Fatigue is hard to define let alone quantify.

My recollection when I was first diagnosed with PMR wasn't fatigue in the usual sense of "being tired or sleepy." I wasn't sleeping too well because of pain but I can't say the lack of sleep made me tired. I was wide awake because that's what pain does to me.

After starting Prednisone I had energy to spare. I liked the energized feeling. I didn't care that I wasn't sleeping because I could find many things to do. I was very hyperactive and probably euphoric because I felt like I didn't have any need for sleep.

No need for sleep came to a halt after a couple of weeks. Sleep deprivation has a way of taking hold eventually and a person can sleep through anything. I slept for two days straight! I think sleep deprivation compounded my precarious health status but eventually everything stabilized.

One of my first fatigue related symptoms after things stabilized was "exercise intolerance." However, it wasn't like exercise made me tired. Rather, minimal activity made me short of breath. I couldn't walk up a slight incline without getting winded and I needed to stop and rest in order to catch my breath. This was my very first symptom I complained about. I told my primary care doctor. My primary care doctor ordered an exercise tolerance test but it was "normal" but I knew it wasn't normal for me.

My exercise "intolerance" progressed. I was in the middle of a 50 mile bicycle ride when I hit the proverbial wall. I didn't really care where -- I just needed to rest and the ditch with tall grass and critters everywhere was as good of a place as any. I hardly had any energy but I managed to check my pulse. My pulse was irregular so I thought that was strange. I told my primary care doctor about the incident and he thought it warranted an EKG. The EKG revealed a heart arrhythmia and left ventricular hypertrophy (LVH) . A random blood pressure check caught a blood pressure of 210/110 a few days later.

Hypertension (high blood pressure) is the most common cause of left ventricular hypertrophy (LVH), a condition in which the heart's left pumping chamber thickens and may not pump efficiently. A cardiologist placed the blame squarely on prednisone.

A year or so later, I was getting used to being short of breath. I told my story about having an ambulance called for me because I felt "slightly more short of breath than my usual." That incident culminated in being admitted to intensive care with an extensive, multiple and bilateral pulmonary embolisms.

I have to hold prednisone responsible for all the above. Since coming off prednisone I was able to discontinue 3 blood pressure medications. I also discontinued warfarin which I was supposed to take for the rest of my life. All my cardiovascular problems have resolved since stopping prednisone.

After my cortisol level improved, the "overwhelming fatigue" also improved. I don't think PMR caused me to have too much fatigue but Prednisone sure did.