Tuesday, May 22, 2012

Survival Tips: Steroids

It's a little after midnight, and I am always asleep by now.  By always, I mean 95% of the time.  The other 5% I am on steroids. Now, I wear a lot of hats.  One I haven't gotten out to show you thus far is my Professional Pred Pusher hat.  

I've taken a lot of steroids in my time - sadly, my muscle tone will never get me any attention in a gym, so it's pretty safe to say it's not the anabolic variety.  Nope, corticosteroids are my ragers of choice - well, not choice, but you get the picture.

I have picked up a few bits and pieces in my time as a pred taker and a pred dispenser, and I feel my personal experience allows me to be a lot more "honest" with my patients about the potential side effects.  I am going to share some of my wisdom (and funny anecdotes) with you, as at this time of night and wired on pred I feel particularly hilarious. ;)

Firstly, learn your steroids.  Most of the generic names end with "solone" or "sone", and a lot of them contain the word "cort" or "pred".  For the sake of this blog, I use a lot of these terms interchangably.  Anyway, you can be given steroids orally, by intravenous injection, injection into muscle or directly into a joint.  All of the above have side effects, problems, pros and cons - but the main points are much the same regardless of the dosage form.  If you have any specific questions about the steroid (or in fact any medication) you have been prescribed, please speak to your pharmacist or doctor who can tailor their advice to your specific situation.  

Advice #1:  Ok.  Roids.  Ragers.  Downers.  Jerkers.  Satan's Tic Tacs.  I have been known to call them a lot of things, mostly nicknames that give you a bit of a sense of one of the main side-effects I experience.  I get teary, emotional, overly sensitive, short-fused, grumpy... getting the picture?  I (and those who love me!) have been fortunate enough to dodge the PMS wagon - hey, I got RA amongst a myriad of other equally awesome diagnoses, something had to give! - but I'm guessing me-on-roids is probably a bit of an insight into what I could have been like once a month.  I have a tendency to warn people, particularly my colleagues, if I've had to crack open the bottle of Satan's Tic Tacs, as it's a little unfair for them to be telling you about how they ran out of milk for their cereal that morning and have you burst into tears.  Or someone doesn't replace the staples when they run out and they incur your wrath.  For the sake of workplace harmony I spell it out for them up front.

Advice #2:  The second side effect that drives me mental is the alertness.  I take my roids at 6am when I first wake up, and will still often be awake at 3am the next day.  Yup.  I'm exhausted, but can't sleep.  This morning's infusion of 125 times my normal prednisolone dose will probably have me pinging for the next 36 hours or more.  Pity those around me who try to get me to make any sense!  It's times like these that you can't sleep, but you can't exactly concentrate enough to do anything purposeful - so I suggest building up your DVD collection, or treating yourself to a TV series from iTunes.  I invested in a digital TV last year that allows me to plug in a USB hard drive, and at the moment I am having a 30 Rock marathon - mostly because I find Tina Fey to be reliably hilarious, but also because the content of your TV watching must be positive and upbeat, lest you dehydrate yourself from irrational emotional outbursts (see point 1).  Anyway, said TV is in my bedroom so on days I can't get out of bed, I just have to motivate myself to reach for the remote and let the TV do the healing.

Advice #3:  The third thing that I should warn you about is the munchies.  Roids stimulate your appetite like nothing else on this earth, and thus I have two very, very important tips for all you roid-virgins out there.  Firstly, remove all forms of carbohydrate from your house.  I have always found consumption of said carbohydrates to be particularly helpful, but I know this to be problematic in the medium-long term.  Secondly, dismember (ie. remove batteries from) or hide your bathroom scales.  They are NOT your friend whilst on roids.  Let me assure you, when you can't sleep you eat, when you can't think you eat, when you're bored you eat, and when you're hungry, you eat.  Remember you will be two to ten times more hungry than usual.  That's a lot of food, my friends.  And if you're as sensitive as me to the weight gain on pred (even when I make a special effort to limit calories... yes, it's a cruel, cruel world!) it's good for tens of kilos.  Yes, that's more than ten.  Multiple tens.  You heard it here first, kids.  Which brings me to...

Advice #4:  Fluid retention.  A sexier pair of words there never was.  Pfft.  Nothing like swollen, puffy body to go with swollen, puffy joints.  Michelin-Woman is sooooo in this season.  Depending again on your level of sensitivity, you may find that the oedema (particularly in your ankles/shins) is quite bad.  People who are already predisposed to oedema - yes, you, with your heart failure, I'm looking at you - need to be particularly careful.  But yes, not your best look.  I tend to wear looser clothing (nothing that draws attention to knees, in particular!) at these times.  This puffiness (which, I should point out, does wonders for fine lines on your face!) is the main reason I live 42degrees below the Equator and still do not own a Goose Down Jacket - I don't need any more help looking as wide as I am tall!

Advice #5:  Tasty, tasty goodness.  It doesn't seem to matter how my roids are administered, but I taste the buggers every darn time.  That includes IV infusion, which I can assure you, is kinda odd.  Anyone who has had the pleasure of taking them will know it's a metallic, dirty, coin taste that can't be covered by much.  I've always found taking the tablets with something that is strongly flavoured (eg. juice, Cola, chocolate milk) and drinking copious amounts of fluid afterwards as a chaser seems to take the edge off a little bit.  Sucking on mints or lollies may help too (I've never needed an excuse to partake in Minties or Musk Sticks!), basically find whatever covers up the flavour for you and go with it.  Pred breath may not be offensive to the people around you, but by golly does it interfere with your quality of life, and no amount of teeth-brushing seems to make a dent in it! 

Advice #6:  Nasty, nasty gut.  Steroids must, Must, MUST be taken with food.  Even when they are diligently taken on a full stomach, people end up with gastric irritation, stomach ulcers, and in severe cases, oesophageal bleeding - all of which are nasty, nasty, nasty and not ideal!  If you're like me, you may get to the last of those options and then oral steroids are either dose limited to very small amounts, or not an option to you at all - which means you have to line up with your arm out to receive your dose IV.  Don't get me wrong, it's convenient if you have someone to put in your cannula and run your infusion (usually good for a lot longer than one dose of tablets!) - but also a bit of a pain in the butt that you can't do it yourself.  As someone who has to take medication now in order to eat (see point 3, eating is kinda my pastime these days, thus this tablet half-an-hour before consuming food is pretty much consuming my life!), I really don't recommend getting to this point.  If you're getting heartburn/stomach pain/chest pain as a result of eating, see your doctor and get it checked out.  Once you start vomiting blood mid-meal you've left it a little late. ;)


So they're my top six things you need to know about steroids.  They're a little more "honest" than you'll get in the product info, or from your local pharmacist - unless of course that pharmacist is me.  Then you get it pretty much verbatim. ;)  Remember though that there are a number of other important side effects you need to be mindful of, depending on whether you're on them short- or long-term, including things like Addisonian Crisis and osteoporosis - again please remember that my blog does not constitute personalised advice and I highly recommend you obtain product information from your pharmacist!

Best of luck if you have to go down this road - they're a catch-22, but steroids for many of us are the difference between being functional and being non-functional.  For me it was a pretty easy decision to make, on balance - even if they do make me grumpy, emotional, fat and puffy.  Then again, perhaps the former are a result of the latter...

* If your steroids look like the image above, it's fair to say they are not in fact steroids.

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