Everett Engel
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About
What Are The Risks Of Steroid Use? For Teens
The High‑Dose, Long‑Term Use of Steroids: A Detailed Look at the Risks
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1. Why Clinicians Turn to Corticosteroids
Potent anti‑inflammatory and immunosuppressive properties that can control disease activity rapidly.
Widely used for a spectrum of conditions:
Autoimmune disorders (e.g., rheumatoid arthritis, systemic lupus erythematosus)
Allergic reactions and asthma exacerbations
Severe dermatologic lesions (psoriasis, eczema)
Certain neurologic diseases (multiple sclerosis relapses)
Offer a "bridge" to other disease‑modifying therapies while patients wait for slower‑acting drugs.
Clinical Dilemma
Despite their benefits, corticosteroids can lead to serious side effects. Clinicians must weigh the risk/benefit ratio on an individual basis and consider tapering strategies or steroid‑sparing agents.
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1️⃣ Side Effects of Long‑Term Corticosteroid Use
System Common Adverse Effect Typical Onset Key Clinical Signs
Metabolic Weight gain, central obesity, dyslipidemia, hyperglycemia Weeks–Months Fatty pads around abdomen; increased BMI; elevated fasting glucose/ HbA1c
Endocrine Adrenal suppression, Cushingoid features Months Moon facies, buffalo hump, purple striae
Musculoskeletal Osteoporosis, muscle wasting, myopathy 3–6 months Bone pain; easy fractures; proximal muscle weakness
Dermatologic Skin thinning, bruising, easy cuts Weeks–Months Thin translucent skin; wide ecchymoses
Cardiovascular Hypertension, arrhythmias Weeks–Months Elevated BP readings; palpitations
Neuropsychiatric Mood swings, anxiety, insomnia Weeks–Months Sleep disturbance; irritability
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4. Evidence‑Based Prevention and Management Strategies
A. Prevention in Patients with Normal BMI (≥18.5 kg/m²)
Strategy Evidence Level Key Points
Baseline cardiovascular risk assessment (including blood pressure, lipids, fasting glucose) Strong (guidelines: ACC/AHA 2021) Detects pre‑existing risk; informs treatment intensity.
Lifestyle counseling – diet rich in fruits/vegetables, lean protein, whole grains; limit sodium and saturated fats Moderate (RCTs such as DASH, Mediterranean diets) Reduces blood pressure and improves lipid profile.
Physical activity ≥150 min/week moderate intensity Strong (WHO 2020 physical activity guidelines) Lowers hypertension, improves insulin sensitivity.
Avoid smoking; limit alcohol to ≤1 drink/day for women, ≤2 for men Strong (USPSTF) Reduces cardiovascular risk significantly.
Routine monitoring of BP and lipids at each visit Moderate (guideline recommendation: AHA/ACC 2017) Enables timely adjustment of therapy.
Consider pharmacologic agents early if BP >140/90 or lipid abnormalities persist after lifestyle Strong (ACC/AHA 2018 hypertension guideline; ACC/AHA 2013 cholesterol guideline) Evidence shows early treatment reduces events.
Rationale
Lifestyle: Proven to lower blood pressure and LDL, reduce inflammation, improve insulin sensitivity.
Monitoring: Allows detection of subclinical disease progression or inadequate response.
Early pharmacologic intervention: Multiple trials (e.g., SPRINT for hypertension; ACCORD for diabetes) show early treatment reduces cardiovascular events.
3. Evidence‑Based Lifestyle Interventions
Intervention Key Study/Guideline Effect Size / Outcome
Weight loss ≥5 % (dietary caloric restriction, Mediterranean diet, low‑carb) Look AHEAD trial; DASH & Mediterranean diet studies ↓ SBP 5–10 mmHg; ↓ LDL 15–20 mg/dL; ↑ HDL 3–4 mg/dL
Physical activity ≥150 min/week moderate (aerobic + resistance) ACC/AHA physical activity guideline ↑ insulin sensitivity, ↓ visceral fat, ↓ BP
Reduce alcohol to ≤2 drinks/day AHA alcohol recommendations ↓ SBP 3–5 mmHg; ↓ triglycerides
Quit smoking CDC smoking cessation guidelines ↓ CVD risk 40% over 10 years
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6. Monitoring & Adjustment
Blood pressure – home BP monitoring daily (morning & evening) for first month, then weekly.
Weight & waist circumference – every 4 weeks.
HbA1c – at baseline and after 12 weeks; repeat at 24 weeks if needed.
Serum lipids – baseline, 12 weeks, and 24 weeks (or sooner if symptoms/side‑effects).
Medication adherence & side‑effects – review at each visit.
