IM Site Injection Reactions

[musclegeek19]

Hi All,

So I started my first IM injection cycle last week (combo of Test-E/EQ, total of 450mg/cc). Doing injections twice per week, rotating between delts (Mon/Thurs - 1cc/injection). Using a 25g, 5/8" syringe. I'm 5'11" and roughly 182lbs, lean at about 10% BF. First one on Monday went well, a little sore for 2-3 days after but went away. My second one on Thursday went in good, however it's now Monday (4 days later) and it's still fairly red, swollen, sore and a bit warm to touch. (Note: these reactions are further down my arm and not directly where I injected) My first syringe was pre-loaded and stored at room temperature. My vials were in the fridge after that (which I moved to my closet this morning) and my second inj. was performed with a cold substance (I read after that it should be room temp/warm for best results) could this be the reasoning? That's the only difference from my first and second injection.

From the research I've conducted, this is normal. Especially for someone using a new substance, and being new to IM injections in general. I plan on waiting until this Thursday (1 week from last inj in right delt) to confirm if I need to go see a doctor. Judging by the replies on other posts I've seen/read, I need not to worry too much, however I'd just like to get some opinions from others whom have experience. (Especially those with Test-E/EQ). If you require any other info, drop me a reply on here or PM.

Cheers! :hu

[bigtavi8]

For a first cycle and first time pinning 450mg/ml is high dosed gear and likely what is causing your problem here. I didnt realize at first you were using such high mg/ml gear. For me that is the only thing i can not handle to inj. Tiramisu explained a lot about how gear has BA/BB higher when the gear is high dosed to keep it into solution. I suspect this might be the problem. It also could be the carrier the gear is in. Read the vial and post what oil it is made in. If its EO some ppl are allerigic to it and swell up like you are. But it is prolly just the high mg.ml thats giving ya the problem. It did to me and i had to switch to seperate compounds such as Test 250, Eq seperate. Same issues occurs with TTE (test+tren).

[musclegeek19]

For a first cycle and first time pinning 450mg/ml is high dosed gear and likely what is causing your problem here. I didnt realize at first you were using such high mg/ml gear. For me that is the only thing i can not handle to inj. Tiramisu explained a lot about how gear has BA/BB higher when the gear is high dosed to keep it into solution. I suspect this might be the problem. It also could be the carrier the gear is in. Read the vial and post what oil it is made in. If its EO some ppl are allerigic to it and swell up like you are. But it is prolly just the high mg.ml thats giving ya the problem. It did to me and i had to switch to seperate compounds such as Test 250, Eq seperate. Same issues occurs with TTE (test+tren).

Thanks for the note dude. I will post up what oil it is made in tonight when I do my 3rd. Also, may have had my GF inject it too fast. I was reading it should be around 45sec-1min/1cc of injection? Sound correct? Strange thing is, my first inj didn't react like this, so could it be the cause of injecting a solution that was stored in the fridge and not warmed up (or room temp)?

[Mr Ontario]

There is some good reads on injections in the Article section :)

[tiramisu]

Don't keep your oil in the fridge :)

If it didn't crash, make crystals, then it at a minimum made it thick like molasses to inject. Hopefully that is the majority of the issue. You should probably expect some discomfort at the high concentrations you are using. Don't be shocked. Still injecting cold oil is certainly part of the problem.

There is no advantage to keeping your vial in the fridge. It is sterile, sealed and contains BA, benzyl alcohol to keep it bacteriostatic, which mean new bacteria will breed extremely poorly in the solution - bacteria static.

[musclegeek19]

Don't keep your oil in the fridge :)

If it didn't crash, make crystals, then it at a minimum made it thick like molasses to inject. Hopefully that is the majority of the issue. You should probably expect some discomfort at the high concentrations you are using. Don't be shocked. Still injecting cold oil is certainly part of the problem.

There is no advantage to keeping your vial in the fridge. It is sterile, sealed and contains BA, benzyl alcohol to keep it bacteriostatic, which mean new bacteria will breed extremely poorly in the solution - bacteria static.

This is my assumption, because as I previously mentioned, my first one was stored at room-temp (pre-loaded for me to show me how to draw, etc) - so that was the only difference between the first and second injection. Performed everything else as sterile as can be. I'll update the thread tomorrow after my third inj. tonight, and see if the temperature difference plays an issue. Gonna stock up on some Ibuprofen too. I'm not going to over worry until the worrying is necessary. I'll use my heating pad tonight also on my swelled arm. Thanks again for the info! Reps to you guys are on the way!

