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.
Immune Hepatitis
Question: I’m trying to find out some side effects of prednisone. A nine year old girl has auto immune hepatitis and is very ill. She is concerned about side effects and would like information on alternative treatments.
Answer: Hepatitis is an inflammation of the liver. There are several types of hepatitis ranging from infectious to drug induced. Immune hepatitis is an uncommon cause of hepatitis; but, like any type, liver inflammation will progress to liver failure if unchecked. Unfortunately, the liver is an organ that is not duplicated like the kidneys or that any mechanical intervention will replicate. Consequently, liver failure will rapidly progress to death unless a transplant is available. There are several drugs used to treat the immune system when is becomes overactive. Steroids like prednisone (pregna-1, 4, diene-3, 11,
20-trione, 17, 21-dihydroxy) are potenent moderators of the bodies immune function. These are used in the early stages to treat disorders of immune function. However, long term these drugs have potentially severe side effects. In general, this class of drugs speeds up the aging process and patients develop diabetes, osteoporosis, coronary artery disease, cataracts, etc. Usually, if steroids are necessary for a prolonged period, other drugs such as Imuran (azathioprine) or cytoxan (cyclophosphamide) will be used. These drugs are used in different cancer protocols and have their own individual risks.
Epidural Risks
Question: I am taking Brufen Retard for lower back pain, due to a worn disk. I have been advised to have an epidural for longer term relief, as I am considering starting a family. What are the risks of the epidural ?
Answer: Low back pain is a common problem and unfortunately, has few good treatment options. Initially, anti-inflammatories and physical therapy are used to relieve the pain. If these regimens are insufficient, surgery or injection is the next line of treatment. Usually, surgery is a last resort and only used with clear pressure of the disc on the nerve or nerve root. In the absence of an x-ray showing this I would recommend a trial of an injection. In my experience, this is only a temporary relief and will buy 6-9 months of relief at best. Long term side effects appear minimal if there are only a couple of injections. There is always a risk of infection, leakage of spinal fluid from the injection site and trauma to other nerve roots causing more severe pain.
