What are cortisone injections used for. How are cortisone injections administered. What are the potential side effects of cortisone injections. How effective are cortisone injections for pain relief. What precautions should patients take after receiving a cortisone injection.

Understanding Cortisone and Its Medical Applications

Cortisone is a term used to describe a group of drugs known as corticosteroids. These powerful anti-inflammatory medications are commonly used to treat various painful conditions where inflammation is believed to be the root cause. At Melbourne Radiology Clinic, the types of cortisone used include Celestone (Betamethasone), Kenacort (Triamcinolone), and Depot-Medrol (Methylprednisolone).

It’s important to note that cortisone is not an illegal steroid medication, unlike those used by some disqualified athletes and bodybuilders. Instead, it’s a legitimate medical treatment used to address a wide range of musculoskeletal problems.

Common Conditions Treated with Cortisone Injections

• Bursitis (e.g., subacromial and trochanteric bursitis)
• Arthritis (in various joints, including the spine)
• Nerve pain (e.g., sciatica and carpal tunnel syndrome)
• Tendinitis and Tenosynovitis (e.g., plantar fasciitis, trigger finger, DeQuervain’s tenosynovitis, Tennis and Golfer’s elbow)
• Other inflammatory conditions (e.g., frozen shoulder, Morton’s neuroma, ganglion cysts, Dupuytren’s contracture)

The Cortisone Injection Procedure: What to Expect

The cortisone injection procedure is designed to deliver a high dose of medication directly to the affected area. This targeted approach allows for maximum effectiveness while minimizing potential side effects associated with oral cortisone tablets.

Step-by-Step Procedure Overview

1. The skin is thoroughly cleaned with an antiseptic agent.
2. A fine needle is guided to the target area using medical imaging equipment (ultrasound or CT scanner).
3. The cortisone is accurately delivered to the area of suspected or proven pain.
4. In some cases, local anesthetic may be mixed with the cortisone for additional comfort.

Does the cortisone injection procedure cause significant discomfort? Generally, the degree of discomfort during the procedure is mild. The use of a fine needle and, in some cases, local anesthetic helps minimize pain. However, certain factors may increase discomfort, such as severe underlying inflammation, extreme pain in the injection area, or anxiety related to needles and medical procedures.

Benefits of Image-Guided Cortisone Injections

Image-guided cortisone injections offer several advantages over blind injections or oral cortisone administration. By using medical imaging equipment, practitioners can ensure accurate placement of the medication, significantly increasing the chances of successful pain relief.

Key Advantages of Image-Guided Injections

• Precise targeting of the affected area
• Reduced risk of missed injections
• Ability to deliver higher doses directly to the source of pain
• Minimized systemic side effects compared to oral cortisone
• Improved overall efficacy of the treatment

How do image-guided injections compare to blind injections in terms of effectiveness? Studies have shown that image-guided injections have a higher success rate and provide more consistent pain relief compared to blind injections. This is primarily due to the increased accuracy in medication placement, ensuring that the cortisone reaches the intended target area.

Potential Side Effects and Risks of Cortisone Injections

While cortisone injections are generally safe and effective, it’s crucial for patients to be aware of potential side effects and risks associated with the procedure. The decision to administer cortisone is carefully made by healthcare professionals based on the patient’s symptoms, medical history, and suspected diagnosis.

Common Side Effects

• Palpitations
• Hot flushes
• Insomnia
• Mild mood disturbances

These side effects typically resolve within 24 hours and usually don’t require treatment.

Rare but Serious Complications

• Allergic reactions to cortisone, local anesthetic, antiseptic, or dressing materials
• Infection (less than 0.1% risk, but more serious if injected into a joint)
• Localized skin changes (e.g., depigmentation, thinning)
• Tendon weakening or rupture (with repeated injections)

Can cortisone injections cause long-term complications? While rare, repeated cortisone injections in the same area may lead to long-term complications such as weakened tendons, thinning of nearby bone (osteoporosis), or changes in skin texture. It’s essential to discuss the potential risks and benefits with your healthcare provider before undergoing treatment.

Effectiveness of Cortisone Injections for Pain Relief

Cortisone injections are widely used for their potent anti-inflammatory properties, which can provide significant pain relief for many patients. However, the effectiveness can vary depending on the specific condition being treated and individual patient factors.

