DEAR DR. ROACH: I am an 85-year-old woman. About seven years ago, I was diagnosed with Lyme disease and put on prednisone. I have been weaned off a few times, but I always got sick and had to go back on it. I’m told I now have polymyalgia rheumatica. I was told that while off the prednisone, my adrenal gland wasn’t working.

My doctor doesn’t want to try to take me off the medication again, but I think it’s causing more problems. Will I ever be able to come off of it? — E.M.

ANSWER: I am very confused about your treatment of prednisone for Lyme disease. Prednisone suppresses the immune system and should not be used for Lyme disease, although rare complications of Lyme disease, such as a nerve palsy, sometimes are treated with prednisone.

I suspect you may have had polymyalgia rheumatica for a long time. As for your other diagnosis, the blood tests for Lyme disease are not perfect, and if you never had the rash of Lyme disease, it’s possible you never had Lyme disease at all.

Polymyalgia rheumatica is an inflammatory disorder of unclear cause that has symptoms of pain and stiffness, especially around the shoulders and neck, and especially in the morning. It is more common in older women. It is treated with prednisone, a synthetic steroid similar to cortisone, and sometimes it can take years before it can be stopped. It needs to be tapered very, very slowly, especially since your adrenal glands (which make cortisone) aren’t working.

Most often, people are able to come off of prednisone, and it’s important to do so because prednisone does indeed have many long-term side effects, including diabetes, high blood pressure, risk for infection and osteoporosis. It might be worthwhile to consult an endocrinologist.

DEAR DR. ROACH: My 51-year-old son developed a case of shingles, which left the right side of his face paralyzed. It affected his eye and caused hearing loss. His doctor told my son that this is called Ramsay Hunt syndrome. They could not say when the facial nerve will be back to normal. My son has been living with this paralyzed facial nerve for eight months, with no improvement. Can you give me any information regarding this virus? — J.E.

ANSWER: I’m afraid I don’t have any good news. Ramsay Hunt syndrome, also called Herpes zoster oticus, is a complication of shingles when it affects the facial and auditory nerves. Early treatment (within three days of the onset of rash, but preferably as soon as possible) reduces the risk of the complications you describe. Facial paralysis is usually permanent if it hasn’t resolved by three months. Hearing loss also often is permanent. Some people also experience dizziness and vertigo.

The disease can be prevented by the shingles vaccine, which is recommended for everyone over 60.

The booklet on shingles explains this common condition in greater detail. Readers can order a copy by writing: Dr. Roach — No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: On the news, they describe an accident victim as “critical” or “stable” or some such expression. What’s the difference between “critical” and “grave”? — D.D.

ANSWER: In the hospital, the admitting physician makes her or his best guess about the patient’s prognosis. “Critical” is usually used for someone in the intensive-care unit, with a high risk of death. “Grave” means the patient is expected to die. However, doctors certainly aren’t perfect at predicting.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

(c) 2013 North America Syndicate Inc.

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