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Injection Pain: What to Know, What to Do!
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Prisoner
Level 3

Join date: Jun 2003
Posts: 2793

INJECTION PAIN: Diagnosing a problem and what to do!

Here is a scenario that I read all too often on the boards:


A user has injected and a day later is having lots of pain and swelling to his injection site.

There are normally 3 reasons why this would occur.

The first reason is that the injectable used contained too much preservative such as benzyl alcohol which will cause tissue damage, and stimulate a local inflammatory response. The pain from this can be moderate and go away in a few days, or it can be severe and take almost a week to subside.

It really depends on how much BA was in the solution injected and how much volume was injected. Normally the pain and inflammation can be controlled with Ice and anti-inflammatory such as Advil and after about the 3rd day, the user should notice a gradual subsiding of the symptoms.

The site should be swollen, and slightly red, but that swelling should be inside the muscle, and should begin to dissipate on the third day along with the pain. This is a slow progression though and could take as long as a week to ten days to fully go away, the key is it will slowly get better, not worse or stay the same.

The 2nd scenario is if you hit the lymphatic system with one of your injections.

The lymphatic system is a network of vessels that flow through your body. It is as extensive as your vascular system, and contains nodes at different parts are like storage depots or garrisons where White cells can accumulate for action.

The important thing to note is that the odds of coming into contact with the lymphatic system, as long as you stick to the conventionally recommended sites of IM injection are very small.

(The recommended sites are deltoids, ventogluteal (side of hip/ buttocks) , dorsal gluteus (back of buttocks top outer corner), vastus lateralis ( abductor lateral (outer side) of quadriceps).

But if you start doing �??site�?? injections, such as pectorals, biceps, inner quads etc. then you run much higher risk of hitting lymphatic tissue and disruption of ducts.

Lymphatic disruption is caused when you puncture into the area. Since it is fluid, but not blood, it has no means of initial clotting so the fluid will continue to flow into surrounding areas causing extreme localized swelling and pain.

The swelling will then track up wards along the lymphatic system. The edema that is caused will also include surface edema �?? i.e. if you indent the area with your finger, the finger mark will remain. That is called �??pitting edema�??.

This edema comes on strong and fast, by the following day it is at its worst. There is normally no redness or �??heat�?? at the site, just swelling and pain.

Ice and Advil can be helpful, but it usually takes a week for the swelling to dissipate, and for up to 10 days before you can resume training that body part, as the swelling can be so bad, it will limit your range of motion and flexibility in the muscle injected.

The Keys to note are that this usually occurs in an unconventional injection site, and there the swelling comes on quickly, and then doesn�??t get worse. There is very little redness, and heat at the site. The site will have pitting edema, where as injection caused by too much BA has no pitting edema.

The third scenario is an injection site infection.

An infection can be caused by a few different factors but key is that you have introduced a bacterium into your muscle that doesn�??t belong there, and is now invading your body.

This can be because what you injected was contaminated, because the needle you used was contaminated, or simply you just didn�??t swab well enough either on the vial or your injection site.

The first thing that happens when you inject some gear is that the bacterium will cause a localized inflammatory response. That includes swelling, and redness, and heat to the area, very similar to if you had injected gear with a high BA content. What follows is that the infection will progress, and your body�??s immune system will put in steps to defend itself.

Ice and Advil may help the pain, and temporarily blunt the swelling, but if you withdraw the therapy, the swelling continues to get worse. By the third day you will notice pitting edema to the area, unlike the lymphatic caused edema that occurs earlier then the third day.

Inside, the body will be attempting to contain the infection by forming a barrier around the infected area which is called a cyst. If the body is successful the infection can remained contained in that pocket and the body will slowly fight it.

However the cyst can continue to grow in size taking up more and more of the muscle belly as cyst formation is not a guarantee that the body is able to kill the infection; it is just a way of slowing its spread.

Without cyst formation, the infection will reach the blood stream and that is when systemic symptoms will start occurring such as high fever, and limb swelling �?? and a gradual progression to systemic septic shock.

