From what I have read on the subject I personally wouldn't want to ever go over 15mg of HC.
This is an excellent distinction...based on your production of cortisol (low in the AM and high at night) with a presumably normal total daily quantity just shifted completely backwards from an optimal diurnal rhythm, less than 15 mg may be plenty sufficient.
That is why I don't believe anyone can say anything about any one person's dose without knowing their test results (preferably saliva, serum and stim). For people like EnduringAngel, a low dose works just great. For people like me with very low cortisol all day and night, a low dose would be a disaster as EnduringAngel pointed out as well.
The body does tend to stop production of cortisol from the adrenals if a large enough dose of exogenous steroid is taken. But this isn't usually permanent and there are reports of people taking steroids for decades and then regaining full adrenal function when the steroids are properly weaned.
As with any medication you should always "start low, go slow, and listen to your body".
While I totally agree with listening to your body, patients with low cortisol report that starting low and slow is often a nightmare. Because of the feedback mechanism, it is possible to end up with less cortisol after replacement than you may have had to begin with...this leads to the most uncomfortable symptoms like panic attacks, racing heart, palps, anxiety, and anything else you would associate with adrenaline rushes.
If testing shows one needs a full replacement dose, most people do FAR better by starting right away on a full replacement dose than by trying to work up. In fact, most people with Addison's have such a deficit of cortisol when they finally manage to get properly diagnosed, that they may need a larger dose at first than they will eventually end up on. That also happened to me and I was able to drop my dose down quite a bit after I had been steady for some time. But it takes time to build cortisol reserves and it is easy to deplete them again with the slightest amount of stress.
Of course this doesn't apply if a full replacement dose isn't indicated.
I started with licorice for a few months it did nothing.
I actually really like licorice and find it very useful for me. It helps to keep cortisol in the active form around longer and also has mineralocorticoid effects that were very good for keeping my blood pressure up and my OI symptoms at bay.
I wanted to come off the high dose, but no one should ever just stop like that, so I lowered to 12.5 just once a week. And then 7 once a week, still taking the 2 a day.
You're right that steroids should never be abruptly stopped and should be weaned. But it is possible to take a large dose as a one time deal and not have to wean down if it is less than three days in duration. This is called "stress dosing" and those of us with Addison's have to learn how and when to increase our typical steroid dose for illness and other extreme stresses. Certainly talk to your doctor about it but you shouldn't have any problem dropping the large dose down to 2 mg like the other doses if you only do it once a week.
Some people do develop more side effects from prednisolone because it is a medium acting steroid and doesn't allow for the diurnal rhythm like hydrocortisone does. It stays too high at night and keeps other hormones from working properly (like growth hormone). However, some people feel so much better on it than HC that it is worth it. It's all about trial and error and finding what works best for an individual. I have a hard time with the ups and downs of HC and do much better on the long acting steroid dexamethasone, for example. But this would not be typical and can only be determined by working with an informed and knowledgeable doctor.
Also I know I am a bit of a hypocrite saying this as I should be in bed now, but we need to realise
not to surf these night energy highs. IE by staying up late on the pc or with lights on.
This is so true...but so hard! Some doctors suggest wearing goggles to block the light but I've never been able to get into this.
What sorts of other things have you done to re-set your body clock other than the melatonin supplementation?
Did you have a sleep study to diagnose the delayed phase sleep? I'm curious how that works because the sleep clinics around here seem to want to kick people out at 5AM which seems like it would miss most of the delayed phase!
Adrenals and thyroid go hand in hand so it does make sence to get your thyroid checked too.
Yes! A friend of mine just went to a new doctor who said that it should be malpractice to prescribe thyroid meds without also checking adrenal function...wish all doctors felt that way. It will be a slow change but hopefully it is happening.
When Im tired most ie in the morning my MCSS is so much worse, I cant cope with any smells, but in the evening when my cortisol is higher I can tolerate smells more.
Yes! Me too! Now that I am on full replacement, my MCS has gotten SO much better. I can even paint now! Though I do wear a mask for the most part just in case. And I got my perfume collection out again last year which makes me ever so happy.
Also Ema you said
"Also, taking more than 10 mg of HC at a time is not a good idea. The body can't use that much at a time and it will contribute to negative side effects (such as high blood sugar and weight gain"
this is so interesting, and im wondering if I should take 5mg hc in morning and 5mg in afternoon like I used to rather than 10mg in morning.
How long does it stay in system for?
Now that I'm on LDN my adrenals seem to be better.
And if I could just get my sleep improved and find something to put me into deep sleep, I'm sure my body would be more happier to stay awake in day.
If 10 mg in the AM is working for you, I see no reason to change. 10 mg seems to work fine at one time for most people. But most people can't use up more than that at once so the body ends up sensing it as "high cortisol" and we all know about the negative side effects associated with that state. Almost everyone I know takes 10 mg as a first morning dose with no problems.
If you feel a lull in the afternoon though, that would be a reason to consider changing up your dosing.
I do know some people with similar saliva tests to you that have tried a full replacement dose as a way to try to "hard" reset the HPA axis. I think they have had varying levels of success though. That pattern can be very hard to break. Have you considered phosphatidyl serine? That is meant to resensitize the neurons in the hypothalamus and may be useful at night for lowering cortisol.
HC seems to peak at about 1.5 hours and most people feel like it has worn off at 3-4 hours especially in the morning hours. Some people are fast metabolizers and burn through HC (like me) and other people seem to find it lasts longer. I've seen reports of a half life of 8-12 hours but I don't know anyone with low cortisol that can go that long comfortably between doses. Of course, I don't know everyone.
http://www.ncbi.nlm.nih.gov/pubmed/18611115
I'm glad you have had success with LDN! Some people certainly do...I think about trying it again from time to time myself.
Remember that you need to sort your sleep, thryoid, diet and anything else going on in the body too. Just fixating on one piece of the puzzle wont work.
Very true...
Ema