Hey it’s time for an update I suppose.
There’s been good and bad this time, so apologies if I can’t be a total upper for your Covid induced captivity.
Few weeks ago, the steroid taper dropped the steroid from “insanely high” to only “this is bad long-term” high. Ha. Three monthly steps.
At the last taper some neuro symptoms started to return. Not anywhere near where they were but disturbing. Just because you don’t want to reverse.
The reality is, getting steroids past the blood-brain barrier is tough. So we have probably learned at what level it stops getting in there for me. Everyone is different.
Also along that same timeframe the steroid side effects started showing up. Blood glucose is constantly elevated. Steroid induced diabetic type reaction. Really common. (They usually tick off your liver and even though you’re producing insulin and the pancreas is fine, the process of using it gets disrupted. So usually when you come off the steroid things go back to normal.)
Also realized Mayo had done a quickie overnight O2 study while I was there and saw one dip they didn’t like and then we all pretty much forgot about it when they kicked me out.
So I got ahold of my local GP to catch him up (he about had a heart attack... his assistant wrote Neurosarcoma instead of Neurosarcoidosis! LOL! Waaaaaaaay worse!) and he’s now going to manage both of those things. Mayo monitoring.
Since I’m still discouraged from wandering out too much, and because Mayo ultimately wants to look at multiple things in upcoming imagery (we also had much of the bigger picture sarcoidosis stuff bypassed by leaving for home immediately, because the treatment didn’t change... deal with the neurology first and that’s mass steroids so it’ll wipe out sarcoid anywhere else in the body anyway) — local GP smartly asked them, “What about just putting him on O2 at night temporarily until schedules work out — then we see if it’s sleep related or something else?”
Mayo liked that idea. They’re also fine with him prescribing an oral diabetes med temporarily while on the steroids if glucose numbers remain elevated.
So that’s the new stuff. Managing.
We went back to the somewhere between “OMG that’s a lot of steroids” initial dose, and the lowest dose now — and that’s sent the neuro stuff back in the correct direction. For the time being.
So. Next steps — Mayo had another long multi-department consultation about me and decided to try to avoid travel still.
Orders to ride the MRI tube again, full spine, and also chest CT with contrast to get a peek at any heart, lung, or lymph node changes after 90 days of steroids. Those will be done here locally in about a week.
Once they have those, if they see anything they don’t like, travel. Back to Rochester so they can get whatever they need tested done quickly.
Either way probably a trip out at six months no matter what.
If they don’t see anything bad and like the spinal cord progress on steroids, then we head into what are called “steroid sparing” drugs.
Specifically methotrexate.
Not a lovely drug but when I asked the pulmonary Doc at Mayo about side effects and how nasty it seems, he joked, “Oh, we use those drugs because the long term effects of the steroid level you’re on are WAY worse!”
Lol... well! Okay then!
Still... even the household nurse AND a psychiatrist friend both said “whoa!” to that drug. It’s... sometimes not well tolerated.
But... the Mayo neurologist is still kinda chuckling in the background at all of this and saying “I told ya so...”
Getting sarcoid stuff out of spinal cords is just a massive massive steroid dose and often the sparing drugs on top of that. She said so the first week there and said, “You ready for this?”
She knows nobody even knows what she’s really asking and just smiles. When pulmonary asked her to consult she repeated her original assessment... get it out of the spinal cord and it won’t come back... deal with the side effects.
So... walking still good. Slight balance issues came and went as the steroid went down and back up. Right hand pain increased and decreased. Still not taking any of the pain meds but did do like three or four single capsules at night in the worst of the taper down. Back to none.
(Not sure if I mentioned it last time but my poor 100 lb boy dog was hobbling around and ultimately the vet found he has old injuries to the equivalent of his ACLs and spondylitis in HIS spine, so he’s now on an anti inflammatory and gabapentin. I laughed because I don’t take mine anymore and asked the vet if mine was okay for him. She said yes. So the dog has like a year supply of drugs now even after cancelling my prescription. Haha.)
