Reader wants to avoid prednisone side effects

Dear Dr. Gott: I am writing to you in the hope that you will have some information for me concerning polymyalgia rheumatica, which I have been diagnosed with and have been dealing with for a little over a year.

I was treated with prednisone, which worked wonders, but I don’t like the consequences of using that and have refused to go back on it again.

I have tried various natural remedies, and they have been of little help to me. Exercise doesn’t really help, but I feel like I have to keep moving.

Dear Reader: Polymyalgia rheumatica is a relatively common disorder, marked in large part by a person’s allergy to his or her normal tissues, leading to painful joints and muscles.

The cause is unknown, but the diagnosis is usually marked by an elevated sedimentation rate (the speed with which blood cells sink when placed in a tube).

Normally, the red rate should not exceed 10 millimeters per hour. In the presence of polymyalgia, it usually exceeds 80.

Drugs such as prednisone that “turn off” the immune system are ordinarily effective in relieving the pain of PMR and may take effect within a day or two.

As you have learned, however, such steroids carry a long list of serious side effects, including deficient immunity, cataracts, osteoporosis, diabetes and many others. As a general rule, the longer a patient takes prednisone (and the higher the dosage), the greater the chances of complications, which are virtually 100 percent in people who take the drug for extended periods.

Therefore, while many doctors start by prescribing high doses that are gradually tapered, recurring pain may be such a problem that repeated courses of therapy are necessary. In addition, untreated PMR can lead to blindness.

Many specialists recommend that steroids be given for several months before the dosage is reduced significantly. This is one striking example of the risk/benefit ratio: Patients must learn which risks are acceptable and work with their physicians to ensure success.

In your case, you should follow the advice of medical personnel, which may include a rheumatology specialist.

To give you related information, I am sending you a copy of my health report “Managing Chronic Pain.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: My husband has ringworm on his behind. He has had it for many years, and it has not gone away after many visits to the doctor and taking every medicine, both oral and topical, possible. Any suggestions?

Dear Reader: Ringworm, a fungal infection of the skin, can be difficult to cure.

I’d first try a topical antifungus medication, such as Lamisil.

If that is not effective, your husband might try Vicks VapoRub. Several readers have found that this therapy often works well.

If that, too, fails to kill the fungus, I suggest a consultation with a dermatologist.