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.