Sunday, December 2, 2012

Friend or Foe....

Babygirl failed to improve with the first two migraine treatments yesterday.  So Neurology and Nephrology put their heads together and picked a third move.  Steroids.

Cortisone-family steroids are a two-edged sword for sure.  Babygirl takes prednisone 5 mg. daily.  This is the lowest she's been on: At various times she been on twenty times as much, and some of the other 'flavors' of the drug (prednisilone among them) have been used in substantial doses as well.  Prednisone is one of her anti-rejection medications.  Its benefit is that it keeps her immune system from 'seeing' the new kidney.  The other benefits of this class of drugs is that they can act as potent anti-inflammatories.

The down side of this class of drugs is a terrifying list of side effects.  It makes you more likely to get infections.  It causes osteoporosis, weight gain and diabetes.  And long-term daily use can convince your adrenal glands that they are no longer needed in a crisis.  Steroids are our foes.

And that last one is something no one really thinks about.  Your adrenal glands do more than run your fight-or-flight responses.  Or to be more precise, you need your fight-or-flight responses in many subtle ways aside from the ability to lift cars off of injured children.

Which brings us to Babygirl.  Migraines have an inflammatory component, so high-dose steroids are frequently given to break protracted migraine attacks.  This was tried once a couple of weeks ago, although strictly speaking she got a more moderate dose and a rapid taper.  So trying a true high-dose pulse is a reasonable thought.  Steroids are our friends.

But Babygirl has a fever, origin unknown.  Steroids can make infections worse.  Her heart has been racing, and her blood pressure is too low OFF of all of her antihypertensive medications.  So adding more steroids seems, theoretically, to be a seriously bad idea until you think of this:  Her adrenal glands should be producing adrenaline (epinephrine) and other hormones to increase her blood pressure under stress, and they are not.  That 5 mg. of prednisone is telling her adrenal glands that they are not really needed right now, thank you.  So her body's secondary defenses (fever for example) are trying too hard to fight something that they are not designed to fight.

So they have two reasons to give steroids.  Therefore we are in the process of receiving "stress dosing."  This is my first experience with using hydrocortisone as anything but a topical cream for bug bites.  Babygirl is getting large doses IV every six hours.  I failed to ask "how long?"  Clearly we aren't going to make it home in time to go Christmas tree hunting this afternoon.  I'm homesick.


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