Saturday and it is the day the youngest grandsons are visiting. I get up and make breakfast and take my morning meds. All I have to do now is wait for the family to arrive. I go to the garden swing seat taking with me the new book that a friend has sent me. It is The Gospel according to BLINDBOY in 15 short stories. Blindboy Boatclub is an Irish satirist and one half of the Rubberbandits. I read the first four stories straight off and really like them. Disturbing and witty tales from someone who clearly has his moments of disturbance.

I also pen a new poem. I think it is my mind trying to rid itself of the nasty images I’ve recently read in a book.

550

I wonder if the flow of ink
might inspire me.
That the feel of the Montblanc
would make my juices run,
but alas it seems in vane.
I'm overwhelmed by Mishima's
description of a kitten sacrificed
to satisfy teenage needs
and then the sailor that fell
from grace with the sea.
A Samurai who suicides 
when the books are finished
is likely to have skinned 
a cat or two.
Left with his horrid vision
I'm pleased the author
had the decency to leave
by his own hand.

                                                             550 07-08-2026

At last the visitors arrive and my three year old grandson comes to find me on the garden swing. He sits beside me and tells me about the journey and that the flowers look pretty and how he helped plant some of them. He also finds his favourite three stones, which we have kept handy. After a while he goes off in search of toys. Everyone eats lunch and the paddling pool appears so there is much water fun. I return to reading my book on the swing seat. There is an afternoon of chat and play with the youngest grandson falling asleep on his aunts lap, this was her first nap trapping. On going inside I find the PDF of my next poetry collection is waiting for me. There are two poems missing so I send them off to the publishers. I’m waiting on the Forward to be written but in the meantime I’ve asked the publishers to consider being the people that send out the authors copies for review. I shall be interested in what they think of that.

Tea time arrives and the family gorge on steak pie and chips followed by chocolate cake. Everyone digs in and eats heartily. What follows is the “putting to bed” ritual once the elder grandson had helped his Nanny to water the garden. While this was going on I cleared away, stuffed Daisy (dishwasher) full and washed up the pots and pans. I returned to drafting the blog while the parents went into “settling down” mode. At last the boys are asleep and the adults clear away toys and settle down for an evening of chat and TV. Tomorrow is a car hunt, a comi con and entertaining grandchildren.

Wednesday and Thursday are Spa days, which means three meals a day, a lot of massage and huge amounts of laying on beds and recliners in different environments and trying not to snore. Both ending up with big meals, night meds and a collapse into bed wondering how I can I be so tired after so much lounging and indulgence. So far Hoar Hall has been a real success.

Thursday our last day at the Spa. We have an early breakfast after having packed and stowed some bags in the back of Elsie (the car). This morning I actually ate a cooked breakfast, the first day I have felt up to it. We put our travel clothes into lockers in the Spa and I headed for the sound sanctum. My partner went off to a pool. I woke up about 10:30 and realised I had probably snored quite a lot and ruined the peaceful space for several Spaees. As I left the sound sanctuary I bumped into my partner coming to collect me. It is almost time for another rub down with an oily rag.

Todays massage was a full body affair , deep tissue with a scalp massage to end. It all goes well The massager took me by surprise by the distance she rolled my swimming trunks down to access my buttocks. However my buttocks appear to have enjoyed the firm oiling they got. At the end we had a bit of a debrief and she said she would send me her suggests for some relaxing and refreshing oils. She was good to her word, however I do not see myself spending £48 on 150ml of relaxing oil for the bath or the same amount for cooling and relaxing gel for my back. She also gave me all the guff about lactic acid crystallising in the muscles and massage breaking down the “knots”, so it important to drink lots of water to wash away the “toxins”. Its all bollocks of course, lactic acid doesn’t from crystals and its the liver and other organs that deal with the lactic acid.

