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Steroid Side Effects: How to Reduce Corticosteroid Side Effects

Saturday, January 12, 2013


Steroid Side Effects: How to Reduce Corticosteroid Side Effects





How to Reduce Drug Side Effects





Theodore R. Fields, MD, FACP



Attending Physician, Hospital for Special Surgery
Professor of Clinical Medicine, Weill Cornell Medical College





Corticosteroids, often called just steroids, are anti-inflammatory drugs. Most are synthetic forms of cortisone, a hormone naturally made in your adrenal glands. These include: prednisone (sold under many brand names, such as Deltasone and Sterapred), methylprednisolone (Medrol), prednisolone (Prelone, Pediapred), dexamethasone (Decadron, Hexadrol), and hydrocortisone (Acticort, Cortef).

Note: This article and the information below do not refer to "androgenic" or "anabolic" steroids, which are properly used only to treat a deficiency of sex hormones in men, but are often abused for muscle-building. They share some chemical similarities but act quite differently - and are not used in treating inflammation.

Corticosteroids come in many forms; these medications can be taken orally or injected (into a joint, into a muscle, or via intravenous infusion) - all of which may be used in inflammatory arthritis. They may also be applied to the skin as a cream or ointment, used for rashes including those of lupus, or inhaled, as is done for asthma and nasal allergy.

Understanding Corticosteroid Side Effects

Steroids are often extremely effective in relieving the pain and other symptoms of inflammatory arthritis and other forms of rheumatic disease. In some cases, they may be life-saving.

However, like all drugs, corticosteroids can have negative side effects. The degree to which they occur is usually dose-dependent: the higher the daily dose and the longer the period of time you take the drug, the greater your risk of side effects. If your dose is low, your risk of serious side effects is quite small, especially if you take the precautions below and any others your physician recommends. Sometimes your physician will arrange for you to take steroids on alternate days, which can decrease side effects.

Reading about these side effects may make you uncomfortable about taking steroids. While you should be fully aware of the risks before starting these medications, please be reassured that many people take steroids with minor or no side-effects. If any of the suggestions here is unclear, or seems irrelevant to you, please discuss it with your physician.

With long-term use, corticosteroids can result in the following side effects. But taking care of yourself as discussed below may reduce the risks.
1.Altered Response to Physical Stress
If you have taken steroids for more than two weeks, even if you then stop, your body may have a decreased ability to respond to physical stress - because your adrenal glands may not react as they should normally. This effect can last as long as a year after steroid discontinuation. If you have a surgical procedure, develop a new serious illness, or experience serious trauma (such as a car accident), your body may not be able to respond to the physical stress. Your blood pressure could drop, and other physical effects can occur, which at times can be very serious. This condition, called adrenal insufficiency, can be avoided by taking "stress dose steroids" should such illness or injury occur while you are taking steroids or during the year after you have been on them. The stress dose makes up for the sluggishness of your adrenal glands and provides your body with the steroid it needs to handle the physical stress. After a year off steroids, essentially all patients have been shown to have recovery of adrenal gland function and are able to respond properly to the physical stress of surgery or major illness.

Self-care tips:
If you are taking or have taken steroids in the past two years, be sure to tell your doctor or dentist. You may need a higher dose of steroid at times of major stress, such as surgery or very extensive dental work or serious infection. Discuss this possibility with the surgeon or dentist, etc., taking care of you at the time.


2.Steroid Withdrawal Syndrome
Rapid withdrawal of steroids, particularly if you have taken these medications for more than two weeks, may cause a syndrome that could include fatigue, joint pain, muscle stiffness, muscle tenderness, or fever. These symptoms could be hard to separate from those of your underlying disease. That's why steroids should never be withdrawn suddenly, but rather must be tapered slowly.

Self-care tips:
If you get symptoms like these when you taper your steroids, discuss them with your doctor. Your physician will work with you to continually try to taper your steroid dose, at a safe rate of decrease. On each visit, discuss with your physician whether it is possible to decrease your steroid dose. Even if you develop a side effect that requires stopping or rapidly reducing your steroid therapy, you still need to taper the dose-never stopping or decreasing the dose abruptly. The adverse effects of an abrupt decrease of steroid dose are often worse than the side effect you were concerned about.


