Biology 202
2002 Third Web Report
On Serendip

"I can breathe! In less than twenty-four hours I am practicing the flute with the kind of breath control I've been missing for months. And all it took was one day and sixty milligrams of prednisone! ...I feel a little shaky and weird, but I can play the flute! But now it is three days later. It is the middle of the night. I'm squinting into the mirror in the bathroom. Only seventy-two hours into my prednisone therapy and my face is definitely spreading. I'm already turning into a pumpkin." (2). I understand what Eugenia Zuckerman meant. I was also on prednisone.

Corticosteroids (9) are wonderful-terrible-wonderful drugs. They make you crazy. (I was in psychotherapy.) They increase your appetite and increase your weight. (I was always hungry.) They put your nervous system on high alert. (I was nervous and frightened, my hands were shaky, and one eyelid twitched.) They produce edema. (My face and ankles swelled.) They cause insomnia, (I stayed up most of the night watching old movies on television.) Moreover, they give you the "gift" of boundless energy. (I bounced off the walls.)

I was obsessed with cleaning my house, (my house was never cleaner), my hair became brittle, my skin became dry, my nails became soft, and my beautiful singing voice became "different." All of these changes came from one drug, prednisone (3).

Corticosteroids are a group of anti-inflammatory drugs similar to the natural corticosteroid hormones produced by the cortex of the adrenal glands. These drugs work by a variety of mechanisms including decreasing the density of mast cells along mucosal surfaces, decreasing chemotaxis and activation of eosinophils, decreasing cytokine production by lymphocytes, monocytes, mast cells, and eosinophils, inhibiting the metabolism of arachidonic acid and other mechanisms.

The terrible side of this drug is that is has these many negative effects. The wonderful side of the drug, though, is its effectiveness in stopping autoimmune response. It stopped the symptoms of my new visitor: my incessant, debilitating, truly unpleasant, life threatening constant companion, Inflammatory Bowel Disease.

IBD is only one of many autoimmune diseases that can come into your life and change it forever. Autoimmune disease is a politically correct visitor, showing no preference for gender, race, age, religion or national origin. It also has no favorite places. It can attack almost any organ in the body, including the nervous system, the gastrointestinal system, connective tissue, joints, eyes, blood, blood vessels, skin, kidney, lungs, and the endocrine system (4). In all these diseases the underlying mechanism is the same: the body's immune system becomes misdirected, attacking the very organs that it was supposed to protect (4).

The word "auto" is Greek for self. The immune system is a complicated network of cells and cell components (molecules) that normally work to defend the body and eliminate infections caused by bacteria, viruses, and other invading microbes. With an autoimmune disease, the body's immune system mistakenly attacks itself, targeting the cells, tissues, and organs of a person's own body. A collection of immune system cells and molecules at a particular organ, called a target site, is broadly referred to as an inflammation (5).

Corticosteroids are in a class of drugs called immunosuppressants, drugs that inhibit the body's immune system's ability to fight infection (5). These drugs are sometimes used for the control of such autoimmune reactions as allergies, skin rash, asthma attack, or even severe laryngitis. These kinds of episodes require a fast controlling agent to calm the attack; with episodes such as these, corticosteroids use is of short duration, and does not do much damage. Sometimes, however, these episodes indicate that serious disease is present. When the disease is autoimmune, doctors prescribe anti-inflammatory agents, the ever-wonderful/terrible corticosteroids. For my illness, my doctor prescribed Deltasone, a more refined version of the generic drug, prednisone (3), (7).

My doctor, Franz Goldstein, told me not to read the PDR, The Physician's Desk Reference, because the list of dangerous side effects would upset me (8). "What was worse", I wondered, "knowing about the dangerous side effects of this drug or not knowing?" I decided that if I was going to learn how to live with this disease, I must trust my doctor. I did not do any research of my own. I just needed to be told that I would survive.

I came to Dr. Goldstein after being under the care of another physician, Dr. R., whose manner was abrasive, who did not take time to answer my questions, who had started me on medication that did not help me, as I got sicker every day. Dr. Goldstein put me into the hospital, attached me to several IV's filled with corticosteroids, glucose and potassium, and soon the symptoms began to subside. I became hopeful. I wasn't going to die.

Ulcerative Colitis, my form of IBD, is a nasty illness, causing a breakdown in the digestive tract (6). The physical symptoms are debilitating, but the feelings of hopelessness and sorrow that set in before diagnosis are even worse. Every day, I waited to feel better, and every day I felt worse than the day before. It is hard to accept that your body is failing, that what is happening is out of your control. No amount of bed rest and tea and toast will make the symptoms go away, or the fear subside. What was happening to me? Would I get well without medical intervention? Would I need surgery? What was this incapacitating illness? What was the cause?