I met up with my partner and we indulge in post massage drinks and lemon muffins. We sit and chat comparing Hoar Hall with Ragdale. Hoar Hall comes out well from the comparison, we would both do it again. Pay less for a room, after all their is no need to be in it between breakfast and bed time and spend more time in the Spa facilities including the very good gym facility they have. At lunch time we go to the dining room to find they are running slow, breakfast had been slower due to only one chef turning up, I assumed that there was still only one chef. At one point the waitress said they had no jugs for tap water but they could do it by the glass. She went away and then returned with jugs of tap water, clearly some one behind the scenes had decreed that jugs would be used. Although slow lunch was nice and another chance to chat. With eating done and tine getting on we retrieved our travel clothes and prepared to leave. Thee was the moment of truth when we paid our bill for the little extras we had had during our stay. I still think a fiver for a side of chips is extortionate no mater how many times they have been cooked. On the whole we got a way lightly. We clamber into Elsie and I drive us home via the pretty route via Ashby and Ibstock, a route strewn with speed cameras.

Once home there was a general flop of relief to be home the garden had survived well and everything in pots looked just fine. I managed to get my bags upstairs at some point but lacked the energy to unpack. I watched Granite Harbour until l fell asleep and woke only to take my night meds ad get off to bed.

Friday and I wake up in my own bed and feel crap with a head ache. I am not amused by this. My partner brings me a hot water and I struggle to get up. I unpack and sort my washing out and put the rest of my clothes away. Breakfast follows as does morning meds and paracetamol. I have a postcard from a friend who sent it only yesterday, it must be a first, a card arriving before the sender has got home. I wait for the paracetamol to take hold and then drive my partner and to the butchers at our local garden centre. Here we buy mounds of sausages, pes and other goodies in readiness for the visit of the two youngest grandsons tomorrow.

Once home there is time to start to draft the blog until my eldest daughter goes of to buy stuff for her face and my partner goes to visit her mother in her care home. I sign the contract to have our house alarm system upgraded and send it off before returning to the blog draft. I’m doing this when my partner returns. We slide into the evening, there is still stuff to do to prepare for tomorrow but tonight there are the last episodes of Granite Harbour to watch. It will be an early night for me so I can be up for the challenge of a three year old and eight month old. I have not written anything for a little while now and I am starting to think my brain or whatever creates my stuff as taken a break. It might just be that my inspiration is running slow or low at the moment. I think unconsciously I am waiting to see the Forward for the next collection, but the author is away on holiday with his family at the moment so I need to be patient and wait and see in the fullness of time.

Tuesday and the first full day at the Spa. Breakfast is at 7:45! I arrive and survey the array of help yourself food. I cannot face it and content myself with toast and marmalade washed down with orange juice and decaf coffee. Its back to the room and for the first time I get into my fluffy white robe and swim joggers. As a first journey into Spa land my partner goes in for her massage while I read my book. The book springs a surprise as the main character, a young teenage Japanese boy, kills a kitten and then watches as another boy eviscerates it. Not what I was expecting! My partne returns and soon it is my name being called.

My “therapist” explains what she is going to do to me and does a brief medical history with me. She then in structs me about disrobing and getting ready for the massage and disappears to check that it is okay to do me as planned. She returns and says we are good to go. The back massage is fun if a little painful in the neck and shoulders. I then get my face sprayed with stuff and some lip balm applied. With my eyes covered up she moves onto my feet where she does some massage with a fancy name. Finally she massages my lower legs with freezing cold balls! That was interesting, and then it was over. I dressed and she recommended things to do and not do. I as then shown the way back to find my partner.

My partner and I go to lunch and find it is a three course meal. Whilst settling down to decide what to eat I look around the dining room, it is full of people in fluffy white robes, it looks like a flock of sheep have all come to lunch. Lunch is tasty and filling and at the end of it we head for some where to rest. My partner and I end up in the sound sanctuary laying on a circular sofa thing with cushions. I was going to read but apparently I ruined the atmosphere by snoring..

