Friday, December 23, 2011

A Bitter Pill to Swallow

     Prednisone makes me absolutely psychotic. I'm not just talking about being antsy or jittery; when I take prednisone, I transform into a full on, super-charged nutcase. It's insidious, because at first, I experience a profound sense of well-being, which then deteriorates into a rapid-fire flight-of-ideas, culminating finally in extreme paranoia and inexplicably irrational behavior. I'm guessing it's a pretty uncommon phenomenon, based on the number of patients I see every day who are taking prednisone without ill effects. Anesthesiologists frequently hear patients reporting that they are "allergic" to epinephrine and steroids. This kind of thing usually causes our eyes to roll back in our heads because it's so absurd: how can you have an allergy to  catecholamines and hormones when your own body produces them? Even so, my reaction to prednisone is as close as it gets to being allergic.
     The first time I took prednisone was somewhere around the second week after I started medical school. In a supreme moment of stupidity, I herniated my L5-S1 disc by trying to force open our electric garage door. I came home from school, and was mad because I couldn't get into the garage. The clicky-thing that was clipped to the visor in my minivan wasn't working, so I entered the house through the front door, ran downstairs to the garage, and tried to open it using the wall switch, but that didn't work, either. It was another annoying thing to have to worry about, and I knew that replacing the motor for the door was going to be expensive. Fuming, I walked back down to the driveway and commenced trying to lift that door myself. Assuming a position like a world champion power lifter, I squatted deeply with my back straight, grabbed the door's handles, and with a simultaneous groan and Valsalva maneuver, attempted to curl the 250 pound door straight up. Within a millisecond, I was visited by the most excruciating pain you can imagine. I couldn't straighten myself up, and I had to hobble up the stairs to get back into the house. Initially, I thought it was just a pulled muscle, and tried taking some ibuprofen, but the pain in my back was severe and it persisted for several days. Sitting through class was unbearable, and after a couple of days, I went to see the doctor. He put me on a two week Medrol dose pack (prednisolone, which is converted to prednisone in the gastrointestinal tract) and sent me home. After only a couple of doses, my thoughts began to race, and I started thinking my husband was plotting against me. It was hard to sleep, and I'd get up after a couple of hours in bed to raid the refrigerator. I consumed massive amounts of large curd cottage cheese, sprinkled heavily with salt. Although it was 1997, and the world wide web was still in its nascence, I managed to find a website which sold religious icons and figurines, and loaded up my shopping cart with several Jesuses and Marys. I didn't realize what had happened to me until I tapered off the prednisolone, and things went back to normal. It was as if I had just stepped off of Mr. Toad's Wild Ride.
     Fast forward to September 2006,  and I am now an anesthesiology attending at Emory University, getting ready to take my oral board exam. Nick and Rory had turned 16 years old in July, and now they were driving an old white Volvo 940 station wagon every day to school. That car was a veritable tank, and probably could have withstood a nuclear attack. I bought it used, and my intuition told me that not even a teenager would be inclined to gun that engine and go speeding down Henderson Mill Road; it just wasn't that kind of a ride. In order to get to school, the boys had to make a left turn from our street onto the main road. It was a scary left turn because the house on the corner lot had a fence facing the main road which was massively overgrown with tall, bushy vines, completely obscuring the view of oncoming traffic coming around the 50 ft curve. When I bought my house in 2005, I had noticed how treacherous that left turn was, and tried to get Dekalb County to come and cut those vines back, but they would only trim them to within 5 feet of the curb. This was not adequate for viewing or anticipating traffic. Once the boys started learning to drive, the vines remained a serious issue, so I approached the homeowner about it. She was an elderly lady who was sick with Alzheimer's. Apparently, her husband used to keep the bushes and vines trimmed, but he had died several months ago, and now, she was alone. I asked her if it would be OK for me to have my yard guy come and trim the overgrowth, but she deferred to her daughter on that issue. Her daughter happened to be there, so I politely, but assertively, expressed my concerns, explaining that the overgrown vines were preventing the boys and me from being able to safely negotiate the left turn. She immediately became defensive, telling me that the entire neighborhood, most of which I'd never even met, thought I was crazy and then, complaining about how loud the boys played their guitars in the afternoons. She was really dreadful, and it was evident that she was going to be of little help. I was exasperated with her for being so unreasonable; after all, I had offered to pay my yard guy to do the work in her yard! I had worried about those vines long enough, and I decided to take matters into my own hands.
