Steroids: The Medicine That Gives And Takes Away
This week, the topic of steroids crossed my path from a diverse number of sources - poison ivy, arthritis, laryngitis, a spinal fracture and failing adrenal glands. As different as the paths were, the outcomes were accordingly disparate. Some results were dramatic and amazing. Some were tragic.
This blog will cover steroids which I have come to respect so much as a doctor, both for the potential good and the potential bad.
Technically speaking, steroids are a relatively large grouping of organic chemical compounds with a characteristic structure. Hundreds of different steroids are known to exist naturally in animals, insects, plants and fungi.
Estrogen and Testosterone: In the animal kingdom, examples of steroids include sex hormones like estrogen and testosterone in addition to cholesterol and anabolic steroids. Anabolic steroids enhance muscle and bone production and have been known to be abused by athletes to boost performance.
Glucocorticoids: Steroids are also essential in the body to regulate metabolism, immune functions and the body's inflammatory response. These particular steroids, used widely for medical benefit, are known as glucocorticoids. The rest of this blog will focus on the glucocorticoid class.
The Give: Steroid Uses
Steroids can have amazing therapeutic effects on the body. Their ability to counter inflammation and the ramifications of this inflammation are often dramatic.
Rash: For my patient with the itchy, inflamed rash of poison ivy, I was able to wield my sword of prednisone (the most commonly prescribed pill form of steroid) to slay the itchy beast and bring relief.
Arthritis: For my patient who hobbled in on inflamed, arthritic knees, an injection of steroid into the knee joints brought an incredible reduction of symptoms, giving the ability to walk free of pain with a probably duration of months. As blockers of the immune system, steroids are used readily to tone down our body's tendency to attack self and cause disease. In lupus and rheumatoid arthritis, steroids can make life manageable again.
Laryngitis: For my patient the actress in a local production, laryngitis threatened the show. But a short course of steroids knocked the inflammation out of the vocal cords, restoring her voice.
Asthma: For my asthmatic patients, steroid inhalers are staples in treatment to prevent the lungs from inflammation and spasm in the face of symptom triggers.
Spinal Injury: In the emergency room, an injection of steroid can save the spinal cord in the face of injury due to compression.
MS and PMR: In multiple sclerosis (MS), steroids can knock back periodic flares of weakness and spasm. For an immune muscle inflammation condition called polymyalgia rheumatic (PMR), a dose of steroids can bring a person from an inability to get out of a chair to dancing. Once a PRM patient was so grateful for their restored function that they promptly sent me flowers! The credit, however, should have gone to the steroid medication. Indeed, steroids can yield miraculous results.
The Take: Steroid Side-Effects
For all their good, however, steroids can also take away from health. Their effects exist on both sides of a seemingly fine-balanced line.
Reduced Immunity: While steroids are used for benefit in their abilities to block inflammation and quell the body's immune system, that hindered immune system opens a door for potential infection.
Thinning or Scarring of Skin: Chronic use of steroids on the skin can also slow the rejuvenation of thick healthy tissue and cause the skin to thin and scar.
Blood Sugar Imbalance: Prescribed steroids enter into a body whose metabolism and other day-to-day functions are dependent on steroids. Because of this, steroids are prone to cause disorder in various functions. Steroids can make blood sugar skyrocket, especially in persons with diabetes.
Digestive Issues: They can also cause irritation of the lining of the stomach and even lead to ulcers.
Mental/ Emotional Changes: While most people feel some boost in their energy and outlook when given steroids, this can go too far leading to insomnia, nervousness and less commonly a full-blown psychosis.
Brittle Bones: The bones can also be affected by chronic steroid use leading to brittle, easily broken bones. The most common examples are hip fractures and in the case of my patient spinal compression fractures.
Adrenal Shutdown: The final and most chronic condition to note is the tendency for prescribed steroids to shut down the body's production of metabolic steroid by the adrenal glands. The adrenal glands make a steroid hormone called cortisol which is important in regulating our sugar metabolism, immune system and other functions. Steroids taken into the body mimic cortisol and can send signals to the adrenals that production is not necessary. This can shut down the adrenal function and cause a crisis when the steroid medication is taken away. While this usually only happens with large doses over sustained time, an individual body's response is unpredictable in regards to this tendency.
Are Steroids Worth The Risks?
Steroids are powerful forces available to us in medical care, but with power can come corruption and dysfunction. The negative aspects of steroids should not prohibit their use, but rather add an aura of respect and caution. It is important to weigh out the risks and benefits with any medication but this is especially true with steroids.
As a general rule, the least amount needed for the least amount of time to get the job done should be used. Monitoring should take place with chronic use, especially for weakening of the bones. When steroids are to be discontinued after chronic use, they should be tapered slowly and not stopped suddenly