Sunday, January 16, 2005

You, too, can join the crew...

Tippecanoe and Nixon, too/Back with Barry's/Not with Lyndon, Ike, or Harry's/Back with Barry's Boys!

(Thanks to the Chad Mitchell Trio)

You are a Folkie. Good for you.

What kind of Sixties Person are you?
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On to the topical stuff:

Steroids, or, How To Have Fun With Potentially Only Minimal Bodily Damage

Steroids are versatile things. There are several different sorts that we medical types use all the time, for all different purposes.

Generally, corticosteroids (as opposed to the other sort, that build muscle and make you kinda grumpy) relieve inflammation and swelling, act as immunosuppressants, and can be used as diagnostic aids for things like Cushing's syndrome (where your body produces too much cortisol, a naturally-occuring steroid).

That's why I, who have the flu, am taking a prednisolone taper (a Medrol Dosepak). Even though prednisolone has immunosuppressive qualities, those are outweighed (at this dosage) by the anti-inflammatory effects. Meaning, in short, that I'm no longer walking around whimpering because my muscles and joints hurt so much.

It's also why I'm up at 3:37 a.m., typing on the computer, but more about that in a second.

In neurosurgical patients who've had bits of their brains removed, the usual starting dose of dexamethasone (Decadron) is four milligrams every six hours. Sometimes we'll go higher, sometimes lower, depending both on the patient and on the bits of brain removed. After a couple of days of that, we'll taper. It's amazing what that amount of anti-inflammatory can do; I've seen patients who weren't able to swallow improve markedly after 24 hours on Decadron.

You see a lot of steroids used in treatment of asthma and allergies, as well. Advair inhaler? Steroid. Big nasty rash I got those months ago? Treated with steroids. Certain types of arthritis can be treated with 'em as well.

Which brings me to the up-at-three-am-part.

There's a nifty little condition called "steroid hypomania". What happens in a person who's taken largeish doses of steroids (say 60 milligrams of prednisone a day) for a time is this: something flips over in the brain that makes them manic. Not leap-out-a-window, I'm king of the world manic, but pretty manic nonetheless. They get up early, the buzz around like bees all day, they tend to have insomnia.

Strangely enough, a milder version of that side effect happens in almost everybody I've seen who takes steroids. The other, nastier side effects like steroid-induced diabetes or weight gain or bloating tend to take a while, but push four milligrams of Decadron into somebody's IV and you can almost guarantee they'll be up at one a.m. humming old Madonna songs.

Which is why I'm blogging this early, when by all rights I should be lying in bed feeling as though I've been hit by a truck. A combination of steroids and aspirin has brought down my fever and taken away my aches and pains, and the steroids have done their magical work and made me peppy at 3 a.m.

This side effect will be gone by Wednesday, when my taper will have worked from 24 mg (yesterday's dosage, humming Madonna songs) to 12 mg.

Why do we taper? Ah, this is a good one. When you take steroids, even for a short period of time, your body gets lazy. Note that laziness is an evolutionary advantage: it keeps you from having to expend energy on things when that energy could better be used to reproduce or just hang out. Anyhow, expose the human body to steroids and it slows down production of its own steroids. Cut off the steroids abruptly and the body gets all grumpy--the steroid-producing bits act as though they've been shot with a rubber band.

So as you cut the dosage gradually, it's giving your hypothalamus etc. time to ramp up again.

And it gives your right temporal lobe a break from rerunning all those mid-Eighties MTV hits, too.

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