Women On Steroids

Even though greater than two thirds of people affected by autoimmune diseases are women, a significant portion of the patient population is male. Our guest speakers for this episode are Dr. Max Gutreiman, specialist in Internal Medicine practicing in Costa Rica, and my cousin Giovanni Estrada Bencardino, radiology technologist from Ibague, Colombia.  Dr. Gutreiman's Ulcerative colitis and Giovanni's Bullous pemphigoid have impacted their lives for over a decade leading them to experience serious complications from their diseases and also life-threatening adverse effects from the medications used to treat them with high dose Prednisone as a staple in their treatment regime.  This episode was recorded in Spanish.

Episode 7. Hombres en Esteroides was recorded in Spanish. Our guest speakers are Dr. Max Gutreiman, Internist from Costa Rica, and Giovanni Estrada Bencardino, Radiology Technologist from Colombia. They shared with us their experience as health care workers as well as patients impacted by autoimmune diseases.  Esperamos que lo disfruten. Pura Vida!

She called me "Brave", and I said: "Brave On Steroids".   Prednisone has significantly enhanced traits in my personality that had stayed under the radar for all of my existence before dermatomyositis.  Sometimes, I am thankful for the added endurance,  fake energy boost, and extra-hours of work due to insomnia. Some others, I don't find being a woman on steroids so much of "a blessing in disguise", but rather a liability.  This episode of my life still gives me goose bumps.   My friend Zehava still feels happy about the outcome and insists in calling me "Brave". 

Dr. Zehava Sadka Rosenberg and I have known each other for 25 years.  She has been a mentor, an advisor and a colleague for equal amount of time before and after my autoimmune disease diagnosis.   As someone who has struggle coming to terms with my medical condition and the secondary effects of the medications used to treat it, I could not have wished for a better friend  than  Zehava. She has been a solid rock and also a sounding board  whenever I have needed her.  Join Zehava and I in conversation as we go over how to best support and advocate for your friends who may be facing difficulties related to the diagnosis and treatment of their autoimmune disorder.   Always remember that their hope for recovery may rely in good part on counting with your friendship and love. 

Our invited speaker, Dr Eric Sigmund, will take us on a journey of discovery exploring the basic principles of image acquisition using diffusion weighted ((DWI) MR imaging and how the technique applies to autoimmune conditions affecting the muscles of the pelvis and thighs. Eric and I work together along we a group of investigators including Dr Steven Baete at the NYU Center for Biomedical Imaging developing MEDITATE. This is a sequence that uses DWI as a probe for assessment of muscle microstructure during exercise activation. The listener will find this episode the right combination of being informative, but yet entertaining. Enjoy!

All medications have the potential of causing adverse effects.  Patients must avoid taking new medication when getting in a plane or while airborne.

Steroid replacement therapy includes immunosuppressants/immunomodulators and immunotherapy. Join Dr Franks and I as we discuss this and more in this rather important subject.

Those of us who have been on steroids for prolonged periods of time can attest to how ambivalent we feel about these pharmacological agents. Prednisone, perhaps the most commonly prescribed corticosteroid, is highly effective in “smacking down” the evil autoimmune disease threatening to send our body into a downward spiral. But prednisone is equally effective in causing adverse effects that can be be quite important, still the lesser of two evils.

In this episode we welcome back Dr. Andrew Franks, rheumatologist and dermatologist at Gramercy Park Dermatology and NYU School of Medicine. Dr. Franks and I will engage in conversation reviewing the available treatment protocols for autoimmune diseases affecting the musculoskeletal system with particular emphasis on dermatomyositis.   #WomenOnSteroids will relate well with the description of the myriad of secondary effects caused by prednisone and other corticosteroids including sleep disorder, cardiovascular alterations, mania and other emotional manifestations, weight gain, hunger and deranged fat metabolism. We will then move on to review steroid replacement therapy including immunosuppressive agents and immunotherapy, and we will end by talking about ancillary factors including diet, vitamins, exercise and stress control, i.e. yoga and meditation.

Imaging evaluation of autoimmune diseases plays a significant role in the correct diagnosis of these conditions. In this episode, we will engage in candid conversation with Dr. Xavier Tomas, musculoskeletal radiologist based at the Hospital Clinic de Barcelona.  Xavi and I have been friends for close to twenty years. We came together through our mutual friend Dr. Anabel Garcia, also a musculoskeletal radiologist and colleague of Dr. Tomas in Barcelona. Dr. Tomas will take the listener in a exploratory journey covering all imaging modalities and their contribution to the diagnosis of collagen vascular diseases such dermatomyositis, scleroderma, lupus and many others with particular emphasis on advance MR imaging techniques that show promise in pinpointing subtle and often subclinical abnormalities that can greatly aid in a more prompt diagnosis and treatment of these diseases.

Imaging evaluation of autoimmune diseases plays a significant role in the correct diagnosis of these conditions. In this episode, we will engage in candid conversation with Dr. Xavier Tomas, musculoskeletal radiologist based at the Hospital Clinic de Barcelona.  Xavi and I have been friends for close to twenty years. We came together through our mutual friend, Dr. Anabel Garcia, also a musculoskeletal radiologist and colleague of Dr. Tomas in Barcelona.  Dr. Tomas will take our listeners in an exploratory journey covering all imaging modalities and their contribution to the diagnosis of collagen vascular diseases such as dermatomyositis, scleroderma, lupus and others with particular emphasis on advanced MR imaging techniques that show promise in pinpointing subtle and often subclinical abnormalities that can greatly aid in a more prompt diagnosis and timely treatment of these diseases. 

