Page "learned" Paragraph 225

Because of increasing anemia, triamcinolone, 8 mg. daily, was started on Feb. 23, 1958, and was continued until July, 1958.

In September, 1958, the patient developed generalized weakness and fatigue which was concurrent with exacerbation of his anemia ; ;

the hemoglobin was 10.6 gm..

In an attempt to reverse the downhill trend by stimulating the bone marrow and controlling any hemolytic component, triamcinolone, 16 mg. daily, was begun on Sept. 26, 1958, and continued until Feb. 18, 1959.

At first the patient felt stronger, and the hemoglobin rose to 13.8 gm., but on Oct. 20, 1958, he complained of `` caving in '' in his knees.

By Nov. 8, 1958, weakness, specifically involving the pelvic and thigh musculature, was pronounced, and a common complaint was `` difficulty in stepping up on to curbs ''.

Prednisone, 30 mg. daily, was substituted for triamcinolone from Nov. 22 until Dec. 1, 1958, without any improvement in the weakness.

Serum potassium at this time was 3.8 mEq. per liter, and the hemoglobin was 13.9 gm. By Dec. 1, 1958, the weakness in the pelvic and quadriceps muscle groups was appreciably worse, and it became difficult for the patient to rise unaided from a sitting or reclining position.

Triamcinolone, 16 mg. daily, was resumed and maintained until Feb. 18, 1959.

Chlorothiazide was omitted for a 2-week period, but there was no change in the muscle weakness.