Adjustments:
Situation Next Step
BP >140/90 after 2 weeks on diet alone Add low‑dose thiazide diuretic (e.g., chlorthalidone 12.5 mg)
BP still uncontrolled after adding thiazide Consider ACE inhibitor (lisinopril 10 mg) or ARB (losartan 50 mg)
Elevated serum creatinine (>1.4 mg/dL) on ACEi/ARB Re‑evaluate; consider reducing dose or switching to diuretic
Serum potassium >5.0 mmol/L with ACEi/ARB Add K‑spend (spironolactone 25 mg) and monitor closely
Weight gain (>2 kg), edema after ACEi/ARB Consider adding furosemide 20–40 mg/d; adjust diuretic dose
Persistent edema >6 weeks despite diuretics Increase diuretic dose or add thiazide‑like (chlorthalidone) if needed
Monitoring Plan
Parameter Frequency Target / Note
Weight Daily at home ≥0.5 kg ↑ → review diuretics
BP Every 3–4 h in hospital, then twice daily at home <140/90 mmHg preferred; >150/90 may need adjustment
Serum electrolytes (Na⁺, K⁺, Cl⁻) Daily during hospitalization; repeat 48‑hr after diuretic changes K⁺ 3.5–5 mEq/L; Na⁺ 135–145 mEq/L
Creatinine/CrCl Daily If CrCl ↓ <30 ml/min, adjust meds & monitor for toxicity
Weight Every morning in hospital; weekly at home >2 kg weight gain over baseline is significant
Symptom review (dyspnea, orthopnea) Daily Worsening symptoms may indicate fluid overload
When to seek medical attention:
Rapid weight gain (>5 lb/2.3 kg in 24 h).
New or worsening dyspnea, orthopnea, edema.
Persistent headache, confusion, seizures (possible hypertensive crisis).
Severe abdominal pain, nausea, vomiting (signs of GI toxicity).
4. Managing Adverse Reactions
Symptom Immediate Action Follow‑up
Nausea/vomiting Encourage small, frequent sips of water; administer oral antiemetic (e.g., ondansetron) if needed. If vomiting >3 times/day or unable to keep down medication → notify provider; consider dose reduction or alternate day dosing.
Abdominal pain / bloating Take a break from the drug for 1–2 days; monitor pain intensity. Persistent or severe pain (> 48 h) → seek medical attention.
Headache, dizziness, faintness Rest in a safe environment; keep hydrated. If headache >moderate severity or associated with visual changes → consult healthcare professional.
Gastrointestinal bleeding signs (dark stools, blood) Stop medication immediately and contact your provider urgently.
Weight loss >5 % of body weight Reevaluate dosage and frequency.
> Tip: Keep a symptom diary to track any new or worsening side‑effects.
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4. Managing Weight Loss
How Much Weight Do You Expect?
On average, people lose about 0.5–1 kg (1–2 lbs) per week while on the program.
The rate can vary based on diet, exercise, and starting weight.
Why We Monitor Your Weight
Too Rapid Loss: Can lead to loss of muscle mass or nutritional deficiencies.
Very Slow Loss (<0.5 kg/week): May indicate inadequate calorie deficit or metabolic adaptation.
Tracking Tips
Tool How it Helps
Digital Scale Accurate weight measurements; log in an app
Progress Photos Visual changes in body composition
Body Measurements (waist, hips) Complement weight for fat loss assessment
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3. Exercise and Activity
Why It Matters
Builds muscle mass → increases resting metabolic rate.
Enhances insulin sensitivity → better glucose handling.
Recommended Routine
Day Focus Duration Notes
Mon, Wed, Fri Resistance training (full body) 45–60 min Use compound lifts: squats, deadlifts, bench press.
Tue, Thu Cardio + Core 30–40 min Moderate intensity HIIT or steady‑state jog.
Sat Active recovery 20–30 min Light yoga, stretching, foam rolling.
Sun Rest —
Key Points
Progressive overload: increase weight or reps every 2 weeks.
Form focus: avoid excessive load that compromises technique.
Recovery: sleep ≥7 h/night; consider active recovery on rest days.
5. Monitoring Progress & Adjustments
Parameter Target Frequency
Body weight 70–75 kg (within ±2% of ideal) Weekly
Body fat % ≤12 % Every 4 weeks
Strength (1‑RM bench, squat) +5 % from baseline Monthly
Resting heart rate 50‑60 bpm Monthly
Energy levels & sleep quality Good/consistent Daily log
When to Adjust
Weight loss >2 kg/month → Reduce daily caloric deficit by ~200 kcal.
Weight gain >1 kg/month (without strength gains) → Increase caloric intake or decrease training volume slightly.
Strength plateau for 3+ weeks → Add a progressive overload stimulus (e.g., increase weight, add sets).