Join me in conversation with Dr. Andrew Franks, who is on the Lupus Foundation of America’s Medical-Scientific Advisory Council, and an advocate for educational programs that increase awareness of autoimmune diseases among the general population.  Believe it or not, autoimmune diseases are the third most common category of disease in the United States after cancer and cardiovascular disease, affecting ∼5 to 8% of the population or 14.7 to 23.5 million people.  Conservative estimates indicate that ∼78% of the people affected with autoimmune diseases are women (1). Women respond to infection, vaccination, and trauma with increased antibody production, whereas inflammation is usually more severe in men resulting in an increased mortality in men and protection against infection in women.  This is however a double edge sword as increased antibody response protects women from infections also increases the risk of developing an autoimmune disease. During the COVID pandemic, patient advocacy groups have urged expansion of eligibility for the paid family and medical leave program to include individuals determined by the Centers for Disease Control and Prevention (CDC) to be at high risk for adverse complications from COVID-19. Dr. Franks and I, along with our research teams at NYU, institution where I worked as Professor of Radiology and Orthopedic Surgery for 12 years until July 2019, were able to develop a dynamic diffusion-weighted MR imaging technique spear-headed by Dr. Eric Sigmund, physicist at the NYU Center for Biomedical Imaging (2). This technique has proven useful in diagnosing subclinical microstructural alterations of the muscle fibers in patients with amyopathic dermatomyositis.  1. Fairweather D, Frisancho-Kiss S, Rose NR. Sex differences in autoimmune disease from a pathological perspective. Am J Pathol. 2008;173(3):600-609. doi:10.2353/ajpath.2008.071008 2. Sigmund EE, Baete SH, Luo T, Patel K, Wang D, Rossi I, Duarte A, Bruno M, Mossa D, Femia A, Ramachandran S, Stoffel D, Babb JS, Franks AG, Bencardino J. MRI assessment of the thigh musculature in dermatomyositis and healthy subjects using diffusion tensor imaging, intravoxel incoherent motion and dynamic DTI. Eur Radiol. 2018 Dec;28(12):5304-5315. doi: 10.1007/s00330-018-5458-3. Epub 2018 Jun 4. Erratum in: Eur Radiol. 2018 Jul 9;: PMID: 29869178. CopyDownload .n

Join me in conversation with Dr. Andrew Franks, who is on the Lupus Foundation of America’s Medical-Scientific Advisory Council, and an advocate for educational programs that increase awareness of autoimmune diseases among the general population. Dr. Franks and I, along with our research teams at NYU, institution where I worked as Professor of Radiology and Orthopedic Surgery for 12 years until July 2019, were able to develop a dynamic diffusion-weighted MR imaging technique spear-headed by Dr. Eric Sigmund, physicist at the NYU Center for Biomedical Imaging. This advanced MR technique has proven useful in diagnosing subclinical microstructural alterations of the muscle fibers in patients with amyopathic dermatomyositis.

The diagnosis of autoimmune diseases is frequently elusive.  It often happens that presenting symptoms, cryptic physical exam findings and family history are misinterpreted by patients with autoimmune diseases and by the physicians and health professionals who care for them.   Join Dr. Andrew Franks and me as we recall the steps that we have taken together in our twelve year long journey as an autoimmune disease doctor-patient team.  Before meeting Dr. Franks, my autoimmune disease was misdiagnosed as a dermatological condition: contact dermatitis. The many doctors who treated me with topical steroids for close to a year did not think of inquiring for constitutional symptoms nor for family history of autoimmune diseases.  It took self-realization for me to push for a referral to Dr. Franks, a world-known expert in autoimmune collagen vascular diseases at New York University School of Medicine.   In this episode, Dr. Franks will go over the crucial steps that lead to successful recognition of autoimmune diseases: 1) anamnesis (listen carefully); 2) Physical exam (rash quality); 3) Biopsy; 4) Laboratory markers; 5) Pulmonary Function Tests; 6) and Imaging (echocardiogram, CT, MRI). 

The diagnosis of autoimmune diseases is frequently elusive. It often happens that presenting symptoms are ignored or misinterpreted by patients, their loved ones, and their doctors. Join is in conversation with Dr. Andrew Franks. Dropping Wednesday September 23rd at 3AM EST.

What motivates you to tune in and listen to "Women on Steroids"? As we well know, we are living through the worst health crisis in recent history, the Coronavirus pandemic. Handling of COVID19 by the corporate world, including health care organizations, has involved the request to their employees to disclose health conditions, also known as risk factors, that may worsen the outcome of those infected with the virus. This includes, among others, the use of medications that suppress the immune system, agents known as immunosuppressant or immunomodulators. Through this process, we have learned to understand the meaning of the expression "essential workers", people whose jobs require them to bypass stay home orders that apply to everyone else in a pandemic. Medical professionals are among those whose occupation places them at greater risk of exposure to COVID19. Patients with autoimmune diseases develop skills that help them to deal with these chronic conditions. Never before COVID19, we had to face the ominous request to have to disclose our medical history. For one thing, autoimmune conditions and the medications used to treat them, such as steroids, make us appear quite “healthy” to the unaware observer.  This episode deals with the process of "coming out" with one's autoimmune disease to family, friends, superiors and co-workers.

COVID19 has exacerbated the struggle for women suffering from autoimmune diseases by unveiling their medical vulnerability. What was formerly hidden  from public knowledge, now must be disclosed. How does revealing our medical weakness affects our workplace interactions, the way that we project ourselves to other, and the way that we are perceived. Are Women On Steroids (#WOS) slacking off from their professional duties? Are they just taking advantage of the "medical gain" provided by their disease? Now that we are seen, can our health weaknesses ever be forgiven?