steroids, albuterol

I was in the hospital briefly with COVID. I had a little afib and tachycardia, PVC's and mostly when out of bed. But even without those, I have trouble taking the meds that could help me out of a dicey respiratory situation. Does anyone else have trouble with steroids? I can tolerate 4mg methylprednisolone but standard treatment for exacerbations of asthma, COPD, pneumonia or COVID is a "pack" starting at 60mg. Albuterol also sets off tachycardia/palpitations so I mix with saline in a nebulizer. Interested what others do. It was scary to have little access to treatments.


The doc in hospital didn't know what to do with me. He wanted to do higher dose decadron (steroid) and was first going to do a beta blocker but I pointed to my blood pressure of 96/50. Ditto diltiazem. He prescribed a quarter dose which I declined the next day with discussion with doc who was on at the time. These problems with meds are prolonging my illness.

ps I am not on blood thinner and my paroxysmal afib is normally infrequent but accompanied by heart rate close to 200.



Edited 1 time(s). Last edit at 12/03/2023 06:07PM by windyshores.

First, sorry that you have had all of this, especially in such a short and tense time. Secondly, and maybe most importantly, you really ought to be on an anti-coagulant. The risk of stroke with any kind of AF is surprisingly high, and with the rate you quoted, you should be on an anti-coagulant, perhaps from now on.

I don't understand how a spray of steroid would put you into AF, but I suppose anything is possible with AF. I think you are probably adrenergic in nature, so you need a beta-adrenergic to help keep your heart rate low. However, as many of us find, when our hearts want to play nice, the rate is loo low if there's beta blockers at play. Maybe another member has an idea, but I don't have one.

I noticed that they give a standard very high dose of Steroids for Covid lung inflammation. I have alot of experience taking these Oral Steroids. They still work at lower doses, so one option is to just take what you can tolerate. As for AFIB, I got episodes coming off the Steroids, as a Cortisol deficit occurs after usage. I found that I could get by with a moderate doses, followed by a long tapering off of the drugs, to allow time for my endocrine system to stabilize.

When I got Covid the Dr. gave me an Rx for high Steroid dose. Since my lungs weren't that bad, I just passed on the Prednisone, I was about a week into the infection, and I found some Ivermectin from a local compound Pharmacy. I noticed a big improvement within a day. Since my lungs were'nt that bad as too cause me too much concern, I started and stopped the Ivermectin 3 times too test this drug on myself. Every time I went on the Ivermectin I had substantial improvement, and when I stopped taking it, the lung inflammation returned. I later did more research, and found out that Ivermectin has a secondary effect on Covid of decreasing inflammation, in addition to the direct anti-viral properties.

Yesterday i took the dose I can tolerate, a mere 4mg mehtylprednisolone, and had quite a bit of improvement. Also did very partial dose albuterol mixed with saline via nebulizer. Things stayed pretty stable with some PVC's at night.

I had suggested in the hospital that we try the decadron equivalent to 4 mg of methylprednisolone but doc wanted more. I think something is better than nothing and will advocate for that low dose more strongly.

@TheAnti-Fib I have noticed more PVC's as the steroid wears off (even at the end of the day, if I take it in the morning) , so appreciate your noticing the same thing. Longer tapering seems a reasonable way to keep things stable, if doses are higher. Useful info, thanks.

@gloaming it is not a "spay" of steroids. I can do inhalers and Diskus. I am referring to docs wanting high dose oral steroids.

I do not as yet need an anti-coagulant. In 2015 one cardiologist wanted me on one and one didn't. These days docs seem to agree. I just went two years without any afib. We'll see how things settle out after COVID but my arrhythmias were pretty limited with COVID once I got off Paxlovid (afte4 4 doses).

A new trigger for my afib is lifting, due to several spinal fractures making my insides a bit more crowded. A hiatal hernia is possible. I seem to be successful so far in avoiding these short episodes now that I figured out that particular trigger.

I am allergic to the iodine in the CT contrast. Usually I take 10-20mg steroids the night before and then ditto before the imaging.

Recently I was told to take 50 plus 50mg within 13 hours. It gave me a prolonged uppder chamber hr.

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susan.d
I am allergic to the iodine in the CT contrast.

Respectfully an allergy to iodine in x-ray contrast is a misapplied term and is a myth that dates back decades and unfortunately continues to be repeated by medical personnel and the public. The other myth that gets repeated is the correlation that shellfish allergy prevents having the x-ray contrast because that has iodine. It is practically physiologically impossible to have a "true iodine allergy".



Edited 3 time(s). Last edit at 12/05/2023 05:42AM by JakeS.

