What are steroids?

Steroids are hormones produced by the adrenal glands that are used to reduce brain swelling. Steroids belong to a class of drugs called corticosteroids. The steroids used to treat brain tumors are not the same as those used by athletes. The most common steroid is Dexamethasone (Decadron). Prednisone may also be used.

When are steroids used?

• Before, during, or after surgery.
• During or after radiation therapy.
• During or after chemotherapy.
• When edema is noted on an MRI scan, even if the person is not having symptoms.

How are steroids given?

Steroids can be given through an IV (intravenous) line, into a muscle (IM), or as a pill (oral). Most brain tumor patients will take their steroids as a pill. Your doctor will order your dose based either on your symptoms or the amount of edema present on the MRI scan. The dose will be adjusted up or down. This depends on how your body responds.

Steroids should always be taken with food to protect your stomach. Your doctor may also prescribe a medicine (Ranitidine® or Zantac®) to protect your stomach. Steroids can also affect the normal bacteria in your mouth, making you more likely to have a yeast infection called “thrush”. Therefore, your doctor may also prescribe a medicine to prevent the yeast infection. Mycelex® troches or Nystatin® are often prescribed.

Over time your doctor will try to decrease your steroid dose. Sometimes this is very easy to do, and other times it is a very slow process. Don’t be surprised if your steroids dose needs to be increased along the way. The brain is very sensitive to edema. Your doctor will work on finding the lowest dose of steroids to keep the symptoms of brain edema to a minimum.

Never stop your steroids without talking to your doctor. Steroids must be decreased slowly over time or “tapered”. The longer you are on the steroids, the slower this taper will occur.

What are the side effects of steroids, and how do I manage them? Although steroids cause a range of side effects, the benefits usually outweigh the side effects. If you have questions about the use of steroids, please talk with your doctor or nurse.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited

What is cortisone?

Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisone is released from the adrenal gland when your body is under stress. Natural cortisone is released into the blood stream and is relatively short-acting. Injectable cortisone is synthetically produced and has many different trade names (e.g. Celestone, Kenalog, etc.), but is a close derivative of your body's own product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation. Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes).

How does the cortisone injection help?

Cortisone is a powerful anti-inflammatory medication. Cortisone is not a pain relieving medication, it only treats the inflammation. When pain is decreased from cortisone it is because the inflammation is diminished. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum.

Seroids: are there safe & effective alternatives?

Doctors tell you that steroids (cortisone, prednisone) only cause side effects after many years. But new research shows that permanent damage is immediate and devastating. Studies show that steroids can cause permanent, debilitating effects after a single dosage.

Steroids The Sleaziest of Drugs

Steroids are fast catching up with antibiotics as the most abused class of drugs in your doctor's black bag. There's no doubt that the discovery of steroids a half century ago was a major advance in medicine-a life-saver for those like the late President John F Kennedy, who suffered from Addison's disease, a disease of the adrenal glands causing insufficient hormone production. Steroids mimic the action of the adrenal glands, the body's most powerful regulator of general metabolism. John Stirling, director of the vitamin company Biocare, credits a very short course (three injections) of steroids with jump-starting his failing adrenal system after anaphylactic shock and saving his life. The problem is, like antibiotics, steroids appear to be a miracle 'cure'. Patients with crippling arthritis or asthma seem to be instantly better on steroids.The wheeze, the swelling, the pain go away. So doctors turn to steroids as the first, rather than last, line of attack for their anti-inflammatory and anti-allergic effects.

As with antibiotics, what was once reserved for the extreme emergency is now being used on the most trivial of conditions. Steroids are now handed out as readily as antibiotics, even to babies, at the first sign of inflammation of any sort. The latest drug set to replace gripe water for babies with croup is a steroid (budesonide); hydrocortisone is included in the latest over-the-counter medication for piles. Steroids make up many OTC skin drugs, and are considered the drug of choice for asthma, eczema, arthritis, back problems, bowel problems like ulcerative colitis-indeed, for any and all inflammations or allergic reactions and new uses are still being invented. The sole exceptionis Addison's Disease, where steroids act as a replacement therapy of cortisone, much as insulin is given to diabetics.

Far from being a wonder drug 'cure all', steroids cannot cure one single condition. All they do is suppress your body's ability to express a normal response. In a few instances, this type of suppression will give the body a chance to heal itself. But more often, the effect is immediate, devastating and permanent damage. And we are only now realizing just how quickly damage can occur. Despite what doctors say, that steroids only have side effects after many years of use, there is no such thing as a safe dose.