Factors Influencing Treatment Success

• Accurate diagnosis of the underlying condition
• Proper placement of the injection
• The severity and duration of the inflammation
• Individual patient response to cortisone
• Adherence to post-injection care instructions

How long does pain relief from cortisone injections typically last? The duration of pain relief can vary widely among patients and conditions. Some individuals may experience relief for several months or even up to a year, while others may have shorter-lived benefits. In some cases, a single injection may provide long-term relief, while other conditions may require periodic treatments.

Post-Injection Care and Precautions

Proper care following a cortisone injection is crucial for maximizing the benefits of the treatment and minimizing potential complications. Patients should be aware of what to expect in the days following the procedure and how to monitor for any adverse reactions.

Key Post-Injection Guidelines

1. Rest the injected area for 24-48 hours, avoiding strenuous activities.
2. Apply ice to the injection site if there’s any discomfort or swelling.
3. Monitor the injection site for signs of infection (e.g., increased redness, warmth, or drainage).
4. Follow up with your healthcare provider as recommended.
5. Gradually return to normal activities as comfort allows.

Should patients limit their activities after receiving a cortisone injection? It’s generally advisable to limit strenuous activities involving the treated area for at least 24-48 hours after the injection. This allows the medication to take effect and reduces the risk of complications. However, complete immobilization is usually not necessary, and gentle movement is often encouraged to promote circulation and healing.

Alternatives to Cortisone Injections

While cortisone injections can be highly effective for many patients, they may not be suitable or desirable for everyone. It’s important to be aware of alternative treatment options that may be considered, either as a first-line approach or in combination with cortisone therapy.

Non-Invasive Treatment Alternatives

• Physical therapy and targeted exercises
• Oral anti-inflammatory medications (NSAIDs)
• Topical pain relievers
• Heat or cold therapy
• Lifestyle modifications (e.g., weight loss, ergonomic adjustments)
• Acupuncture or massage therapy

Other Injectable Treatments

• Platelet-rich plasma (PRP) injections
• Hyaluronic acid injections (for joint conditions)
• Prolotherapy
• Stem cell therapy (still considered experimental for many conditions)

Are there any natural alternatives to cortisone injections? Some patients may prefer to explore natural anti-inflammatory options before considering cortisone injections. These may include dietary changes (e.g., incorporating more omega-3 fatty acids and antioxidant-rich foods), herbal supplements (e.g., turmeric, ginger), and mind-body techniques such as meditation or yoga for pain management. However, it’s crucial to discuss these options with a healthcare provider to ensure they are safe and appropriate for your specific condition.

Long-Term Considerations and Frequency of Cortisone Injections

While cortisone injections can provide significant relief for many patients, it’s important to consider the long-term implications of repeated treatments. Healthcare providers must balance the benefits of pain relief against the potential risks associated with multiple injections over time.

Factors Influencing Injection Frequency

• The specific condition being treated
• Individual patient response to cortisone
• Overall health and medical history of the patient
• Presence of other treatment options
• Risk of side effects with repeated injections

How often can a patient safely receive cortisone injections? The frequency of cortisone injections varies depending on the condition and individual circumstances. Generally, most healthcare providers recommend limiting injections to the same area to no more than 3-4 times per year. This guideline helps minimize the risk of local tissue damage, tendon weakening, and other potential complications associated with repeated cortisone exposure.

Monitoring Long-Term Effects

Patients who receive multiple cortisone injections should be closely monitored by their healthcare provider. This may involve:

• Regular follow-up appointments to assess treatment effectiveness
• Periodic imaging studies to evaluate the condition of affected tissues
• Consideration of alternative or complementary treatments to reduce reliance on cortisone
• Ongoing evaluation of the risk-benefit ratio for continued cortisone therapy

What are the potential consequences of receiving too many cortisone injections? Excessive use of cortisone injections in the same area can lead to various complications, including:

• Weakening or rupture of tendons and ligaments
• Thinning of skin and subcutaneous tissues
• Localized fat atrophy, leading to dimpling or depression of the skin
• Cartilage damage in joints
• Increased risk of infection
• Systemic side effects if the cortisone enters the bloodstream in significant amounts

Patient Education and Informed Consent

Ensuring that patients are well-informed about cortisone injections is crucial for achieving the best possible outcomes and maintaining patient trust. Healthcare providers should take the time to educate patients about the procedure, its potential benefits, and associated risks.

