we start tapering/reducing
the amount we are having. In actual fact, the symptoms were just being covered up by that magic little pill and weren't really getting better at all.
So when you start dropping the mgs the symptoms look like they are coming back........when in actual fact, they never really went away, in the first place.
I think that we need to reduce to a level where we can feel the symptoms again......and then up it by 5mgs and sit there for a while longer. You should only reduce the amount of pred to the level that you are still feeling comfortable and not have any pain/symptoms.

This here is my theory. :razz: :ohmy: :unsure:

I hope you start to feel better soon

drz
05-19-2013, 11:54 PM
Sorry, I forgot to mention that I am also taking MTX 15 mgs weekly. I am in South Florida where there are no Weg specialists that I know of. The closest is in Jacksonville which is 5 hours from me. I am mostly happy with the rheumy I have, but am planning on talking to her about consulting at my next appt. Even though I have read this advice over and over on this site, I have been apprehensive...not wanting to seem...I don't know, can't put it into words. Particularly since my condition is not as bad as many.

Thanks for everyone's warm welcomes and suggestions.
K

Many of us drive or travel much further to see someone we trust with our Wegs treatment. You are lucky to be so close. Some people only go see their expert once for consultation or maybe more often when beginning treatment. The expert can also consult more often with a doctor that is closer who is monitoring and prescribing your treatment.

JeanMarie
05-22-2013, 02:09 AM
I had a cardiac workup when I started to be short of breath & nothing showed on a chest xray. My Rheumy said she wouldn't assume it was wegs. Well it was wegs, but I think she was right not to assume.