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Suggest Treatment For Vertigo And Insomnia While Treating Temporal Arteritis
Question: I After a positve biobsy I was diagnostic as having a giant cell temporal arteritis and was given a corticosteroide therapy ( prednisone ,) starting at 60 mg for 2 weeks then reduced to 40, 30 and now to 20 mg since october 2015. Other medication are vitamin D 50,000 units, calcium 1 gm and residrinate 35 mg per tablet,
All medical symptoms have deseaper now, virtigo an insomnia persist after almost 2 month....
I am followed by a rhumatologist every 2 weeks all other hematology test ( ESR , C reactive protein, ) are within the acceptable range. Recenlly I went on dec 22 15 for a Emg and a CT Scan. What I can expect of the complications and long term side effect on prednisone when the dosage will be reduced progressively. Can I leave the country without continuos medical surveillance .I can provide you with analytical result later.
Thank you
xxxxx XXXXXXX D.pharm.
All medical symptoms have deseaper now, virtigo an insomnia persist after almost 2 month....
I am followed by a rhumatologist every 2 weeks all other hematology test ( ESR , C reactive protein, ) are within the acceptable range. Recenlly I went on dec 22 15 for a Emg and a CT Scan. What I can expect of the complications and long term side effect on prednisone when the dosage will be reduced progressively. Can I leave the country without continuos medical surveillance .I can provide you with analytical result later.
Thank you
xxxxx XXXXXXX D.pharm.
Brief Answer:
Giant cell arteritis
Detailed Answer:
Good evening
Thank you for writing on health care magic
I have gone through your history. As per your queries:
1. As for long term effects of prednisolone, it can cause transient rises in blood sugars and blood pressure. At your age, other complication which is common is osteoporosis and cataract formation. You are already on treatment for preventing osteoporosis. But never the less, risk: benefit ration these complications are much smaller as compared to temporal arteritis. But do check your blood sugars periodically.
The cramps you are having along with insomia can be due to the dose of Prednisolone as this much dose is enough to give these side effects. Prednisolone causes calcium mobilization from the bones and hence can cause your cramps, which will settle once the dose is reduced.
2. As for tapering the steroids, well it is something we need to see if your symptoms reappear again or you do fine even on low dose. If they come back again we need to add you on a steroid sparing drug, Like methotrexate. Normally we add early as steroids are needed for a long duration in Temporal ARteritis, but that will depend on your rheumatologist.
3. You can always try conventional theraphy like Yoga,. It always helps in the long run in keeping your body flexible and stregnthens the immune system.
I hope the information was useful
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Giant cell arteritis
Detailed Answer:
Good evening
Thank you for writing on health care magic
I have gone through your history. As per your queries:
1. As for long term effects of prednisolone, it can cause transient rises in blood sugars and blood pressure. At your age, other complication which is common is osteoporosis and cataract formation. You are already on treatment for preventing osteoporosis. But never the less, risk: benefit ration these complications are much smaller as compared to temporal arteritis. But do check your blood sugars periodically.
The cramps you are having along with insomia can be due to the dose of Prednisolone as this much dose is enough to give these side effects. Prednisolone causes calcium mobilization from the bones and hence can cause your cramps, which will settle once the dose is reduced.
2. As for tapering the steroids, well it is something we need to see if your symptoms reappear again or you do fine even on low dose. If they come back again we need to add you on a steroid sparing drug, Like methotrexate. Normally we add early as steroids are needed for a long duration in Temporal ARteritis, but that will depend on your rheumatologist.
3. You can always try conventional theraphy like Yoga,. It always helps in the long run in keeping your body flexible and stregnthens the immune system.
I hope the information was useful
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Mediratta.
Re: Giant cell temporal arteritis
Many thanks to your medical follow-up to my request of dec,19.2015. I appreciate your guidance as for additional blood test and medication to be taken.
As mentioned to you earlier I am having both the Emg and CT scan on dec 22 and will definetely get back to you .I did not took the prescribed methotrexate from the begining...have I made a mistake!
Sincerely
Dr.J XXXXXXX
Re: Giant cell temporal arteritis
Many thanks to your medical follow-up to my request of dec,19.2015. I appreciate your guidance as for additional blood test and medication to be taken.
As mentioned to you earlier I am having both the Emg and CT scan on dec 22 and will definetely get back to you .I did not took the prescribed methotrexate from the begining...have I made a mistake!
