pain for two weeks after shot

Discussion in 'Pharmacy' started by icekitsune, 09.19.14.

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  1. icekitsune

    icekitsune 7+ Year Member

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    Hi everybody,
    I got a phone call from someone who received a flu shot and had pain in the arm afterwards and that had an Apt to see a doctor. They still have pain and its been two weeks. Someone told them the shot was given too high. This is the first time it has happen to mw and I feel terrible .did this happen to anyone else?
     
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  3. 297point1

    297point1 1,000+ Post Club 7+ Year Member

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    My flu shot last year hurt for TWO MONTHS. For two weeks, I couldn't lift my arm any higher than my shoulder.
    Worse yet, a friend gave it to me.

    I don't know if it went in too high or not, but it was a colossal p.i.t.a.
     
  4. Gombrich12

    Gombrich12 2+ Year Member

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    I've heard this before, it's possible you went too high or hit a nerve, or maybe they are just having a bad local reaction. I wouldn't worry about it, review your technique and keep going on. I've noticed a lot of people give the a shot directly without even finding the deltoid, so that might cause them to go a little higher.
     
  5. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member SDN Administrator 7+ Year Member

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    I have never heard of this it hurting that long. I have never heard of "too high". Is there a muscle above the deltoid in the arm? Unless it is going into the neck I don't see how it could be too high.

    What gauge/length needle are you using? I can imagine that being an issue.

    I tell people to massage the area and apply a cold pack. I also roll the syringe between my hands so it is not so cold when I inject. So far, very few complaints.
     
  6. Promethean

    Promethean Syncretist 2+ Year Member

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    So, interventions come with risks and benefits.

    Even if your technique was perfect, it is entirely possible to have done some minor damage to a delicate structure. After all, you are shoving a sharp piece of metal deep into someone's flesh. Sometimes, it is going to hurt. Sometimes, for two weeks or more.

    I have to self-administer an IM medication once a week. I've changed my administration technique to give it as a deep subQ rather than an IM shot, with the supervision and support of my prescribing doctor. Blood tests show the drug is well absorbed using this technique and I've had no issues doing it this way. I switched because when I had to use a large muscle, I went into my leg. Easier to reach for self-admin than deltoids or glutes. Most of the time it worked fine. Every so often, though, I would end up crippled for a few days to a couple of weeks from deep, aching pains in my quads. After having to call off work once because it hurt so bad, I changed my routine. No more discomfort.

    I'm not suggesting that you change yours, since altering the route could change the performance of the injections you are giving. Just saying, sometimes, shots hurt. For longer than expected. There are reasons IM is not a preferred route if there are alternatives. Good thing people only need a flu shot once a year, instead of 4 times every month.

    It is troubling that people are so quick to blame another professional's technique rather than explaining that mild discomfort is not an unexpected complication. (I am giving you the benefit of the doubt, that you injected her deltoid and not her trapezius or something ridiculous.)
     
  7. MatCauthon

    MatCauthon 7+ Year Member

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    We had a few of these complaints last year-- they may have even turned into settlements. I personally feel like the vaccine class did not emphasize vaccine placement enough, and the risk of hitting delicate anatomical structures such as the axillary nerve. Hitting that nerve can cause some serious problems, so this isn't an issue to be taken lightly. Anectdotally, I have heard a lot of pharmacists mention that this issue happens more often we are aware.
     
  8. klowman

    klowman 7+ Year Member

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    This happened to me last year! My partner at work gave me the shot, and I immediately felt something was wrong. I had numbness and tingling in my hand and pain and discomfort for weeks.
    I have heard at least one patient complain of such an experience as well. I definitely think we need to be very
    conscientious of placement and technique!
     
  9. zelman

    zelman 7+ Year Member

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    Administration too high can end up causing bursitis. You've got to hit the muscle, not the joint.
     
  10. icekitsune

    icekitsune 7+ Year Member

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    I don't know if i did anything wrong. I used a 25g 1 inch. Found the acromion process by feeling the bony protrusion on the shoulder, used two fingers down and inject there. All my other ones had no complaints but I'm worried about her and about any legal ramifications should there be issues from her visit to the md. Though I guess she signed a sheet but I possibly unintentionally caused her pain.
     