Local doc is handling — what I’m starting to think are just the beginning — of crazier side effects and is tossing some O2 in me at night here shortly (he’s working on the orders) which he says will likely help the whole process along too. When I sleep well and for longer periods my neuro symptoms drop and stay down. Doesn’t take much. A couple extra hours and big changes.
Certainly proved all bladder issues that were neuro went away. Still some bowel but those are a million times better. By proving it, I mean the diabetic reaction to the steroids means I get to go through more water than I should in a day! LOL.
Annoying. But normal at the moment.
So. The bad was it reversed a bit. The good is everybody on the team got it under control and now we take a peek and see how much this crap has shrunk.
How much determines dose and aggressiveness of steroids and the sparing drug. And if any heart, lung or other nastiness is seen, that’ll factor in also.
Essentially the neuro said they’re always shooting for about one year from start to maximum shrinkage whenever possible, and everyone’s body reacts differently. They get limited on how much steroid and sparing they can do and the longest is two years on these stupid high doses.
In other news, the awesome pulmonary Doc at Mayo is headed home at end of next week. He is a fellow from Cleveland Clinic and time to go back to Cleveland and share all he learned with colleagues and patients there.
(Oh fun, moving during Covid.)
Part of that long meeting about me was seeing which attending/ supervisor is taking over my case and assigning themselves or a new fellow, as well as the neurology consult. He gave me the new Doc who’s in charge’s name and tips on how to trigger the Mayo messaging system to reach the assistant who will then get automatically notified to flip the Doc on my case, etc.
He called and talked at length after hours on a weeknight, closing out all his long term patients. Super guy and clearly very engaged.
Cleveland is lucky to have him.
So kinda in the thick of it now — but confident that everybody has a plan. And glad we got the reversal back toward the positive in neuro symptoms.
Watching the sugar, testing the blood levels, eating healthy, working a ton from home, organizing all the Comm back and forth with all these Docs, and basically just plugging away here. It’s kinda boring in a way compared to the initial flurry of activity but still fun. Kinda like having a second part time job at times. Ha.
Worst symptom right now I’d say is right arm and hand cramps occasionally. The neurons are partially reconnected and much happier but the muscles are grumpy about it at times. As are the ligaments and such on steroids. Tight.
So you stretch actively and constantly without really thinking about it, and once in a while one of the muscles gets grumpy and cramps up. Ha.
“I don’t want to play right now!”
Whiner! LOL.
I’d love to go do some PT for all of it but still not recommended.
Oh. Almost forgot. Steroids mess with calcium too but can go either way. So that’ll get checked here shortly as well. If it drops, supplement has to be done of it and Vitamin D. And bone density has to be monitored. If it spikes, well I dunno what they do for that. But they’re suspecting it’ll be low so I’m already on OTC supplements for that.
Nobody is too concerned about that one at the three month mark.
Joints cracking and popping like popcorn I’d also say is mildly annoying but par for the course right now.
Again, nobody concerned.
The most commonly said thing to most symptoms right now is, “Yeah. You’re on a lot of steroids.” Haha. Definitely in the steroid side effect weeds now!
Today was 25th wedding anniversary. We chilled at home with some chicken and veggies and remarked we’ve been through fires, and floods, and all the usual and now a pandemic... whatever!!
LOL
If you see me start building an Ark in the driveway... mmmm.
When even the GP asks, “So how are you feeling on all those steroids?!” you know he was wondering if it was a typo. Ha.
I HAVE talked to others I’m MORE which just floors me. OMG they must feel terrible.
(For those wondering it was 40mg prednisolone for 30 days, 30 for 30, and 20 when symptoms reversed. Back to 30. I saw one patient on 80 in one of my groups! But short term. Dealing with a flare up of multiple autoimmune issues. Still. Insanity. That’s a ton.)
It’s also fun to feed the stoner dog my drugs now. LOL. He’s much happier and active but zonks out occasionally after his pills. I know the feeling buddy! Ha.
He wants a cookie now.