[musclegeek19]

I picked up some Ibuprofen for the time being. Anyone think Rub A535 will help with the pain?

[Mr Ontario]

No I would not agitate the area anymore then needed :) Ice it , if anything a little.


I picked up some Ibuprofen for the time being. Anyone think Rub A535 will help with the pain?

[musclegeek19]

No I would not agitate the area anymore then needed :) Ice it , if anything a little.

Sounds good, thanks. 400mg of Ibuprofen for now, lol.

[musclegeek19]

The Ibuprofen is definitely helping with the pain/swelling. It's still a bit red/warm today but definitely does not feel/look as bad as it did yesterday. Third injection was last night in the other delt with the compound stored at room temperature (not the fridge, lol) and it went in smooth, feels great today. My guess for this reaction on my right delt is that I injected a cold oil (being stored in the fridge). However, if it proceeds to get any worse or not go away, I'll go see the doctor. Gonna hit shoulders/biceps tonight at the gym so hopefully it's good to go after another 1200mg of Ibuprofen all day while I sit at my desk, lol.

[Mr Ontario]

Sounds like your going to live... don't forget to check out the articles section as well on injections etc


The Ibuprofen is definitely helping with the pain/swelling. It's still a bit red/warm today but definitely does not feel/look as bad as it did yesterday. Third injection was last night in the other delt with the compound stored at room temperature (not the fridge, lol) and it went in smooth, feels great today. My guess for this reaction on my right delt is that I injected a cold oil (being stored in the fridge). However, if it proceeds to get any worse or not go away, I'll go see the doctor. Gonna hit shoulders/biceps tonight at the gym so hopefully it's good to go after another 1200mg of Ibuprofen all day while I sit at my desk, lol.

[tiramisu]

Don't get used to relying on ibuprophen, it's definitely not good for you.

[musclegeek19]

Don't get used to relying on ibuprophen, it's definitely not good for you.

Definitely not relying on it, just for temporary use! :)

[macka]

I'd also try an allergy pill. Sometimes it will keep things in check and lessen the swelling. Kinda like what they can do for a bee sting.

[musclegeek19]

Sounds like your going to live... don't forget to check out the articles section as well on injections etc

Done. Some of the info there seems like it could be an infection, however being my first cycle and having the sterile process down 100%, I'm assuming it's:

(A) the cold oil injection
and/or
(B) my body reacting to the compound (being 450mg/ml)

Because this is still ongoing from last Thursday, however the pain/swelling is definitely decreasing so I'm assuming its not an infection/abscess as I read the sides don't change and/or will get worse if that was the case.

I appreciate all the info guys, cheers!

[musclegeek19]

I'd also try an allergy pill. Sometimes it will keep things in check and lessen the swelling. Kinda like what they can do for a bee sting.

Any specifics or just a general off the shelf allergy pill?

[tiramisu]

... off the shelf antihistamine may help if it is a mild allergic reaction. if it helps great if it doesn't then you aren't having a mild allergic reaction :)

[macka]

what T said

[TryGear]

also for future injections "maybe you already do" remember to aspirate before injecting.....once the loaded syringe is in the muscle you want, pull back on the plunger a bit, if you get some blood remove and use a different site, as that would mean you're in a blood vessel and a thick oil sitting in a blood vessel could also be your problem. generally good aseptic practice and common sense will make 99% of all injections safe and painless. good luck.

[musclegeek19]

also for future injections "maybe you already do" remember to aspirate before injecting.....once the loaded syringe is in the muscle you want, pull back on the plunger a bit, if you get some blood remove and use a different site, as that would mean you're in a blood vessel and a thick oil sitting in a blood vessel could also be your problem. generally good aseptic practice and common sense will make 99% of all injections safe and painless. good luck.

Thanks for the note, yes I did aspirate before injecting.

[Prisoner#22]

looks like you contracted a mild case of cellulitis from your injection.

cellulitis is a skin infection and can happen if you didn't clean the skin enough prior to injection. You introduce a bug from the surface of your skin into the skin.

I just got off IV antibiotic therapy because of the same thing. I went tanning and I guess I didn't wash the tanning product off my skin well enough prior to injection, and picked up an infection that way.

I would advise to avoid the ibuprophen, and if the swelling and redness persists past a 2-3 days get seen by a doctor, as these infections can turn serious like mine did... it can become necrotizing.

