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Steroids

Moon face from steroids 

Moon face from steroids

I am not a medical doctor nor medically trained in any way.  Please use your web browser to print off this page for doctor consultation.  

Steroids are biological compounds found in plants, animals, and fungi. Steroids that are formed in the endocrine glands of the human body are called steroid hormones. One particular kind of steroid hormone, called glucocorticoids, has been proven to be effective in the treatment of certain cancers.

Leukemia is a condition in which the white blood cells are reproducing at an abnormal and dangerously rapid rate, forming white blood cell clumps called “blasts.” Allowed to reproduce unchecked, they take over the body, resulting in death. Per a study, the steroid hormone glucocorticoids, (sometimes referred to as “corticosteroid”) is capable of impacting white blood cells, causing cellular death of cancer cells, and are very important for attaining remission in certain cancers. There are two synthetic glucocorticoid products manufactured for this purpose: Dexamethasone and Prednisone. [1]

Unfortunately, there can also be adverse side effects with long-term use. A study was completed in 1975 to see the effects from long-term use of corticosteroids. It was found that they markedly increased the chance of getting dangerous, lethal infections, which increase the risk of mortality and further suppress the immune system. The most common side effect is osteoporosis, i.e., the bones becoming brittle. [2]

In treating cancer, some side effects can be mitigated by using a procedure called “pulsing,” or using them for a certain number of days on, then off. Even so, side effects do occur. Here are some of the more common ones:

Side Effects: redistribution of fat (moon face, weight gain), sore spots on the body that are tender to the touch, (also, mouth sores,) electrolyte imbalance, muscle weakness (loss,) insomnia, elevated blood sugar levels (predisposition to diabetes,) osteoporosis (risk of bone fractures,) Osteonecrosis (rare,) [3] increased appetite, increased or decreased energy, mania, psychosis, emotional highs or lows (depression,) irritation of the stomach lining (predisposition to peptic ulcer,) stunted growth, swollen abdomen, and thin arms & legs, headaches, salt craving, shakes, increased risk of glaucoma and cataracts, peptic ulceration (Note: See “Mitigating the Side Effects” below) For further information go to the Mayo Clinic website at www.mayoclinic.com/health/steroids/HQ01431

Mania or Psychosis

Mania is characterized by intense rages. Psychosis is characterized by hallucinations or delusions. When a patient exhibits mania or psychosis, call the treating physician immediately. Another parent told me that her son was bouncing off the walls from steroids. When she brought her son to the doctor he told her that it was steroid induced psychosis. The doctor reduced the dose by 50 percent and the weird behavior disappeared. Another possible remedy as relayed to me by a patient is a prescription for potassium. She said that it noticeably reduced steroid induced anxiety and mood swings.  

Get on a Basic Healthy Diet and Eliminate Processed Foods

When fighting cancer, every action possible should be taken to improve overall health. Most fast foods, packaged, frozen, and instant, lack nutrients because of the way the food is processed. Focusing upon fresh foods is one of the main actions you can take to assist your health. Lean proteins such as turkey, skinless chicken breasts, wild salmon, lean pork, etc., are best. Portions that are too large are also hard on the digestive system, small meals eaten more frequently are far better for your health.   Another doctor recommended stews and soups made with organic with meats, saying that these are  much easier to digest than other foods.

For more diet suggestions for cancer patients: www.cancer.gov/cancertopics/eatinghints/page3

Mitigating the Side Effects

Redistribution of Fats Steroids cause a redistribution of body fats, which result in a distended abdomen and the so-called “moon face”. Adding more fats to the diet, when on steroids is foolhardy. Lots of salads, green vegetables, fruits and lean meats, are the ideal diet for cancer. 

Mouth Sores Steroids can cause a deficiency in riboflavin. Riboflavin (also known as B2) is a B vitamin that is water-soluble.  It is a vitamin that you need to replace every day. Riboflavin is important for growth and red blood cell production and helps in releasing energy from carbohydrates. A deficiency in Riboflavin results in mouth sores, anemia, sore throat, swelling of mucous membranes and skin disorders. Because riboflavin is a water-soluble vitamin, leftover amounts leave the body through the urine. There is no known poisoning from riboflavin. [5] See the Mouth Sores page on this site for further information and remedies. 

Electrolyte Imbalance When I found out that steroids cause electrolyte imbalances and questioned our doctors about this, they recommended products like Gatorade and PowerAde. There is a problem with these types of products because they have a high sugar content. High amounts of sugar are a bad idea when on steroids, as another side effect from steroids, is sugar imbalances that can lead to diabetes. Symptoms of an electrolyte imbalance are: shakes, fatigue, lightheadedness, cramping, confusion, nausea, muscle spasms and  anxiety.  A company by the name of Alacer, produces a product called Electro-mix. It does not contain sugar, is reasonably priced, and Kayla’s doctors approved the use of this product. Each box has 36 packets. You put one packet of powder into a 32ounce container of water. Drink throughout the day. Available through health food stores or the Internet.  

Muscle Loss

To avoid muscle loss, my first thought was to improve protein consumption through the use of protein powder. We tried many protein powders and Kayla really likes Jay Robb the best, go to www.jayrobb.com. These protein powders taste fantastic and blend very smoothly.  Per a doctor, egg whites are the easiest protein for the body to digest therefore this is what I recommend to any patient fighting illness.  I spoke to the staff at Jay Robb’s company and they said that if you call their customer service number at Toll Free:1.877.JAY.ROBB they will ship you samples of their products free of charge. This way you can try their products to see if you like them. 

