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  #1  
Old 08-08-2011, 10:02 AM
Momma22 Momma22 is offline
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Have to do solumedrol iv?

Hi -

I am new here My husband has a recent case of optic neuritis (1 month ago), has been experiencing some numbness in his foot, back pain, tiredness and sensitivity on his skin. Went to neuro and they found 1 area of inflammation on his brain and 2-3 on his spine. His eye sight is slowly improving, and the other symptoms are annoying, but he is still able to work, etc. He is not official diagnosed since he has only has one episode.

My question - the doctor wants him to do a 5-day course of solumedrol (in iv). Our concern is that he has been on predinsone before for nasal polyps and he feels awful! Terrible back pain and really moody. We are both hesitant to do the iv for the side effects.

Our question is, is it worth it? Does the iv just treat the symptoms or help prevent more inflammation?
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  #2  
Old 08-08-2011, 10:12 AM
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Sequoia Sequoia is offline
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Hi [B]Momma22[/B], and welcome to MSWorld!

Optic Neuritis is the one symptom which actually can show long-term improvement with IV solumedrol. Even MSers who normally opt not to do steroids make an exception for bouts of ON.

For everything else, 'roids can help shorten the length &/or severity of an exacerbation, but they don't improve the long-term outlook.
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  #3  
Old 08-08-2011, 10:18 AM
CocoH CocoH is offline
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Quote:
Originally Posted by Momma22 View Post
Hi -

I am new here My husband has a recent case of optic neuritis (1 month ago), has been experiencing some numbness in his foot, back pain, tiredness and sensitivity on his skin. Went to neuro and they found 1 area of inflammation on his brain and 2-3 on his spine. His eye sight is slowly improving, and the other symptoms are annoying, but he is still able to work, etc. He is not official diagnosed since he has only has one episode.

My question - the doctor wants him to do a 5-day course of solumedrol (in iv). Our concern is that he has been on predinsone before for nasal polyps and he feels awful! Terrible back pain and really moody. We are both hesitant to do the iv for the side effects.

Our question is, is it worth it? Does the iv just treat the symptoms or help prevent more inflammation?
For me, it was worth it to do the IV solumedrol. It greatly improved the symptoms I was experiencing. Though what surprised me is that it took a couple of weeks for it to all kick in. I did have some side effects but they were short lived. I think with the IV vs. taking the oral for a longer period of time, it's "normal" that you'll still experience side effects but they only last a short time, vs the whole month or whatever that you're on the oral.
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  #4  
Old 08-08-2011, 10:22 AM
cosake cosake is offline
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I was in the same boat as your husband last year. I had ON, and was diagnosed as MS-CIS (Clinically Isolated Syndrome) because we only had the one ON flare that we were able to definitely say was MS-related.

I went on a 3-day IV Solumedrol with a 10 day prednisone taper. Eyesight was greatly improved within about 4-5 days.

In May (18 mos. after ON), I had my first "real" flare since the ON - right side muscle weakness in the arm and leg. Difficulty walking, standing, cooking, writing, typing, etc. I opted to forgo the IVSM for that flare.

If I did get ON again, though, I would definitely do IVSM. I have enough other medical issues that chancing damage to my eyesight does not need to be added to the list.

It is a personal choice for each person.
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  #5  
Old 08-08-2011, 10:45 AM
Momma22 Momma22 is offline
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Thanks for the quick replies! So - are you saying that the longer it takes to recover, the less chance the eye sight comes back?

Also, I forgot to mention that we are now gluten free. (Hubby has all kinds of environmental allergies.) He has also started taking Fish oil and b12.
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  #6  
Old 08-08-2011, 11:08 AM
cosake cosake is offline
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I think eyesight is an area to be especially careful and do all that you can to get it better quickly.

I can't say with certainty if the longer it lasts the more damage there might be. That would be a question for your husband's neuro.
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  #7  
Old 08-08-2011, 01:14 PM
Redwings Redwings is offline
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Hi Momma22:
Does your husband HAVE TO do a Solu-Medrol IV series? No. As Sequoia pointed out, steroids shorten the duration and perhaps severity of a flare, but they don't affect the ultimate outcome. So if it has been a month since the start of the flare and your husband is still able to work, he might not get a benefit from the steroids that makes it worth the aggravation to do them.

Steroids work best if they're administered right at the start of a flare. After about two weeks, the damage has already been done and steroids aren't as effective. Some doctors (my own included) won't even prescribe steroids after that two-week window has passed. Your husband is already a month out from the start of his flare. He might or might not get much, if any, benefit. Some people do have lingering inflammation weeks after a flare and do get some improvement from steroids, but the speed and amount of recovery are much less predictable when they're administered later.

