What can you do to stay healthy while taking corticosteroids medications?

While taking steroid medications such as prednisone, it may seem that your body’s reactions to the things you do and the food you eat are out of your hands. If you feel overwhelmed or frustrated with some of the outward effects of your medications, your doctor can help you to come up with some strategies to minimize side-effects. However, it is important to realize that you play the most important role in helping yourself to stay as healthy as possible. There are many things you can do on a daily basis to help minimize the side effects of both steroid medications and your pericarditis symptoms.

A healthy diet is important for everyone, but it is especially important for people with pericarditis and those taking steroid medications. While taking steroids, your cholesterol, triglyceride, and blood sugar levels may increase. For these reasons, it is absolutely essential that you not increase your calorie intake and follow a low sodium, low-fat, and low-carbohydrate diet. You do not need to cut out all of the foods you love, but concentrate on eating whole grain breads and cereals and lean sources of protein such as chicken and fish. When you need a snack, look to vegetables—they are low in sugar and calories and provide the perfect food for “grazing.” Try to eat them without Ranch dressing or vegetable dip, because these items carry lots of fat and calories. If you need something to accompany your vegetables, try lighter dips like hummus. It is also important that you minimize alcohol intake when taking steroid medications, since steroids may already irritate your stomach.

Steroids may deplete certain vitamins in your body, such as vitamins C, D, and potassium. Your doctor may recommend for you to take supplemental vitamins or increase your intake of certain foods in order to make up for these deficiencies. Usually it is beneficial to take a multivitamin every day, but speak with your doctor to see which one is right for you, since some vitamins can adversely affect certain conditions. For example, people with antiphospholipid antibodies, especially those taking anticoagulants such as warfarin (Coumadin), should avoid vitamin K because it can increase the risk of blood clots.
Steroids can also contribute to a thinning of the bones known as osteoporosis, which may put you at an increased risk for bone fractures. Your doctor may prescribe a drug for osteoporosis or advise you to take a calcium or hormone supplement. Bisphosphonates such as Actonel, Fosamax, and Boniva are commonly prescribed, as are parathyroid hormone (Forteo) and other medications. To help keep your bones as strong as possible, try to increase your intake of calcium and vitamin D. Calcium helps to keep bones strong and vitamin D helps your body make use of calcium. Foods high in calcium include milk and milk products, tofu, cheese, broccoli, chard, all greens, okra, kale, spinach, sourkraut, cabbage, soy beans, rutabaga, salmon, and dry beans.

In addition to increasing your risk of osteoporosis, steroid medications can weaken your muscles. Staying as active as possible will help you to maintain strong muscles and bones. Weight-bearing activities such as walking, dancing, and running will help your muscles stay strong and healthy. Many people report that these activities make them feel better mentally as well. In fact, there are actually chemicals in your brain triggered by significant exercise (usually about 30 minutes per day) that help you to attain a “natural high.” Your doctor can help you to assess your personal condition and decide on an exercise routine that is best for you. However, you should never put yourself through more than reasonable discomfort when exercising.

People with pericarditis should never smoke due to their increased risk of cardiovascular disease. Steroid medications increase this risk by upping blood pressure, triglycerides, and cholesterol. Smoking, steroids, and pericarditis make a very bad combination.

Steroid medications can also increase the risk of infection; this risk increases if you are also taking immunosuppressive drugs. For this reason, it is important that you try to avoid colds and other infections. Washing your hands regularly is perhaps the best way to keep germs at bay. More serious infections can lead to serious—even fatal—illness. The infections that most worry doctors are kidney infection, a type of skin infection called cellulitis, urinary tract infections, and pneumonia. It is important to be on the lookout for any changes in your health, because people taking steroids may not run a fever even though they are very ill. If these infections go untreated, they could enter the bloodstream and pose an even bigger threat, so it is important that you notify your doctor at the first signs of an infection or illness. In addition, live virus vaccines, such as FluMist, the small pox vaccine, and the shingles vaccine (Zostavax) should be avoided because they may cause disease in individuals taking steroid medications.
Finally, since medications can increase your risk of cataracts and aggravate glaucoma, especially when you take steroids for long time, try to get an eye exam twice a year. Notify your doctor of any major changes in your vision.