Insomnia

Many patients have trouble sleeping because of the medications used in their treatment.  Please go to the sleep page on this site for answers and tips on this subject. 

Elevated Blood Sugar

removing added sugar from the diet is a step that improves everyones health.  This becomes far more important for a patient taking steroids as these drugs can cause elevated blood sugar that can lead to diabetes! Vitamin C helps to alleviate cravings.  See if your doctor will allow you to take normal dosages of vitamin C on a daily basis. If this is not allowed then try to consume fresh fruits that have vitamin C in them such are Tangerines and Oranges.  

“A 12-ounce can of Coca-Cola, for example, has almost 10 teaspoons of sugar. A 24-ounce bottle of Pepsi-Cola has 21. Popular sports drink PowerAde packs 15 teaspoons of sugar in a 32-ounce bottle.” Charles P. Brenner, DDS, PA. Taken from the website www.dentistryforyoungpeople.com

Osteoporosis/Osteonecrosis: Bone Loss

Our daughter, Kayla was prescribed the steroid hormone, Dexamethasone. As a consequence of this steroid Kayla also manifested osteoporosis, which is the bones becoming brittle and porous. In severe cases patients can get Osteonecrosis (bone death) over time, the drugs cut off blood supply to the bones causing bone death.  A doctor recommended the following regimen to help build Kayla’s bones, this is an excerpt from the letter.   This is certainly an unusual presentation, although the infiltrative disease itself can cause osteopenia, and the methotrexate (chemo) and steroids are going to exacerbate it. When you say you did a scan, was that x-ray or DXA? If a DXA was not done, she should have one in a center that can compare it to her bone age (which should be done at the same time, if not done in the prior six months) and has appropriate age-matched controls.

Given the unusual fracture presentation, I would check calcium, phosphate, magnesium, albumin, alkaline phophatase, PTH, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D levels; as well as a urine calcium: creatine.

Calcium and vitamin D should be maximized for everyone. At her age, she should be getting at least 800 mg elemental calcium daily (in divided doses). Previous recommendations about vitamin D intake (400iu) are probably too low, and she should get more like 800 – 1000 IU.

If she has osteoporosis and has had three fractures, there would need to be consideration of the use of bisphosphonates, but I don’t know about use concomitantly during leukemia treatment.

Kayla’s Daily Supplements for bone loss

Bone Active available through Vitamin World has 800 IU of vitamin D, Vitamin K 100 mcg, Calcium 1200 mg, Magnesium 300 mgs. Sold for around $10.00 Lots of green vegetables such as broccoli, green beans and salads. Our oncologist approved the use of this supplement. 

Besides the above diet, resistance exercise, using weights or rubber bands, etc., is key for building up bone density. The University of Arizona has an excellent page regarding bone density and exercises that increase the density of bones. http://ag.arizona.edu/maricopa/fcs/bb/exercise.html

In Conclusion

Kayla is a testament that much can be done to help a person who is going through intense chemotherapy and steroid treatment. Anyone can be made nutritionally healthier and emotionally happier. Much of Kayla’s success is due to my careful observations and painstaking research. With cancer patients, chemotherapy reactions and supplement reactions must be carefully monitored, and must be approved by a doctor.

Once approved, play it safe even further by trying the nutritional supplement with a reduced amount to ensure there is no allergic reaction. If the label says the serving size is two tablespoons, test it out by taking 1 teaspoon. Wait and see if there is any reaction. This is how I have always tested things with Kayla. 

Mega doses of  supplements is foolhardy and completely reckless for someone going through the rigors of chemotherapy. The recommended dosages are there for a reason. Do not exceed label dosage recommendations and NEVER self treat!

May your health and well being be improved! 

~

References

1. The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company.

2. Experimental disseminated candidiasis. II. Administration of glucocorticosteroids, susceptibility to infection, and immunity. J Infect Dis. 1975 Oct ;132 (4):393-8 1185009 (P,S,E,B) Cited:2 D L Hurley, J E Balow, A S Fauci

3. Pediatrics. 2008 Jul;122(1):e53-61. Effect of long-term corticosteroid use on bone mineral density in children: a prospective longitudinal assessment in the childhood Asthma Management Program (CAMP) study. Kelly HW, Van Natta ML, Covar RA, Tonascia J, Green RP, Strunk RC; CAMP Research Group. Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-0001, USA.

4. University of Texas at Austin, News December 1st 2004

5. Medline Plus, National Library of Medicine and National Institute of Health.

6. 1:J clin Oncol. 2007 Apr 20;25(12):1498-504 High Body Mass Index increases the risk for osteonecrosis in children with acute lymphoblastic leukemia. Niinimaki RA, Harila-Saari AH, Jartti AE, Seuri RM, Riikonen PV, Paakko EL, Mottonen MI, Lanning M.

7. Pediatr Blood Cancer. 2008 Apr;50(4):833-7 Decrease in peripheral muscle strength and ankle dorsiflexion as long-term side effects of treatment for childhood cancer. Hartman A, van den Bos C, Stijen T, Pieters R.

 

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