Solu-medrol Infusion Therapy

[T-lynn]

Hoping some one may be able to answer this,have had 2 rounds of solu-medrol 1000mgs for 5 days once while hospitalized in March because of a nasty attack.The neuro done a 30 day oral taper down with prednisone.

Had second attack early June and was able to do the 1000mg solu-medrol Infusions at home now with a 40 day oral prednisone taper down.

Now I'm suffering from severe insomnia,I feel like the energizer bunny and the steroids has played havoc with  my insulin levels(taking glucophage while on the steroids).

Can the use of this much steroids ,in this short of time period cause long term damage,even though it helps the major attacks

[Momzilla]

Always, of course.  Don't even have to ask.  

Chris*

[Quixotic1]

We're still friends, aren't we??  Q

[Quixotic1]

My, my, now we have to exchange apologies....I didn't mean to sound harsh, frustrated or whatever.  Reading back over what I wrote, it did sound stern, didn't it.  Sorry to all.  I think I was just concentrating on what I wanted to convey.  

Never in this forum do I want any of you to apologize to me.  We've got to feel comfortable to say what we want and what we need to.  So no offense meant or taken on either side, 'kay?

Chris, your son's heart would pound so hard from the bronchodilators, the albuterol group.  They really whip the heart into a frenzy, though they have gotten so much better over the 2 and 1/2 decades I practiced.  We used to have just epinephrine which is pure adrenaline.  Those kids used to bounce across the room!

Quix

[Momzilla]

I didn't mean to be so counterproductive.  Sorry.  I just remember steroids taking such a toll on his little body from the time he was six months old.  His heart used to pound out of his chest.  I was very young.  I'm sure I got a lot of all that wrong during an emotional time.  

Now I look at drugs from a clinical study point of view, too,  I guess.   Does the benefit outweigh the risk?  That's what I do at the office I work in.  I'm sorry, Lynn, it didn't help you much.  Didn't mean to frustrate you, Quix.  Please forgive me.

Chris*

[Quixotic1]

Yes, Jamie, you're absolutely right.  One of the serious effects of long term steroids is definitely loss of calcium from the bones, osteoporosis and pathological fractures.  My comments above weren't meant as as a discussion of all the side effects of steroids.  Mainly I meant to answer Lynn's question about the insomnia and respond to Chris's question to Lynn "Is this the best you can do?"  with concern about whether the benefits outweighed the risks with regard to treatment of MS relapses.

I've looked at a couple studies that were done to determine if HDMP (high dose methylprednisolone) for relapses increased an MSer's likelihood of developing  osteopenia over people with MS who did not receive stroid pulses.  Those studies found that they did NOT.  The larger determining effect for osteopenia in MS is immobility.

I was explaining that the "standard of best care" for relapses of MS is currently 3 to 5 day pulses of VERY high steroids.  This is to try to blunt the effects of what disability the relapse might cause and shorten the duration of the relapse itself.  The high dose is needed to cross the blood-brain barrier and have a strong anti-inflammatory effect deep within the brain.

Chris, I would not spend any time now worrying about any effect the childhood use of steroids will have on your son now.  Once off of them, the body works to recover from whatever suppression was done.  The main thing that can't be overcome is premature closure of the bony growth plates which would result in the child not growing to his fullest potential.  It sounds like that didn't happen, at least not severely.  The other effect that would not heal is if a cataract had developed.  I don't know if the increased risk for cataract is life-long assuming the person does not continue to take oral steroids or use high dose inhaled steroids.

I disagree with the statement that the steroid cause longterm heart or organ damage, except in the occasional patient who is steroid-dependent for many years and who has increased blood pressure as a result.  Not all kids opn steroids have elevated blood pressure.  In this case, yes, one could see eventual heart and kidney disease as in indirect effect.  In general, the blood pressure returns to normal when the steroids are stopped.

Don't get me wrong, guys.  Steroids need to used judiciously and their effects must be monitored.  But, they are often life-saving.  In asthma, they can prevent lont-term damage and restriction in the lungs.  

Also, do not mix up the steroids we are talking about here - the physiologic steroids - with the "anabolic steroids" abused by athletes.  Totally different story.

Quix, OUT!

[Jamie_teaches]

Am I wrong in my impression that long term use of steroids causes bones to become brittle and leads to osteoporosis? My grandmother suffered from Rheumatoid arthritis starting in her 30's and the drug of choice has long been prednisone. She developed severe osteoporosis and I thought it was directly related? Just wondering. Thanks!  Jamie

[T-lynn]

You did not discourage me from steroid use.

I have had 2 major attacks since March and I really think the steroids have kicked my butt this time around and my body just needs a break .

And I know there's no guarentee that the steroids will work.

I just need a break from the roids and the relapses.Maybe just a good long vacation.

[Quixotic1]

I DID NOT mean to discourage your treatment with steroids.  It is the standard of practice for all suspected MS relapses.  Though it has not been shown to reduce the disability from a relapse it is felt to shorten the duration and lessen the severity of the relapse.  Quix

[T-lynn]

Thank You vey much.