     The following Saturday, I got up early, before it was light outside, armed myself with hedge clippers and pruning shears, and walked over to the old lady's fence to begin lopping off those vines. This generated some interest in passers-by out on their daily walks. I was doing mortal combat with bushes and vines in some else's yard, and I was taking no prisoners. I felled one long skinny branch after another with my clippers, hurling them like javelins up and over the fence, into the adjacent yard. I was on a mission, and I felt I had done everything I could do to rectify the situation before resorting to such extreme measures. The sun was starting to shine, and I became aware of a rustling noise on the other side of the fence. Thinking it was the old lady's daughter coming to confront me, I crouched behind a bush, phoned Nick, and told him to come and pick me up across the street. I gathered up all my equipment, and made a run for it. From the corner of my eye, I could see an elderly Asian man, standing on the sidewalk on the other side of the street, watching me with an amused expression. I sat down on the curb, waiting for Nick while surveying my handiwork, and unfortunately, I had hardly made a dent. The rustling noise ended up being a real estate agent, who was coming to place her sign on the street corner: the old lady's house was up for sale.
      That evening, I developed an itchy red rash, which I thought was poison ivy. It was all over my arms and legs, and it looked horrible. I tried Benadryl and calamine and hydrocortisone cream, but the itching persisted and soon, I was clawing at my skin. I could hardly concentrate at work because the itching was so bad, so I called the dermatology clinic and got an appointment that afternoon. The dermatologist was impressed with the severity of my reaction, and based on the serpentine pattern of the welts, he determined it was calcium oxalate-induced dermatitis, not poison ivy. I had never heard of this before, but certain vines and plants, like daffodils, contain needle-like calcium oxalate crystals, which can lodge beneath the skin, causing profuse itching. He put me on a very high dose of prednisone for two weeks, and the timing couldn't have been worse. I was flying to San Diego in a couple of days to take my oral boards. Predictably, after the first day on prednisone, I was bouncing off the walls, and by the time I got to San Diego, I was crazy as a loon. I slept only one or two hours every night for the few days I was in my hotel room, not because I was studying, but because I was steeping in steroid-induced psychedelia. Somehow, I managed to pass my oral board exam. I hardly remember anything about about San Diego, the boards, or the trip Nick, Rory, and I took to Toronto for my cousin's wedding the following week.
     Yesterday, I had the day off from work, and I spent the early part of the morning getting our Christmas tree decorated and planning the menu for Christmas Eve dinner. It's been a down-to-the-wire kind of holiday for me, and I was determined to cross those two things off my list, no matter what.  I've felt kind of Grinchy this year, but that's a whole other story; no wait, that's actually a book. As I was wrapping the last of the Christmas gifts, a job I don't particularly care for, I carelessly bent over at the waist to pick up a big package. I felt my back tighten protectively, so I adjusted my posture and kept working. That sensation in my back always makes me think about being laid up in bed after herniating my disc, tripping on prednisone, and it occurred to me that there's a freaky causal relationship between my sometimes self-destructive sense of determination and the subsequent need for prednisone. The sense of urgency I felt about the garage door that was stuck and the overgrown bushes in the neighbor's yard blind-sighted me, and I ended up in worse shape than I was before. Now that I'm nearing 50, my perception of what's truly urgent in life has changed drastically, and I spend a lot less energy reacting foolishly to life's little challenges. I'm happy to report that I've been prednisone-free for the last 8 years. It appears that what I'm really allergic to has been my own stupidity in situations where I have no control, and that's an even more bitter pill to swallow.


  1. I just finished eating a fried Biscoff sandwich a la mode, and enjoying your diverting post. I'm happy to report that the steroids don't affect my behavior/diet at all ;)

    1. A fried Biscoff sandwich, a la mode?! Now, that sounds decadent! Glad you're feeling better and that the steroids aren't making you too crazy.