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JakeS
Respectfully an allergy to iodine in x-ray contrast is a misapplied term and is a myth that dates back decades and unfortunately continues to be repeated by medical personnel and the public. The other myth that gets repeated is the correlation that shellfish allergy prevents having the x-ray contrast because that has iodine. It is practically physiologically impossible to have a "true iodine allergy".

Here is an article on the topic: [www.ncbi.nlm.nih.gov].

I have seen that article before. demonstrates how ophthalmology has been impacted by the x-ray contrast iodine myth.

The other issue w contrast is that the reactions patients experience are not true allergic or anaphylactic reactions. Contrast media reactions are one of two types. The first type are called Allergy Like or anaphylactoid (toid = resemble) sometimes also called idiosyncratic. The second type are Physiologic.

The research decades ago has been proven to be wrong. The only thing a shellfish allergy tells the staff is the patient has an allergy. Shellfish allergy carries no more weight for consideration than if a patient tells staff they have bee sting or dog allergy.

It amazes me that these myths continue to be repeated by medical personnel.



Edited 1 time(s). Last edit at 12/05/2023 09:06AM by JakeS.

Any others have experience with steroids or albuterol in the context of tachycardia and/or afib or even PVC's/PAC;s?

Doc wanted to accompany with beta blocker or diltiazem but bp was low.

I am concerned I will eventually face a situation where my life depends on steroids but not able to take them.

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windyshores
I am concerned I will eventually face a situation where my life depends on steroids but not able to take them.

That's not a realistic scenario. Afib won't kill you, so if steroids are necessary it would be insane to skip them just because you might have an afib episode and be uncomfortable.

I am not afraid of an afib episode per se. Your posts are always so harsh Carey. I have a lot of palpitations with 4 mg so am asking what others experience at 60mg and what strategies are used. I am not on blood thinners. Afib usually involves heart rate close to 200. I just want to hear of others' experiences. I am not insane Carey. Doctors at a top hospital did not want to give me decadron due to concerns about my heart, despite being really sick with COVID. My bp was very low which made them leery of beta blockers and diltiazem as well. I guess you know more than the docs. I am kind of done with this forum. There should be moderation. What are the terms of service for this site?



Edited 2 time(s). Last edit at 12/05/2023 06:13PM by windyshores.

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windyshores
Your posts are always so harsh Carey.

My response to that would be I'm shocked you thought that was harsh, but this has happened before so maybe I shouldn't be. I certainly didn't mean it to be harsh. I just tend to write short, to-the-point responses, and you always seem to think they're some sort of attack. They're not.

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There should be moderation. What are the terms of service for this site?

Look at the very top of this page, the title, third line down. You're talking to the moderator. I'll ask Shannon to review my post and he can do as he will. In the meantime, please reconsider leaving the site. I don't think I've ever said anything to you that warrants that kind of response.

Maybe there is alternative drug that will work for you, to treat the Asthma/COPD. Albuterol and Methylprednisone are probably the main ones utilized. As a former Asthmatic, I was given at least 5 different drugs, but that was 40 years ago.

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JakeS

I am allergic to the iodine in the CT contrast.


Respectfully an allergy to iodine in x-ray contrast is a misapplied term and is a myth that dates back decades and unfortunately continues to be repeated by medical personnel and the public. The other myth that gets repeated is the correlation that shellfish allergy prevents having the x-ray contrast because that has iodine. It is practically physiologically impossible to have a "true iodine allergy".

Iodine contrast resulted in producing body rashes for more than half my life. Unless there are other component ingredients in the contrast, then I speculate my rashes after each contrast was the result of iodine. I also am allergic to 152 foods after getting extensive testing. #1 is pineapple (closes up my throat). #2 is shellfish. So it could be possible that I’m actually allergic to iodine.

Carey I have long participated in health forums, posting on topics where I have more expertise than I have with afib. On other sites, participants are required to be welcoming. We are also prohibited from giving medical advice but, instead, must ely on our own experiences. Some of the info you provide with so much authority is debatable and needs to be identified as your opinion or experience, not absolute fact.

If you are a moderator I suggest you look over your responses, at least to me, and put yourself in my shoes. Using language like "it would be insane" is not appropriate, and even belittling.. Think about other ways to express yourself. This is my last post. I will find another forum.

A doctor at a Harvard teaching hospital was leery of giving me steroids, and the inpatient doctor felt the same. I was having breathing issues with COVID. I posted here with a legitimate concern. If my breast cancer returns, I may need steroids before chemo. I have lupus and high antibodies for scleroderma. I have COPD and asthma. Steroids are clearly in my future.



Edited 1 time(s). Last edit at 12/06/2023 06:36AM by windyshores.

