The medical mob now says the physiological dose is around 5mg (4-6) rather than the previous estimation of 7-8, but cortisol levels for individuals vary. I intend to reduce the cumulative dose of prednisone by going more slowly with reductions rather than pushing on and increasing pain & inflammation which requires a dose rise. At this stage, my doctor is as reluctant as I am to add another drug with new side effects, especially considering the low rates of success in reducing prednisone that most "steroid sparing" drugs have for most people.

And then there's seeing if the PMR has resolved, which should mean that inflammation stays under control while pred is reduced. But each of us has our own medical history that independently determines our inflammation levels and predisposition to inflammation, whether from poor diet or lifestyle, or things like latent tuberculosis, which I have. Latent TB means the immune system is permanently patrolling to control TB, making us more prone to inflammation, and more at risk of developing full blown TB by taking either/both prednisone and "steroid sparing" drugs.

Interestingly, the most obvious way to increase naturally produced cortisol is to return to the highly stressful life I had which kept cortisol and adrenaline at constantly high levels for years. (I now take a beta blocker to control adrenaline.) Should I postpone plans to start meditating next year, as that reduces cortisol but brings many health benefits? It's not a simple equation - I hope that meditating might reduce my body's need for so much cortisol, but mainly, I just want to feel better, more peaceful and more healthy.