Any large class of organic compounds with a characteristic molecular structure containing four rings of carbon atoms (three six-membered and one five). They include many hormones, alkaloids and vitamins.
The above, I imagine after choosing a life of easy culture and civil service instead of biochemistry, is a fairly crude definition of a steroid. I do not know the molecular compounds of steroids. Why would I? Nor do I know the specifics of the steroid I have come to loathe called Dexamethasone. All I know is that above description of a steroid fails, quite dramatically to encompass the sheer power of a drug I have been taking for nearly five years and for that whole period of time has be routinely kicking me in the guts. My quick Google search makes it sound so innocent. I know some steroids are innocent, but ever since I watched an episode of California Dreamin’ where Tiffany became addicted to steroids to enhance her volleyball performance, I have known there are something to be wary of. And wart I have been.
Of Dexamethasone, the Internet describes it as a medicine this time and as ‘a synthetic drug of corticosteroids type, used especially as an anti-inflammatory agent’. I’m not going to begin to understand what that means, all I would say, is that for the moral of our current story, remember it’s use as an ‘anti-inflammatory agent’.
Whilst we are on the subject of uses, I do not know, as this blog should clearly indicate, why I take this drug so routinely. I think I understand why I am talking it now, but why Dexamethasone supports pretty much all the myeloma treatment I have ever been on, well, that reason is anybody’s time to research. In light of my ignorance, I thought the least I could do was to investigate the list of known side effects, for it is those where I feel I know the drug as well as I need to.
According to Wikipedia the side effects of taking this dreamboat can include acne, insnomnia, vertigo, increased appetite, weight gain, impaired skin healing, depression, euphoria, hypertension, increased risk of infection, raised intraocular pressure, vomiting, dsyspepsia, confusion, amnesia, irritability, nausea, malaise, headaches and cataract. These are the common side effects. If you are bored, research further but I think I have copied enough to get my point across. They do a lot and they are unpleasant.
Steroids are hard on the body. They have always been hard on my body. In fact, such has been my response to steroids that for the last two treatments I have had, I have been allowed to take a lower than the recommended dose so that I could have something that resembles a normal human’s week at the end of it. I would rather take any other of my routine medications, even the one that gave me nightmares.
Wikipedia’s list failed to list my biggest problem with the stuff and that’s the fatigue. The inevitable crash after the fall. And it was inevitable. I used to prefer taking my month’s steroids over four back to back days as opposed to weekly, just so I did not have to deal with them as much. I didn’t always succeed, but that was my goal. Get them out of the way as soon as humanly possible, whilst still adhering to the will of the Medically Trained People.
Why on earth are you telling us all of this, Emma?
Patience. Something I lack in abundance, but bear with me. There is relevant, I assure you.
Scooped up all the shock that happened 10 days ago now, I was prescribed what is medically known as a ‘pulse of steroids’; with the particular steroid being, yes you guessed it, Dexamethasone. At the time, I thought I had been on a similar pulse of steroids before, but I soon discovered that the only thing I had to compare this pulse to from previous treatments was like walking up Parliament Hill and comparing it to Mount Snowdon.
The course started with taking 20 tablets (40mgs of Dex) for four days, reducing to 10 tablets (20mgs of Dex) on days 5 and 6. By Day 7 and 8 I was down to just five tablets ( 10mgs Dex) and for the final two days, I was prescribed a piddly two tablets per day. Just in case you were wondering, this was to be taken on top of my usual-keep-things-at-bay and not-so-usual-pile-of-pain-medication. So, I have been taking a lot of medication. The prescription for the first four days was for more steroids than I had taken in the last four complete monthly cycles of treatment. It was a LOT of steroids.
When I first heard of this mammoth dose, I thought that it was the sour cherry on top of a pretty ropey, dry cake. It didn’t take long, even in the mental state I was in that day, to be apprehensive about this course of treatment. Eyes were rolled.