Sincerely
Dr.J XXXXXXX
Brief Answer:
Giant cell arteritis
Detailed Answer:
Good evening Dr XXXXXXX
Sorry for the late reply. just got back from work
Yeah do let me know the results of EMG and CT> I Am suspecting they may be normal here
Well, nah dont worry. It s not a mistake at all. Methotrexate will help reduce steroid quickly and prevent the relapses we expect when the steroid dose is tapered. So you can consult your rheumatologist and start it now if you want. It takes around 4-6 weeks to start acting. But at least we will be sure the disease will not relapse on tapering it
Will wait for your results
Do let me know for more queries. Would be happy to help out
REgards
Dr Naval
Giant cell arteritis
Detailed Answer:
Good evening Dr XXXXXXX
Sorry for the late reply. just got back from work
Yeah do let me know the results of EMG and CT> I Am suspecting they may be normal here
Well, nah dont worry. It s not a mistake at all. Methotrexate will help reduce steroid quickly and prevent the relapses we expect when the steroid dose is tapered. So you can consult your rheumatologist and start it now if you want. It takes around 4-6 weeks to start acting. But at least we will be sure the disease will not relapse on tapering it
Will wait for your results
Do let me know for more queries. Would be happy to help out
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Mendiratta ;
This will resume my medical status findings as of dec,26 2015 and in connection with our earlier discussion with you.
1 My . recent diagnossis of my GCA referred for cramping of the hands and calves: I have a normal neurological and electrophysiological assessment with no evidence for carpal tunnel syndrome, radiculopathy, myopathy or generalized neuropathy. I was advised to resume magnesium supplementation although my laboratory finding are within specifications. with low dose of benzodiazepine , and performing regular nocturnal calf and foot streches. should the above measure prove ineffective.... .
2.The biochemistry ( hematology ) results done on a monthly base since october 2015 for automated Sed.Rate are 15, 19 and 22 ref. range are 3- 46 ) C-reactive Protein collected on 15.11.20 were 10.5 ( ref .range 0.0 - 10 )
3. The impression from the Medical Imaging Dept. are normal CT examination of the brain, in particular the brainstem, cerebellum and internal auditory canal.A more detail finding could be forward to you if needed.
4,.The prednisone dosage cedule taken since october 19 to dec. 2 was decreased progressively from 60 mg to 15 mg a day. for now for one month. All other medication remain unchanged ( Methotrexate 20 mg a week, 1 gm Calcium, Actonel 35 mg a week, folic acid and vitamin D 50,000 unit once a week .I am to perform a blood test while away for winter every month for ESR, ISD, and CRP.
Question:
1.Having . consistent vertigo , severe nocturnal cramps and other prednisone long term side- effect what is your overall asessment to my present GCA. diagnostic. Can I leave Canada for a 3 month period assuming that I follow the medication and blood test.
2.What could we expect from sudden complication now during this period .I do have some medical coverage being outside.
3.Is Methotrexate supplement mandatory...side -effects are frightening .Why folic acid was added NOW
I am also taking for my prostate hyperplasia 2 medications : Oxybutynine ( Ditropan) and Fenasteride (Proscar)... .
With sincere thanks and best wishes for the new year 2016.
Dr.J XXXXXXX
This will resume my medical status findings as of dec,26 2015 and in connection with our earlier discussion with you.
1 My . recent diagnossis of my GCA referred for cramping of the hands and calves: I have a normal neurological and electrophysiological assessment with no evidence for carpal tunnel syndrome, radiculopathy, myopathy or generalized neuropathy. I was advised to resume magnesium supplementation although my laboratory finding are within specifications. with low dose of benzodiazepine , and performing regular nocturnal calf and foot streches. should the above measure prove ineffective.... .
2.The biochemistry ( hematology ) results done on a monthly base since october 2015 for automated Sed.Rate are 15, 19 and 22 ref. range are 3- 46 ) C-reactive Protein collected on 15.11.20 were 10.5 ( ref .range 0.0 - 10 )
3. The impression from the Medical Imaging Dept. are normal CT examination of the brain, in particular the brainstem, cerebellum and internal auditory canal.A more detail finding could be forward to you if needed.