Key Elements of Patient Education

1. Explanation of the condition being treated and how cortisone may help
2. Description of the injection procedure and what to expect
3. Discussion of potential side effects and complications
4. Information on post-injection care and activity restrictions
5. Guidance on when to seek medical attention after the procedure
6. Exploration of alternative treatment options

Why is informed consent important for cortisone injections? Informed consent is a critical aspect of medical care that ensures patients understand the nature of the treatment, its potential risks and benefits, and any available alternatives. This process allows patients to make educated decisions about their healthcare and helps establish a trusting relationship between the patient and healthcare provider.

Addressing Patient Concerns

Healthcare providers should be prepared to address common patient concerns regarding cortisone injections, such as:

• Fear of pain during the procedure
• Anxiety about potential side effects
• Questions about the long-term impact of cortisone use
• Concerns about the effectiveness of the treatment
• Inquiries about alternative treatments or lifestyle modifications

By providing thorough information and addressing these concerns, healthcare providers can help patients feel more comfortable and confident about their treatment decisions.

Advances in Cortisone Injection Techniques and Formulations

The field of cortisone therapy continues to evolve, with ongoing research aimed at improving the efficacy and safety of injections. These advancements may offer new options for patients and healthcare providers in the management of inflammatory conditions.

Recent Developments in Injection Techniques

• Ultrasound-guided injections for improved accuracy
• Needle-free jet injectors for reduced pain and tissue damage
• Computer-assisted injection systems for precise medication delivery
• Combination therapies (e.g., cortisone with hyaluronic acid or PRP)

How do these advanced techniques compare to traditional cortisone injections? Advanced injection techniques often offer improved accuracy and potentially better outcomes compared to traditional methods. For example, ultrasound-guided injections allow for real-time visualization of the needle placement, ensuring that the medication is delivered precisely to the target area. This can lead to increased effectiveness and potentially reduce the risk of complications.

Emerging Cortisone Formulations

Researchers are exploring new cortisone formulations that may offer improved benefits or reduced side effects:

• Extended-release cortisone preparations for longer-lasting effects
• Targeted delivery systems to minimize systemic absorption
• Combination drugs that pair cortisone with other therapeutic agents
• Bioengineered corticosteroids with enhanced anti-inflammatory properties

What potential advantages do these new formulations offer? These emerging formulations aim to enhance the therapeutic effects of cortisone while minimizing potential side effects. For instance, extended-release preparations could provide longer-lasting relief with fewer injections, while targeted delivery systems may reduce the risk of systemic side effects by keeping the medication localized to the treatment area.

Future Directions in Cortisone Therapy

The future of cortisone therapy may involve:

• Personalized treatment approaches based on genetic profiles
• Integration of artificial intelligence for optimized injection planning
• Development of novel anti-inflammatory compounds with cortisone-like effects
• Improved imaging technologies for even more precise medication delivery

As research in this field progresses, patients may benefit from more effective, safer, and tailored cortisone treatments for a wide range of inflammatory conditions.

Cortisone Injections Patient Guide- Melbourne Radiology

Cortisone Injections – Patient Fact SheetMelbourneRadiologyMarch 10, 2019March 27, 2023

This information sheet is intended for patients receiving a cortisone injection as part of their procedure at Melbourne Radiology Clinic.
Cortisone is used to treat pain in various parts of the body where inflammation is felt to be the cause of this pain.

Cortisone is the name used to describe a group of drugs commonly known as corticosteroids. The types of cortisone used at Melbourne Radiology Clinic include Celestone (Betamethasone), Kenacort (Triamcinolone) and Depot-Medrol (Methylprednisolone). Cortisone is used to treat pain in various parts of the body where inflammation is felt to be the cause of this pain. The reason why cortisone is effective in treating such pain is because it is a powerful anti-inflammatory. Cortisone is NOT an illegal steroid medication, such as those steroids used by some disqualified body builders and athletes

In regard to musculoskeletal problems, cortisone injections are performed in order to reduce or even eliminate pain associated with a variety of disorders, such as:

• Bursitis (most commonly subacromial and trochanteric bursitis)
• Arthritis (any joint may be injected, including joints of the spine)
• Nerve pain (most commonly for sciatica and carpal tunnel syndrome)
• Tendinitis and Tenosynovitis (such as plantar fasciitis trigger finger, DeQuervain’s tenosynovitis, Tennis and Golfer’s elbow)
• Other miscellaneous conditions where inflammation is a contributor to the pain, for example frozen shoulder/adhesive capsulitis, Morton’s neuroma, ganglion cyst injections and Dupuytren’s contracture.