We won�??t get into this here other than to say, if you felt a fever coming on, then the only place you should be worrying about getting to is the closets Emergency department, as your life could literally be in peril. Once septic shock begins, if it is not caught soon enough it becomes impossible to stop the process regardless of how young and healthy you are; you will die.

So, back to the beginning, if it is the 3rd day, and you are beginning to develop the symptoms I discussed �?? the pitting edema, and the swelling and pain along with HEAT at the site of injection that is not subsiding, then you pretty much can surmise that you have yourself an abscess.

By finding the original spot that you injected and pressing down with a finger tip, it should be soft and boggy, there should be a finger indentation left in the skin, and there may also be a slight discoloration to the area.

So what is needed to fix this, and reverse this as soon as possible so that the least amount of damage is done to your muscle?

You need to get the infection out as soon as possible. Treating this with straight antibiotics may not quickly kill off the infection as the area will have been sealed off by the body so that the bacteria cannot utilize the vascular system to spread.

In that same token, the antibiotics may not be effectively delivered in a fast enough time period to quickly kill off the infection, putting a halt to the infection�??s progression.

Aspiration is a necessity and should be done as soon as you have confirmed that it is indeed an infection.

By inserting an needle syringe combo directly into the site in the exact path that your original injection took, and using a large gauge needle �?? 18 or even larger 16 gauge needle, (make sure to swab really well before hand, and have sterile gauze to cover the site following) insert the needle with the syringe empty, and once you have inserted it an 1/8 inch or so begin to aspirate as you slowly sink the needle in depth.

You will know when you hit the abscess, as you will quickly suck up a small quantity of fluid that will resemble bloody, but purulent (yellow tinge to it) puss and some remnants of the injection fluid, whether it was suspension or oil.

Expect to aspirate at least as much as you injected and possible ½ mL more, however sometimes you won�??t find anything, and it usually is because you either aspirated too early �?? i.e. you didn�??t wait until the third or 4th day, or it isn�??t an infection, or you just plain missed the site which really is hard to do.

If you don�??t aspirate, you could end up with an ugly hole in your muscle.

Physicians are reluctant to aspirate thinking that they will give the antibiotics a chance to do the trick rather than spending the extra time to pull out the infection. Many times they leave it up to the patient to decide this matter, and will order a course or oral antibiotics.

The problem is, a lot of times the oral antibiotics will not work, and the patient will have to come back for IV therapy, and at this time aspiration may not be an option �??but rather surgical debridement�?? because the abscess has formed a large hole.

What will work, and works best with minimal harm is rapid diagnosis of the problem by the user at home, and rapid treatment. That means drawing out the infection, and going to the emergency department. You can bring the syringe with you to show the contents to the Nurse, and physician.

It will certainly get you seen quicker. The doctor at that point will likely prescribe an oral antibiotic called Keflex (cephalaxen) This is a relatively side effect free medication that will work well and quickly if you have drawn out the infection. It will work poorly If you do not get the abscess drained.

So if you do not aspirate the area yourself, insist the doctor does it who is prescribing the antibiotics.

If all this is done properly, within a week you will be back to normal, and may not even miss any training time. You can train like normal through the antibiotic course, and you don�??t have to stop your cycle. As long as your symptoms continue to lessen there is no need for follow up with your Doctor.

Don�??t be afraid to go see your physician about this as there is no judgment they can place against you. They are bound to treat you for whatever illness you have regardless of how it was caused.

Finally, make absolute sure to finish the entire course of antibiotics you are prescribed! We don�??t want to be breeding super bugs fueled by steroids now do we!

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dirtbag
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Join date: Aug 2007
Posts: 3559

Good post !!

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bushidobadboy
Level 3

Join date: Nov 2004
Posts: 15565

Very nice Pris. This could do with being stickied.

I never really considered the lymphatic sytem in all of this before. Which is surprising as the one time I seriously fucked up an ant. delt injection, I surely must have blocked a major lymphatic channel, as my whole arm swelled up like a sausage.



