Weaning off of prednisone & pain management

@dadcue Do you need to go to a special kind of doctor for a cortisol test?

@prestol
I’ve seen the cherry juice at Trader Joe’s also but I did not check the nutritional label for sugar. In my research different brands of tart cherry juice can contain anywhere from 0 to 32 gm. of sugar per serving!
So I might be better off with the capsules after all. I will see if I can find a 0 gm one to try to see if I like the taste!

I guess I’m a little confused as the TJ juice says no added sugar, but lots of naturally occurring sugar. So maybe there are various types of cherries containing differing amounts of sugar. I thought “tart cherries” were all one type?

My bottle says 100% Montmorency Tart Cherry Juice
Total Sugars 28g which includes 0g Added Sugars
120 Calories per 8 oz (240ml) serving

I also have light apple juice which has Total Sugars 11g and 0g added sugar
45 Calories per 8 oz (240ml) serving
59% Fewer Calories and Sugars than regular apple juice.

I guess they just add water to decrease the calories and sugars of the apple juice. I suppose that can also be done with the Tart Cherry Juice to make it "light." The cherry juice alone was too tart for me.

I have mixed 1/2 of the light 42% apple juice and 1/2 of the 100% Tart Cherry Juice together and it tastes good --- more cherry flavor than apple flavor.

I just figured out my "light apple juice" costs the same as the 100% apple juice for the same quantity. I should buy the 100% apple juice and dilute it with 50% water. Then I would have 2 bottles of light apple juice for the same price as one bottle.

I’m confused by it too—no added sugar maybe, but how can it have 0 gms of “natural “ sugar? I thought that they all came from one type of cherry? Maybe the way it it processed? Anyway I will ask my primary doctor. The natural sugar might be ok if I drink a small amount. Otherwise I will just try the capsules. Good luck to you and I hope the juice works for you!

@dadcue
I’m worried it might be too tart for me also, lol! I do like sweet flavor! I will ask my doctor and see what she says, otherwise I will probably end up trying the capsules.
Very creative what you did with the apple juice!

My primary care doctor ordered a morning cortisol level when I wasn't feeling well on 3 mg of prednisone. It is a routine lab that should be done if adrenal insufficiency is suspected. When my cortisol level was low, I was referred to an endocrinologist.

"Generally, a random serum cortisol of over 400 nmol/L at any time of the day makes adrenal insufficiency highly unlikely,8 while a morning serum cortisol of less than 100 nmol/L strongly suggests adrenal failure.13 In interpreting such results, one must consider the patient's current and prior steroid usage."
https://pmc.ncbi.nlm.nih.gov/articles/PMC6297573/
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There is a fancy cortisol level test that is called a synacthen test that is more involved and probably requires an endocrinologist to interpret.
https://pubmed.ncbi.nlm.nih.gov/29846658/
My endocrinologist didn't think I needed a Synacthen test. She expected my cortisol level to be low given I was on Prednisone for a very long time.

While my a.m cortisol level was low, my endocrinologist was encouraged that it wasn't dangerously low. I was told to stay on low dose Prednisone (less than 3 mg) for an extended period of time. After 6 months my cortisol level improved and it was deemed to be "adequate."

One more comment, I have been in a few situations lately where I can tell that my adrenal glands are working. Gives me the confidence to more aggressively reduce my prednisone intake. I really feel like I could just stop taking it but I don't dare do that.

How can you tell your adrenal glands are working?

I couldn't tell for sure. I had to go with what my endocrinologist said -- my cortisol level was "adequate." However, my endocrinologist wouldn't say my cortisol level would be adequate every day after I stopped prednisone. I was told to restart prednisone for "any reason" if I felt the need. There was a need and I had to go back on 60 mg of prednisone. My first attempt to stop prednisone didn't go so well but a lot was learned. I learned to expect the unexpected!

My cortisol level isn't checked anymore. I'm told that cortisol levels are variable depending on the time of day and what happens during the day. There is no "normal cortisol level" for every situation. There was no guarantee my adrenal function would be adequate for every situation. It was only adequate on the day and at the time it was tested.

My overwhelming fatigue is not a problem anymore. I feel much better being off prednisone.

Prednisone replaces the cortisol our adrenals produce. Since I'm not on prednisone anymore --I have to assume my adrenals are working. A low cortisol level caused by adrenal suppression because of prednisone use won't improve until prednisone is reduced. Adrenal function improves gradually with time so don't expect to feel better as soon as prednisone is stopped.