Hacker News new | past | comments | ask | show | jobs | submit login

Dexamethasone is a serious drug and corticosteroid [1]. It was prescribed for a friend after eye-surgery and having skin / eye inflammation problems, I used it (with no doctors advice) recklessly albeit with very small quantities.

The drug was hyper-effective. An unbelievably tiny quantity can remove any inflammation (eye, skin, hair skin rash, etc...). But the fall out and side-effects are no joke even for seemingly super minuscule doses. It was a horror story for me with horrible eye inflammation, small inflammations in different parts of the body and a skin rash I still struggle with until today. Mind you I took small localized doses and not an injection. I wasn't aware that it can travel through your skin, get into your blood and make a mess.

I think the research will need to specify potential side-effects and their probabilities. It's trade-off at the end of the day.

PS: Do not ever think of trying it without medical advice and doctor supervision.

[1]: https://en.wikipedia.org/wiki/Dexamethasone#Adverse_effects

Well, yeah, steroids are incredible, shame they have such severe side effects. Following a parvovirus B19 infection I developed severe joint problems(basically got advanced arthritis at the age of 28, how fun), and all it took to sort out was one steroid injection. I won't lie, for the next few days after the injection I felt like a superhuman, all the issues went away and in general I felt super great. Obviously that's not something you can continue doing because the side effects get really bad after a while, my doctor warned me that if the issues come back I probably won't be able to get another injection because the risk is too great, but for a one-off thing it was like a miracle cure.

That's the problem with evolution. Any protein in the body ends up with multiple completely unrelated functions.

If it's in the blood stream for enough generations, the body will find some alternate use for it. It's like a compression algorithm on your DNA.

...and so when we try to use meds to counter certain proteins or block receptors, we discover that it has a dozen totally unrelated impacts. "Oh, that blood pressure medication? Well let's just have it also randomly give you prostate cancer!" (real example).

Organic evolved animals are the worst type of spaghetti code - if there was ever something you'd want to redesign from the ground up, it's us.

Then add to that that there isn't even any "standard" type of human. We're all different - and even different groups of us have different smatterings of genes. Sometimes it correlates with our ancestors background - sometimes it doesn't. Who knows! Evolution! We're all each just individual experiments running around to see which genes can procreate the most.

...and it's not even as though each of us is a single experiment on a specific gene, that would be too easy. We're each an experiment on a unique collection of thousands of genes that evolution hopes will average out the results across the entire population. Try to wrap your statistics PhD around that!

Then also factor in that modern human evolutionary pressures are totally different than they were even a couple of generations ago, and it becomes clearly evident that evolution is in a complete state of dysfunctional disarray.

Spaghetti code has more negative connotation than I’d attribute to our insanely adaptive, flexible, and efficient organism.

Evolution is romanticized, but its ability are limited, not infinite.

The more complex a species, the less adaptivity it has to fundamental shifts in environmental pressures. The interconnections between protein functions are directly responsible for that trade-off, and become a liability.

The time scales for evolution far beyond our current level of genetic complexity, probably extend beyond the life span of the Earth.

Now the benefit of this speghetti-code situation is that no intelligent designer is required - obviously a fundamental ingredient of abiogenesis, but does it benefit an species that's capable of genetic editing?

Nope. At this point, it's really just a bottleneck to even repairing the most straight-forward genetic diseases.

As a species, we're approaching the time where we've obviated evolution. ...I won't say we've seen that yet because reproduction rates are still very uneven across population segments, but it's only a matter of a few more generations (cataclysms not withstanding).

It’s not spaghetti code... I just think your analogy is weak and misleading.

Not sure how you’re defining complex but humans pretty soundly refute that adaptability thing.

It’s not a “bottleneck” it’s just... life. Can you point to an animal anywhere near as successful as humans that doesn’t have.. genetic variability? No. It’s a requirement and precondition for our success, not some flaw we overcame despite.

I think what he means by spaghetti code is that it's not readable or easy to understand or maintain by humans.

Every protein has multiple functions, so we can't make changes easily without side effects. Bottlenecking human intervention specifically.

