Thanks for your response, the study results are what I was hoping to find. I have found a couple of small studies that show prednisone to be effective but the one you referenced has more detail to it. I downloaded it, my hope is that if we can meet with the Dr and present enough evidence to sway their opinion. My frustration is that we found something that works and now must play these games. We know massive doses would be bad, that is why you go low dose but I guess this treatment is "outside the box" and our local medical profession is locked into "we just don't do that". Part of the issue with living in a small town. We have considered a covid clinic but there isn't one close. We did print out Mayo's protocol but it starts with exercising to break the fatigue cycle and her PEMS is so bad that a mild 15 minute walking exercise put her down for two days. Endurance and conditioning are minimal after all this time, which is why we were excited to find something that made her feel like starting to exercise. We will keep plugging away!