Eventually the sound sanctuary was abandoned and we made or way to the Spa terrace where we found sun loungers and settled down to read and apparently snore again. As the day clouded over we retreated to the room only to find the key not working so a quick trip to reception was in order to get new keys. I take the opportunity to draft the blog and then shower before dinner.

We dined and went to bed very tired but in a Spa relaxed kind of way.

Monday and its the start of a three day Spa break. I get up sluggishly and make toast and take my morning meds. I have a headache so I slug about a bit and then take paracetamol before I take a shower. Feeling a bit more revived I pack my bags for the trip. partner and I have lunch and then I pack the car. At two o’clock we say farewell to our eldest daughter and head for the Spa.

I drive us to the Spa and drop my partner and bags at reception and go of to find a parking space. Its a nightmare, the place is rammed with cars, no spaces left at all. In a severe bout of “fuck it” I stuck Elsie in a reserved space close to reception and joined my partner at reception. The process was quick with a helpful receptionist and our bags got take to our room on the fifth floor.

After a quick look at the suite and discovering the route to the bathroom, its a big suite, we returned to reception and nabbed our free arrival drink. Sitting in the Long Galley sipping our freebies I looked over the drinks price list. My conclusion was that I will be drinking a lot of the complimentary lemon water. After a quick study of the hotel plan I returned to he car to put on my non driving shoes on and then my partner and I went exploring. The gym is well equipped and worth a visit. The Spa is on different levels and has a couple of pools and spa areas as well as treatment rooms. There are also some odd spaces like an “unlimited reading room”. No idea what this is about, yet. Having explored, it was back to the room to cool down. I ate my contraband pastry and started the days blog. We are dining late tonight so I might move the car and have a nap curled up in my nice white fluffy XL bathrobe.

Saturday and its up early, at least for me. My socials sorted I take my morning meds. My partner and I go to the local garden centre for breakfast. I know I will be outfaced by the large breakfast and go for the traditional with added eggs. It is a good change to occasionally eat a hearty breakfast at the start of the day. Having been well fed my partner shops for slip on shoes to take to the Spa on Monday, I sit on the fitting seat and wait whilst passing my opinion when asked. With shoes bought we move to the food hall and buy what we need for the rest of the weekend. With all our needs fulfilled we head for home.

There is a period of rest when I cool down and regather my energy and then I drive my partner and I to Astley Book Farm. It is a tucked away farm near Nuneaton that houses over hundred thousand used books. A vast rambling series of interconnected barns filled floor to ceiling with books. I of course head for the poetry section only to find an elderly gent occupying the whole poetry aisle. I have a bit of a sit down thinking he will move on, after all who goes into a poetry aisle and lingers? Old buggers with hearing aids, that’s who. In the end I negotiate getting past him and start to peruse the shelves. I have book tokens to spend so the world is my oyster. In the midst fall this poetry there is a “How to play rock guitar” complete with instructional CD for £3:50. It has a Stratocaster motive on the front, how could I resist?

So I gather my four books and instructional CD. One of the books is Fourteenth Century Verse and Prose. It has clearly been studied by a student who has written in numerous pencil notes, mostly translations of the more tricky words. I am delighted to find that the book contains a glossary. A glossary compiled by one J.R.R. Tolken. Its good to get an idea of what Tolken was doing as an academic before he wrote the Hobbit and all the other Hobbity tosh he wrote later.

The other three books are collections of single poets, Yevtushenko, Rupert Brooke and D.J. Enright.

With my books tucked under my arm I approach the pay desk and ask if they take book tokens. Yes they do but the website is a bastard to work, could we go away while they sort it out. We do go and make our own coffee at the bar in one of the sitting areas. We find ourselves in the same area as the old man with hearing aids who was the poetry aisle blocker. I sip my coffee and note how the book barn has gone down hill a bit, no café or hot food, its clear they are struggling. With coffee drunk we go back to the pay desk and find they have the book token website up and running. I present my token and pay the additional pound I owe. I remind the woman that we need to pay for two coffees and she gives us to then free as compensation for havining to wait to pay. We load up the car and I drive home.

