Doug's Hearing

I took Doug to his ENT appointment at UTSW on Monday.
He had a repeat audiogram. This test showed his hearing is better in his left ear - about 15 db. His left ear is the one we are trying to get back to normal. Not all good news however, the test also showed the hearing in the right ear (the one that has always been bad) has decreased about 10db.

He will follow-up with with another audiogram in 3 months (Feb 2009).

Tuesday, Doug saw Dr Cohen (the rhuematologist who treats the Autoimmune Inner Ear Disorder).

Questions -Answers:

1) Prednisone - 60 mg (30 mg in am and 30mg in pm)
Question: When can we start the taper off prednisone due to the side effects
(fatigue, weakness, extreme acne, hunger, insomnia, mouth ulcers etc)
Answer: A taper schedule has been established. Yes, I will give you a prescription for 100 so that you will have enough for a month.

2) Side Effects (fatigue, weakness, extreme acne, hunger, insomnia, mouth ulcers etc...)
Question: I can barely function most days due to the fatigue, weakness and inability to sleep.
Answer: Yes , I will give you a prescription for Ambien to help you sleep...make sure you can sleep 8 hours. Yes, I will give you a prescription for Nystantin Oral Suspension for the mouth ulcers...due to oral thrush (yeast infection for those non-medical people) Yes, you should take Citrical with Vit D due to potential of bone loss of being on both Prednisone and Methotrexate.

3) Methotrexate - 10pills taken all at once, once a week, typically on Monday.
Question: Can the methotrexate be taken sooner than the recommended 7 days as when this medication is taken, the hearing improves. Doug had taken the medication at 6days, then 5 days, and again in another 5 days.
Answer: Dr Cohen would rather Doug did not take methotrexate more often but take 12 days at one time instead. Yes, I'll give you a prescription for the increase.

4) Folic Acid - taken daily except for the day he takes Methotrexate. Folic acid is necessary for the production and maintenance of new cells, while Methotrexate inhibits the metabolism of folic acid.
Question: Do I need more folic acid if increasing methotrexate.
Answer: Yes, I'll give you a prescription.

5) Travel - Amsterdam trip 11/30-12/12
Question: Can I travel?
What if I get sick due to being exposed to so many people on a plane/hotel...traveling overseas.
Answer: No you cannot travel. If you get sick (runny nose, fever, flu like symptoms) Doug is supposed to call Dr Cohen immediately. This is an immune deficiency disorder, which has been extremely made even more deficient due to the Methotrexate. Yes, he was given a doctor's note for DeLaRue saying that he needs to avoid travel.

6) Follow-up / Closing Remarks.
The ear injection did not help.
Prednisone is causing too many side effects, Doug is happy to taper this medication.
Medications for the side effects were prescribed by Dr Cohen.
Methotrexate seems to be working, Dr Cohen increase the dose and has add more folic acid.
Dr Cohen and Doug are both pleased with the hearing increase in left ear.
See Dr Cohen again in 3 weeks.
STAY HOME & DON'T GET SICK!