What's your definition of success?

To exist.

Existence is table stakes. All interesting things happen on top of it.

Nonetheless, it's a very freeing view to consider that just by existing you've already succeeded. Everything that comes after is an adventure. You've already beaten far, far greater odds just by being here than anything you'll accomplish in life.

is there a greater mystery than existence itself?

Something being more mysterious doesn't make it more interesting.

What's my private key? It's a mystery, but not a very interesting one.

Why does the universe exist? It's mysterious, maybe the most mysterious thing of all, and 8lit's interesting, but I'd say it's not the most interesting question of them all.

by mystery, i mean much more than that which is not known.

i mean to convey: something that is difficult or impossible to explain. something that is deeply interesting and provokes wonderment.

what is more difficult to explain and understand than the fundamental nature of existence?

perhaps it is not apparently immediately _useful_.

but in a cosmic sense, of what use is it to understand thought objects in the world when there is a complete lack of understanding of the consciousness in which these thought objects arise?

i’m curious what are some candidates for “most interesting question of them all” in your view. this is something which sparks a genuine curiosity in me and would love to hear your perspective.

Existence is a mystery indeed, but in this context, it's not an achievement. It's a starting condition for all achievements.

how do we know that achievement is of value?

how is it possible to know what is _actually_ of value as opposed to what is _apparently_ of value?

in your profile you mention:

> I do software nowadays, but I'm constantly looking for opportunities to do something actually useful for humanity.

how does one arrive at a belief about what is useful?

> how is it possible to know what is _actually_ of value as opposed to what is _apparently_ of value?

It's in our heads, but since we all run the same hardware architecture, it generalizes quite well.

it is evident that people don’t actually converge on singular sets of beliefs in this way. but for sake of argument let’s put that aside and suppose we actually do.

even with this, this doesn’t address the concern of actuality versus appearance.

consensus reality has been wrong in the past, and can be shown wrong again.

so how can you be so sure?

>As a species, we're approaching the time where we've obviated evolution.

This is hubris. Everything that humanity may accomplish in the future, from editing its own genome to creating general artificial intelligence, is a product of that same evolutionary process. We do all that out of our innate need for self preservation and reproduction—evolutionary imperatives for all organisms.

But it’s more accurate to think of evolution as a universal computational process occurring within the substrate of (bio)chemistry. That computation will yield further computation (intelligence and its products).

This way you can define evolution to mean absolutely anything, at which point the word loses its meaning.

If we stick to traditional, useful definition of biological evolution, then we can confidently say that it stopped being the driving force for plant and animal life no later than when we've first learned to communicate and remember ideas; we've made it irrelevant when we've learned to write. It still works on microscale, but that's mostly because things breed and die faster at that scale, there's more of it, and we can't efficiently poke at it with any sort of precision.

Eh, you could argue evolution is still relevant in human populations up till today.

Well we’re constructed the same way that is: by an intern that is just copy pasting from examples he’s seen work plus occasionally typing it out himself and making an error.

Except no. The error rate is very very low, and is basically the perfectly adapted “error” rate for best survival. So... not even an error.

Again, people love teaching for analogy here but humans are just nothing like code, to be honest.

Maybe the lesson is that interns are very good at copying.

The lesson is that there's millions of copies and the one that performs best on an endurance test gets to be released.

Except there's no StackOverflow to help with evolution...

“Spaghetti code“ doesn’t imply “buggy”, so I think is a decent description. Evolution found a good local optimum, but I think that the optimal design would be quite a bit better than what we have now.

A classical example is https://en.wikipedia.org/wiki/Recurrent_laryngeal_nerve. Nobody in his right mind would design a nerve running from your brain to your larynx that way.

> “Spaghetti code“ doesn’t imply “buggy”, so I think is a decent description. Evolution found a good local optimum, but I think that the optimal design would be quite a bit better than what we have now.

> A classical example is https://en.wikipedia.org/wiki/Recurrent_laryngeal_nerve. Nobody in his right mind would design a nerve running from your brain to your larynx that way.