3.Infection
Long-term steroids can suppress the protective role of your immune system and increase your risk of infection.

Self-care-tips:
Have a yearly flu shot as long as you are on steroids. If you are on steroids for a prolonged period of time, discuss with your doctor the possibility of getting Pneumovax - a vaccination against a certain type of pneumonia. Get immediate medical attention for signs of possible infection, such as high fever, productive cough, pain while passing urine, or large "boils" on the skin. If you have a history of tuberculosis, exposure to tuberculosis, or a positive skin test for tuberculosis, report this to your doctor.


4.Gastrointestinal Ulcers or Bleeding
Steroids may increase your risk of developing ulcers or gastrointestinal bleeding, especially if you take these medications along with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin.

Self-care tips:
Take the steroid medication after a full meal or with antacid as this may help reduce irritation of the stomach. If you experience frequent heartburn, discuss it with your doctor. An acid-reducing medicine may be prescribed. Call your doctor right away if you have any severe, persisting abdominal pain or black, tarry stools.


5.Osteoporosis
Thinning of the bones, with an increase in fracture risk, can be a result of steroid therapy. At the beginning or before the start of steroid therapy, many physicians ask their patients to have a bone density test, especially if the steroid dose is high. The test will be repeated in the future, to assess the effectiveness of measures to prevent bone loss.

Self-care tips: Take calcium supplements and milk products, like cheese or yogurt, to get your calcium intake to at least 1500 mg of calcium a day. It is essential that calcium be taken throughout steroid therapy, since one can lose 10-20% of bone mass within the first 6 months of corticosteroid therapy.
Take a multivitamin to be sure you get a minimum of 400 IU of vitamin D a day, because it helps the absorption of calcium. Some physicians recommend 800 IU of vitamin D a day.
Smoking and alcohol increase the risk of osteoporosis, so reduce or eliminate these habits as much as possible.
Weight-bearing exercises, such as walking, running, and dancing, are helpful in stabilizing bone mass. Exercise will also improve your balance and flexibility and decrease your risk of falls. Ask your doctor about which kinds of exercises are appropriate for you.
Other bone-preserving medications that your doctor may prescribe depending on your individual medical history include: alendronate (Fosamax), calcitonin (Miacalcin), raloxifene (Evista), and risedronate (Actonel). If women have hot flashes after menopause and are treated with estrogen, this will also help preserve bone density.
Assess your risk of falls. Thoroughly examine your home and correct situations that might result in a fall, such as eliminating scatter rugs and any obstacles between bedroom and bathroom, and installing night-lights.


6.Weight gain
Steroids affect your metabolism and how your body deposits fat. This can increase your appetite, leading to weight gain, and in particular lead to extra deposits of fat in your abdomen.

Self-care tips:
Watch your calories and exercise regularly to try to prevent excessive weight gain. But don't let weight gain damage your self-esteem. Know that the weight will come off - and your stomach return to its normal size - relatively easily in the six months to a year after you discontinue steroids.


7.Insomnia
Steroids may impair your ability to fall asleep, especially when they are taken in the evening.

Self-care tips:
Ask your physician if you can take your entire daily dose in the morning. Try to establish a regular hour for getting into bed and small rituals that help you prepare for sleep. Make sure your bedroom is cool and dark and free of noise. Learn relaxation exercises to help you get rid of the day's tension. If all of this doesn't work, ask your doctor about other options.


8.Mood Changes
Especially in doses over 30 milligrams per day, steroids can affect your moods. Some people can feel depressed, some extremely "up" and others go up and down for no apparent reason. You also may feel irritable or anxious.

Self-care tips:
Just being aware that steroids can do this sometimes makes it less of a problem, but this side effect at times requires that the steroid dosage be decreased. When the steroid dose is absolutely necessary, sometimes another medication can be added to help with the mood problem. Make sure your family and friends know about this possible side effect - so they will know what's going on if you respond in an unexpected way. Ideally, tell your family and friends about this possible side effect as you start the medication, so that they can help you detect any changes in your behavior.