How big is the inevitable crash going to be? When am I going to crash? How am I going to go to the toilet over the next week? Am I even going to be able to go to the toilet? What’s my mouth going to taste like? Will I be able to drink water?
Sometimes, I should spend less time worry about the answers to unknown questions and just let Myeloma take me for a ride. I mean, that sounds all very nice and tranquil and a creator of less worry knots. To be clear however, I would never complain about worry knots. If worry knots exist and you were to mention your own worry knots to me, especially after 10 days on steroids, there might be problems. Or at least some solitarily mocking.
I am digressing. I am constantly digressing and that’s because I am here to tell you what it actually feels like to take 238mg of Dexamethasone. It makes your brain feel like fuzz. My mental recall, unless it is about episodes of the West Wing, is… well… what was I saying? At this rate, I am going to wish I had different friends. They are too learned for me right now.
Digressing again… I was right to be apprehensive about it. Prior to starting, I had already discovered that the Dex offered some pain relief in the 24 hours after taking it, but this was the only benefit I saw and I did not know for certain that it was the Dex that had made it easier to get around on that particular day. My immediate thought was that I was not going to be able to move for at least 10 days. At a push, I thought I would get through the first few days and then I would be a bedbound mess for weeks after, unable to get out of bed for a drink. Thankfully, so far at least, that has not happened.
Instead, the steroids ploughed me into a period of emotional instability supported by mass uncontrollable, US reality TV level of food cravings. It’s probably best to break it down. Wikipedia needs to update it’s ‘common side effects’ information because nowhere on that list did I see fatigue, constipation, tin mouth, facial hair growing at the speed of light and tears, lots and lots of tears.
My first few days can be easily categorised as ‘the crying days’. Without the Dex, I dare say that I had some very valid excuses to cry, but on the Dex it was uncontrollable. My usual stoicism forbids this sort of behaviour and I have managed to install a usual system where my crying is done in the privacy of my fortnightly counsellor’s sessions or alone at the darkness of night.
I returned to the safety of Mamma Jones’s nest after the latest of my Bad News Day, and it was there, where I am surround by my immediate family, where I found a lot of things to get emotional about. I could feel that a full outburst was never far away and it wasn’t far away. Somedays, I cried just because the pain was overwhelming me. Other days, and these are the ones that surprised me, I cried in gratitude and in sadness and all of it was completely out of my hands. Something as simple as Mamma Jones bringing me my dinner. She cooked it, carried it upstairs to my room and served it to me every day. Almost every delivery resulted in tears, whether she saw them or not. The steroids made my insides come out.
The worst part of my behaviour was around my nieces. Aged 5 and 10 years old, I do not know if they have an idea why they Auntie Emma constantly breaking into silent tears mid conversation over the course of a weekend. It’s not something I chose to do, it was completely out of my hands and that is a testament to the power of steroids.
For the first few days, as I acclimatised and things sunk in, I just had to look at them and I immediately began to miss them. My brain would fast forward to that point in time where I once again won’t be there and I’d worry they wouldn’t remember me. Thoughts like that could come in an instance. Would I always be their favourite auntie (if I am indeed their favourite auntie) if they cannot remember me at all? I asked the eldest if she would miss me, I know I shouldn’t have done, but my steroids took away the filter. Her answer was a ‘maybe’. So, bathed in love and not feeling remotely vulnerable, I cried again. The eldest was supposed to spend two days with me in London, and even the guilt at having to let her down had me blubbing.
At my most confusing, at least what I imagine was the most confusing for them anyway, was a very innocent conversation about breasts or in our case ‘boobies’, that may well be ranked in my non-existent list of worst conversations ever. At the age of 10, my eldest niece is going through the changes girls go through. Her little sister enjoys this and proceeding to tell us that ‘Lara has little boobs, Auntie Emma has BIG boobs and I have no boobies’. That was it. That’s all she said. Even recounting said story makes my ears water. I immediately started to cry, not loadly, it was more of a silent, please do not see this, sort of cry. It was so innocent, but it highlighted how much there is for me to lose and I have absolutely no control over it. I think they rallied together, but I am pretty sure they had a few days of thinking that Auntie Emma was a total wing bat.
