Stress dosing Cortef (HC)

[concepcion]

We have a couple of questions re. stress dosing Cortef/HC (hydrocortisone) with ME/CFS, PEM & PMS.

- Does PMS count as an extra "stress" that would benefit from stress dosing? My daughter always feels overwhelmed and anxious with PMS.
- Does PEM count as such a "stress" also?

 

[Ema]

How much HC is your daughter taking? It's possible that she just needs a larger daily dose.

Anything that puts stress on the body could potentially require a stress dose. It really depends on symptoms. It's not uncommon for me to need extra steroid the day my period starts for example or if I get a migraine.

But if I needed more steroid every time I was active, I would look more at whether or not I was successfully meeting my daily steroid requirement or always teetering on the edge of low cortisol. It's much easier to prevent going in the hole than it is to climb out of it, in my experience.

 

[concepcion]

Thanks Ema.

We followed the protocol @ stopthethyroidmadness.com, which uses temperature and symptoms to guide. Her temps were within .2 degrees F for 5 days, so that would indicate that she was on a stable dose. However, thinking about it, the result may have been different if she took her temps during PMS. It seems that if you need to stress dose often then you are not on enough, but I'm not sure if that takes into account cyclical occurrences, such as PMS, and repeated occurrences, such as PEM. I don't think everyone with adrenal fatigues suffers from these two issues and ME.

While what you say, regarding the problem of needing more steroid every time one is active, is true, not all activity leads to PEM. In my daughter's case, she spends 95% of her day in bed (the other 5% would include things like going to the bathroom, sitting on a couch). PEM would arise from a big phone consult with a doctor, a rare outing, a visit with someone that goes on too long. So it certainly doesn't happen from everything, but she is careful to avoid the things that could cause PEM. Given these PEM-inducing scenarios, the rule would be to stress dose for the event, but would she continue to stress dose for the PEM, which usually kicks in later the next day?

Do you get migraines every cycle? Do you find yourself stress-dosing for those every cycle? Does it help?

 

[Ema]

I think stress dosing for things like a doctor's appointment or a visit or the like is perfectly sensible. I don't see any harm in carrying on with a higher dose for a couple of days afterwards either if it helps with PEM symptoms. Just make sure to taper if over 3 days.

Temps usually will increase in the luteal phase but they are generally still stable at the higher level if the dose is sufficient.

Adrenal dysfunction in ME/CFS is typically different than in typical Addison's. I'm not sure what you are dealing with? It's typically more of a brain problem in ME/CFS and complicated by the fact that most of is have underlying infections as well that cause a need for increased cortisol. It's a very fine line to walk between having enough cortisol to feel well and having too much or too little.

Many people, including myself, with chronic infections find that a mixture of a longer acting steroid with HC often provides better steroid cover throughout the day. I took dexamethasone, for example, along with my HC and that got me out of bed for the first time in several years. Most people with Addison's don't find this necessary or helpful.

I would also look at Florinef. The conventional wisdom is that only those with primary Addison's need it but that isn't the case. Low aldosterone can cause horrible symptoms related to low blood volume and low electrolytes.

I had a migraine break for a couple of years and now they are back. I can usually break a migraine with 20 HC and 2 Advil though I ended up with quite a lot more yesterday to get rid of the bugger. Cortisol certainly plays a role in migraines both as causative agent and as a stressor but unfortunately it is a complex issue. I would look at DHEA levels and consider supplementation if that or pregnenolone are low. Pregnenolone in particular may modulate GABA which can be helpful in migraine prevention.

 

[concepcion]

Are you still on dexamthasone Ema?
The problem with Florinef is that it has fluoride, and my daughter has a problem with this.
She tried Pregnenolone a couple of years ago, but it just made her more tired. And GABA proved problematic also. It's all a bit of a challenge.

 

[Ema]

Are you still on dexamthasone Ema?
The problem with Florinef is that it has fluoride, and my daughter has a problem with this.
She tried Pregnenolone a couple of years ago, but it just made her more tired. And GABA proved problematic also. It's all a bit of a challenge.

I am actually just getting ready to go back on dex. I was off for a while but recent stresses mean that I seem to need it again unfortunately. Right now, I'm on HC and Medrol but Medrol makes me weepy whereas dex does not.

There is bioidentical aldosterone available...

 

[concepcion]

Thanks. I will pass all this on to my daughter.