The matter is, the possibilities of DNA are infinite, you can create Godzilla if you knew how. The problem is, nobody knows how, so evolution is all we have - random mutations and survival will lead to /something/. Even genetical engineering now is in essence copy pasting of certain parts that we know work in a specific way, bound by what currently exists. But if you could really grasp biology, that works down to the single molecule and atomic levels, and actually dictate it however you like, I think it would be the final technology we would ever need.

Spaghetti code absolutely implies buggy because code != biology. They operate completely differently, in fact potentially opposites (logic is the opposite/complement of intuition, ie neural nets, of which our body operates far more like an adaptive/analog machine than a logical one which is brutally unforgiving).

In code, a single typo breaks the whole thing. So spaghetti code by definition is bad and breaks easily.

Sure, we have a fuck ton of complexity. But it’s only messy to us because we don’t understand all the conditions that led to it.

Humans certainly have flaws, but in general we are as well suited to surviving on Earth as you possibly can be, especially on the whole.

I’d say: we’re so so much better designed than any code that exists anywhere today, that it’s a farce. We are literally the opposite of spaghetti code. We’re Antifragile!

Memory leaks, data loss, intermittent bugs, bad edge case handling are all examples of bugs that could result from a typo and not break the whole system outright.

Furthermore, there are plenty of examples of single gene mutations/interventions that are deadly/crippling.

> In code, a single typo breaks the whole thing.

A single typo sometimes breaks the whole thing. Sometimes, it does not. The same is true for genetic mutations in humans - most typos are harmless, a few give us nasty cancers.

Yes, but that process is also what makes us live in the first place (variability). It definitely breaks, but on the majority it works better than anything we know of.

"The spaghetti code works fairly well" is a different claim than "it's not spaghetti code", though.

"Spaghetti code" doesn't mean "broken". It means "hard to maintain". Our modern medical system is pretty decent proof that maintaining a human is quite a bit of work.

> In code, a single typo breaks the whole thing.

Only in high-level languages, when you have to deal with grammar.

DNA is better compared to binary code fed to a CPU. There is no equivalent of "a single typo breaks the whole thing" there; whatever you feed the CPU, it will execute something. Whether you'll like the results or not is another question - but the same is true with biology. The DNA is there, physically, and it will interact with proteins in one way or another.

Spaghetti code is spaghetti code. It refers to to the code being essentially so interwoven with each other that changing a single thing has consequences for many other locations in the code. Spaghetti code can be 100% bug free.

There are myriad of examples of our body having feature which you could equate to biological spaghetti.

Code cockroaches?

I donno, I am inclined to agree with the spaghetti code connotation. Humans are insanely adaptive, flexible, and efficient, but there are some serious design flaws. Here are some examples of a few things I could see improving: The need to inhale and exhale out of the same place that you need to eat and drink is bad engineering, too much risk of choking or drowning. The sexual reproductive organs sharing the space with waste elimination is unsanitary during copulation. Finally, bipedal upright legs. Legs are awkward and unbalanced, and the knees are extremely susceptible to injury, we would greatly benefit from a more robust mobility design.

Extra Credit: A prehensile tail would be extremely useful in many situations and I believe may decrease the risk of injury for elderly people. With an adequately strong prehensile tail, older people would be able to use it as a sort of a tripod leg to keep themselves upright with less risk of falling.

I'm with you on the tails. Tails would be cool.

But, I think the double use of orifices (air, food, urine, semen) is a good idea. Minimizing orifices seems to be an advantage... fewer avenues for outside stuff getting in. (And I don't think human sexual organs are necessarily dirtier due their location; urine is more or less sterile, and feces shouldn't really come into play under ordinary circumstances... )

The problem with spaghetti code is that decently intelligent people are forced to work with it and they would be vastly more productive if it weren't spaghetti.

No such advantage with our bodies, as they are only "worked on" by probabilistic processes.

> No such advantage with our bodies, as they are only "worked on" by probabilistic processes.

Well, and doctors. Who often have to deal with unintended or undesired side effects of medications and surgical procedures.