[tiramisu]

looks like you contracted a mild case of cellulitis from your injection.

cellulitis is a skin infection and can happen if you didn't clean the skin enough prior to injection. You introduce a bug from the surface of your skin into the skin.

I just got off IV antibiotic therapy because of the same thing. I went tanning and I guess I didn't wash the tanning product off my skin well enough prior to injection, and picked up an infection that way.

I would advise to avoid the ibuprophen, and if the swelling and redness persists past a 2-3 days get seen by a doctor, as these infections can turn serious like mine did... it can become necrotizing.


A big WTF??? He injected cold oil with a 450 mg/ml dosage and has post injection inflammation and you respond with cellulitis with a follow up of necrotizing fasciatis?

Why not throw in bubonic plague?

That's just mean.

... He probably only has aids.

[Prisoner#22]

A big WTF??? He injected cold oil with a 450 mg/ml dosage and has post injection inflammation and you respond with cellulitis with a follow up of necrotizing fasciatis?

Why not throw in bubonic plague?

That's just mean.

... He probably only has aids.

Sorry but the description of the reddness on the skin totally describes cellulitis... I'm just trying to be helpfull bro... I am an RN afterall with years of E.R. experience. Its really easy to contract cellulitis... all it takes is a scratch on the skin at the wrong time when there is the wrong kinda bacteria pressent.... Thats what cellulitis does by the way... it turns the skin necrotic... obvioulsy some baterias move much quicker than others... most cellulitis is the slower moving stuff, but you can never be too carefull.

Like I said I just got off IV antibiotics myself. Not trying to make waves.. just trying to be helpfull... If you don't want my expertise I'll just keep my mouth shut from now on and lurk, and watch guys treat their infections with ibuprophen and icepack for days on end before they go into hospital and realise it is an infection and they have to have faciotomys, when if they would have been seen right away, they could have resolved the issue in a matter of a few days.

[tiramisu]

Don't lurk, the RN training is valuable BUT you have cellulitis and the OP has just injected himself with oil stored in the fridge with a 450 mg/ml dosage.

It seems much much more likely that you are ignoring the likely cause for the symptoms and jumping straight to infection.

If I inject cold oil, with a test dosage of 450 ml/mg I can guarantee that I will have a sore lump for a week.

[macka]

No offense P22, but in all honesty I think you are over reacting from your experience. Been there done that with my children. If he had cellulitus would he not also have other signs like a fever? I'm not trying to diminish your knowledge in any way. Would it not be best to ask him more questions as to his condition before jumping from no worries to defcon5?

[japh]

Its all about awareness. If it isn't just inflammation and is an infection its good to be aware of that possibility. Nothing wrong with that.

I wouldn't lurk. Your knowledge, work ethic and subsequent achievements are an asset here.

[Prisoner#22]

cellulitis is actually really common guys. When I triaged i would see it like almost once a shift... You can get it from just a scratch, a cat bite and its guarenteed, or a human bite... but its more common than you think. In my case it occured because I didn't swab enough and had oily skin from the tanning bed... Its easily curable if you get it looked at as soon as possible.

Fever and chills is a bad... that means the infection has spread from the skin and gone systemic... thats like a real emergency as you can go into sepsis (septic shock)... not good... You always want to have a site that is suspect seen by somebody with experience sooner than later. as the sooner you get antibiotics the sooner it will resolve and the less complications you will endure.

Cellulitis is different from an abscess... abcess is a pocket infection in the muscle, it can be sterile or infectious, the body works to form a hard capsule around it to prevent it from spreading. Cellulitis infects the top layers of the skin, then into the fats, and finally the muscle, but it spreads more laterally much quicker then an abscess infection ever could.. and since most people arent pucturing themselves that deeply (into the muscle tissue), cellulitis infections are much more common than Intramuscular abcesses.

if the OP could take a pic of his site and post it.. that would be helpfull... I have seen a lot of cellulitis over the years to be able to distinguish quite well if it is or isn't just by glancing...

working triage in the ER, after a while you pretty much have a good idea whats wrong with the person as soon as they present in front of you, as every disease and condition has a pattern or recognition symptoms e.t.c.

Here is a little blurb I wrote a few years back for a sticky on another board:

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!