I’m tired once I get home and need to rest. The evening arrives and I watch the dying embers of the Commonwealth games before continuing to watch series two of Criminal Record another series that is siding into the realms of desperation script writing. Its always disheartening when you can predict the plot line, who is going to tragically die, who is going to screw who and who will be in the next series, if there is one, more flawed, guilt ridden or psychopathic than before thus posing the scripty writers the impossible task of writing something believable about a bunch of characters that you lost patience with a long time ago. It all makes Midsomer Murders really appreciated, normal policemen, how refreshing. I take my night meds and go to bed knowing that tomorrow I need to rest and begin to pack for the rapidly approaching Spa break.

Sunday, I wake up knackered and feeling off. I have some toast and take my meds. On checking my blog I find that I have not finished Fridays and not published it. I set about finishing Fridays and get it out there published. With that done I start on the weekend blog pages. It takes me till early afternoon to catch up. My afternoon is spent reading some of my new poetry books and napping whilst making a mental list of the things I am going to pack for the Spa break.

The evening is food and a lot of TV films and the final episodes of Criminal Record. Of course it ends with repacking the dishwasher and taking my night meds and going off to bed. Tomorrow is a Spa day.

Friday and my partner brings me hot water before going to the gym. I check my messages and social media before getting up and showering. I am feeling fatigued and the effort of showering takes a lot of energy out of me. As I sit and recover I fold my fresh washing and get my clothes put away. I dress and move onto breakfast and the post that is waiting for me. To my surprise there is a bill reminder for the boiler service. The next letter I open is the invoice that I am being chased for. Of course I get on it and pay the outstanding invoice and move on to ordering an Hippo bag so that we can clear the growing collection of obsolete garden items and bags of old text books. In the background the Commonwealth games plays on as the decathletes slug it out on the pole vault and the mixed 4 x 400 relay teams race off for a place in the finals. I draft the blog until my partner returns from the gym.

In the afternoon there is an excursion to the garden centre for a bacon roll and the purchase of three more plants. On our return I gather together my gardening tools and plant the new plants into three pots on the front drive. They are draught resistant perennials. The plan is to get them established in large pots so they form a “colony” and over winter them. In spring they will get transplanted in to the garden, mostly at the front. Its all part of the strategy to reduce as much of the work in the garden as possible and to maximize draught resistant plants.

The evening rolls round with the Commonwealth games and ultimately episodes of Criminal Record before taking my meds and getting off to bed. Nothing from the Cancer nurse who rang me yesterday and said she would come back to me.

Wednesday and I continue on my reduced steroids regime. I am not sure if I am experiencing any change or any adrenal insufficiency at the moment, all I can do is continue to monitor myself. The day is slow, by which I mean I have lazed a great deal and little of anything else. I did build a support structure for the tomato plants that were in danger of keeling over under the weight of their own foliage. My sunflowers have also been provided with additional long support canes. However my sunflowers are a source of disappointment and embarrassment. I have grown them believing that they are purple teddy bear sunflowers. I bought the seeds labelled as this over the internet. It turns out there is no such thing as a purple sunflower! I’ve been duped by Photoshoped pictures. I checked the purpleness of my sunflowers when I noticed that one of them was beginning to flower and that the colour was yellow. On investigation I find that sunflowers are genetically incapable of producing purple pigmentation. The question is whether I go into revenge mode and track down the bastard that duped me. I suspect I will not unless I see them being advertised again. I am unlikely to be trusting anything on my news feed again or indeed Esty.

So the rest of my time is filed with Commonwealth games and the final episode of STEAL. Of course the broken people somehow survive and walk off into the sunset with twenty million in bitcoin. I take my reduced night meds and go to bed.