9.Fluid Retention and Elevated Blood Pressure
Because cortisone is involved in regulating the body's balance of water, sodium, and other electrolytes, using these drugs can promote fluid retention and sometimes cause or worsen high blood pressure.

Self-care tips:
A low sodium diet helps reduce fluid accumulation and helps control blood pressure. Look for low-salt versions of typically high-salt foods, such as chips, soups, canned vegetables, salad dressings, and prepared foods. You'll get more salt "taste" if you salt food at the table rather than during cooking. Watch for swelling of your ankles, and report it to your doctor. Have your blood pressure checked regularly, especially if you have a history of hypertension. In some instances, your physician may prescribe diuretics (water pills) or other medications to manage these problems.


10.Elevated Blood Sugar:
Since cortisone is involved in maintaining normal levels of glucose (sugar) in the blood, long-term use may lead to elevated blood sugar or even diabetes.

Self-care tips:
See your doctor regularly for blood sugar checks while you are on steroids. If you already have diabetes, follow your prescribed medical and dietary regimen with care, including regular monitoring of your sugar levels, ideally both at home and in your physician's office.


11.Eye Problems:
Steroids can sometimes cause cataracts or glaucoma or worsen these conditions if they are already present.

Self-care tips:
If you have a history of glaucoma or cataract, tell your ophthalmologist if you are started on steroids because a special schedule of check-ups may be needed. If you develop any visual problems while on steroids, see your ophthalmologist promptly. Some steroid-caused blurred vision may be temporary and not serious. However, ophthalmology evaluation should always be arranged for any new visual symptoms while on steroids. Let your ophthalmologist decide if the symptom is serious.


12.Atherosclerosis (Hardening of the Arteries)
Steroids may increase the rate of development of atherosclerosis, which could increase your risk of heart disease. This risk is probably much more significant if steroids are taken for more than a year, and if taken in high dose.

Self-care tips:
Follow a heart-healthy lifestyle - a low-cholesterol and low-fat diet, regular exercise, and stress management. If you develop signs suggesting a heart problem, such as chest pain, get medical attention quickly. Make sure that your cholesterol and blood pressure have been checked and treated if necessary.


13.Aseptic Necrosis
Steroids, particularly at higher doses, can sometimes lead to a form of damage to bones called "aseptic necrosis" - the death of parts of bone. This can occur in a number of bones, but the bone at the hip joint is the most common.

Self-care tips:
Hip pain, especially if you have no hip arthritis, could be an early sign of this damage. Remember, your hip joint is actually in your groin - so that's where the pain would occur - not on your outer buttocks. If you develop groin pain, report it to your doctor immediately so tests can be done to detect the problem.

I have completed my final round of it this past tuesday. I plan on eating ress salt/healtier meal planning, rest, exercse and plenty of water. Everyone is different and can have side effects they did not mention like skin dryness. I will take care of my skin by drinking more water, moisturizing, I wil put on hold exfloiting until my skin heals and improves.

  
  Member Comments About This Blog Post:

JAH1977 1/26/2014 10:07AM

    I was on steroid therapy, both oral and IV, November and December 2013. As a nursing student, I tried to be mindful of calories, etc., during the therapy, but gained 20 pounds and had horrible muscle pain from withdrawals when I tapered off. Ive stopped gaining but haven't lost a pound in 5 weeks. I also developed ulcers and high blood pressure. My blood pressure and ulcers are improving, and I'm feeling better but I can not get the scale to move. I'm carefully pre planning my food every morning and exercising daily. I'm just wondering if you experienced weight gain and how your journey turned out. I know every day that I don't gain more is a blessing and I won't give up. Any perspective is appreciated, though.

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GETSALONG 1/12/2013 9:58PM

  emoticon Very helpful, i have experienced many of these side effects and didn't know to watch for them... it's scary, for sure!

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DAY 43 CHOOSE TO, NOT HAVE TO

Wednesday, January 09, 2013

OVER WHELMED WITH WHAT YOU HAVE TO DO??? I SEE YOUR HANDS!!

THE WORDS HAVE "TO DO" ARE USED A LOT. IN REALITY WE DON'T LIKE TO BE TOLD YOU HAVE TO DO THINGS emoticon emoticon .