CORTISONE INJECTION

1. The skin is prepared using an antiseptic agent.
2. The needle is then guided into the relevant body part using medical imaging equipment, such as an ultrasound or Computed Tomography (CT) scanner. The guidance allows a high dose of cortisone to be accurately delivered into the area of suspected/proven pain without the side effects of taking cortisone tablets. This gives you the best chance of pain relief, as injections performed without guidance may not work due to incorrect placement of cortisone.
3. The degree of discomfort during the procedure is generally mild as the needle used is fine and local anaesthetic is mixed in with cortisone. If only one pass is planned (meaning that the needle will only penetrate the skin once) then local anaesthetic is usually NOT injected into the skin. It is our experience that injecting local anaesthetic into the skin in a single pass procedure is actually more painful, as local anaesthetic stings a little prior to taking effect. Also, the needle used to inject the local anaesthetic results in similar discomfort as the needle delivering the cortisone. Local anaesthetic is only injected into the skin if more than one pass is made through the skin. Of course, if you wish for local anaesthetic to be injected despite our recommendation, we are happy to do this.
4. A greater degree of discomfort may occur if:
   – the underlying inflammation is severe
   – the area to be injected is severely painful
   – the needle tip requires to be repositioned several times in order to distribute the cortisone effectively
   – a previous bad experience has resulted in a fear of needles, or there is a general anxiety/phobia of needles and other medical procedures.

In cases where a cyst, ganglion, bursa or joint is distended with fluid, the cortisone will be injected after an attempt to aspirate (remove) the fluid in order to improve comfort.

Benefits, Risks, Complications and Side-Effects of Cortisone

As for all medical procedures, there are risk associated with the administration of any medication, including cortisone. The chances of cortisone providing you with the benefit of pain relief in most patients outweighs the risk of experiencing a side effect(s) (discussed below). The decision to inject cortisone is not taken lightly and is carefully made by your referring doctor and based on your signs, symptoms and past medical history, as well as the suspected diagnosis. Frequently, a trial injection is made where the diagnosis is not clear, however the body region that is to be injected is suspected of causing your pain.

The side effects and risks of a cortisone injection include:

Allergy to any of the substances utilised during the procedure, such as the cortisone, dressing, local anaesthetic or antiseptic. This is usually minor and self limiting.

The cortisone may result in palpitations, hot flushes, insomnia, and mild mood disturbance. This usually resolves within 24 hours and no treatment is necessary.

Infection is a rare but serious complication (<0.1%), especially if injected into a joint. Most infections take at least a day or two to manifest, so pain at the injection site after 48 hours is considered to be due to an infection until proven otherwise. Even if not definitively proven, you may be commenced on empirical antibiotic treatment.

Localised skin and subcutaneous fat atrophy (thinning resulting in dimpling).

Hypopigmentation (whitening of the skin) at the injection site. This most commonly happens in injections of the palm of the hand or sole of the foot.

Mild increase in blood sugar levels in diabetic patients for several days and may last up to a week.

Transient increase in pain at the injection site before the cortisone takes effect. Occasionally this may be severe, however usually lasts only 24–48 hours and is treated with a cold pack, paracetamol and anti-inflammatory medication. If this occurs and you are concerned, especially if the pain is not settling despite the above treatment, then please call contact your referring doctor so that they are able to examine, assess and manage you appropriately.

Cortisone injection administered directly into a tendon has been reported to weaken and damage the collagen fibers, thus carrying a risk of delayed rupture. For this reason, cortisone is only injected around the tissue surrounding a tendon and the tendon is rested for one week.