Well, the difference is that for programming you almost always have an enormous surplus of computing power, while evolution is a race to the bottom on who can do most with fewer resources.

Tell that to your immune system. It's necessary, but reasonably likely to kill you or at least make your life miserable.

If we're so insanely flexible and efficient, why do we have the same body plan as every other tetrapod? We walk upright, but our weight is cantilevered out from a spine that is manifestly not designed for that.

Sure, every living creature and really any complex system has these problems: they can’t be perfect.

But you also can’t point to anything better.

> But you also can’t point to anything better.

I mean, not yet. The days of "let's tweak it so the blood vessels go behind the retina" or "let's add a bit more cartilage to the knees" aren't here yet, but they're probably coming eventually.

Evolution doesn't really optimize for the "keep this body running at age 100" scenarios that we find ourselves in lately, and there's a lot of legacy code.

Evolution is dumb. What dictates evolution is who survives. People wish to live 100 years old and be like 20, but that would be very complex, and eventually, humans exist as a species just fine without it, that is, the DNA keeps existing and replicating without that advantage. If conditions dictated that the humans who are young for 100 years leave more of their DNA than those who do not, then eventually that is the path we would have taken - maybe that is the path we WILL take, if conditions allow. But it's just a selfish wish. It's like saying an ant worker should live decades. Good for itself, maybe, but adds little value to the survival of the species, the job gets done as it is.

You are assuming evolution leads to the best adaptation. That's simply not true. It finds a local minimum and that's it. It's evident that a human that stays fertile and young for 100 years leaves more offspring then the current human. But the way to get there might not be continous improvement of fitness and thus evolution will never get there by itself.

It does not "lead" anywhere. It's a wandering in the wild. Some paths lead to cliffs, some will keep you going for a long time. A vast number of paths will be taken, but in any given time you only see the species - better yet, the individuals - who have not fallen off a cliff.

I like the idea of evolution, because "it is what it is". It happens whether you believe it or not. It has no goal, it just happens. And, it's not that evolution "changes" species, it's that whoever survives becomes the definition of what a species is at all, therefore "evolution" is just the observable outcome, the process is natural selection. So, it's pointless to "blame" evolution, to say "it is not good enough". I, you, we don't even know what's "Good enough" and for whom. Even whatever we consider "humanity" is the outcome of our natural selection. Your very wish to live forever, is the outcome of our natural selection.

The wish to genetically engineer our species' future members, will only be judged good or bad by its outcome, not by our planning. What you see now is what works, and the proof it works is we are still here. For example, if we end up destroying the world and our species with nuclear weapons, the path of evolution giving us intellect will have proven to be a bad one for this branch of DNA called "human species".

I can only say I have a very bad gut feeling about conscious genetic altering of humans, and I trust there are many arguments to find if I analyze it. Perhaps it's only some aspect of my DNA's self preservation not wanting to lose over some made-up DNA.

Anyway, I agree there’s ways we can improve, only disagreed with the implication that we’re running on some sort of hacked together or sloppy system. The redundancy of biology is incredible, the opposite of easy to break.

I mean, it is hacked together and sloppy.

Ureters come out near the vagina, causing UTIs. Our intestines are better suited for being on all fours, leading to hernias. We eat and breathe with the same orifice, and some of us choke to death from it. Our eyes have blind spots that lead to our brains filling in details, sometimes inaccurately. Goosebumps are vestigial, men have nipples, human embryos briefly make tails and gill slits, heads are too big for the birth canal, etc. etc. etc.

If we had the technology to design a human from the ground up, we'd make a lot of fixes.

As with many hacked together and sloppy codebases, it still works, fairly well. That doesn't mean it's not hacked together and sloppy, though.

Sloppy compared to what? What would you point to as better? Where would you put the urethra, for example?

Many of your examples are contrived. Sure they have some failure modes, but they also are succeeding trillions of times a day.

I’d bet a lot of money a “human designed human” would not perform better, except for taking ideas from other humans, and only when done in very limited cases.

> Sloppy compared to what? What would you point to as better?