Thursday starts with hot water and my usual check of the social media and my messages. Amongst my messages is one that includes a link to Billie Whitelaw performing Samuel Becket’s Not I. It is an amazing fifteen minute piece where all that can be seen is a mouth delivering Becketts words. Its a very strange experience watching just a mouth deliver a stream of consciousness monologue. It is a tour de force and an unexpected way to start a day.

I get up and have breakfast with my morning meds while drafting yesterdays and todays blog. Amazon deliver my new swim joggers to go with my new swim googles. These are a luxury I have given myself to take away on the upcoming Spa break. My partner returns from the physio as I continue with my drafting and watching the Commonwealth Games. Out of the blue the specialist prostate cancer nurse rings me, apparently prompted by the woman who last reviewed me. We chatted for a while and I explained what I was doing with the reduction of my steroids. She was unaware of any steroid reduction policy. We discussed my discomfort at reducing so quickly by 50% and would prefer to reduce slowly by 1mg at a time, especially at this level. She under took to find out if the tablets come in variable dosages and to talk to the consultant pharmacist about tapering off protocols and policies. The call ends and I return to watching the Commonwealth games and see our heavy weight woman weight lifter win gold with a new games record.

Eventually I find my way into the garden and the swing seat where I watch the clouds in the sky and drift around for a while until my partner returns from seeing her mother in the care home. We chat for a while and then I water the tomato plants and the sunflowers as my partner makes tea. I bring my washing in and return to drafting the blog before eating tea and settling down to watch the current drama series. The evening ends with night meds and bed.

Monday and I wake after a restless night. A brief breakfast and morning meds before I make contact with Appliance Man. Our dishwasher is full of water and clearly is not well, hence the call to Appliance Man. Fortunately he remembers Daisy Dishwasher as he has mended her before. He will come to us on Tuesday morning and will work his magic. It my eldest daughters birthday so when she emerges there are birthday greetings to do. The morning goes by with some chores and some writing until it comes time to go and have a celebratory late lunch at Pesto.

Pesto at 2pm is quiet and almost empty, an ideal eating space. The service is also quick which is a bonus. Its really relaxing to be able to eat good food in a quiet space and watch the few other dining families. There is time to chat and observe life and to reminisce. I was intrigued by a dish that was served in a twist of brown paper. Despite trying I was not able to see what was inside and in the end asked the waitress what was in the brown parcels. Calamari was the answer. After the meal we head home for presents and card time, with more singing of Happy Birthday.

The evening slides into the Commonwealth Games athletics. Its the boring early rounds so its soon on to the current drama series STEAL. Like all of the recent dramas it is beginning to get beyond what the suspension of reality can stand. Of course every major character is flawed in some way or other. In this case the bright policeman is a gambling addict owing ninety thousand, as they all do. The main woman has an alcoholic mental health nurse mother and a childhood that goes with it, plus of course her career was not what she thought her psychology degree would get her. MI5 officers are just a bunch of abducting and murdering thugs who just threaten everyone with the greater good and being able to kill people and get away with it. As for the villain there is of course the paranoid one who resorts to killing members of the gang having been worked on by the hostage that the gang has taken, where any self respecting gang would have topped him straight off as a lability. I suppose all of this is meant to give depth and dramatic effect but after a while it just becomes unbelievable and just not credible. Anyway there was some of this then medication and bed. However before bed there was bailing out the water filled dishwasher and hand washing the evenings dishes. How the ordinary can be a pain in the arse when tired. For those wondering what happened to my Japanese kneeling women who had to have her head stuck back on, I am pleased to say that she healed nicely and was returned to her spot in the garden in the morning. The operation was a success.

Tuesday and I struggle to get up early but I manage to be up and dressed by the time Appliance Man arrives and sets to work on Daisy Dishwasher. My partner and my eldest daughter go off to the gym. I oversee Appliance Man who tends to our machine and declares Daisy fit for further duty. So there is a quick exchange of real money and he leaves. I like to pay for these things in cash, I wonder if the recipient ever declares it or if there is a moral battle that takes place or if they just go “Fuck the tax man” and stick it in their pocket. I think I just like giving people the option. I always pay for petrol with cash ever since my card got cloned at my local petrol station.