BUT THE PHRASES YOU HAVE TO CAN MAKE YOU REBEL AND DO THE OPPOSITE. emoticon emoticon . SIDE NOTE: HERE I CALL IT THE NEGATIVES. YOU CAN CALL IT WHAT YOU LIKE.

CHANGE YOUR WORDS. TRUTH IS YOU DO NOT HAVE TO ANYTHING. YOU GO TO WORK, CLEAN HOUSE BECAUSE IT IS A CHOICE AND IF YOU DO NOT DO THEM MAY NO LIKE WHAT MAY HAPPEN. emoticon . NO LONGER USE THE WORDS YOU HAVE TO ANY MORE FROM NOW ON! SAYING I CHOOSE PUTS YOU IN CHARGE AND AFFIRMS THAT YOU WANT TO SEE RESULTS.

CHOOSE YOUR ACTIONS. I DON'T HAVE TO! I CHOOSE TO!

DON'T USE HARSH WORDS OR NEGATIVE SELF TALK IT MAKES YOU FEEL BAD.

TODAY I CHOOSE TO MAKE HEALTHIER CHOICES IN MY MEAL PLAN AND EXERCISE. LOVE ON YOUR SELF. AFTER GOD DON'T MAKE NO JUNK.

  
  Member Comments About This Blog Post:

GETSALONG 1/11/2013 11:26PM

  emoticon i just love this, it really helps, doesn't it :)

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MARTY728 1/10/2013 1:19PM

    emoticon emoticon emoticon emoticon

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LEVELPATHS 1/10/2013 2:50AM

    Ok I will do this! I don't ***have*** to do anything. My hubby is always telling me this! :-)

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100 DAYS WEIGHT LOSS CHALLENGE

Tuesday, January 08, 2013

DAY 41 -----------------MOTIVATION IS A CHOICE

MOTIVATION IS A CHOICE. YOU CAN NOT SEEM TO GET MOTIVATED.

MOTIVATION AFFECTS EVERYTHING. MOTIVATION BECOMES YOUR PUSH TO GET THINGS DONE.

WHEN MOTIVATION IS STRONG YOU DON'T GIVE IT MUCH THOUGHT. WHEN IT IS GONE THAT CAN SPELL TROUBLE AND YOU MAY NOT KNOW HOW TO GET IT BACK. SO YOU NEED A WAY TO JUMP START YOUR ACTIONS AS WELL AS KEEP YOURSELF MOVING. ONCE YOU GET STARTED. WHERES THE JUMPER CABLES??

CREATE IT YOURSELF.

MOTIVATION IS A CHOICE. IT IS CREATED THUR SELF TALK, THOUGHTS AND ATTITUDE AND IN MY CASE PRAYER AND LEANING ON MY FAITH.

YOUR DRIVE AND ENERGY ORIGINATE INSIDE YOUR HEAD. YOU CAN MOTIVATE WHEN EVER YOU WANT TO.

INVENT NEW PHRASE OH I AM IN OR OH I AM ON IT!!! CREATE A POWER PHRASE THAT SUITS YOU. MAKE IT PERSONAL.

WHEN EXERCISE IS TRYING TO EXIT OR ESCAPE ME.

1. PLACE OUT MY WORKOUT CLOTHES.
2. GET MY WATER BOTTLE.
3. USE THE DVD OR TAPE I WANT TO USE AT THE TIME.
4. GET MY MP3 PLAYER PREPARED.
5. WITH WEIGHTS READY FOR USE
6. MAKE SURE I HAVE MY PENS AND TAB IN HAND TO RECORD WHAT I DONE.

THIS WORKS WELL FOR ME WHEN I AM DRAGGING. FIND OUT WHAT WORKS FOR YOU..........




DAY 42 MAKE IT HAPPEN



DISCOURAGED? DO YOU CARE ABOUT YOUR WEIGHT OF FITNESS LEVEL ETC? FENCE RIDING ABOUT YOUR EXERCISE AND DIET ALWAYS MAKES YOU FALL ON THE WRONG SIDE.