Sloppy compared to, say, crocodiles, which largely haven't changed in hundreds of millions of years. We humans aren't well designed for our current use cases, as we changed a whole bunch of our behaviors in the last few hundred thousand years.

> Where would you put the urethra, for example?

I'd leave that up to a biomedical engineer. Perhaps they'd rig up a system like reptiles and birds have, where the useful water gets reabsorbed and they excrete urea crystals.

> Sure they have some failure modes, but they also are succeeding trillions of times a day.

Again, this is true for spaghetti code. It is a mistake to think "spaghetti = broken". Spaghetti = hard to understand/maintain.

The diff between the error rate of crocodiles, humans, and spaghetti code is really where it doesn’t stand up.

Crocodiles > humans >>>>>>> spaghetti code.

End of story, unless your spaghetti code only fails a very small amount, I guess. Not what I assume most people think when they think of it.


Won’t let me respond to you directly, but I haven’t failed to note that. I’ve never seen someone say anything positive about the reliability of spaghetti code.

You keep ignoring the point that spaghetti code and error rate are not related by definition. It's been spelled out to you multiple times now.

Reminiscent of heavily optimized code perhaps?

> if there was ever something you'd want to redesign from the ground up, it's us.

Well god wrote all the code in like 7 days for this dump, so what did you expect? Quality?

Though I sometimes equate end times with "I'll get around to fixing that bug one day" as every supposed date of end times never comes. god really is a programmer.

Two widely deployed things were created over 7 days. Life, and JavaScript. Both turned out to be a huge mess.

Similar experience for me. I was in the worst pain of my life, suffering from a herniated disk and sciatica. I got an epidural steroid injection and the pain completely went away. I felt like I could run through walls, fortunately I didn't test that hypothesis. The relief lasted for about a week and then the pain started to come back but it was never as bad as it was before the injection. Fortunately steroid do more than just relive pain for herniated disks, they actually stimulate healing as well. But the doctor told me in no uncertain terms that this wasn't something I could do again anytime soon, it's a one-off.

Anecdotally supported advice: keep that core strengthened!

I was tweaking my back every 4-6 months (like Nearly bed ridden for a week each time for 2 years, then Last summer I started doing an hour yoga class once a week and haven’t had any problems since!

I'm asthmatic and every now and then have to do a 1-week course of Prednisone.

It really is quite amazing how it makes you feel superhuman ... but oh dear, the crash the other side is horrible.

I remember reading the side effects the first time I took it and was shocked - but it's essentially the "nuclear" option when it comes to inflammation and honestly, still one of the best things we have.

As I understand it, even if you unwisely continue taking it, the superhuman side effect goes away quickly.

Don’t mess around with steroids.

> I won't lie, for the next few days after the injection I felt like a superhuman, all the issues went away and in general I felt super great.

You might have been manic. That's a well known side effect of dexamethasone.

Inflammation can be caused by inflammation.

So x happens that triggers inflammation. Then you get stuck in a loop.

To be clear, it's generally advisable to only take a prescription drug under the direction of a doctor. This isn't unique to dexamethasone.

Steroids plus eyes can lead to glaucoma. My doc won't let me use them anywhere near the face.

Random aside - I wish I had a tough love doctor that would tell it to me like it is, and pay close enough attention to refuse to let me do things.

I don’t even really use the term “my doctor”, I just see a doctor when I need to. I’m 30 and live in a large city, and I’ve rarely seen the same doctor more than a couple times in a row. I go in for a physical roughly once a year, and the doctor will sit and talk with me for 10 minutes or so. But otherwise if I need something checked out in between I often get seen by a PA or whatever doctor in the practice is free. I’ve never really felt encouraged by the same doctor to see them repeatedly, or to email them personally if I have a medical question like I know some people do. So when I move to a different neighborhood or something, I just end up seeing a different doctor next time.

Am I just getting bad doctors? How do you find this type of buddy doctor that becomes a long term relationship and really cares about you personally, like I hear about other people seeming to have.