An extremely rare complication is avascular necrosis (bone death) which some doctors suspect may rarely occur when cortisone is injected into a joint, though this has not been proven

Remember that the side effects of cortisone that are commonly reported in the media, such as osteoporosis, weight gain, acne and diabetes only occur when taking cortisone tablets for at least several weeks (typically many months to years). These side effects do not occur with the careful use of cortisone injections.

Of course there are. Since a cortisone injection is used for treating pain, it is an optional procedure. Other options should be discussed with you referring doctor and may include anti-inflammatory medications, exercise, physiotherapy and surgery to name a few. The role of our radiologist is to perform the procedure requested by your referring doctor and therefore ensure that the cortisone is injected safely and into the correct location.

There is no scientifically proven limit for cortisone injections, however as a general rule, three injections into the same body part are permitted over a twelve month period. Injections more frequent than this are felt to place the injected tissue at risk of softening/weakening, which may be an issue in a joint for example, as this may accelerate arthritis. Also, if you have failed to respond to a series of three injections, then it is probably time your condition was reassessed to find out if the diagnosis correct. Has your condition worsened and are other forms of treatment, such as surgery, more appropriate?

If you do require more than three injections in a year, then the risk of the injection must be carefully balanced against the benefits of pain relief. Your referring doctor or the doctor at Melbourne Radiology Clinic will be happy to discuss your condition and address any concerns that you may have.

After a cortisone injection, it is strongly advised to rest the affected joint for 24 hours and refrain from doing strenuous activity or exercise for several days. Resting after the injection is vital to reduce inflammation effectively.

Once administered, a cortisone injection begins to work almost immediately, although there are times when it may take five days to a few weeks for the full effect to be felt. Timing of relief varies depending on the severity of the inflammation or how long it has been present. Depending on the condition, a person may need more than one injection.

Your Images and Report

One of Melbourne Radiology Clinic’s specialist radiologists, a medical doctor specialising in the interpretation of medical images for the purposes of providing a diagnosis, will then review the images and provide a formal written report. If medically urgent, or you have an appointment immediately after the scan to be seen by your doctor or health care provider, Melbourne Radiology Clinic will have your results ready without delay. Otherwise, the report will be received by your doctor or health care provider within the next 24 hours.

Follow-up Appointment

Please ensure that you make a follow up appointment with your referring doctor or health care provider to discuss your results.

Your referring doctor or health care provider is the most appropriate person to explain to you the results of the scans and for this reason, we do not release the results directly to you.

Cortisone Shots – The Little Shot of Horrors (horrible side effects)

There is a burning question out there, yet doctors seem hesitant to address this question. I’m not sure why since so many people seem to experience this.

*affiliate links are used in this post

Do cortisone shots have side effects?

I firmly believe they do!

While I was recovering from my neck surgery, I was told to not bend over, but instead to bend at the knees. I listened to the doctors orders, but unfortunately I then hurt my knee from bending so much.   I saw a different doctor for my knee and we both suspected a torn meniscus. An MRI revealed that nothing was torn, but that there were several other issues going on in there. He thought that a cortisone shot in the knee would be the best option. Honestly, I didn’t know much about them. I mentioned that I had heard of Cortisone injections before and I also knew someone who had a Cortisol shot before…were they the same thing? He said they were not  – that Cortisol is a steroid. 

Honestly, I had a lot of questions. The thought of a needle being inserted into my knee sounded kind of barbaric.  Will there be pain after a cortisone shot in the knee? How long does a Cortisone shot last? I also wondered, if this worked, how often can you get a cortisone shot? Not that I wanted to do this often, but if it offered major relief, then I imagine I would be all in! Of course, I hadn’t had it done yet either, so I still didn’t know what to expect after the cortisone shot!

What is Cortisone, what does Cortisone do and what does a Cortisone

shot do?

Cortisone is used to reduce inflammation in the joints (typically the knee joint, elbow joint, etc. ) and also in an effort to reduce the pain.

Last week I went in to have the cortisone shot. Do cortisone shots hurt? Well, here is my opinion on this. Cortisone shot pain is minimal. The doctor applied something to “freeze” the skin (it felt like dry ice – super cold), and then he injected an anesthetic, which stung just a little bit, then he gave me the cortisone shot. I have to admit that it wasn’t nearly as bad as I thought it would be; I had envisioned a long needle weaving around the inside of my knee, but hit was very tolerable.