I expected the mood altering side of steroids to manifest itself into rage. Sorry, I meant RAGE! It did not. Even when two women complained bitchily to me that I had put my luggage in the wrong place on a train carriage resulting in them dismantling my disabled friendly bag set up lovingly done by Big Sister, so they did not need to lift up their own suitcases, even then, the rage was nowhere to be seen. Instead, I apologised, returned to me seat and cried. I should have told them why I couldn’t move my luggage, or why they had just seen my sister escort me onto the train, or why one of the bags was full of prescription medication and another contained two empty specimen bottles awaiting 24hrs worth of my urine, or why I was free to travel in the middle of a week day. I should have done all or any of these things, but I didn’t. The steroids just made me cry and I am wholeheartedly ashamed of myself.
Maybe that will come, but if it is anywhere near as strong as the tears, stay away from me. Actually, don’t stay away from me, the steroids make me paranoid and I do not want to feel like that either. Anyway, I cannot do up my bra at the moment, so I doubt I’ll be getting into any physical fights any time some.
I suppose the tears the could be neatly boxed under Wikipedia’s ‘depression’ section. I do not think I have been able to portray the weight of the feelings I felt. Just do me a favour and trust me when I say it was ‘bad’. Thankfully, as my dose has lowered, there have been less tears. I have been feeling far more aligned with my usual self and that involves burying my true feelings until I am alone or with my counselling. A healthy approach if ever there was one.
All other side effects, possibly with the acceception constantly thinking I have glandular fever and excess facial hair, are concentrated around bodily holes. That is how powerful steroids are.
If there is one thing that a pulse of steroids did to me that I was expecting, was to increase my appetite. A bodily hole. I dare not total up how much I have eaten in the last ten days nor how many calories have been consumed on pretty much zero physical activity. It’s a lot. Like, a bloody lot. As I soon discovered, the Dex did not have me searching for all foods, just the bad ones. I know asparagus is good for you and I like asparagus, but a tin of mushy peas made a far better plate fellow with a pie. Like I really had to explain that?
Dexamethasone when taken in isolation and mixed with my body loves nothing more than carbohydrates. If said carbohydrates happen to be served fried, with butter or with a sprinkling of cheese,served with a massive piece of chicken, comes in a packet disguised as a crisp, or as a cake then that was Nirvana. Fulfilling each craving felt medicinal.
Thinking about food beats thinking about death, but I have never known my desire to eat to be so all consuming. I’ll be honest, and this does make me weak, no ifs or buts, I gave in to every single craving. I’m sure a nutritionist might have a view on this, or just an opinionated person who eats a lot of greens, but I do not want to hear it. I know that it was bad having a bowl of frozen mash potato as a snack one hour before dinner, but I needed the instance gratification despite the fact I had only just finished half a tub of hummus and had porridge for breakfast. The four slices of Soreen that followed that dinner were also completely necessary and, unavoidable. It was treatment.
I know that I have had steroid cravings before, but this last week has been a whole new realm. I arranged a supermarket delivery on Saturday and on top of including foods that would keep me semi-independent, I ordered Skips, Wootsits, Squares (salt and vinegar), toffee popcorn, mini popodoms, boxes of cereal and a packet of bagels. The shame!
On Friday, I sent my friend on a quest to my favourite bakery in London to buy slices of my two favourite cakes in our fair land. It was all to satisfy a craving that started 24 hours before. On Thursday, I found myself on Tottenham Court Road with 90 minutes to kill between appointments. In theory, the cakes could have been mine then, but in practice, they could not be. Do you know why? Because I could not walk the 0.8 miles round trip to get them. I had to settle for a Krispy Kreme instead and I do not really like a Krispy Kreme. Oh, just to maintain some level of continuity with this blog, do you know what happened when I realised I was unable of walking to Konditor and Cook for my slices of Lemon Chiffon cake and a Curly Whirly? I cried.