It is critical to get a primary care physician you bond with, or at least can build some rapport with. My late father was a cardiovascular and thoracic surgeon, but then decided to go back to school (while teaching) to get his boards in internal medicine. He had two motivations: one was not to be the Old Surgeon that has to have his privileges revoked, and the other was his evolving relationship with the world, largely facilitated by SSRIs. His journey from surgery to internist over many years gave him what I think was a pretty good insight into the human condition.

As an internist and primary care physician, he had one patient who presented with back pain and was loaded on opiates, wanting refills plus more dope. He talked with her for almost an hour (a unique privilege most don't have in today's healthcare system, and likely none will going forward) and ended up sending her home with an SSRI and a note to check back in a little while. A few weeks later she was calling the clinic's owner raving about how she felt so much better, her back didn't hurt anymore, etc. I'm not writing that to say SSRIs > opiates, just to say in her situation he correctly identified her pain was due to depression. You don't get there unless you have rapport with your doc and the time to talk with them.

The point is that you have to find a doc you like and one that can spend time with you. Unfortunately I don't know of a good way of doing that. I'd hook you up but my dad passed some years ago. I'd love to hear people's ideas on finding someone like him — I need a doc, too.

I think you get it by going to the same doctor over many years. Continuity of care is important!

That can be very difficult. Increasingly, physicians employ a staff of PAs and/or nurse practitioners who handle cases. Those staff seem to move around more frequently than physicians, so even if I keep going to the same office, the staff may have almost entirely changed.

This, coupled with the fact that, as an American, my ability to see a particular doctor (or even supporting staff) is highly dependent on whom I am employed with at any given time.

If you switch jobs regularly, you will likely end up on multiple insurance plans, each with their own set of participating medical professionals. Sometimes there is overlap, often there is not.

For those that can get insurance via their state or federal health care exchange you can pick your insurance based on doctors covered.

I'm going to disagree with all the other commenters so far. You are only going to find a tough love doctor if you're really, really lucky. Having a long relationship with a doctor might help with continuity of care, but the truth is there is no doctor that is going to be more invested in you than YOU.

In fact, I would recommend going to MORE doctors if you have concerns. That's why you get second and third opinions for important medical decisions.

I have high cholesterol. My father had a heart attack around 40. His father died of a heart attack. I told all my past doctors this and I have never gotten "tough love". Maybe because I have a young looking face and I'm rail thin. Maybe because I know my family history so they assume I know the risks. I put off statins in favor of trying diet and exercise unsuccessfully until I met a doctor that finally DID more forcefully suggest a statin. I should have started taking them way sooner.

A doctor is not where to find tough love or to find a friend. A doctor is where you go for expert opinions and recommendations. Inform yourself and be responsible for your own health.

That's been my experience with doctors. Even our kids doctor, who we see multiple times a year.

My mom has a fairly good relationship with her doctor, but she worked in the same hospital with him for 30 years.

> Am I just getting bad doctors? How do you find this type of buddy doctor that becomes a long term relationship and really cares about you personally, like I hear about other people seeming to have.

Doc here:

Stay in one place, go to the same guy repeatedly over time, and ideally, be really candid with them, and send them your family members. When I see half (or more) of a household, it's an entirely different dynamic. You can't buy the sort of relationship that comes of seeing someone's kids grow up, and then treating that kid. That kid is like... 5% blood relative to the doc at that point. He will never be "just a patient." Or when you treat someone and their mother - that's a different level of candor right there, because that person trusts me with their mother - that right there suggests I can be more open with them, because they won't immediately blame/hate me for news they don't like.

Time is the key, though. A lot of patients, if they get "tough love", turn around and go to a different doc. Especially the ones that say they just want to hear it straight - they are trying to convince themselves, I think. So getting to "tough love" is something that's built up over time, in both directions. (Also, studies suggest that it's somewhere between "not effective" and "actively harmful" when it comes to positively changing patient's health-related behavior, so it's not a super high priority.)