Bushy

PS - I checked out your blog and it's looking good. I tried to post a comment, but for some reason couldn't get to grips with the process, or maybe the site was having issues.

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Dave1188
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Join date: Jan 2007
Posts: 429

wow awesome post

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Hagar
Level

Join date: May 2007
Posts: 1695

Could another reason be an allergic reaction to something else? I have some test which caused swelling and pain 1 or 2 days after injection.

I took the stopper off and baked it in the oven at 225 degrees for 10 min to evaporate some of the BA. Then I injected it in to my ventral glute.

After that I walked like Dr. Frankensteins assistant Igor for the next few days and bought some human grade test that's painless.

Also I wanted to hit my biceps to but I'm a little worried about hitting a lymph node now.

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bushidobadboy
Level 3

Join date: Nov 2004
Posts: 15565

Hagar wrote:
Could another reason be an allergic reaction to something else? I have some test which caused swelling and pain 1 or 2 days after injection. I took the stopper off and baked it in the oven at 225 degrees for 10 min to evaporate some of the BA. Then I injected it in to my ventral glute.

After that I walked like Dr. Frankensteins assistant Igor for the next few days and bought some human grade test that's painless.

Also I wanted to hit my biceps to but I'm a little worried about hitting a lymph node now.


I think that some people also react to the type of oil or possibly some degree of rancidity or oxidisation that occured in the oil, prior to it being used to make up the batch.


Bushy

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JJ
Level

Join date: Apr 2008
Posts: 2326

Hagar wrote:
Could another reason be an allergic reaction to something else? I have some test which caused swelling and pain 1 or 2 days after injection. I took the stopper off and baked it in the oven at 225 degrees for 10 min to evaporate some of the BA.

Then I injected it in to my ventral glute. After that I walked like Dr. Frankensteins assistant Igor for the next few days and bought some human grade test that's painless.

Also I wanted to hit my biceps to but I'm a little worried about hitting a lymph node now.


The nodes (glands) are in specific areas of the body, behind the knee, in the groin, chest, armpit.. um... NECK! cant remember where else - but NOT the biceps.

But Prisoner was saying that there is more chance you can hit some lymph ducts/pipework(!) etc in a smaller area like that, which would cause a spillage of lymphatic fluids swelling the area right up..

great post, and i NEVER considered the lymphatic system when using sharp implements on myself (tried to cut my leg off once and even then...)

anyways, great post prisoner, and in your NEW avatar, jesus man, you truly look pro there - it shows you for the size you really are i think.

JJ

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Renton
Level 1

Join date: Mar 2007
Posts: 4004

Thanks Prisoner. My vote too for a sticky.

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sdspeedracer
Level 4

Join date: Nov 2006
Posts: 573

Makes one think having a large gauge (16 ga pig-sticker) needle available is wise planning. Thanks.

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FuriousGeorge
Level 5

Join date: Dec 2004
Posts: 1225

great post prisoner.

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JJ
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Join date: Apr 2008
Posts: 2326

X2

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BestDaddyEver
Level 1

Join date: May 2008
Posts: 396

Sticky this shit up, making it all nice and gooey, mods. :)

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Jazz_Man1898
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Join date: Feb 2008
Posts: 234

sdspeedracer wrote:
Makes one think having a large gauge (16 ga pig-sticker) needle available is wise planning. Thanks.


Agreed!!!


Very informative Pris, Thanks!! My vote is for a sticky too!

Jazz

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Growing_Boy
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Join date: Apr 2007
Posts: 4536

awesome post Prisoner. Scary thought though, I'm referring to the worst case scenario. I too vote for the stickyfication of this thread.

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Willith
Level 3

Join date: Mar 2008
Posts: 89

Wow.....I'm curious- how often do people tend to get infections?

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xXDevilDogXx
Level 1

Join date: May 2008
Posts: 637

Great thread to link newbies to.


STICKY!