Studies show that steroids cause permanent, debilitating effects after a single dosage. With long-term use, some of the more common side effects of steroids include changes in appearance, such as acne, development of a round or moon-shaped face and an increased appetite leading to weight gain. Steroids may also cause a redistribution of fat, leading to a swollen face and abdomen, but thin arms and legs. In some cases, the skin becomes more fragile, which leads to easy bruising. These take weeks to begin appearing.

Psychological side effects of steroids include irritability, agitation, euphoria or depression. Insomnia can also be a side effect. These changes in appearance and mood are often more apparent with high doses of steroids, and may begin within days. Injected Triamcinalone (see above), or oral dexamethasone seem to cause these changes less, but as they stay in the body an undesirably long time, rendering them second choices.

An increase in susceptibility to infections may occur with very high doses of steroids. Prednisone may also aggravate diabetes, glaucoma, and high blood pressure, and often increases cholesterol and triglyceride levels in the blood. In children, steroids can suppress growth. These effects are reversed once the steroids are stopped.

Long-term damage: quick and dirty

Steroids don't take years to damage your system, as doctors maintain. Permanent, crippling damage can occur weeks after you've begun treatment.

• Osteoporosis can occur within a matter of months. Steroids cause 8 per cent reduction in bone mass after four months (Ann Int Med, November 15, 1993), the equivalent of the effect on your bones of having your ovaries removed. Even low doses of inhaled steroids (400 micrograms per day) reduce bone formation (The Lancet, July 6, 1991).
• Low doses (10-15 mg prednisone) for a year can cause cataracts (Surv Ophthalmol, 1986; 31: 260-2).
• Topical steroids may begin to cause eye damage or raise pressure after two weeks. Extensive visual loss can be caused by a 1 per cent hydrocortisone ointment, which is available OTC (BMJ, August 20-27, 1994).
• Rub-on steroids have caused Cushing's syndrome in children as soon as a month after treatment has begun (Arch Dis Child, 1982; 57: 204-7).
• Inhaled steroids slowth growth in children after six weeks (Acta Ped, 1993; 82: 636-40. See also, The Lancet, December 14, 1991).

Side effects that may be caused by the long-term use of steroids include cataracts, muscle weakness, avascular necrosis of bone and osteoporosis. These usually do not occur with less than four weeks of treatment.

Avascular necrosis of bone, usually associated with high doses of prednisone over long periods of time, produces hip pain and an abnormal MRI scan. It occurs most often in the hip, but it can also affect the shoulders, knees and other joints. Caught early, the joint can be saved by "decompression" by an orthopedic surgeon. Once full developed, Avascular necrosis is painful and often requires surgical joint replacement for pain relief.

Steroids reduce calcium absorption through the gastrointestinal tract which may result in osteoporosis, or thinning of the bones. Osteoporosis can lead to bone fractures, especially compression fractures of the vertebrae, causing severe back pain. Calcium, at least 1500 mg of the calcium carbonate form or equivalent, should be taken. There are new medications (Fosamax in particular) that also may help to prevent osteoporosis.

There is also a relationship between steroids and premature arteriosclerosis, which is a narrowing of the blood vessels by fat (cholesterol) deposits. In general, there is a close relationship between the side effects of steroids and the dose and duration of their use. Thus, a high dose of steroids given over a long period of time is more likely to cause side effects than a lower dosage given over a shorter period of time.

"Furthermore, my investigation revealed that the majority of AIDS patients suffer from metabolic and endocrine abnormalities [1]. The high prevalence of adrenal insufficiency observed among AIDS patients provides strong evidence that AIDS in these patients is caused by the use of corticosteroids" Mohammed Ali Al-Bayati Ph.D. Toxicologist, and Pathologist Toxi-Health International, 150 Bloom Dr., Dixon, California 95620, USA more

"Dr. Al-Bayati, discovered that the steroid treatments, Prednisone and Azathioprine had completely destroyed my immune system and were the culprits that were not allowing my bodily systems to repair themselves. In essence my HMO gave me the appearance of medication induced "Aids." Larry J. Boyd, Suisun City, California

Topical corticosteroids are often prescribed intermittently for short-term reactive treatment of acute flares and supplemented by emollients. Reactive treatment with corticosteroids offers rapid and effective symptomatic relief for acute flares. However, there are considerable safety concerns associated with their use, particularly when they are applied continuously. Potential adverse events are primarily cutaneous (principally skin atrophy, but also telangiectasia, hypopigmentation, steroid acne, increased hair growth and rosacea-like eruptions), but there may be systemic effects (suppression of the hypothalamicpituitary- adrenal (HPA) axis, growth retardation, increased risk of glaucoma cataract and Cushing’s syndrome).16–20