Bonus points if you go to someone that only takes cash. For a once or twice a year visit, it's not that much money (compared to, say, one month of most prescription meds), but it means they don't have to hustle you through an 8-minute visit to keep their lights on. You can only get so much of a connection with someone that's forced to hustle you out of the door - it's jarring and kind of upsetting to everyone involved, on both sides of the interaction. (When I was in training I was told pretty candidly I'd make a fantastic attending one day, if I learned to actually hustle patients fast enough to be able to afford keeping an office open. ... You can imagine, I structured my career towards cash patients only. I don't like being inaccessible to folk, but I hate it less than I hate giving people half-assed help when they're in need.)

Another good element is going to a physician that you're community-bound to in some way other than a strict transaction. Your kid's little league coach will have an entirely different relationship to you than "random doctor." That's becoming less common these days, unfortunately - with the way reimbursement is swinging, I don't know of many docs that still have time for much in the way of community activities. They exist, but they're a lot rarer than they used to be.

As someone who has glaucoma (diagnosed at the young age of 25, unfortunately, but thankfully with almost no vision loss) and also has a need for corticosteroids due to other issues... yes, this is a very fine line I sometimes have to walk. Corticosteroids exacerbate eye pressure problems that come with glaucoma, which could counter the effects of my glaucoma medications.

Yeah. I've got psoriasis on my eyelids, and it's not a fun calculation to have to make. Especially during "rub my eyes all the time" allergy season.

I had anaphylaxis after accidentally eating something with peanuts in it and went to the hospital. I was given* Decadron (brand name dexamethasone) among other things, eventually I was fine and went home later that evening.

The next day I got out of bed and pretty much fell over. I could barely stand up. Wife took me to the hospital again, it turns out I had a reaction to dexamethasone.

Definitely not something to play around with.

*I don't recall if it was a pill or an injection. Probably injected, since I had trouble swallowing.

All true, but the trade-offs here are clear. This drug is being looked at for patients who are in the hospital on oxygen or a ventilator. At that point side effects aren't very relevant since their odds of dying are somewhere between 25-40%. Anything that significantly reduces those odds is going to be worth it.

Not sure what side effects you experienced with Dexamethasone, but I can speak about my experience with Prednisone, which is a drug in the same family (glucocorticoids [1]). I was prescribed Prednisone in order to fight off a severe allergic reaction to something that was never identified (this is not an unusual scenario). It worked wonders. I would say it's at 100 to 1000 more potent than benadryl. Now, once you get on Prednisone, you become dependent. You can't just quit cold turkey. You need to taper off. I didn't know that if you try to accelerate the tapering you might experience some surprises. I was just very enthusiastic to reduce my dose. I ended up with some excruciating joint pains in the Emergency Room (or A&E, as this was happening in London). After some MRI, they concluded I have nothing, gave me an ibuprofen and discharged me. This was not a fun experience (except for seeing how many drunk people visit the ER on a weekday night in London).

While modern medicine was not able to tell me what happened with me, I created this little mental model: Prednisone was keeping my immune system in check. Without enough of it, the immune system went haywire, and I was experiencing something akin to severe acute rheumatic arthritis. Once I upped my dose, this went away. I was then very disciplined with my tapering, and eventually, after 3 more months, I got off of Prednisone. Five days from now I'll be 2 years Prednisone free.

[1] https://en.wikipedia.org/wiki/Glucocorticoid

I can speak to both. But, for me, Prednisone was the hardest to break; I took Prednisone for more than 10 years with very high doses first and slowly tampering off. It saved my life and, yes, it worked wonders. On very high doses I was on the top of the world—euphoria. But once the tampering started, that’s when the negative side effects came: sleepless, agitation, restlessness, depression, mood swings, and much more. My doctor mentioned that with its benefits she could list a side effect from A to Z. You have one year one me, but I too get to celebrate being Prednisone free.

I'm surprised that medical studies seem to happen in silos. The severity of adverse effect is well known in China during the 2003 SARS period. Dexamethasone is cheap probably due to the mass production of the drug in China in the early noughties. Before isolating the coronavirus of SARS corticosteroid drug abuse led to serious problems where patients had their lives saved but eventually disabled.

