Steroids
Steroids save lives but we have to face-up to their side-effects
By Dorothy Byrne
A woman I barely know
leans across the dinner table and strokes my cheek. ‘No wrinkles at
all!’ she says enviously. ‘How do you do it?’
It’s a compliment I
have grown used to in recent months. Despite being in my 50s, my skin is as
smooth as a toddler’s bottom.
It’s a compliment I have grown used to in recent
months. Despite being in my 50s, my skin is as smooth as a toddler’s bottom.
But my secret is not Botox. ‘Steroids,’ I
reply. ‘15 mg a day.
 |
| Wrinkle-free: Dorothy Byrne, Head of Channel 4 news, hates that being on steroids has given her a 'hamster face' |
I am one of the
quarter of a million Britons who take steroids long-term. They are
corticosteroids, which are not the same as the anabolic steroids taken by
bodybuilders.
In my case, steroids
control the painful symptoms of a temporary auto-immune condition called
polymyalgia rheumatica (PMR).
Others take steroids
for inflammatory conditions such as Crohn’s disease, chronic asthma, chronic obstructive
pulmonary disease, ulcerative colitis and rheumatoid arthritis.
Steroids truly are
wonder drugs — life-savers in some cases — that for decades have been relied on
for their ability to reduce inflammation.
But they have some
unpleasant effects on physical appearance that patients are often embarrassed
to talk about. It is time for us to come out.
As head of news and
current affairs at Channel 4, I am meant to talk about subjects others find
difficult to discuss. How strange that one of those subjects should be my own
body.
As you can imagine,
drugs with so much power have side-effects when taken long-term — prednisolone,
the most commonly taken long-term steroid, can cause osteoporosis after just a
few months.
But the potential
medical consequences hardly bother me on a day-to-day basis. What makes me
miserable is the way steroids make me look. That smooth skin comes at a price —
we steroid-takers call it the hamster face.
‘You could buy
yourself a little wheel to spin round on, Mum,’ said my teenage daughter Hettie.
She did tell me I was
still her beautiful mother ‘underneath’. At least she was honest. Many people
have told me I look just the same — does this mean I’ve always looked like a
hamster?
Doctors call our
chubby chops ‘moon face’. It’s caused partly by water retention, but also by
the peculiar way in which steroids redistribute fat round the body.
We also have little humps on our backs just below the
neck, known as ‘buffalo hump’.
 |
| Dorothy before: Steroids make takers look puffier because they cause water retention and redistribute fat to the face, back and midriff |
There is another
weird fat deposit round our midriff.
Meanwhile, our arms
and legs lose muscle and fat.
Some medics refer to us as ‘lemons on matchsticks’. Others
call us ‘potatoes on sticks’. Obviously, they don’t say these names to our
puffy faces.
Doctors are, of
course, mainly concerned with the long-term medical benefits of taking steroids
and so often don’t mention temporary changes in appearance to patients.
I’ve interviewed several
people who didn’t know until I told them that the weird fat deposit round their
torso was caused by steroids.
Similarly a lot of
doctors don’t, or hardly ever, mention the possibility that you’ll put on
weight. In fact, someone on long-term steroids for PMR might expect to put on
half a stone.
The higher the dose
and the longer you are on steroids, the more weight you are likely to put on.
This is because steroids make you feel hungry, affecting the areas in the brain
that control feelings of hunger and satiety.
A study of PMR
patients found more than two-fifths put on significant weight. Several people
I know on steroids complain of weight gain of a stone or a stone and a half.
I’ve heard of one woman who put on five stone.
My consultant did
warn me about weight gain and advised me to surround myself with oranges
(rather than crisps or chocolate).
Thank God she did. I
quite often sit down and eat five, one after another. I can polish off two
supermarket string bags of satsumas in a night. But despite eating healthily, I
have still put on half a stone.
I don’t like the new
me. I was invited to a party at which one of the key draws was the presence of
the Leader of the Opposition.
I looked at my
puffiness in the mirror and just couldn’t face going out that night. I asked
myself if it was rational for a woman to feel too unattractive to meet Ed Miliband.
Still, I stayed at home.
Feeling isolated, I went on the internet and was
hit by a cry of pain from across the world.
Someone with eosonophilia pneumonia — a lung
condition — describes the love/hate relationship patients have with
steroids: ‘I began to look like someone I didn’t even know. But the alternative
to prednisolone was to stop breathing.’
Someone who’s had two organ transplants
agrees. ‘It’s a lifesaver, but is hell for its side-effects.’
‘I would rather have the pain than a moon face
and weight gain,’ another wrote.
Some people feel
steroids have had a serious effect on their social lives. ‘I miss being
pretty. I used to love having so many friends, but now all I think of is how
they talk behind my back about how I look,’ said one woman.
I asked myself if it
was rational for a woman to feel too unattractive to meet Ed Miliband. Still,
I stayed at home
A teenager with
Crohn’s disease writes: ‘I absolutely hate this moon face! It is
probably the worst thing I have to deal with in my life. I really can’t bear
the thought of having to go back to school looking like this. Please can
someone help me?’
That poor child
didn’t think Crohn’s disease, a serious illness, was the worst thing that has
ever happened to her — what bothered her was her face.
People who go on to
websites are more likely to be complainers. So I asked some sensible,
middle-aged women on long-term steroids what they felt. I expected them to
scoff at such distress; I was wrong.
Val Emblen, who was
64 when she went on steroids, put on 1½st.
‘When I looked in the
mirror, it was a different person looking back. I found it very difficult to go
to the hairdressers,’ she says.
‘I didn’t want to buy
clothes for someone with this new shape. I felt I was presenting myself to the
world as someone who was not me. I didn’t realise how important body image was.’
Her doctor was sympathetic
and Val agrees the change in appearance was the price she had to pay for
improved health. But she believes patients should be warned.
‘Doctors should tell
you because knowing it happens to other people is important,’ she says.
Gilly Gilmore was 54
when he was prescribed the drugs.
‘At first, I felt
hugely relieved. Then I put on a stone and felt depressed. My face puffed up
and it made me feel dreadful. The shock made it much worse.’
Should doctors think
more about how miserable sick people are about the way they look?
Years ago, I was so
seriously injured in a motorbike accident that I later discovered doctors had
considered amputating my leg. I feel grateful and lucky that most people don’t
even notice I limp.
But for decades my
wardrobe has been designed to hide the huge scar on my leg, which has defined
my vision of myself.
Millions of people
feel a lower sense of self-worth because of changes to their bodies through
illness or accident and they could be happier if they talked about it.
I have a friend who
disagrees strongly. She has lupus and has also had a kidney transplant.
She’s been on
steroids for decades and thinks doctors shouldn’t warn patients about puffy
faces, as it could put them off potentially life-saving drugs.
But the hospital she
attends provides counselling about weight gain and facial and body changes to
patients who want it.
In these difficult
financial times, it’s hard to see scarce resources being diverted to such
services. But couldn’t doctors and family and friends help by recognising and
discussing the problems?
When people stop
taking steroids, their hamster faces disappear and most lose the extra weight.
Perhaps I will shrivel
up like Ursula Andress in the film She.
Mostly, I look forward
to worrying about wrinkles again.
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