As with anything that goes in, it must come out. Wikipedia definitely neglected to tell us about this. The only thing I will say on this matter, is sodium docusate. Sodium docusate and lots of it. My long experience in large doses of steroids does not support any argument towards diarrhoea. Steroids mixed with the pain medication I am on, causes the opposite issue. I prepared for this eventuality and so far, so every four days. Yesterday, my experience can only be classed as sublime.
Being on so many steroids also had me searching my brain for the techniques of years gone by. Again, this relates to holes. Linseed is a lifesaver, just don’t accidentally let a puppy eat it.
Finally, no story of mountains of steroids would be complete if I did not mention the effect it has on my mouth. I used to call it Tin Mouth. I still call it Tin Mouth. I think I have listed enough life altering side effects already, but do not underestimate the impact of having everything in your mouth, including your salvia tastes like mental. Thank goodness nobody but my dentist gets near my mouth. Every flavour is distorted. No amount of ice lollies will get rid of it. My tastebuds are tainted. The weather this weekend was lovely, but I could not quench my thirst with an ice cold glass of water because such a thing would taste of week old unbrushed teeth mixed with pond. Thankfully, though probably not for my kidneys, steroids make me less thirsty than usual, but unfortunately one still needs fluids to function. People like me need fluids to take their 20-40 pills per day. The trusty brew is strictly off the menu. The only thing that tastes remotely like something I would want in my mouth is lemon squash. That was another thing I had to think about and prepare for. Squash had to be purchased.
I think you get it now. A course of steroids is no walk in the park. I mean, I cannot walk around a park at the moment, but it’s hard. The Dex, even though it is there to help, above all the other medications I take it seems, mostly to hinder. Nothing seems safe from it. I would even go as far as saying I hate them. I hate that I have to make sure I take it by 11am, even if I am too tired to make sure my stomach is full, so I can get a good night’s sleep. I hate that even though I have taken it early everyday, there have still been nights where the power of the Dex have overpowered the strength of my sedatives.
Most of all, I hate the unknown. I finish said course of steroids today and I have no idea if I am about to have one of those, all too familiar steroid crashes. I have been preparing myself for this for 10 days, and it looks like it may not come. Do I let my guard down? It’s not worth the punt.
I will never live a life completely free of steroids. I may get to be free of them for the next week, but they’ll be back. They’ll always come back. Dexamethosone goes with Myeloma like salt in porridge. They should always be served together. It’s an acquired taste.
In conclusion, despite everything I have written, I am a liar. Despite previously willing this pulse to end as quickly as possible and for the steroids to depart my body, I do not want to stop taking them in the short term. In fact, first thing this morning I called the Medically Trained People ready to beg them to allow me to take more.
I do not want to prolong the mouth, waist and emotional altering torment just to give me something to talk about. I just want my pain to improve. And at the beginning of last week, for 12 hour periods at a time, my pain improved. The Dex really did act as an ‘anti-inflammatory agent’. Last week, when I was taking 20 or 40mg a day of steroids, I may have been eating non-stop and crying at the sight of the dog, but I could walk normally. I did not walk like Quasimodo. The ‘pulse’ of steroids, designed to control my pain, actually did control my pain. I’ve weighed it up in my head. I will get more from the steroids right now, crash or no crash, than I would by not taking them. The radiotherapy is going to work, it’s just not going to work right away and I need some independence. I need to be able to clean the mushy peas I dropped on the kitchen floor on Saturday.
I never thought I would say it, but I don’t think I can do it without them.
P.S. I cannot think of steroids without thinking of the sign my friend made for me all the way back in 2012, that states ‘It’ Only Da ‘Roids’. She’s literate by the way, I think the use of ‘da’ was designed to make me smile. It’s a thought I hold close. Through tears, shout, late night shopping and whatever else it throws at me; steroids are not my controller.