Inherited genes, together with the way the immune system responds to certain triggers or environmental factors, may influence the development of an autoimmune or immunopathic disease (5). Some immunopathic diseases are known to begin or worsen in the presence of a trigger such as a viral infection. When I was a new mother, 23 years old, I developed a virus, was hospitalized with severe abdominal pain and a fever of "unknown origin," After many tests, I was sent home without a diagnosis. Whatever it was, was gone. I got well. The human body is resilient; homeostasis is a wonder. Ten years later, however, I became ill with different symptoms. After exhaustive testing, I was diagnosed with IBD. Was there a connection between the earlier virus and the new disease? Yes. Viruses can act as a trigger mechanism when there is a genetic predisposition to immunopathic disease. Family members with autoimmune disease may inherit and share a set of abnormal genes, although they may develop a different autoimmune disease (5).

My adventure with prednisone lasted for 8 years, and, although life became more normalized, it never became normal. Corticosteroid medication saves lives, by inhibiting the body's tendency to attack its own tissue. Quite soon, symptoms subside and normal functioning of the target organ resumes. However, as bad as the physical side effects of this medication are, the emotional side effects may be worse.

The mind and body work together. In a healthy state, the balance of the two is a wonder. The I-function comes into play (or it doesn't) in a synchronized ballet, where the mind and body send action potential signals, inputs and outputs, and reafferent loop systems. When all is working well, streams of neurotransmitters go to all the right receptors, keeping the body in a state of homeostasis, so that it can receive and distribute appropriately all these neuro chemicals. When disease strikes, however, the system changes, the signals get crossed or deleted or multiplied, and the body begins to break down or fall apart.

When medication is used to correct an illness, side effects might be physical or emotional, depending on the drug. With this medication, both the body and brain are seriously affected by unpleasant and sometimes dangerous side effects. The side effects normally associated with most FDA approved drugs are relatively standard and predictable; they could include: dry mouth, rash, gastrointestinal symptoms, blurred vision, sodium retention, these annoyances influence a patient's decision to continue or discontinue a medication. Sometimes, the pharmacist will advise the patients to ride out the side effects for the length of time that they need to be on the drug.

With corticosteroids the side effects are more serious. In addition to the non-life-threatening symptoms I mentioned earlier, such as increased appetite, insomnia, and edema (especially in the face), prednisone also carries with it some dangerous side effects as well. These include bone thinning (osteoporosis), hypertension, muscle problems, hip joint deterioration, glaucoma, cataracts, increased blood sugar, kidney involvement, delayed wound healing, decreased ability to fight infection, increased sensitivity to the sun and increased fat deposits, which compromise the heart (7). It is better not to read the PDR when you are first put on corticosteroids. My doctor gave me good advice.

Although I could not do much about the physical side effects that might occur, I could do something about the emotional roller coaster. My emotional symptoms included insomnia, fear, nightmares, anxiety, trembling hands, and huge mood swings that would cause me to cry with little provocation. My understanding and sympathetic Dr. Goldstein told me that psychotherapy might help me to learn to live with the strictures and emotional burdens of this disease. So I made an appointment with a psychiatrist.

The mind/brain is an amazing entity. With the help of a mild tranquilizer, my psychiatrist taught me relaxation techniques and I attended scheduled sessions of cognitive behavior talk therapy once or twice a week. I began to read about the disease and the medication, to learn how I could control it, rather than have it control me. After the initial shock of the illness started to dissipate, I was grateful for two things. First, that the prednisone worked and my symptoms were under control, and, second, that with the help of a wonderful support system, my family, I began to reorganize my thinking so that I was not only a "sick person." My adventure with prednisone ended in 1987 when the prednisone was no longer able to control the symptoms of my Inflammatory Bowel Disease. My doctor, fearing a risk of color cancer, and anticipating additional years of prednisone side effects, recommended extensive surgical intervention.

This surgery brought with it a new set of emotional problems, but, ironically, the psychological lessons I had learned during my prednisone years prepared me to adapt to and accept life conditions that often cause despair and depression.

What I learned from prednisone is the difference between chiaroscuro and real life. In chiaroscuro painting, the artist creates the illusion of depth with alternating patterns of light and dark (1). During my first years on prednisone, my life was alternating patterns of light and dark, wonderful days or terrible days, painful days or euphoric days, hopeful days or desperate days.

As my therapy progressed, however, I learned that I was not just a person defined by the light and dark of the drug; rather, I am a three dimensional person, not a two-dimensional illusion of reality.

I began to resume my life. I could go to the movies again. I could do the marketing by myself. I could travel to Europe with my husband. My children were seeing their mother return.

WWW Sources

2) Bookshelf: Coping with Prednisone (Zuckerman & Ingelfinger) ,

3) Deltasone (Prednisone) - Side Effects & Warnings ,

4) Autoimmune Disease the Facts (National Women's Health Information Center) ,

5) Understanding Autoimmune Disease (National Institute for Autoimmune Disease) ,

6) Ulcerative Colitis (National Digestive Diseases Information Clearinghous) ,

7) Prednisone: Good Guy - Bad Guy (TransWeb) ,

8) Drug Information (PDR.net) ,

9) Allergy Glossary (Health on the Net Foundation) ,

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