I left the office feeling relieved that it was over, but about two hours after I got home I began to feel “funny”. Not haha funny, but really strange. I got extremely hot…then really cold. Then hot, cold, hot, cold. I took my jacket off, put it on, took it off, etc. every 10 minutes or so, for the rest of the day. I was flushed, sweaty and clammy. I felt extremely shaky, like I feel when I haven’t eaten in awhile, so I imagine my normally perfect blood pressure was elevated (by how much, I don’t know).  I probably should have called the doctor but I kept thinking these horrible effects would wear off shortly.

 

I grew concerned and starting searching the internet to see if others experienced these same symptoms. I was actually shocked at what I read. There were so many people that had posted on message boards and medical sites, talking about these same symptoms. I also learned that the cortisone shots increase your blood sugar, which obviously can be very dangerous for those who are pre-diabetic or those who have full-blown diabetes. My blood sugar runs just a little bit high, and I assume that is why I felt so crappy.

More Cortisone shot side effects

That night, I went to bed as usual, but I did not sleep at all. Not even a wink. I was having the same hot and cold flashes as I did earlier, the jitters coupled with a rapid heartbeat, and the leg where I had the cortisone shot was jumping uncontrollably.  I have had severe Restless Leg Syndrome (RLS) since I was a child, and it is typically kept under control with medication. Apparently the shot triggered something in that leg because I was kicking and flailing all night long. I didn’t fall asleep until 6 a.m. It was awful. I kind of wondered …is Cortisone a steroid? I felt kind of amped up, and I know steroids can do that to a person. It would make sense to me that these could be steroid injection side effects too.

I just wanted all of these Cortisone side effects to go away. One of the most frightening things when you’re going through something like this is the not knowing how long the feelings will go on. 

So here we are, one week later, and I am still having these symptoms (though they are not quite as severe as the first couple of days). I get really shaky (out of the blue), break out in a sweat while I am doing absolutely nothing, and just generally feel really crappy. I plan on calling the doctor tomorrow, as I want to know exactly what he gave me (name, dose, etc.), and ask why I wasn’t warned about these side effects. While reading other’s posts online, many of them said that their doctors told them these adverse effects aren’t due to cortisone injections. I beg to differ, and call HOGWASH.

Is it possible I am allergic to cortisone? I can’t help but wonder since other people have had none of these side effects.

Do cortisone shots cause shakiness and heart racing?

They did for me, and I want to get to the bottom of this.

Are Cortisone injections bad for you?

I can’t answer for everyone, but for myself and for those who have experienced these horrible symptoms after  an injection, I imagine you would hear us all should a resounding, “YES”!

One thing for sure is I will never, ever, have another cortisone shot. If you are planning on having one, I would definitely reconsider, or at least do your research first. If you are diabetic, I hope you’ll think twice.

Have you ever had these or other side effects of cortisone shots?

Update! A reader suggested using Magnesium to reduce/eliminate the side effects. She said it helped her. Thanks Debbie!

*Note – please do check with a doctor before using supplements or product recommendations you see here.

Here are a few ideas to help you relax and hopefully help you sleep while you are suffering with the side effects of Cortisone shots.

 

    Aromatherapy

Shower tabs

Lavender Pack

Enjoy more from Eighty Mph Mom! 

Getting Creative With Your Foundation

Side effects of steroids

Side effects of steroids

Listed below are some of the most common long-term side effects of high-dose steroids in growing children. It is important to note that different patients may have different reactions to steroids. The key to successful steroid treatment is being aware of the potential side effects and working to prevent them. Reducing the dosage of steroids is necessary when the development of side effects is intolerable for the patient and inspires concern in the doctor. If the development of side effects cannot be corrected by reducing the dose or changing the regimen of taking the drug, then it is recommended to abandon the course of steroid treatment as a whole.

• Side effects of taking steroids
• Comments and recommended observation
• Issues to be resolved and discussed with your therapist

• General and external, Weight gain, Obesity
• Dietary advice should be given to all families before starting steroid therapy. It should be noted that steroids increase appetite.
• Nutrition must be balanced to prevent weight gain. Follow diet and nutrition recommendations for the whole family.

• Cushingoid signs (moon face)
• The fullness of the face and cheeks becomes more noticeable over time.
• Careful adherence to a dietary regimen, limiting sugar and salt intake should help control weight gain and minimize cushingoid symptoms.

