Buckets and Streams: Learning the Cortisol Pump

The cortisol pump is changing lives, both patients and doctors are taking notice. As more people switch to cortisol pumping, I see more and more questions and confusion about programming the pump’s basal rates.

Cortisol Pumping requires a whole new way of thinking about your steroid dosing. Whatever dosing schedule or amount you were using with pills does not simply translate into the pump. The continuous method of delivery is so different you can’t really think of it in “doses” anymore. With cortisol pumping you program a set amount of units per hour in time blocks of your choosing, and your steroid is infused at that rate in continuous, tiny, drips. Your rates build on each other. With oral steroids, each pill is a separate dose. The dose you took at 7am doesn’t have any influence on the dose you take at noon, not so with the cortisol pump. Each delivery rate on each time block you program will affect the others. It’s an art really, knowing which times need which rates. Titrating your basal program is sort of like carving a sculpture. The sculpture you’re creating is your perfect cortisol peak. You mess up one part, and the whole sculpture is junk, but when you get it right, its a thing of beauty.

Another analogy I’ve been using a lot lately is about buckets and streams.

Wait, what does that have to do with cortisol pumping?

Okay, pretend you’re a fish, and you’re flopping around on the ground. Think of your pills as buckets of water (cortisol) that just get dumped on you from time to time throughout the day. It’s enough to keep the fish alive, but that’s no way for a fish to live. The pump is more like a stream. It keeps flowing and the water level gradually rises and lowers based on your basal program. You could, in theory, measure all the water in that stream. You could put it in buckets and keep dumping them on the fish as it flops in the dry creek bed, but its not the same. The fish is still going to do much better living in the stream.

What I’m saying is, buckets and the stream are not equal, and neither are pills and the pump. I think new pumpers sometimes set themselves up for frustration when they apply conventional wisdom of oral steroids to cortisol pumping.

Also published on Adrenal Alternatives Foundation

UPDATE: Please check out thecortisolpump.com a comprehensive and research based guide to cortisol pumping!