Appliance Man leaves with his cash and I check my emails to find that the draft of The Cancer Years: The Rechallenge has arrived. I check it, add bits to it and and then send it onto the person who has agreed to write the Forward for it. My partner and eldest daughter return from the gym and we all go out to the café in the local garden centre for a bacon roll and a decaf coffee. The garden centre looks like it has been hit by a plague of locusts. The benches are bare save for a few straggly bedding plants as if autumn has come early this year and in many senses it has. The fields are all harvested, the trailers are stacked full of hay bails and other crops are struggling to reach full maturity. There is a lot of stunted sweet corn. I note that farmers o longer burn off their fields anymore. If they did it now there would be wild fires everywhere. We return home and I settle down to draft the blog while listening to the choral promenade concert. Our return also finds the confidential waste bags that we ordered sitting waiting for us, so over the next few days my eldest daughter and I will be filling them ready for collecting and destruction. I

I feed myself in the evening as my partner is out with a friend dining. There is athletics to watch, a guitar to play and I still have a pile of unread books to read. Of course today os the first day that I reduce my steroid intake, I have loaded my dosettes for the next two weeks with only one 2.5mg of steroid each day. Its a big reduction in relation to the 5mg prescribed. It should be slower. It should be reduced by 1mg a day for some weeks in order for my adrenal system to re-establish itself. I should be monitored for adrenal insufficiency and I should also be educated about the signs of adrenal insufficiency. As far as I can make out I should be watching for muscle weakness. The nhs Lanakshire policy states: “As steroid dosage is reduced/weaned below 5 mg daily prednisolone
Symptoms of steroid withdrawal may develop including weakness, anorexia,
dizziness, nausea, weight loss, malaise or lethargy.” Other sources suggest insomnia may occur.

Here is what one article says about Prednisolone tapering.

Does prednisone shut down your natural cortisol production? Here’s the precise answer

By Sina Hartung, MMSC-BMI, Harvard Medical SchoolReviewed by Eureka Health Medical Group

Published: August 4, 2025Updated: August 4, 2025

Key Takeaways

Prednisone replaces the cortisol your adrenal glands normally make. A daily dose as low as 5 mg for more than two weeks signals the brain to turn off ACTH secretion, so adrenal cortisol output drops within days. Up to 60 % of patients on ≥7.5 mg for three weeks develop measurable hypothalamic-pituitary-adrenal (HPA) suppression, which can persist for months after stopping unless the drug is tapered.

How exactly does prednisone change my body’s cortisol production today?

Prednisone is converted in the liver to prednisolone, which binds glucocorticoid receptors with greater strength than your own cortisol. The brain senses this and immediately lowers ACTH release, so the adrenal glands reduce output within 24 hours.

• Brain feedback loops react within hoursACTH concentrations fall by about 80 % six hours after a single 20 mg prednisone dose.
• 5 mg daily can still suppress the adrenalsMRI studies show adrenal gland shrinkage in patients taking as little as 5 mg for 14 days.
• Even alternate-day therapy is not risk-freeHPA axis testing finds 27 % suppression in people on 15 mg every other day for eight weeks.
• One week of 60 mg daily slashes serum cortisolIn healthy adults given 60 mg prednisone each day, serum cortisol fell sharply in a dose- and time-dependent fashion, reaching only a small fraction of baseline after seven days. (BMC)
• Just 5 mg for a few weeks dims the morning peakAn expert review notes that doses as low as 5 mg prednisone daily taken for “more than a few weeks” can significantly suppress the body’s normal early-morning cortisol surge. (DrOracle)

Sources

Which warning signs tell me prednisone has suppressed my cortisol too far?

Because blood cortisol is low, stress tolerance falls. Certain symptoms require prompt medical review.