• Increased hairiness (hirsutism)
• Medical examination.
• The occurrence of this effect is not a sufficiently serious reason to refuse a course of steroid treatment.

• Acne, ringworm, papillomas
• More common in adolescents.
• Get a special treatment (temporary treatment) and do not rush to change your steroid regimen.

• Slow growth
• Monitor the patient’s growth at least every 6 months (usually, patients with DMD are not tall, even those who are not on steroid therapy).
• Ask your son if he is worried about his short stature. If you are worried, discuss with your doctor the need for an examination by an endocrinologist.

• Delayed puberty
• Development monitoring. Find out about a family history of late puberty.
• Discuss the issue of puberty. Ask your son if he is worried about delayed puberty. If your son is concerned, discuss with the doctor the issue of examination by an endocrinologist.

• Adverse behavioral disorders (here you will find many recommendations on this topic)
• Determine initially: general mood, temperament, attention deficit hyperactivity disorder. Keep in mind that all of these parameters may experience deterioration temporarily for the first 6 weeks of steroid therapy.
• Consult a psychologist before starting steroid treatment if the child has behavioral problems. Changing your prednisolone regimen later in the day may help. Discuss this issue with your doctor.

• Immunosuppression / adrenocorticosteroid deficiency
• Be aware of the increased risk of infectious diseases and the need for timely treatment. Inform all medical personnel that the child is taking steroids and carry an individual patient record with you. Make sure you don’t stop taking steroids. It is very important that a patient on permanent steroid treatment does not allow pauses in taking the drug for a period of more than 24 hours.
• Get vaccinated against varicella before starting steroid therapy; If vaccination is not performed, in case of accidental contact of the patient with patients with chickenpox, you should immediately consult a doctor. If there is a threat of contracting tuberculosis, special monitoring may be necessary. Discuss with your doctor what to do if you have to stop taking steroids, such as replacing prednisone with an equivalent if deflazacort is temporarily unavailable, or whether you need an IV during an illness or nutritional deficiency. Discuss intravenous loading of methylprednisolone for surgery or underlying disease. Use droppers for parenteral nutrition.

• Increased blood pressure
• Blood pressure measurement at every clinic visit.
• If you have high blood pressure, limit your salt intake and aim for weight loss. If this does not lead to the desired result, then the doctor should prescribe ACE inhibitors or beta-blockers.

• Impaired glucose tolerance
• Urinalysis for glucose with rapid test with impregnated substrate. Consult a specialist for frequent urination or increased thirst.
• Blood tests may be needed if urine glucose levels increase.

• Gastritis / gastroesophageal reflux
• Watch out for reflux symptoms (heartburn).
• Avoid non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, naproxen. To eliminate the symptoms, you can take specific medications and antacids.

• Peptic ulcer
• Abdominal pain may be due to damage to the gastric mucosa. Get a fecal occult blood test if you have anemia or a history of aggravation.
• Avoid NSAIDs (aspirin, ibuprofen, naproxen). Medications and antacids should be taken symptomatically. Seek advice from a gastroenterologist.

• Cataract
• Annual eye examination.
• If cataract develops and affects vision, consider switching from deflazacort to prednisone. Seek advice from an ophthalmologist. Cataracts should only be treated if there is visual impairment.

• Osteoporosis (bone demineralization) and increased risk of fractures
• Note any history of fractures. An annual bone density test (DEXA) is recommended. Annual analysis of the level of vitamin D in the blood (ideally at the end of winter). With a decrease in its level, add vitamin D3. The doctor should assess the intake of calcium and vitamin D.
• Vitamin D supplements may be required depending on blood levels. After 3 months of treatment with vitamin D, recheck the level of vitamin D in the blood. Aerobic exercise may help. Make sure you get enough calcium in your diet, otherwise special supplements may be needed.

• Myoglobinuria (Urine color is brown, because it contains breakdown products of muscle proteins. It is necessary to do tests in the appropriate laboratory)
• Observe changes in urine color after exercise.
• Avoid strength and eccentric exercises such as incline running or trampolining. Intensive fluid intake is very important. A kidney exam is needed.

