In my last column ^[1], I described how a couple of incidents, one on the subway and one at work, during the first few months of steroid and Revlimid ^[2] (lenalidomide) treatment had given me hints that more than physical effects were going to be involved in my multiple myeloma treatments.

After five months on chemotherapy, it seemed that, while my medicines were apparently going to control the myeloma – I was approaching “very good partial response” – I could tell that the chemotherapy was having profound effects on me emotionally.

Continuing to work in a steam cooker job seemed to pose a lot of risks.

I had focused on and was closely monitoring the physical side effects of the chemotherapy – which were many.   Nights after taking the steroids, I was often up till 3 a.m.   Peripheral neuropathy was getting worse, even after the Velcade ^[3] (bortezomib) stopped.  Fatigue was intermittent, but luckily I was an excellent nap taker.

But I hadn’t been warned of or prepared for the psychological effects.  In June, just six months after the diagnosis, I decided I had to retire.   A few weeks after a stem cell harvesting, I retired.  I was 63.

In the two years since the diagnosis, the psychological effects of the medicines, far more than multiple myeloma or the retirement, have been the greatest challenge for me.

Steroids make me sociable and chatty during the 12 hours after taking them, but when they are wearing off, they make me unpredictable and pretty grouchy to live with.  And they can make me aggressive and impair my judgment as well.

As I mentioned, I yelled at a colleague at work.  I’ve yelled at aggressive drivers (I never drive in Manhattan myself – I decided many years ago that it was bad for my soul).  I’ve yelled at food delivery bicyclists who ride on the sidewalks with heavy electric motors.  I managed to enrage a crazed subway passenger in a crowded car.

Most dramatically, when I once motioned with a hand gesture to a middle-aged bicyclist on a pedestrian path to slow down, I must have also enraged him for he slapped me in the face as he passed by!

Without thinking, I ran after him and grabbed him off the bike.   We both fell over, and his teenage children who were following on their own bikes started yelling at us to cut it out.

My poor wife was horrified.  Indeed, what in the world was I doing?   Three broken ribs later, I understand my instinctive reaction, but what idiocy!

I think I now have my emotions under control – I must look pretty sane at least, as tourists are constantly coming up and asking for directions.

But I do think I was greatly under-counseled on the psychological dangers of the steroids.  My doctor had switched me from dexamethasone ^[4] (Decadron) to prednisone ^[5], and while it seemed to me to have a much gentler impact on my body, the emotional effect was apparently quite insidious.

These may not be anabolic steroids that body builders and athletes take to improve performance, but ‘roid rage’ can occur even to those not on anabolic steroids!

I have developed some techniques for handling these side effects, which I will describe in a later article.

At a minimum, each day I spend a few minutes trying to “tune in” to both the emotional and physical state of my body.

Leaving the house with a smile rather than a scowl, regardless of how I feel, is always a wise thing to do.

But my myeloma journey is going to be (I hope!) a long course, and a multitude of techniques are on the list to cope.