Doctors' Answers to "Frequently Asked Questions" - Cortisone

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Cortisone and Insulin [posted 1/13/99]
Question: I just completed a series of 3 cortisone injections for Lumbar Spinal Stenosis. How long will my blood sugar readings be high? How high will/should they go? I am concerned. My diabetic doctor is out of town at present.

Answer: Usually a few days only.

Cortisone Drugs [posted 11/11/98]
Question: Thanks, I read all about my synthroid, very helpful. Do you have any information on a drug I took for over 10 years in the mid 70's, the name was Cortef (not sure of the spelling) It was a form of cortisone, steroids. My doctor gave it for a low adrenal reserve or something. Do you know of any possible problems with mussel weakness, please, if you can, any information.

Answer: All the cortisone like steroids will weaken muscles. They also cause a distribution of fat from the periphery to the abdomen as well as many other effects. This weakness is called a steroid myopathy which is occasionally permanent.

Cortisone Reaction [posted 11/05/98]
Question: I am a 48 year old female in good health. I had a cortisone shot about 3 weeks ago in my heel for a bone spur. After about the 5th day, my heel reddened and eventually I ended up in the hospital with severe pain and swelling for several days. The only thing that worked was meds for gout, which the tests showed I didn't have. I was released from the hospital, and rested my foot for 3 more days. After walking about for three days, my foot is in worse shape than before. The foot doctor put me in a soft cast, to keep it from moving. That just makes it worse, because it is swelling and itching insanely. The doctor said to stay off it (Of course I have to because I can't put any weight on it anyhow), and to take Benadril, and that hasn't helped either! Any suggestions?

Answer: The medicines for gout are probably non-steroidal anti-inflammatory medications. These would normally be used prior to injecting steroids into a joint. Normally, these would be used for long periods and in moderately high dosages unless you cannot tolerate them. So, some of the sequence of this doesn't make sense. What were the drugs you were on?

Cortisone Injections [posted 7/24/98]
Question: I was visiting your website for information on the safety of cortisone injections. I have a question regarding a condition I have that is being treated with cortisone. When I was 14 years old I was diagnosed with apthous stomatitis, or non-herpetic canker sores, which there is no treatment for. In the past few years my outbreaks have become more frequent and quite severe. My dermatologist prescribed a course of oral Prednisone and the sores disappeared almost instantly. Now that the outbreaks occur so often and are so painful, I am considering cortisone injection as a preventative measure. All reports state that cortisone injections used for "short term" treatment is safe. What is defined as "short term?" Can I receive 1 or 2 injections per year and still be okay?

Answer: Yeah probably, but first, what is the medical condition that is being treated? Sounds like some sort of condition like lupus or one of its cousins. If you haven't had an evaluation by a Rheumatologist you might consider it. Steroids will speed up your aging process. They cause/accelerate cataracts, osteoporosis, diabetes mellitus, muscle weakness and atrophy, etc. The bigger the dose and the longer one takes it the more these problems will occur. If it is necessary so be it. But, again what is the condition that is being treated?

Cortisone Heel Injections [posted 7/23/98]
Question: I am going to have a cortisone injection in my heel for plantar fascitis. I have heard that it is very painful.

Answer: Usually not severe unless the injector doesn't use anesthesia/lidocaine.

Cortisone shots
Question: I have been trying to get some relief from plantar facitus. I am 5'6 and weigh 130. I have been put to sleep for about 10 minutes, and shots were put around the ankles and bottoms of both feet. This was about 3 weeks ago. I went back about 2 weeks ago with the same pain in my heels and arches. I was given an injection in the arch area. This helped the area it was given in. My problems with my heels are still the same. I can't stand to walk more than a few steps, and standing in one spot is out of the question. Is there a danger of me going back and getting another injection into my heel area? I have 2 pairs of orthotics, ice treatments, ultrasonic, and stretching treatments. Are injections in the feet safe, and are they going to make my bones weak later in life?