Information based on consensus statement (published in January 2010)

How to calm tachycardia: a cardiologist advised two simple and effective methods

• Health

A pounding heart, severe lightheadedness, a feeling of fear and dizziness – this is how a tachycardia attack is most often described. In some situations, this is a normal reaction of the body, but frequent attacks are dangerous.

September 9, 2022

Source:

iStockphoto

In a healthy adult, if he is calm and not engaged in physical labor, the heart rate fluctuates between 60-80 beats. Such work of the heart is quite enough to pump blood through the vessels and deliver oxygen and nutrients to all tissues. During physical exertion, sports, under the influence of stress or emotions, fear, our heart beats faster. This is necessary in order to provide the body with everything necessary in conditions of increased stress.

After you calm down, your heartbeat returns to normal. But if a tachycardia attack occurs suddenly, at rest or with minimal exertion, you feel bad – this is a reason to visit a doctor. In addition, it is important to be able to quickly calm the tachycardia in order to recover. “Doctor Peter” talked about the danger of such attacks with Ekaterina Kiyashko, a cardiologist, a general practitioner.

Almost jumps out of the chest

In healthy people, tachycardia may suddenly occur under the influence of various external stimuli. Moreover, we can even feel an accelerated heartbeat – against the background of various emotions, both negative and positive, with a strong fright, excitement. Tachycardia can develop during physical activity, especially if a person is poorly trained, because in this case his heart and blood vessels are not ready for a sharp change in stress.

An attack of tachycardia can provoke smoking, since nicotine and other substances in tobacco smoke negatively affect the functioning of the cardiovascular system.

In these cases, the episode of palpitations resolves on its own after the influence of stress factors, hormones, or training ends, the load stops.

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Heartbeat warns of health problems

Feeling a strong heartbeat, the first thing we think about is heart disease. But cardiologist Ekaterina Kiyashko clarifies that tachycardia can occur without heart disease, with other conditions that make the heart work more actively, pumping blood into the vessels of the body. The most common are:

1. anemia and hidden iron deficiency, which is common in young girls;

2. thyroid problems;

3. dehydration;

4. lack of potassium and magnesium for various reasons.

Palpitations can be a symptom of disturbances in the work of the autonomic nervous system with an increased level of stress, improper sleep and rest. Then our sympathetic nervous system is activated and the level of stress hormones (adrenaline, cortisol) rises, which contributes to an increase in heart rate.

Frequent attacks need to be dealt with

If heart palpitations are frequent, the person is worried – what if it is dangerous and I might die? Ekaterina Evgenievna says that the degree of danger depends on the cause of tachycardia. If it is not associated with heart disease, for example, in the conditions listed above, then the rapid heartbeat itself does not pose a danger to life and health.

It is quite another matter if the cause of the rapid heartbeat lies in a heart disease. In this case, you need to figure out what kind of tachycardia it is, how the heart works. They are different, both dangerous and not. In any case, it is better to consult a doctor and understand the cause and type of tachycardia in order to understand how to cope with attacks.

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Hold your breath or cough

An attack can occur anywhere, what can be done if a strong heartbeat suddenly occurs? Dr. Kiyashko elaborates: there is a safe natural method to reduce the heartbeat that everyone can use in any conditions.

This is a respiratory (or vagal, in scientific terms) “trick” – move to deep breathing, hold your breath after a deep breath.

There is another option – you can just cough intensively. At this point, there is a reflex slowdown in the pulse.

If this does not help, see a doctor immediately.

For serious tachycardia with cardiac causes, these methods may not help. In such situations, be sure to schedule a visit to the doctor in the near future, especially if the tachycardia does not go away on its own. In some cases, you need to call an ambulance. These are situations where tachycardia is accompanied by the following symptoms:

• chest pain,

• in the region of the heart,

• cold sweat,

• shortness of breath,

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• weakness,

• severe dizziness,

• or loss of consciousness.

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How to eliminate seizures

The frequency and severity of palpitations with severe malaise and all other manifestations strongly depends on the causes of the disease. In general, “tachycardia” is a general concept, complaints of palpitations alone are not enough to talk about any universal recommendations. Both non-cardiac tachycardias, in which the heart itself is healthy, and some caused by heart problems, can be completely eliminated quickly and effectively. In some cases, the doctor will recommend taking medications, treating the underlying disease – anemia, hormonal failure, etc.