Unless there are other component ingredients in the contrast

Yes, there are other ingredients in the contrast. It is not pure iodine and believed the other ingredients trigger the mast cells. Decades ago, the contrast used was called ionic also known high osmolarity. They had significantly higher numbers of reactions than the use of the non-ionic or low osmolarity agents used today. Yet, both classifications of contrast still used iodine. The non-ionic agents are different once injected. That is why they have less than 1% reaction rates. If there were true iodine allergies the rate of reaction should not have decreased.

The article posted by George discussed a similar situation w the ophthalmologic use of Provanol Iodine. It was not the iodine people reacted to it was the components of the Provanol that caused the very small number of reactions.

#2 is shellfish. So it could be possible that I’m actually allergic to iodine.

No. Also well documented and was in article George posted. The allergen in shellfish is tropomyosin, a muscle protein. The shellfish myth was an erroneous conclusion based on the theory that contrast has iodine and shellfish has iodine so shellfish allergy means contrast allergy. People with shellfish allergy are injected w/o reacting all the time. Shellfish allergy carries no more weight than a bee sting allergy. A shellfish allergy does not indicate a patient should be premedicated w steroids. The American College of Radiology Manual on Contrast Media discusses there is no need for premedication for a shellfish allergy unless the patient has had previous adverse reaction to contrast.

Iodine contrast resulted in producing body rashes for more than half my life.

Not disputing this. People still react. Cutaneous reactions are the most common reactions patients experience. Based on the number of hives or severity of skin reddening many times patients are watched rather than go right to medicating them. The patient’s response to contrast is not anaphylaxis. The patient presents resembling anaphylactic reaction. It is known w a true allergic reaction to a substance such as a bee sting the patient’s IgE response is different then the response to contrast. This is why contrast reactions are classified as allergy like or anaphylactoid. Not anaphylactic.

Iodine allergy is a misapplied term that the community is trying for years to correct and educate. Unfortunately, it is so entrenched and, in some cases, sadly still taught to personnel the myth continues to be repeated over and over again. When asked if patients have allergies the patient should respond with contrast media not iodine. If one has a reaction to antibiotics the patient says I have an allergy to and names antibiotic. We do not name a component of the drug we say the name of the drug. The same should apply here. The patient should report contrast media not iodine.



Edited 3 time(s). Last edit at 12/06/2023 08:10AM by JakeS.

Windyshores,

I have been on this forum for about 10 years and from my perspective, Carey is spot on 100% of the time. The forum's success is contingent upon Cary's advice. If he seems a bit harsh, it's usually in response to someone that has been misguided or possibly a bit harsh in their questioning or responses. I love the fact that he is point on and brief without an abundance of superfluous dialogue. The amount of knowledge and experiences shared on this forum far exceeds anything most Cardiologists and many EPs have been exposed to.



Edited 1 time(s). Last edit at 12/06/2023 09:30AM by Ken.

Carey, Not that you are looking for any more votes of confidence but I never find you harsh. Being the worrier that I am, sometimes I need to hear and read the words "Afib won't kill you". Perspective helps.

People who are moderators aren't doing it for their health. They do it out of duty and good will. Such people tend to be busy with other pressures on them. Busy people can be terse, perhaps sounding abrupt, and maybe they rub some people the wrong way with their tone, but they're still the same people of good will who want to help, not to injure, and not to turn away.

You can't please everyone.

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gloaming
People who are moderators aren't doing it for their health. They do it out of duty and good will. Such people tend to be busy with other pressures on them. Busy people can be terse, perhaps sounding abrupt, and maybe they rub some people the wrong way with their tone, but they're still the same people of good will who want to help, not to injure, and not to turn away.

You can't please everyone.

I completely concur. I'm a mod on another health site and know the drill well! Being a mod is a large amount of work!

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GeorgeN

People who are moderators aren't doing it for their health. They do it out of duty and good will. Such people tend to be busy with other pressures on them. Busy people can be terse, perhaps sounding abrupt, and maybe they rub some people the wrong way with their tone, but they're still the same people of good will who want to help, not to injure, and not to turn away.

You can't please everyone.

I completely concur. I'm a mod on another health site and know the drill well! Being a mod is a large amount of work!

Yep, I was a mod on a very large health forum for years and it was a LOT of work, 24/7. It is care and service really for others who need a good resource for scary, confusing conditions.

I find all of the moderators here extremely knowledgeable and helpful. Don't take their replies personally. Take their replies with a grain of salt...or potassium. 😁😁😁



Edited 1 time(s). Last edit at 12/08/2023 06:54PM by FibberMcGee.