Living with Steriods' Stigma.
Lifesaving uses of the hormone agents are overshadowed by athlete scandals
Jan. 22, 2008 12:00 AM
by Connie Midey | The Arizona Republic
For every Marion Jones, stripped of her 2000 Olympics medals in track after admitting to steroid use, there are countless people like Jayce Pangilinan whose lives depend on steroids.
The doctor-prescribed steroids Pangilinan uses aren't the kind athletes abuse. She takes them not to build muscle but to manage lupus, an incurable autoimmune disease with which she was diagnosed at age 13.
"People do (act alarmed) when you say you're taking steroids," the Chandler 17-year-old says. "All they know is the type athletes take. All steroids can have bad side effects, but the type I'm taking save my life, too."
Her physician, Paul Howard of Arthritis Health in Scottsdale, says patients also are alarmed when he recommends the drugs. "Many have heard steroids are not good things," he says, "but I wouldn't practice rheumatology without them being available for critical situations."
Steroids are hormones produced naturally in the body and available in synthetic versions by prescription, he says. They're classified in types that have little in common but a name made infamous by allegations of abuse, most recently in former Senate Majority Leader George Mitchell's report, which accused slugger Barry Bonds and almost 80 other baseball players of using steroids to gain an advantage over rivals.
Anabolic steroids, the kind the ballplayers are accused of taking, build tissue | from simpler molecules in the body and are used legitimately to treat a handful of uncommon medical conditions. The male sex hormone testosterone is a steroid with anabolic effects, capable of spurring muscle growth.
Corticosteroids, produced by the adrenal glands, are catabolic. They break down tissue and serve as potent anti-inflammatory agents, Valley allergy and asthma specialist Duane Wong says. They're the kind Pangilinan takes.
When Wong, of Arizona Allergy Associates, prescribes steroids to reduce inflammation in an asthmatic's airways, patients and family members often express confusion.
"They think they're going to end up looking like Barry Bonds, with a big head and very muscular," he says.
That won't happen with corticosteroids. In fact, he says, "You need a little bit of (natural) steroids in your body every day, or you won't survive."
When larger amounts are needed to control the inflammation typical of conditions such as asthma, eczema, lupus and rheumatoid arthritis, synthetic corticosteroids sometimes are prescribed.
"These are medications we're very, very careful with," Wong says. "But over a short period of time, they can be lifesaving."
Taken in high doses, for an extended time or without careful medical monitoring, however, corticosteroids can stunt growth, thin bones and cause cataracts. Side effects are more likely with corticosteroids taken orally, Wong says, because they're absorbed throughout the body, not just in a targeted area as with topical cream, nasal spray, or inhaled or injected forms of the drug.
"A lot of people are very steroid-phobic, and rightly so," Wong says.
Sharing that concern, doctors typically prescribe corticosteroids as "rescue therapy," in the smallest dose and for the shortest time possible to create the needed effect, rheumatologist Howard says.
In breaking down substances in the body, corticosteroids "put the brakes on an overactive immune system," he says. They protect the lungs, heart, kidneys and other parts of the body when excessive inflammation must be controlled quickly or can't be controlled by other means.
Howard prescribed the corticosteroid drug prednisone to dampen Pangilinan's immune system and ease her severe fatigue, joint pain and skin rash, decreasing the dosage when her disease went into remission. In lupus, the immune system - unable to tell the difference between foreign substances and its own body - makes antibodies that attack healthy cells and tissues, according to the Lupus Foundation of America.
But relief came at a cost in the beginning.
"At 13, you're trying to build up your confidence and deal with body-image problems," Pangilinan says. "It doesn't help that your body changes. The prednisone gave me a kind of moon face, and I gained 30 pounds and got stretch marks all over my legs and on my abdomen."
The drug also made her shaky and moody, and it stimulated growth of body hair, including on her face. Compounding her insecurities, much of the hair on her head fell out after she had chemotherapy to stop lupus-related kidney inflammation.
"At first I was shy about telling people what was happening," she says. "No one (except family) knew why my hair was falling out and I was gaining weight, but it was hard to bring it up in conversation, to just go up to someone and say, 'Oh, hey, I have lupus.' "
With anabolic steroids, side effects can be equally devastating, more so when the drugs are obtained illegally and not doctor-supervised for a medical condition. Conditions treated legally with anabolic steroids include delayed puberty, hypogonadism (a condition in which the sex glands produce little or no hormones) and body-wasting in people with AIDS.
John Kearney, a sports-medicine physician with CORE Institute (Center for Orthopedic Research and Education), with offices Valley-wide, says heart problems are the most serious of anabolic steroids' documented ill effects.
But if he wants to get teenage boys' attention, he reminds them that taking the drugs to bulk up for sports will make their testicles shrink, cause depression and mood swings, spoil their social life and impair their school performance.
In teen girls and women, anabolic steroids also can disrupt menstrual cycles, deepen the voice, promote facial-hair growth similar to men's and cause male-pattern baldness.
"We know the dangers in kids," says Kearney, on the medical staff at Sun Health Boswell Hospital in Sun City and the faculty at Phoenix Baptist Hospital. "But when you talk with them, you have to talk about instant gratification."
Synthetic anabolic steroids mimic the muscle-building ability of testosterone produced naturally in the testicles, he says. But they also affect the brain and perhaps every system in the body, disrupting natural checks and balances.
"If you tilt that too far to suit your needs," Kearney says, "you can get really bad results, just because your body doesn't know how to react. With so many long-term health effects, the trade-off isn't worth it."
For Pangilinan, there isn't a choice, at least until researchers find an equally effective alternative to the steroids she takes by prescription.
She looks forward to that day. The medicine that controls her lupus also makes her susceptible to a long list of ills, including infection, thinning of the skin, depression, salt retention, high blood pressure and muscle weakness. So participating on cheer squad, strenuous and with outdoor practices, is out. And pool parties are decidedly less fun now, covered as she must be in SPF-50 sunscreen, a long-sleeve shirt and long pants in 100-degree weather.
But corticosteroids keep her alive, and knowing that makes it a little easier to swallow the prednisone, plus the blood-pressure medicine, immunosuppressants, vitamins and minerals, 16 pills in all, that she takes every day.
They make it possible for her to get out of bed every morning, take honors classes at Basha High School, work part time at In-N-Out Burger and volunteer at Mercy Gilbert Medical Center with pain and fatigue in check.
"When everything's under control," Pangilinan says, "I try to take advantage of that and make good use of the time, instead of sitting around. I believe I'm blessed. There are times when you just want to be normal, but having lupus makes me appreciate when I'm healthy enough to do what I want to do."