What should you look for while on corticosteroids therapy?

Possible side effects of taking these steroid medications are:
Changes in appearance

  • Acne
  • Development of round/moon-shaped face (sometimes called “Cushing’s syndrome” after the physician who first described it)
  • Weight gain due to increased appetite
  • Redistribution of fat, leading to swollen face and abdomen, but thin arms and legs
  • Increased skin fragility, leading to easy bruising
  • Hair growth on the face

Psychological problems
  • Irritability
  • Agitation, psychosis
  • Euphoria/depression (mood swings)
  • Insomnia

Increased susceptibility to infections

Stomach irritation, peptic ulceration

Irregular menses (periods)

Aggravation of the following preexisting conditions:
  • Diabetes
  • Glaucoma
  • High blood pressure

Increase in:
  • Cholesterol
  • Triglycerides
  • May suppress growth in children

Long term side effects:

    • Avascular necrosis of bone (death of bone tissue due to lack of blood supply):
      • Usually associated with high doses of prednisone taken over long periods of time.
      • Produces pain, including night pain. 
      • Occurs most often in hip, but can also affect shoulders, knees, and other joints.
    • Osteoporosis
      • Thinning of the bones.
      • Can lead to bone fractures, especially compression fractures of vertebrae with severe back pain.
    • Cataracts
    • Glaucoma
    • Muscle weakness
    • Premature atherosclerosis – narrowing of the blood vessels by cholesterol (fat) deposits.
    • Pregnancy complications –Doses of 20mg or more have shown to increase pregnancy and birth complications, such as preeclampsia.

Changes in Left Atrial Mechanics Following Pericardiectomy for Pericardial Constriction.

Although impaired left ventricular (LV) filling in constrictive pericarditis (CP) is attributable to external constraints by a tethered pericardium, impaired left atrial (LA) function can further impair LV filling. This study evaluated LA mechanics in CP and assessed the impact of pericardiectomy on LA mechanics. Interesting study to read. Please click here to go to Journal of The American Society of Echocardiography. 

Ulcerative cutaneous lesions... Look deeper that the skin!

A 70-year-old man presented with multiple skin lesions as the first presentation of lung cancer. Please click here to go to the full case. Leave comments and questions.

An old drug with a new use

Colchicine is a well-known anti-inflammatory medication. It is used for gout, pericarditis and other chronic inflammatory diseases. This study, colchicine suppressed the activated neutrophils in atherosclerotic plaques in patient with CAD and unstable angina and decreased cardiovascular events defined as acute coronary syndrome, out-of-hospital cardiac arrest, and non-cardioembolic ischemic stroke.  Click here to to go to the study.
Menthol overuse and toxicity is very rare. However, menthol toxicity has been linked with skin, gastrointestinal and neurological symptoms that is hard to discover. Please click here to learn more about this interesting case that one of my colleagues came across during his daily rounds. 

Bronchoesophageal Fistula Secondary to Broncholith

Another interesting case of an 85-year-old gentleman presented to us with recurrent pneumonia with history of TB and lung silicosis. CT scan of the chest declared the reason for this recurrent lung infections. Click here for full access to the recently published case. looking for your comments.  

Unusual cause of bleeding in liver cirrhosis patient

A 42-year-old man with occult GI bleeding presenting with weakness and fatigue. Initial work up was negative including upper GI scope. We published this interesting case to entertain unusual duodenal variceal bleeding. Please click here for the full print.

Adult Kawasaki disease.

Please Click Here for the new published case of Adult Kawasaki Disease. 

Distinguishing cellulitis from its mimics

Please click here for the new published review paper at the Cleveland Clinic Journal of Medicine titled: distinguishing cellulitis from its mimics

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