[tiramisu]

You may want to update that posting to include Benzyl Benzoate and EO histamine reactions. BA is generally only one source of issue and it's usually not that that there is too much BA (which happens too) but when you take a hormone powder and mix it with too much BA and not enough BB the BA is drawn into the tissue very quickly often leaving the hormone recrysatlizing in the tissue. Keflex is good stuff and available from the fish supply but is not effective on staph - z-paks - azithromycin is probably the way to go if staph is likely.

Self Aspirating an abscess is generally frowned upon as you don't really know where the damn thing is or if it's got tubules of puss. The abscess should actually be scanned to see what's going on and make a plan. The downside is that it's more likely some hack ER doctor will cut half your bicep off removing the abscess and then pack it with gauze to heal. This approach definitely works but it should be last step butchery not first step surgery. Damn doctors like their knives.

[Prisoner#22]

You may want to update that posting to include Benzyl Benzoate and EO histamine reactions. BA is generally only one source of issue and it's usually not that that there is too much BA (which happens too) but when you take a hormone powder and mix it with too much BA and not enough BB the BA is drawn into the tissue very quickly often leaving the hormone recrysatlizing in the tissue. Keflex is good stuff and available from the fish supply but is not effective on staph - z-paks - azithromycin is probably the way to go if staph is likely.

Self Aspirating an abscess is generally frowned upon as you don't really know where the damn thing is or if it's got tubules of puss. The abscess should actually be scanned to see what's going on and make a plan. The downside is that it's more likely some hack ER doctor will cut half your bicep off removing the abscess and then pack it with gauze to heal. This approach definitely works but it should be last step butchery not first step surgery. Damn doctors like their knives.

Yah, I hear you on not enough BB, and BB reactions, however.. reactions to BB ... from what I know either you react to it or you don't... I have heard of people injecting straight BB and not having a problem. I of course have never done that.

and yah... I self aspirate because I'm a little more experience at doing it... in the ER you are 100% correct! The docs do like to grab an ultrasound machine to assist in seeing if there is a pocket to aspirate.

In my experience... if you know personally where the pin hole is, and you remember the angle in which you injected, (which usually is the same as always as it is you doing it with your body mechanics lol) then you got a better chance of finding the pocket yourself than some quack Doc who thinks steroids injected IV give a high lol

As for EO... personally I stay as far away from that stuff as possible.

My opinion is stick to the gear that is reasonably dosed... i.e. 250mg per ml to 300 mg per ml... try to avoid tempting fate with the 400 plus stuff lol

[grifter]

That self aspiration thing reminds me of Greg Valentino poking the syringe into his bicep to drain the abscess. No thanks!

Lots of factors to consider when taking the plunge (pun intended). Research and research some more, have everything you need on hand (anti e's, antibiotics, etc) also may be a good idea to let a family member, wife, girlfriend or buddy know what your taking in case you run into any complications.

[Prisoner#22]

That self aspiration thing reminds me of Greg Valentino poking the syringe into his bicep to drain the abscess. No thanks!

Lots of factors to consider when taking the plunge (pun intended). Research and research some more, have everything you need on hand (anti e's, antibiotics, etc) also may be a good idea to let a family member, wife, girlfriend or buddy know what your taking in case you run into any complications.

I agree. If I wasn't an Nurse with years of experience using needles, and seeing the procedure done in hospital I wouldn't do it. I don't recomend anybody do it unless they have training and experience like mine.

And yah that Valentino documentary was way overboard!!! didn't drop a few needles on the floor, pickem up wipem off and stickem back in?

[Prisoner#22]

I will add though, Its not like I do this all the time... I've done it on two different occasions... both happened a few weeks out from shows, so there was a need to get the problem fixed asap at that time.

[macka]

I've never had to self aspiriate an infection, but I am anal about the hygiene when it comes to injections. You need to be pretty damn clean when you inject. I have had redness and heat from a reaction and once it looked like a blood cascade down my arm.

[musclegeek19]

Update:

Swelling/pain has gone down drastically. It doesn't seem to be an infection. No fever present. All that remains now after 10 days is a small lump about 3" away from the injection site (so about the middle of my bicep). It feels more like a knot (muscle trauma). Doesn't hurt just sitting there, only if I put pressure on it, or squeeze/flex my bicep at its peak position. If I massage the lump/bump, a slight discoloring in the skin arises. I still believe it was the injection of cold oil, because my other arm feels completely normal now. All the correct sterile steps have been taken while injecting. Anyways, it hasn't gotten any worse which is great, but if the lump/bump doesn't go away at any point, I'll go see my doc. Thanks for all the info guys.