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Jazz_Man1898
Level

Join date: Feb 2008
Posts: 234

We have reached sticky status!!!!!!!!!! HOOOOORAH!!!

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Cortes
Level 4

Join date: Mar 2005
Posts: 7145

Nice. I think it would be cool to have Prisoner write articles for T-Nation. I don't know if either party is interested in such an endeavor, but I would certainly like to read them.

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BestDaddyEver
Level 1

Join date: May 2008
Posts: 396

Cortes wrote:
Nice. I think it would be cool to have Prisoner write articles for T-Nation. I don't know if either party is interested in such an endeavor, but I would certainly like to read them.


I agree, Cortes. I haven't been on this site long, but Prisoner is one of the most knowledgeable guys I've seen on any site. Congrats on the sticky, Prisoner!

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pushharder
Level 5

Join date: Apr 2005
Posts: 38042

Can hitting the lymphatic system's consequences include a low grade fever?

A guy I know is suffering big time right now after pinning the inside of the rectus femoris. Redness, localized pain, and general achy feeling everywhere but no soft, spongy spot where the pinning occurred.

The inject was this past Monday night and wow, the poor guy is still hurting, lethargic and very sore.

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rainjack
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Join date: Apr 2003
Posts: 14604

Great post Prisoner.

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Prisoner
Level 3

Join date: Jun 2003
Posts: 2793

pushharder wrote:
the inside of the rectus femoris.


where exactly are we talking about here?

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pushharder
Level 5

Join date: Apr 2005
Posts: 38042

Prisoner wrote:
pushharder wrote:
the inside of the rectus femoris.

where exactly are we talking about here?


Right smack dab on top. No fever today as far as the thermometer says but it feels thataway.

The guy should not have pinned there but live and learn.

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Prisoner
Level 3

Join date: Jun 2003
Posts: 2793

Was the injection on the thigh area or the ventrogluteal area?

Also is the swelling localized or tracking?

Is it hot/ warm to touch compared with opposite side?

Is there any pitting edema? i.e. when you make an imprint with your finger in the area of inflamation, does it remain when you remove your finger?

and... how many days has it been.. is it geting better or worse? tried any ibuprophen? or ice? if so how has it responded?

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pushharder
Level 5

Join date: Apr 2005
Posts: 38042

Prisoner wrote:
Was the injection on the thigh area or the ventrogluteal area?


Right on top. Halfway between knee and hip.


Also is the swelling localized or tracking?


The entire top side and lower half of the thigh down to the knee. Swelling was visible but not significant.


Is it hot/ warm to touch compared with opposite side?


Warm but not hot. Red too.


Is there any pitting edema? i.e. when you make an imprint with your finger in the area of inflamation, does it remain when you remove your finger?


No. Whole area is firm and very sore. No detectable bolus.


and... how many days has it been.. is it geting better or worse? tried any ibuprophen? or ice? if so how has it responded?


Finally getting better. Was even able to ride horseback last night and do several sets of RDLs today. Up until today, knee flexion was excruciating.

Pinned Monday night. By Wednesday, Thursday and Friday pain was debilitating. Simple walking around was a chore. Squatting to get something out of bottom of fridge was a no-no.

If wife touched thigh during sex she was promptly thrown completely out of the bed landing on the floor with resounding thud. (j/k)

Achy, flu like feeling those three days but for some unknown reason did not take temp until Friday when it showed up normal every time in spite of continued achy feeling. Could do practically nothing on Thurs. and Fri.; no ambition. Just like having the flu.

Would've gone to doc on Friday but it was the Fourth of July here and that would've necessitated a 85 mile one way trip to hospital emergency room. All closer "Urgent Care" facilities and doctors were BBQing and boating.

Sat. and Sunday (today) no flu-like, achy feeling. Leg still somewhat red compared to other leg.

Started Azithromycin on Wed. Took last pill today (250 mg). Took this because it's the only antibiotic laying around and figured it was better than nothing.

Ibuprofen and acetaminophen did help. Ice felt good but stiffened leg noticeably when removed.

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