TO GET PAST THIS YOU HAVE TO RAISE THE IMPORTANCE OF YOUR GOAL, AND MAKE IT HAPPEN. IF SOMETHING BECOME REAL IMPORTANT TO YOU GETTING MOTIVATED IS EASY.


HOW DOES YOUR WEIGHT AFFECT YOU? WOW!!

1. ENERGY LEVELS
2. HEALTH
3. QUALITY OF LIFE
4. ENDURANCE.
5. APPEARANCE IF YOU ALLOW.
6. SELF CONFIDENCE IF YOU ALLOW
7. FAMILY/KIDS
8. CAREER

CONVINCE YOURSELF THAT ISSUE ARE SO IMPORTANT THAT YOU MUST SEE CHANGES IN THEM AND MAKE IT HAPPEN.

  
  Member Comments About This Blog Post:

STOPPLAYING2011 1/18/2013 8:13PM

    emoticon I do the same thing to get motivated i get on my work out clothes and lace up my sneakers this tells me it,s time to get moving emoticon emoticon

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LEVELPATHS 1/9/2013 9:10AM

    emoticon

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FITNHEALTHYKAL 1/9/2013 5:25AM

    emoticon for such a great blog full of timely and excellent reminders!

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GETSALONG 1/8/2013 10:19PM

  emoticon so inspiring! I'm on it!!! emoticon

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KATI5668 1/8/2013 9:55PM

    great blog..good reminders for us all...

emoticon

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BJPENNY70 1/8/2013 9:39PM

    Thank you for this reminder. illness has thrown me off my game. I am trying hard to get back where I was.

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BLC CHALLENGE GOALS AND STATS.

Sunday, January 06, 2013

MY GOALS: CHALLENGE WILL INCLUDE BODY, MIND AND TEMPLE. AND TO COME A STREAKIER.

BODY - VEGGIES 4-5 DAILY, FRUITS 2-3 DAILY 5-8 GLASSES OF WATER. SORRY BUT I DO STRUGGLE WITH DRINKING PLAIN WATER AND HAVE BEEN KNOWN TO ADD SOME CRYSTAL LIGHT AND INCLUDE HERBAL AND GREENS TEAS TO HELP OUT.
EXERCISE AT LEAST 5 DAYS A WEEK. INCORP SOME STRENGTHENING TWICE A WK.

MIND- PROPER REST AND SLEEP HAVE TO IN BED BEFORE 12:00 THIS INCLUDES NEEDED TEA BREAKS AND TIME FOR RELAXING. AS A MOM OF A SPECIAL NEEDS SWEET HEART I NEED IT AT TIMES.

TEMPLE NOW THIS IS MINE PERSONALLY AND I WILL BE ACCOUNTABLE FOR IT. DEVOTIONALS DAILY READING. READING SCRIPTURES AND STUDYING AND OR MEMORIZING.

MEASUREMENTS:

NECK 14
BREAST 42 1/2
BICEP 14
WAIST 37
WRIST 7
HIP 45
THIGH 26
CALVE 15

  
  Member Comments About This Blog Post:

LEVELPATHS 1/7/2013 3:11PM

    Good goals! :-)

emoticon

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MARTY728 1/7/2013 11:34AM

    emoticon emoticon emoticon

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FITNHEALTHYKAL 1/7/2013 7:17AM

    emoticon emoticon emoticon

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RECIPE

Saturday, January 05, 2013

BANANA SHAKE WITH CHIA SEEDS

1/4 BANANA
1 CUP SKIM MILK
2 TSP SPOONS OF CHIA SEEDS
1 TBSP OF SMART BALANCE RICH ROASTED PEANUT BUTTER
1 TSP OF CINNAMON

CALS 200
FAT 10.4
CARBS 21.8
PROT 9.8

For me it was needed for a quick snack in between now and dinner.

  
  Member Comments About This Blog Post:

LUVSBULLDOGS 1/6/2013 2:29PM

    I bought chia seeds, haven't used them. If I can find them, I'll try your recipe. xoxo, Berta

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LINOVER 1/5/2013 9:35PM

    Sounds interesting. I will have to try it.

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BABY_GIRL69 1/5/2013 5:30PM

    How does it taste? Happy New Year!

God bless,

Dee

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