The chinese lead scientist in SARS/Covid19 is known for saving lives with these drugs (super high dose and cocktail drugs) but also warned their serious effect after the treatment. There was a huge debate of stop using them all together in favour of traditional chinese medicine (which is equally biased). Of course they save lives but you are at risk of huge comprises of the human body.

reference: http://www.j-smu.com/oa/pdfdow.aspx?Sid=2009112284 or https://wenku.baidu.com/view/7eef29aa0029bd64783e2c40

Sorry for the probing question but why did you take your friend's prescription?

Am I understanding you correctly, that it both fixed your eye inflammation, and had a side effect of horrible eye inflammation?

Corticosteroids are strongly contraindicated for topical application to the face, because of the risk of glaucoma.

Systemic (that is, oral/intravenous for full-body effect) corticosteroid use doesn't usually have this specific side effect.

The side-effects of corticosteroids are generally No Fun Whatosever (I speak both as a former pharmacist and as someone who has needed them on occasion) but they're the go-to treatment for some very unpleasant inflammatory conditions. But you should remember that they're immune system depressants and should never be used without medical supervision.

(Side effects range from glaucoma leading to blindness -- for misuse of topical creams on the face -- through to sudden death -- for abrupt withdrawl from prolonged systemic doses.)

Systemic steroids absolutely have a risk of glaucoma:


Yes. It was akin to addiction. It suppress inflammation but after the effect is gone, a worse inflammation onset. Getting off of it gave me the worst!

I think parent is saying it can fix eye inflammation, but for him it caused eye inflammation.

Not to be over-speculative, but I think OP is probably referring to the rebound effects of corticosteroids which have been documented recently as related to skin conditions [1].

[1] https://www.jaad.org/article/S0190-9622(17)32533-1/pdf

The "a skin rash I still struggle with until today" is probably skin thinning, too. Powerful steroids can permanently reduce the thickness of the skin, revealing capillaries in thin-skinned places like the face. It can look like a permanent sunburn.

While I do believe they should not have announced it in public, but this could be useful. Steroids are immunosuppressants and end up neutering the immune system. Severe cases for Corona virus ended up due to hyperactive immune system (based on various reports). Taking a steroid is good for short term when you have an auto immune disease or inflammation, swelling, but it hurts the body's capacity to fight other infections. I had RA and was given a steroid for a week. No pain whatsover, i could run, and go about my day normally. Side effects: I could not sleep, and the moment i stopped taking them, the pain returned.

Could work in short term but this seems more like a stop gap than any cure/medicine which works against the virus. This is something which would taper your immune system down so you wont have adverse effects. The potential side-effects are huge.

They aren't claiming that this cures the virus. It's purely to treat the cytokine storm that causes most covid deaths. This is for people who are already hospitalised and receiving oxygen, with the most dramatic results for those on ventilators. At that point the mortality rate is high enough that the risks of side effects are worthwhile.

Thank you. Yes, that makes sense. That was what got me confused.

The only thing this comment should used as evidence of is that taking prescription medication without a prescription - especially a steroid of all things - is idiotic. The layman has absolutely no way to tell what a small or minuscule dose actually is.

Yes, it's a serious drug indeed. I was involved a few years ago in caring for someone who was taking dexamethasone (as part of cancer treatment).

The side-effects when the dose was just a little too high were......scary. In the sense of severe, bewildering psychosis.

Your post needs to mention that this is for use in SEVERE COVID-19 patients; those on oxygenation and ventilation. At that level, side-effects from the steroidal pale in comparison to DYING from COVID-19.

I think the research will need to specify potential side-effects and their probabilities. It's trade-off at the end of the day.

Here's a different perspective on dexamethasone:


Is this true? I have taken the strongest steroids topical, oral and by injection (undiagnosed DH) and never had any side effects except small time relieve of my symptoms that could have been fixed by a strict diet

Why on earth would you take something like this without medical direction?

For systemic inflammation problems (including uveitis, joint pain, and intermittent brain fog), have you experimented with probiotics, especially acidophilus (including L-92), as well as cutting gluten and other potential allergens from your diet?

Guidelines | FAQ | Support | API | Security | Lists | Bookmarklet | Legal | Apply to YC | Contact