Let’s talk immunocompromised vs immunosupressed
Medicine

Let’s talk immunocompromised vs immunosupressed

Pull up a chair. Gather round the table. Grab your favorite salty snack (TEAM OLIVE REPRESENT) because this needs to be addressed, especially considering the fact that the CDC has recently authorized the 3rd shot for immunocompromised people in the US. You can find their recommendation here.

Y’all got your salty snacks ready?

We are immunocompromised.

The most common retort to this factual statement is “But we don’t take high enough doses of steroids! We just take what our body would naturally produce.”

Yes, that is very true. That is why I use the term immunocompromised and not immunosupressed.

I like to view the difference between the two as such…

Immunosupressed

Think of immunosupressed like a heavy weight pushing down on your immune system.

Can the immune system work? Or is there something preventing it, something pushing back against it, something suppressing it?

Immunocompromised

Think of immunocompromised like a broken bridge over water. You better bring some extra planks if you would like to cross that path without getting wet.

Will the immune system work? Or is there some external action that needs to be taken in order to help it? Can we trust it to work without intervention? Or is it compromised?

We are immunocompromised.

Long-term corticosteroid use (i.e. our community) is commonly referred to as “high risk” due to being immunocompromised.

Having a weakened immune system can make you more likely to get severely ill from COVID-19. Many conditions and treatments can cause a person to be immunocompromised or have a weakened immune system. Primary immunodeficiency is caused by genetic defects that can be inherited. Prolonged use of corticosteroids or other immune weakening medicines can lead to secondary or acquired immunodeficiency.

From the CDC

This is not because of the amount of steroids we take. This is because we take a medicine that is so integral to a properly functioning immune system. When sick, we must physically intervene in order for our body to not send us into a crisis (which can, and has been deadly within our community). The difficult comes in determining when we are sick.

About 3 percent of Americans have weakened immune systems for a variety of reasons, from a history of cancer to the use of certain medications such as steroids.

From the New York Times

I will openly admit that we fall into this gray area. Technically, our maintenance dose is under the 20 mg of prednisone a day (equivalent of 80 mg of hydrocortisone) that impedes (suppresses) the immune system. If we are well managed on our maintenance dose of corticosteroids, we should be fine. BUT (and this is the huge caveat), none of this matters when we are sick.

Our compromised immune system is why we have “sick day rules.”

Don’t believe me? This is why we have “sick day rules” from organizations such as the National Adrenal Disease Foundation, Addison’s Disease Self Help Group, and CAHISUS (to just name a few).

Several years ago, CAHISUS launched their “more@4” campaign when sick. The premise was that when you are sick and double your dose, be sure to take an additional doubled morning dose at 4am.

I also like to have my sick day dosing rules follow the phrase “double dose, double frequency.” You take each of your normal dose twice, but spaced out throughout the day. Example:

  • 15 mg @ 8am
  • 10 mg @ 12pm
  • 5 mg @ 4pm

Becomes…

  • 15 mg @ 8am
  • 15 mg @ 10am
  • 10 mg @ 12pm
  • 10 mg @ 2pm
  • 5 mg @ 4pm
  • 5 mg @ 6pm

And if you’re really sick, 30 mg @ 4am. The advice is slightly different when you are on the cortisol pump, and it can be found here.

Conclusion

That was a bit of a tangent to support the fact that our immune system is compromised. We are at a higher risk during an illness because the responsibility falls on us to increase our medicine, monitor our symptoms, and ensure we don’t crash towards an adrenal crisis. Or if we are crashing towards an adrenal crisis, we seek proper medical intervention rapidly. We cannot just “sleep off” a fever or not worry about vomiting. Healthy immune systems can.

We are immunocompromised.

My doctor recommended that I seek out the third shot. I will follow her recommendation and get it.

I would like to remain Clearly Alive.

Amber Nicole is Clearly Alive

PS – To those living outside of the US that do not have as good of access to these vaccines, I am so sorry. My heart hurts for y’all. I hate it that we have such easy access to them in the US, and yet we have an embarrassingly large amount of our population refusing them due to misinformation campaigns.

It’s not fair.

Please stay safe.