Answer: It sounds like you are trying the correct things. Are you wearing your orthotics? Are you doing any aerobic exercise or walking/running for exercise. Do your regular shoes have built in orthotics (like RocPorts).

Cortisone shots
Question: My 18 year old daughter has spondilosis in her lower back. She had surgery 4 years ago and has rods for scoliosis. She is extremely active and has recently been in a lot of pain. Her doctor wants to try Cortisone injections. I am concerned about side effects and am looking for information on this and any other options we may have.

Answer: I guess the first question is why is she having pain now? What has happened to her back or the rods? I'd worry less about the steroids than this question. Steroid injection is pretty standard and seems to have little side effects if given in the epidural space. It is limited to two or three injections.

Cortisone
Question: Is it safe to take Cortisone if one is thinking of becoming pregnant?

Answer: Cortisone is a steroid hormone naturally produced by one's adrenal glands. Taking cortisone as a replacement hormone is usually not attended by any risks to the embryo. However, most people take cortisone (or simialr drugs such as Prednisone) in higher than repalcement doses to treat different medical conditions such as asthma, lupus erythematosus, or other diseases. Long term use of steroids during pregnancy can affect the baby and suppress that adrenal function of the baby. Other side effects are theorized, but are rarely seen. We usually counsel women to take as little cortisone or other steroids during pregnancy as possible. However, often the use of steroids is critical to ensure the health of the mother and we think that her overall health is generally more important than any individual drug. If the peditrician is aware of steroid use by the mother problems after birth can usually be avoided. The adrenal glands in the child will usually develop normally after birth.

Predeltin
Question: I have been put on a dose of cortisone (Predeltin) for Inflammatory neuropathy. I started on 12 tablets for 10 days and since then it has been reduced with 2 tablets every week. Currenly I am on 4 per day. I am unsure about the side effects of this drug - I heard about premature ageing - will this happen after such a short course ? Bloodpressure going up - My bloodpressure went up a lot What about me wanting to fall preganant in 6 months time ?? The only other side effects I know of is the bloating of the body which has not really happened to me - I do however have a large appitite since starting on this drug. But it worked !! The pain in my hands and feet is all but gone.

Answer: Steroids are incredible drugs for certain diseases. They are powerful anti-inflammatories and often are the only drugs available in certain diseases. We would use them more commonly if the side effects weren't so troubling. The side effects are usually limited to chronic use;that is, short term use is usually without major problems. The longer the steroids are used and the higher the dose the more the long term side effects. These side effects are to basically speed up the aging process. The eyes develop cataracts, bones develop osteoporosis and fracture, arteries develop hardening at a faster rate, serum glucose levels rise and often lead to diabetes mellitus, muscles weaken and atrophy. These changes usually take some time to develop and are faster with higher doses. Physicians try to use the smallest dose of steroids for the shortest time available; but, for many diseases there is absolutely no alternative to their use and the side effects must be accepted if the patient is to improve.

Side Effects
Question: What are the common side effects of cortisone treatments

Answer: Cortisone is a steroid which is used as an anti-inflammatory. It is commonly used in treating asthma, and other diseases requiring steroids. Steroids in general speed up the aging process causing Diabetes Mellitus, cataracts, coronory artery disease, osteoporosis, muscle weakness -basically any aging process depending on the organ system. For this reason they are used judicially and for as short a period as possible.

Heel Pain
Question: I have been having heel pain for several months. My orthopedic doctor has placed me on some painkillers. He said if it shows no improvement, he'll give me an injection. I am also undergoing some physiotherapy treatment, ultrasound and some exercises. However it does not show any improvement. I understand the injection is some drug called cortisone. Will it help and what are the side effects as I understand that the injection is done on the muscles.

Answer: Cortisone is a steroid and used in large doses for long periods of time will have major adverse effects. Used briefly(even in large doses) the side effects are minimal. Some patients experience insomnia with a single dose; but, this should be about it for one shot. Do not use multiple repeated shots (2 or 3 would be OK).


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