There is some misunderstanding about steroids in that many people think it's the steroids that cause healing. So the question comes up about, When do steroids kick in? They kick in almost right away to quell inflammation. But they don't repair or heal damage. The body has to do that on its own, and that can take days to weeks to months. So what some folks think is a delayed reaction by steroids (e.g., "they took two weeks to work"), is really the body's normal time to begin healing that made the noticeable improvement, not that the steroids swam around in the body for two weeks and [I]then[/I] decided to start working.

Steroids do wonderful things, but they also do some unpleasant and terrible things. If your husband felt terrible on a dose of prednisone that's relatively low when compared to the amounts of Solu-Medrol (IVSM) used for treating MS flares, he might not do well on an IVSM series. While the amount of prednisone used for nasal polyps might be, say, 60 mg per day, IVSM is typically used at a dose of 1000 mg per day -- more than 10 times greater. Even if your husband's neuro decides to prescribe a lower dose, say, 500 mg per day, that's still a pretty big whack of steroids.

I'm always a bit amazed at the folks who have a full-dose 3-day series and say they had no side effects. I've had literally dozens of IVSM 3-days (for recurrent optic neuritis) and always have [I]some[/I] side effects, ranging from tolerable to so pronounced that I couldn't go to work for a week -- and that was due to the steroids, not the ON. So in your husband's case, he has to decide if the possible side effects -- which could be severe, based on his earlier experience -- are going to be worth the possible improvement in his symptoms when he's already past the two-week window of maximum effectiveness [I]and[/I] he's still mobile and working [I]and[/I] he's already noticing some improvement in his vision. IVSM will not give him any [I]more[/I] improvement in his vision than he will have if he doesn't take the steroids at all (as evidenced by the findings of the Optic Neuritis Treatment Trial).

Since you mentioned your husband's mood swings while on prednisone, it's also important that I bring up steroid psychosis. Some people have such profound psychological effects from steroids (even low dose, but especially at the high doses used for MS) that they actually go a bit psychotic. If that's a concern, then the risks of the steroids surely outweigh the benefits for him, based on what you've described.

With regard to your husband's vision, the Optic Neuritis Treatment Trial found that [I]most[/I] people get [I]most[/I] of their vision back after ON. Some get all of it back, some get some back and a few get none back. Generally speaking, most vision is recovered within six months. Beyond that, the chances of further recovery become much smaller, to the point that further recovery shouldn't be expected. Although recovery can happen after that, it's not common. Since your husband has noticed some improvement in his vision after a month, that's a much better sign than if he hadn't had any recovery at all. But at only a month out, it's too soon to tell what the final outcome will be. At this point, though, steroids probably won't do much, if anything, to speed up the process.

As a bit of comparison, some folks get good recovery within about two weeks, whereas I don't even start to see improvement until three weeks, then it takes a few more weeks before my vision recovers to whatever amount I'm going to get back. After my worst episode, I got some recovery as much as a year later, but I still lost a big chunk of visual field permanently. So you never know...
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  #8  
Old 08-08-2011, 01:41 PM
cosake cosake is offline
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Redwings - I am once again impressed by your concise, knowledgeable response to an issue. I respect all that you have to offer everyone here.

I always learn something from you too !

I do have to say that the only steroid side effect that I had was sleeplessness. I ended up taking some xanax to fall asleep for a few nights. (I do have to wonder if I perhaps have some sort of tolerance for steroids as I was on prednisone for over a year while I was a child battling an autoimmune blood disorder. As soon as I went off the steroids things would get all wacky again so I eventually had my spleen removed and things have been great since then.)

My neuro will also only prescribe the IVSM if I am less than 10 days into a flare. After that, he says that it will not be effective enough unless it is an extremely severe flare up.

Although I am considered to have 20/20 vision, I do have some mild lingering damage to my optic nerve from the ON. I only notice slight deficits here and there but the neuro-optho says that my right optic nerve is not as healthy as my left.
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  #9  
Old 08-09-2011, 10:43 PM
CocoH CocoH is offline
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Quote:
Originally Posted by Redwings View Post
There is some misunderstanding about steroids in that many people think it's the steroids that cause healing. So the question comes up about, When do steroids kick in? They kick in almost right away to quell inflammation. But they don't repair or heal damage. The body has to do that on its own, and that can take days to weeks to months. So what some folks think is a delayed reaction by steroids (e.g., "they took two weeks to work"), is really the body's normal time to begin healing that made the noticeable improvement, not that the steroids swam around in the body for two weeks and then decided to start working. ,
Thanks for that info, Redwings! No one has ever explained that to me before. I'm with Cosake, I always appreciate your informational & thorough posts.
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  #10  
Old 08-10-2011, 05:59 PM
Redwings Redwings is offline
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Hi cosake and CocoH:
You're welcome! Thanks for the shout-out.

Momma22, what did your husband decide about IVSM?
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