• Morning fatigue that feels worse than before treatmentIn surveys, 52 % of patients with adrenal suppression describe profound morning weakness.
• Low blood pressure when standingSystolic drops of ≥20 mm Hg suggest inadequate cortisol to maintain vascular tone.
• Nausea, abdominal pain, or fever during stressThese may herald an adrenal crisis, a medical emergency with a 6 % hospital mortality rate.
• Persistent hyponatremia on routine labsSerum sodium under 135 mmol/L occurs in one-third of suppressed patients.
• Therapy longer than three weeks can already depress the HPA axisClinical reviews note that courses of prednisone taken for more than 3 weeks are enough to measurably lower your own morning cortisol, so any dose changes should be tapered rather than stopped suddenly. (Healthline)
• Adrenal-insufficiency risk may persist up to a year after stopping steroidsHospital guidance warns that recovery of the adrenal glands can take as long as 12 months after discontinuing prednisolone, during which time extra “stress-dose” steroids may be needed for illness, surgery or trauma. (UHP)

Sources

Why do adrenal glands shrink during longer prednisone courses?

Long-term ACTH deprivation causes atrophy of the adrenal cortex, just like an unused muscle loses bulk. Recovery depends on both treatment length and dose.

• Cellular atrophy sets in after three weeksHistology shows cortical cell apoptosis after 21 days of pharmacologic glucocorticoid exposure.
• Higher doses delay recoveryPatients on >20 mg for three months average 6–9 months before ACTH and cortisol normalize.
• Children recover faster than adultsPediatric data reveal average HPA recovery in 8 weeks versus 20 weeks in adults.
• Quote from Sina Hartung, MMSC-BMI“Adrenal involution is a predictable physiologic response—what varies is how quickly we give the gland a chance to regrow by tapering doses responsibly.”
• Ultrasound confirms 13–42 % adrenal shrinkage after 5 monthsIn Beagle dogs given high-dose prednisolone for 150 days, the maximal caudal-pole diameter of both adrenal glands fell by 13–42 %, then partially rebounded by day 211 once dosing stopped. (BMC Vet Res)
• Systemic steroids reach 1–3 % of adults, magnifying atrophy riskA tapering primer notes that 1–3 % of the adult population receives glucocorticoid prescriptions, often for prolonged courses, exposing millions to potential HPA-axis suppression and adrenal involution. (NIH)

Sources

How can I taper prednisone safely to let my adrenal glands recover?

Tapering reduces the dose gradually, allowing ACTH pulses to restart without triggering inflammation withdrawal.

• Reduce by 10 % of the current dose every 1–2 weeks after you reach 20 mgClinical trials find this schedule keeps relapse rates below 5 % in most autoimmune conditions.
• Switch to morning dosing when possibleGiving prednisone at 7 am aligns with the natural cortisol peak and lessens night-time suppression.
• Use physiologic hydrocortisone during the final stretchPatients shifted to 10 mg hydrocortisone split doses experienced smoother withdrawal in 70 % of cases.
• Quote from the team at Eureka Health“A slow taper is an investment; every extra week on a lower dose buys back months of adrenal function later.”
• HPA axis recovery may take up to 12 months after stopping long-term steroidsLong-term users had documented suppression lasting “months to over a year,” so morning cortisol or ACTH stimulation tests are repeated before declaring full recovery. (DrOracle)
• High-dose courses (>20 mg for >8 weeks) should fall by 2.5–5 mg every 2–4 weeks once you reach 20 mgEndocrine taper guidelines advise stepping down to 5–10 mg at this slower pace and then by 1 mg intervals to minimise adrenal crisis risk. (EndoConsult)

Sources

Which lab tests and medications matter when monitoring adrenal suppression?

Targeted labs and adjunct drugs help clinicians judge whether tapering is safe and whether substitution is needed.