4,.The prednisone dosage cedule taken since october 19 to dec. 2 was decreased progressively from 60 mg to 15 mg a day. for now for one month. All other medication remain unchanged ( Methotrexate 20 mg a week, 1 gm Calcium, Actonel 35 mg a week, folic acid and vitamin D 50,000 unit once a week .I am to perform a blood test while away for winter every month for ESR, ISD, and CRP.
Question:
1.Having . consistent vertigo , severe nocturnal cramps and other prednisone long term side- effect what is your overall asessment to my present GCA. diagnostic. Can I leave Canada for a 3 month period assuming that I follow the medication and blood test.
2.What could we expect from sudden complication now during this period .I do have some medical coverage being outside.
3.Is Methotrexate supplement mandatory...side -effects are frightening .Why folic acid was added NOW
I am also taking for my prostate hyperplasia 2 medications : Oxybutynine ( Ditropan) and Fenasteride (Proscar)... .
With sincere thanks and best wishes for the new year 2016.
Dr.J XXXXXXX
Brief Answer:
Pertaining to queries
Detailed Answer:
Good evening Dr XXXXXXX
Sorry for the later reply. Was occupied with festivities at home and my new born daughter and somehow lost track of time.
1. I knew the EMG and CT would come normal. It is a good thing. The cramps are probably due to continuation of high dose of steroids which are causing the calcium and vitamin D depletion from the muscles. SO I would recommend you to lower the dose after consultation with your rheumatologist.
2. Abotu Methotrexate, I thought you werent taking the medicine yet. If you are on 20 mg and ESR is normal in your case, we can definately taper your steroids. It has less side effects than steroids. Only thing we need to monitor is your complete blood count and liver function tests. If they are within normal limits, you are good to go. Plus it is needed in GCA, as it works as a Steroid Sparing drug, that is similar effect of steroids but lesser side effects. Folic acid is added to reduce the side effects of Methotrexate as it causes Folate depletion which can cause low blood counts.
3. About the vertigo, it is something of concern to me. Since your CT brain is normal, other thing we need to look into is your Cervical Spine( Neck) and the Ear as GCA can involve the Internal Auditory artery as well( It has been ruled out int the CT). It is always a difficult thing to manage and to figure out where exactly it is coming from. You can try with Vertin ( Betahistine) or Stugeron for a few days and see the response.
4. I think you are good to travel. But prior to it, just sort out the vertigo issue as it is the only thing I am concerned about. You can continue medications as advised. The protocols are different at your place with lof of blood tests monitoring, we usually do it in 3 months period once the patient tolerates. All in all, I feel you ll be fine if you travel, but just once we know why vertigo is happening
I hope the information is useful. Do let me know for more queries. Sorry again for the late reply
REgards
Dr Naval
Pertaining to queries
Detailed Answer:
Good evening Dr XXXXXXX
Sorry for the later reply. Was occupied with festivities at home and my new born daughter and somehow lost track of time.
1. I knew the EMG and CT would come normal. It is a good thing. The cramps are probably due to continuation of high dose of steroids which are causing the calcium and vitamin D depletion from the muscles. SO I would recommend you to lower the dose after consultation with your rheumatologist.
2. Abotu Methotrexate, I thought you werent taking the medicine yet. If you are on 20 mg and ESR is normal in your case, we can definately taper your steroids. It has less side effects than steroids. Only thing we need to monitor is your complete blood count and liver function tests. If they are within normal limits, you are good to go. Plus it is needed in GCA, as it works as a Steroid Sparing drug, that is similar effect of steroids but lesser side effects. Folic acid is added to reduce the side effects of Methotrexate as it causes Folate depletion which can cause low blood counts.
3. About the vertigo, it is something of concern to me. Since your CT brain is normal, other thing we need to look into is your Cervical Spine( Neck) and the Ear as GCA can involve the Internal Auditory artery as well( It has been ruled out int the CT). It is always a difficult thing to manage and to figure out where exactly it is coming from. You can try with Vertin ( Betahistine) or Stugeron for a few days and see the response.
4. I think you are good to travel. But prior to it, just sort out the vertigo issue as it is the only thing I am concerned about. You can continue medications as advised. The protocols are different at your place with lof of blood tests monitoring, we usually do it in 3 months period once the patient tolerates. All in all, I feel you ll be fine if you travel, but just once we know why vertigo is happening
I hope the information is useful. Do let me know for more queries. Sorry again for the late reply
REgards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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