Doctor Kaminstein is a Board Certified Gastroenterologist, who is presently not in active medical practice due to disability. Before disability, Dr. Kaminstein practiced Gastroenterology/Hepatology in West Chester, PA for over 15 years.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Synthetic cortisone medications (corticosteroids) simulate cortisol, a naturally occurring, anti-inflammatory hormone produced by the adrenal glands. Such drugs (for example, prednisone) have since benefited many, but are not without potential side effects.
The two major problems related to continuous steroid treatment are:
drug side effects and
symptoms due to changes in the balance of normal hormone secretion (withdrawal symptoms).
The production of corticosteroids is controlled by a "feedback mechanism," involving the adrenal glands, the pituitary gland and brain. known as the "Hypothalamic-Pituitary-Adrenal Axis" (HPAA).
Using large doses for a few days, or smaller doses for more than two weeks, leads to a prolonged decrease in HPAA function.
Steroid use cannot be stopped abruptly; tapering the drug gives the adrenal glands time to return to their normal patterns of secretion.