Definately everything I needed to know,When I go to the pharmacy today I will look for the alert braclet for MS and steroid use.

This round of steroids ,mainly the taper down has made me grumpy and anxious.But I keep telling myself 3 more weeks.

I have often thought of the spasticity in the event of something would happen.

I do have in my car a vital of life package that has all my current info on,it was given to me by an EMT. Buy that doesn't help if I'm with someone else.

Your info was great!

I have sworn off the steroids for many months to come.The next attack will have to be treated differently or wait it out.

[Quixotic1]

Longterm damage to organs is rare.  Steroids given constantly in young childhood is a different story.  The major consequences are growth retardation, susceptibility to infection, cataracts.  Heart damage?  Not from my knowledge.

I was addressing Lynn's specific situation.  Shorterm steroids exact very little price.  Longterm the problems can be widespread.  

Quix

[Momzilla]

My oldest son is a severe asthmatic.  He spent most of his first five years in the hospital either in the emergency room, or admitted to the pediatric floor.  He was on corticosteroids for at least two weeks of each month--I kept track.  I was a wreck, knowing the consequences of the drugs, but finally, his doctor spelled out the reality to the young mother that I was:  It was better than the alternative.  He wouldn't breathe without them.  

He graduated high school this past June.  He is a bright young man, much taller than I, healthy, lifts weights, on his way to a university this coming fall with 3 transferable classes under his belt from AP courses he took in school.  (I can brag, can't I?)  

The steroids are a tough drug.  We used to lock him in our room and take turns sleeping because he didn't.  He would rock in his crib from the extra energy he had when he was a baby.  He would be SO cranky.  When he got old he enough, he told us it was like having 40 cups of coffee and 12 energy drinks in one sitting.  

Does it cause damage?  Yes.  The doctors told us we knew it had the potential to do damage to his heart and major organs.   Short bursts over a few days should have little long term effect unless prescribed over and over.  Who knows what effect this will have on my son when he's older?  But he wouldn't have survived without it.  It was the best we could have done for him.

Are steroids the best you can do?  Do the benefits outweigh the risks?  What will happen if you don't use them?  What are some alternatives?  Are there any?  What if you do nothing?  I think Steroids are an excellent drug.  But there is a price.  And they should be respected.  Not taken for granted.  Used only when absolutely needed.  Like Quix says, the whole adrenal system goes on autopilot.  That really should tell you something.  

I hope I'm not getting anything wrong from my early motherhood days.  Bad flashbacks!  Anyway, more to ponder.....

Christina*

[Quixotic1]

Hi, I did my post-doc work in Immunology/Allergy and used tons of steroids in my practice over the years.  To answer your last question, No, the steroids will not have done any permanent damage with regard to your nervous system or your ability to sleep.

Steroids have lots of side effects on the mood and energy.  And these effects may be different at different doses.  Some people become incredibly grouchy, anxious and irritable.  Some become frankly psychotic (unusual).  Some are euphoric and just feel great (me).  An increase in energy is very common, that's what is going on with your insomnia.  You are likely right at the dose that energizes you maximally.  I don't know what the right kind of med would be to counter this.  You need to talk with your neuro.  It is not permanent.  

The steroids do, of course, messes up glucose metabolism by lowering glucose tolerance.  They are glucocorticoids.  That's one of their major functions in the body.  

Make sure you get an wear a Med-Alert that states "Steroid Dependent".  You have received enough steroids now to presume that your adrenal glands will likely not respond properly in a physiologic emergency.  When the adrenal glands sense extra cortisol floating by in the blood, they supend their own production (it's a feedback loop).  If the extra cortisol is present over a long period of time (a month or more) the adrenals go into a sort of semi-hibernation.  They get lazy and don't respond as quickly as they would normally to low levels of cortisol or a need for more.

In times of great stress in the body, say, a major injury (eg. car accident), the adrenals immediately produce massive amounts of cortisone to support life-functions (which includes raising blood sugar, supporting the blood pressure, and a whole host of other functions).  If the adrenal glands are suppressed from medical administration of steroids like you have had, they may not respond to a stressor (injury, surgery, sudden illness) and the result is shock and sometimes death.

Any emergency responder would need to know that your adrenals may be "lazy", that is, they can't respond properly, so they would give you IV steroids during the crisis to support life functions.  Ideally, when we treat someone with steroids for an extended  period of time, we taper them to wake the adrenal glands back up and to prevent "rebound" return of the symptoms that we are treating.  But, suppression of the adrenal glands is unpredictable.  It makes sense to make sure that in an emergency you would get some steroids (even if you didn't need them) rather than not get them and die from shock.

Also the "alert" should mention MS so that if you are unconcious your spasticity is not misinterpreted to mean brain damage from something else.

More than you wanted to know?  Did this make sense?

Quix