Full adrenal recovery may take up to a year after long-term steroidsEndogenous cortisol production can remain impaired for 3–12 months after stopping high-dose prednisone, so early testing may underestimate ongoing suppression. (DrOracle)

8 am serum cortisol under 5 µg/dL signals high riskValues below this threshold predicted failed rapid taper in 92 % of patients.

ACTH stimulation test confirms recoveryAn increase to >18 µg/dL 30 minutes after 250 µg cosyntropin means the axis is competent.

Fludrocortisone usually not requiredPure glucocorticoid withdrawal rarely causes mineralocorticoid deficiency, so adding fludrocortisone is reserved for marked hypotension.

Methylprednisolone may allow lower total doseIts higher receptor affinity means a 4 mg dose matches 5 mg of prednisone, reducing cumulative exposure.

Hold glucocorticoids before ACTH test to avoid false reassuranceDiscontinuing prednisone at least 24–48 hours before cosyntropin minimizes assay interference and prevents falsely normal stimulated cortisol values. (DrOracle)

Having read this you can see why I ignored the person who did my oncology review and told me to cut my dose by half for a week (at first) and to two weeks when I challenged it and then stop it altogether! I have in fact cut my dose in half and will continue that until at least the next oncology review in September unless I experience adrenal insufficiency. I suspect the inclusion of all this stuff is all about my anxiety of taking control of my steroid tapering in the face if what I perceive of as ignorance of my oncology team. when al is said and done, today I have started a process that is important.

I draft the blog and ponder on something I read on one of my news feeds. It was an article on how to know if your wife is “quietly quitting” your marriage. Their were five tell tale signs the first of which was, and I quote, “She stops laughing at your jokes”. I am amazed that this is first on the list but I’m more amazed that this is something I should be doing. Really is this my role, make her laugh, be the entertainer, the monkey on the street organ. I say I say why did the chicken cross the road? According to this article I’m screwed. Onward nevertheless. Two priest were stopped by police. The policeman says I’m looking for child molesters. The priest look at each other and say “we will do it”. You can blame David Sedaris for that one.

Sunday and its a lazy morning and one that continues to prompt me to ask “what is this?”

549

I feel becalmed,
drifting in circles,
directionless.
In this state
I see the stars rotate
and I an ever fixed mark,.
Around the ocean,
the sea life 
with its tides and currents.
Atop of it
I bob about
drifting.
Is this
what it is.

                                            549 26-07-2026

The day drifts between some clearing up and some mending. Firstly there is the soft toy tigers eye to stick back in, and then one of my Japanese kneeling women from the garden lost her head when my partner tripped over her. So I called on all my mending skills to stick the head back on and of course gaffer tape it to keep it in place until set. More trying was the time spent trying to mend my phone. The screen went black and I went into serious problem solving. Eventually I get the screen back up and running and change my display settings, it might last, it might not.

The rest of the day goes by with Commonwealth Games and in the evening the discovery of a new and reasonable drama series called Steal. I get to the end of the day, draft a brief blog, take my meds and go to bed. Tomorrow is my eldest daughter’s birthday so there will be cake and lunchtime treats at our local Pesto.

Saturday and its up for breakfast with my partner on the patio. With food and morning meds out of the way my partner and I go to the garden centre butchers to buy meats and other goodies to eat in the warm weather that is coming. Once home I sort out some things for my eldest daughters birthday on Monday. The afternoon starts with a shared lunch with my partner taken on the swing seat in the garden. A lazy time before I return to the house and prepare the cottage pie evening meal.

A friend sends me a picture of the tattoo she has had done today to celebrate her and her partners fortieth wedding anniversary. It is a really good Japanese inspired tattoo. Her partner also has a similar one. I spend my evening watching the Commonwealth Games and an interesting western where everyone apart from the two children die. I draft the blog and think abut whether I am any further forward in thinking about what stage of my cancer journey is at. I still do not really know so the “what is this?” question is still very much a live question for me. I take my meds and go to bed.