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.
Over the years, researchers began to learn
why some
patients develop symptoms of decreased adrenal function, while
others
never do. The production of corticosteroids is controlled by a
"feedback
mechanism," involving the adrenal glands, the pituitary
gland, and
brain -he Hypothalamic-Pituitary-Adrenal Axis" (HPAA). The
continuous
administration of corticosteroids inhibits this mechanism,
causing the
HPAA to "hibernate."
We now know that the amount of
the drug
needed to suppress the HPAA varies from person to person. As a
general
rule, using large doses for a few days, or smaller doses for
more than two
weeks, leads to a prolonged decrease in HPAA function.
Thus, steroid use cannot be stopped abruptly. Tapering the
drug gives
the adrenal glands time to return to their normal patterns of
secretion.
(It may take a period of time for things to get completely back
to
normal). How quickly steroids can be tapered depends on
continued control
of the underlying disease with decreasing doses, and on how
quickly our
body adjusts to the need to produce its own hormones. If things
go well,
four to six weeks (or longer) is a reasonable period.
Unfortunately, tapering may not always completely prevent withdrawal
symptoms.
Present thinking suggests that steroid withdrawal may involve
many
factors, including a true physiological dependence on
corticosteroids.
Further, tests of HPAA function do not always correlate with a
patient's
symptoms, and these tests are of no value while taking steroids.
Therefore, it can be difficult to determine the true cause of a
patient's
symptoms or how he/she may react to stress (for example, from a disease flare-up,
procedure, or
surgery). Restarting or increasing dosage may be the only
solution.
Taking steroids every other morning gives the body a better
chance to
recover function. The day without the hormone allows natural
stimulation
of the hypothalamus and pituitary glands. Thus, alternate-day
therapy is
ideal, if possible, once the disease is under control. It is
still not
clear whether new steroids being developed will available to
decrease the risks of side
effects and HPAA suppression.
We must assume that all patients exposed to steroid therapy
for even a
short time have diminished HPAA function. Patients who have taken steroids noticing any of
the above
or other unusual symptoms should notify their doctor. Keep
in mind that
some medications or alcohol can increase the need for larger
steroid
doses. You should carry a list of all your medications in your
wallet to
alert medical personnel in case of emergency. This is
especially important
if you are receiving steroid therapy or have recently stopped
taking
steroids. Supplementation may be needed during periods of
stress, even up
to a year after discontinuing corticosteroid therapy.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
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