Thursday, June 14, 2007

Bitter little pills

So, in consulation with my oncologist two days ago we decide that as I still had all sorts of sleeping problems around the steroid pill popping period during cycle two, and yet I've been doing so well on not vomiting or even feeling any passing nausea, that maybe I was ready to reduce the steroid intake.

I sort of admitted to her that on both cycle one and two I had inadvertently lapsed on taking the last few Dex pills - more to do with having trouble remembering to take them once I was back at work and eating locations changed. It's all very easy to recall how many of which packet to take when you have a complex spreadsheet type list on the front of your fridge. Less so when you're scoffing a sandwich at your desk.

Anyway, I was duly given the same amount of Dex as a pre-med through the portocacth but the prescription of pills for afters has been reduced.

Except there's one problem... I got up very late yesterday and had breakfast at around 12.30. With that I took the first dose (2 pills) of Wednesday's Dex. Then come dinner (no point having lunch if you had breakfast at 12.30 after all) I realised I had a dilemma. The prescription says to take 2 pills with breakfast and 2 with lunch. If you take them any later you end up really screwing up your sleep. So I skipped them, instantly halving the already reduced dosage.

And, in that weird way where you know you really shouldn't ignore doctors when they cheerily say "keep taking those pills!", my body immediately noticed the absence of Dex. I have duly popped another two pills this morning, along with the ondansetron which also combats nausea, but still I could hardly keep my breakfast down. If I smell a strong food smell, it turns my stomach.

Not a nice experience and not one I'll be repeating in a hurry.

And I suddenly find myself viewing the small bottle of Dex with a strange fondness. Even if they cause all sorts of nasty side effects. Here's the list from wikipedia:

- Stomach upset, increased sensitivity to stomach acid to the point of ulceration of esophagus, stomach, and duodenum
- Increased appetite leading to significant weight gain
- A latent diabetes mellitus often becomes manifest. Glucose intolerance is worsened in patients with preexisting diabetes.
- Immunsuppressant action, particularly if given together with other immunosuppressants such as ciclosporine. Bacterial, viral, and fungal disease may progress more easily and can become life-threatening. Fever as a warning symptom is often suppressed.
- Psychiatric disturbances, including personality changes, irritability, euphoria, mania
- Osteoporosis under long term treatment, pathologic fractures (e.g., hip)
- Muscle atrophy, negative protein balance (catabolism)
- Elevated liver enzymes, fatty liver degeneration (usually reversible)
- Cushingoid (syndrome resembling hyperactive adrenal cortex with increase in adiposity, hypertension, bone demineralization, etc.)
- Depression of the adrenal gland is usually seen, if more than 1.5 mg daily are given for more than three weeks to a month.
- Hypertension, fluid and sodium retention, edema, worsening of heart insufficiency (due to mineral corticoid activity)
- Dependence with withdrawal syndrome is frequently seen.
- Increased intraocular pressure, certain types of glaucoma, cataract (serious clouding of eye lenses)
- Dermatologic: Acne, allergic dermatitis, dry scaly skin, ecchymoses and petechiae, erythema, impaired wound-healing, increased sweating, rash, striae, suppression of reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria.
- Allergic reactions (though infrequently): Anaphylactoid reaction, anaphylaxis, angioedema. (Highly unlikely, since dexamethasone is given to prevent anaphylactoid reactions.)

So out of all of those they don;t even mention the sleeping problem. Though my doctors tell me that the Dex is what is causing it. But I can also count the infected oesophagus, heartburn, indigestion, constipation against these innocent looking little pills.

But I love those little pills if they can stop me feeling sick.

1 comment:

Anonymous said...

I'm thinking that with the pharmacological cornucopia you have peppermint tea just aint gonna cut it! Hope you feel less pooh very soon - or at least that the mania that Dex promises kicks in and you feel like you should be ruling the world.