Tuesday, May 31, 2011

Solu-Medrol Treatment for Multiple Sclerosis: Side Effects and Tips

If you look up the potential side effects of IV Solu-Medrol treatments for Multiple Sclerosis (or the other numerous potential reasons one might might receive this treatment), you will find a very long and somewhat scary list. That's not what this entry is only about (I'm not going to list here what you can search online for). This entry is about trying to decrease the chance of developing many of those side effects and try to make receiving this treatment as comfortable as possible
By the way, after you receive the IV corticosteroids, we usually give a short by-mouth taper off of steroids so your body isn't "shocked" by the sudden cessation of some medication it was just getting used to. Some of the residual symptoms one experiences can last during the by-mouth dosing time but often slowly improve within about a week after you stop all the corticosteroids.

*** After reading over this for me, my nurse pointed out something very important from her experience working specifically with MS patients receiving Solu-Medrol. Solu-Medrol is NOT a substitute for your regular MS medications. Therefore you should not think that if you forget to refill it or can't use it while on a vacation, that Solu-Medrol is an adequate "backup plan." It is not. That sort of thinking is a good way to get you into a wheelchair quicker than someone else who doesn't think that way. You should also never stop your regular MS medications while receiving this Solu-Medrol treatment, unless your doctor wants you to for some specific reason. ***

 Before Infusion Starts
·         Be Well-Hydrated: Drink lots of fluids before you go for your infusion. Being well-hydrated makes your veins larger and easier to find, which makes insertion of the IV line a breeze.
·         Protect Your Gut: Solu-Medrol causes gastritis and heartburn if administered on an empty stomach. It is wise to eat a large meal before your treatment. Treat yourself to your favorite (healthy) foods and fill up -– food will taste strange for a couple hours after your treatment, anyway. 

·         Request Paper Tape: You may ask that paper tape be used to secure the IV line, at least on the first layer next to the skin, which can then be covered with standard tape or a bandage for protection. Solu-Medrol makes your skin very fragile, especially around the area where the IV line is inserted. Paper tape will come off much easier when it is time to remove the IV.
·         Choose Your Hand: Decide ahead of time which hand you prefer be used for the IV. The line may be kept in place for up to five days, and it can be annoying to have it in the hand that you use for holding a book or using a computer mouse. Of course, the placement may be decided for you when the nurse looks for an “easier” vein to use, but you can state your preferences if this is a concern for you.
During Infusion
·         Have Mints Handy: During the infusion, you might experience a metallic taste in your mouth. It is helpful to have strong mints or gum to use, as water doesn’t help and other beverages or foods taste terrible.
·         Try to Relax: Bring your music or a book on tape to listen to during the infusion. Books and magazines are also good, but there is always a chance that the IV line will make these awkward to handle. Try some deep breathing exercises –- count each breath up to ten, then count back down to one.
·         Slow Down: If your face starts feeling hot or if your heart starts beating fast, ask the nurse to slow down the rate at which the medicine is being infused.
·         Flush With Saline: Make sure that the nurse flushes your line with saline after each infusion. Rarely nurses may not think much of this, but it may help decrease the bruising and thinning of the skin in that arm.
Following Infusion
·         Eat Comfort Food: As mentioned, food will taste strange for a couple hours after treatment, so bland is good. However, you will want to avoid anything greasy, as this could aggravate heartburn. Also, limit sweets and things with high sugar content, as Solu-Medrol will increase blood sugar levels.
·         Avoid Salty Foods: Solu-Medrol causes water retention. This can lead to feeling bloated all over, as well as to swollen feet and ankles. Avoid salty foods and drink lots of water to minimize this effect, which should disappear within a week of the last treatment.
·         Be Quiet: Solu-Medrol makes most people feel anxious and agitated. During this time, it is best to stay home and be calm and quiet. Do not try to go to work –- you will not be productive and your interactions with your co-workers may come back to haunt you.
·         Don’t Drive: You may have a hard time concentrating, may be nervous, or your perception may be “off.” Even if you think it will be okay to drive, it is a good idea to have someone drive you home after each infusion. Leave the worries about traffic and the quick decision-making needed for driving to someone else.
·         Troubleshoot Insomnia: Solu-Medrol causes insomnia, which some people call a “welcome” side effect, as they end up cleaning house, balancing checkbooks and answering e-mails. However, you need your rest during this time –- this treatment is putting a huge strain on your body which can actually make things worse in some people. Try different techniques to help you sleep, but don’t hesitate to ask your doctor for medicine for this purpose. A little temporary Klonapin for this is rarely an issue, but many times a little over-the-counter benadryl before bed or tylenol PM is just as effective, and less expensive.
Other Less Common Tips
·         Use Herbs with Caution: Solu-Medrol side effects may be exacerbated by some herbs, including aloe, Asian ginseng, bayberry and licorice.
·         Protect Your IV Line: If you need an MRI during this time, do not allow the MRI technicians to use your IV line to administer the gadolinium. While this saves them time, the gadolinium is caustic and could cause your vein to collapse, meaning the IV line will have to be reinserted for your next Solu-Medrol treatment.
·         Avoid Infections: Steroids greatly reduce your immune system’s ability to fight infection. Avoid any contact with people who have symptoms of colds or other viruses. If you have not had chickenpox, it is extremely important to avoid people with chickenpox or shingles. If you had chickenpox in the past, you will be more vulnerable during your treatment to developing shingles. Notify your doctor immediately if you develop a fever, chills, respiratory symptoms or a rash.
·         Avoid Vaccinations: It is a good idea to avoid all vaccinations during this time. It is especially important to avoid getting the smallpox vaccine (this probably won’t inconvenience anyone too much). I would also not get the flu shot at this time, but you should especially avoid the flu vaccine that is administered as a nasal spray, as that is a live vaccine. (Actually, if you have MS, you should really never get a live vaccine unless specifically discussed with your doctor)

HOPE THIS HELPS. If you have other pointers that you think should be added, or modifications of this... please email them in to me. I will not mention a thank you for your addition if you ask me not to.