Quick Reference Table
Parameter Target
Resting HR <70 bpm
Resting BP <120/80 mmHg
BMI 18.5–24.9
Waist Circumference (men) ≤94 cm
Body Fat % 10–20%
VO₂max >45 ml/kg/min
RMR ~1,800 kcal/day
Daily Steps ≥10,000
Avg HRV (RMSSD) >40 ms
Sleep 7–9 h/night
Macro Ratio 30% protein, 30% fat, 40% carbs
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4. Data‑Driven Analysis & Recommendations
4.1 Data Summary (Hypothetical)
Parameter Baseline Current Goal
VO₂max 35 ml/kg/min 42 ml/kg/min 50+
Resting HR 72 bpm 68 bpm <65
RMSSD 20 ms 30 ms >40
Sleep Duration 6.5 h 7 h 8 h
Body Fat % 28% 26% <22%
Protein Intake 80 g/day 110 g/day 120-140 g
2.3 Training Plan
Aerobic Base Building (Weeks 1–4)
Frequency: 5 sessions/week
Session Types:
- Long Slow Distance (LSD): 90–120 min @ 65–70% HRmax
- Tempo: 45–60 min @ 75–80% HRmax
- Interval: 6 × 4 min @ 90% HRmax with 2 min active recovery
Progression: Add ~5–10 % distance each week, cap at 150 km total.
Strength & Mobility (Weeks 1–12)
3 sessions/week: core stability, hip mobility, plyometrics.
Include a session of dynamic warm‑up and cool‑down stretching.
Recovery (Throughout)
Post‑ride foam rolling; weekly massage or self‑massage routine.
Nighttime sleep hygiene: dark room, 7–8 h sleep, no screens before bed.
Hydration & nutrition: electrolytes after long rides, protein post‑exercise.
How to Use This Plan
Section When to Apply
Weekly Ride Schedule Each week (Monday‑Sunday)
Ride Details Immediately before or during the ride; note time and effort
Recovery & Nutrition Tips After each ride; incorporate into your evening routine
Mindfulness & Mobility 5–10 min at the start of every session, especially after intense days
Tracking Progress
App Suggestions: Strava, TrainingPeaks, or Garmin Connect to log rides.
Journal Prompt (After Each Ride):
- How did I feel before and after?
- Was the recovery routine effective?
- Any new thoughts or insights?
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Final Words
You’ve earned this pause. Cycling is not just a sport; it’s an experience that weaves together strength, speed, scenery, and self-reflection. By honoring your body with rest, breathing with intention, and learning from each pedal stroke, you’ll ride smarter, stronger, and more fulfilled.
Keep the momentum—whether you’re on a flat road or a steep climb, remember: the best journeys are those that balance effort with ease.
Happy riding, and stay tuned for more insights. ?♀️?
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1. Start With a Gentle Warm‑Up
Walk or jog in place – 2–3 minutes of light movement to wake up your joints.
Arm circles (forward & backward) – 10 each direction, keeping the motion smooth.
Hip rotations – 10 per side; this loosens the pelvis and core.
Why?
A brief warm‑up raises blood flow, activates muscle fibers, and reduces injury risk when you get into a steady cycling cadence.
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2. Find Your "Comfort" Cadence
Set the bike’s resistance low (or use a light hill on an outdoor route).
Pedal at 80–90 rpm for 1‑3 minutes—this is a comfortable, easy pace.
Note the feel: you should be able to keep speaking in full sentences without gasping.
Why?
Identifying a cadence that feels effortless lets you build endurance before adding harder intervals. It also ensures you’re not overtaxing your breathing early on.
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3. Add a "Power" Interval
Increase resistance (or find a short uphill section).
Pedal hard for 20‑30 seconds at the same cadence, aiming to feel like your effort is significantly higher.
Return to easy pace for 60‑90 seconds.
Repeat this cycle 3–5 times.
Why?
Short bursts of high intensity raise heart rate and improve lactate threshold without exhausting you entirely. It’s a gentle way to introduce interval training.
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4. Cool‑Down
Slow down to an easy pace for the last 2–3 minutes.
Optionally, perform light stretching if you feel tightness or soreness.
Why?
Cooling helps your heart rate gradually return to normal and reduces muscle stiffness.
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Quick "Checklist" (for on‑the‑fly reference)
Step What to Do Why It Matters
1️⃣ Warm‑up 2–3 min of light cardio or dynamic stretch Prevents injury, increases blood flow
2️⃣ Main set 4–6 min moderate effort (or a single interval) Builds cardiovascular fitness
3️⃣ Cool‑down 2–3 min low intensity + static stretches Promotes recovery, reduces soreness
✅ Time ≤ 10 min total Fits into busy schedule
Feel free to tweak the exact minutes and intensity to suit how you’re feeling that day—consistency is more important than perfection.
Let me know if you’d like a specific example (e.g., treadmill walk/running or bike intervals), and I’ll put it together for you. Happy training!
