Getting a cold, for anyone, isn’t fun. You feel off, out of sorts, grotty and just generally rubbish. Having a cold for me is slightly more complicated. I still have all my usual adrenal insufficiency symptoms but also the ‘normal’ illness ones on top. I also have asthma, which can add to the problem.
When a person who doesn’t have adrenal insufficiency has a cold, their bodies mobilise lots of resources to help fight the illness. One of the things the body does is it starts to produce more of the stress hormone, cortisol, made by the adrenal glands. Because people who have adrenal insufficiency don’t make any or enough of this hormone, we have to replace what the body needs with medication. This is where we follow our ‘sick day rules’, guidelines as to what to do when we’ve got an illness, and we’d likely stress dose (double our dose) of the replacement. The tricky bit is you have to guess a bit- it’s a bit like being told you’ve got to make dinner for guests coming over but it could be for 2 people or 20 and you’re not going to know how many until they all show up. If you over cater, you’ve got food left over for days on end and have to find a way of getting rid of it somehow, or if you under cater people will go hungry. There’s no way of checking the amount of cortisol in your blood, even if you see a doctor (unless you’re in a&e), which is why it makes it a difficult illness to manage.
If you under-cater for adrenal insufficiency, you put yourself at risk of adrenal crisis, which can be life-threatening. But there are things you can do which help you ‘guess’ what to do. The challenge can be trying to do maths and logic when you’re feeling fuzzy because you’re sick. I use my phone and get my husband to help me with it. This is how my morning started today:
I check my Blood Pressure. If my BP is particularly high, this would be an indication I might need to stress dose. My BP goes higher if I’m heading for crisis and it goes down if I increase my Hydrocortisone.
I check my Heart Rate. The same as BP- a high Heart Rate means I might need to change my Hydrocortisone.
I keep an eye on my temperature. An increase of 1 degree C means I have to double my daily doses of Hydrocortisone. If it reaches 39 I can triple my dose and 40 means I have to go to hospital for IV hydrocortisone.
I check my Peak Flow. This is actually for asthma but is useful. Today, my heart rate, BP and temp are all slightly higher than usual but are still fine, so not requiring an increase in Hydrocortisone. My peak flow, on the other hand, has dropped by 80 (also still fine), which means my cold is bothering my asthma a bit but my adrenal insufficiency is fine at the moment.
I keep an eye on symptoms. A cold makes you feel off anyway, but I look out for any low-cortisol symptoms which might start appearing and then address them if I need to. At the moment everything feels ‘normal’ for me, so it’s fine. I also avoid any extra ‘stresses’ I don’t need to address today, because it would be like poking a bear with a stick!
Some people can get a bit obsessed with numbers and figures, but I tend to check my BP etc if I feel worse so something might need changing, rather than checking them all the time and getting paranoid about it.
The downside of getting a cold is that I already take cocodamol four times a day, so can’t take any cold products with paracetamol in (like lemsip), and my asthma means I can’t take anything with decongestant. So plenty of tea for me instead!