  11. icekitsune

    icekitsune 7+ Year Member

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    Thanks for the reply. Idk, someone told her it was too high but as stated in another reply. I found the bony part on the shoulder right before it curves down, and below two finger widths, I gave the shot. So I hope nothing bad happens when she sees her MD.
     
  12. Spydra

    Spydra 2+ Year Member

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    OP, I'm not sure if this will make you feel better but every single shot I've received has hurt for more than 2 weeks. No tingling or numbness, just soreness that at times makes moving very uncomfortable. The doctor always tells me before hand that most people experience mild discomfort for a few days, but a few people will experience discomfort a bit longer. I guess I get to always be one of the "few people" lol. Whenever I feel a bit panicked about my arm still hurting I've never been told the shot was too high or not done properly. They just suggest I massage the area and gently move my arm.
     
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  13. icekitsune

    icekitsune 7+ Year Member

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    Thanks I appreciate it. The only thing that seemed to raise concern is that she can't move her arm very well and that its worse in the am
     
  14. Spydra

    Spydra 2+ Year Member

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    Yeah that's been my experience with every shot as well. I can move my arm, it just hurts lol. I get all my shots in the same arm whenever possible for this very reason. The one time I had to have shots in both arms that doctor got the stinkeye for months lol. I would really be in a tizzy if I couldn't feel my fingers or couldn't move at all though, which doesn't seem to be the case with your patient so that's a good sign.
     
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  15. maria1oh

    maria1oh 7+ Year Member

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    My arm was sore for a few days. I noticed the rph kept the needle in for a longer than usual time so that may have caused the soreness.
     
  16. Unchained

    Unchained 5+ Year Member

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    Tell your patients that the best way to prevent the flu is by washing ones hands regularly, avoiding people with the flu and keeping hands away from facial membranes. The flu shot has no established efficacy. The process by which it comes to market is questionable from a scientific point of view. When the five o'clock news comes on and says that the "gov't recommends that everyone over the age of 6 should get a flu shot" it is our job to be the voice of reason. Let the media continue collecting their checks from Sanofi and Novartis.
     
  17. Old Timer

    Old Timer SDN Advisor SDN Advisor 7+ Year Member

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    You have data to backup this baseless assertion.....?????
     
  18. Unchained

    Unchained 5+ Year Member

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    There are two ways they evaluate vaccines. They conduct either vaccine effectiveness trials or vaccine efficacy trials. Vaccine efficacy trials represent the higher standard in that it is a RCT (randomized control trial). Vaccine effectiveness trials are used to evaluate the flu vaccine. They allow for the introduction of several types of bias including confounding, selection and information bias. Thus it is less reliable. CDCs website itself can only site a vaccine effectiveness of at best 60% in this heavily biased standard. All of this data is readily available on the CDC website. Also in the package inserts which come with the vaccines.
     
  19. Old Timer

    Old Timer SDN Advisor SDN Advisor 7+ Year Member

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    So that's a one paragraph answer when you could have just said. No I don't have any data to backup my assertions. You need to turn in your spatula as you have no idea from where you speak. Flu vaccine effectiveness will vary for many reasons (that a pharmacist with modicum of brain cells would understand), but from a public health standpoint it is clearly effective.



    Vaccine Effectiveness - How Well Does the Flu Vaccine Work? (The CDC)


    Flu shot: Your best bet for avoiding influenza (The Mayo Clinic)



    So while the flu vaccine is not 100% effective. The benefits outweigh the risks and anyone who does get their head gear from Reynolds Wrap would know that.
     
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  20. Unchained

    Unchained 5+ Year Member

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    The CDC website also says that there is no established VE for individuals over the age of 65 but they recommend getting it anyhow. There are natural immune boosters which are not created in a lab in India which are more effective than the vaccines. The vaccine does not come without risks. It is estimated that only 10% of reactions are submitted to VAERS due to many factors. You just keep being a good corporate troll and doing what you are told. Do a little research and you will learn what influence the drug companies have on the CDC and ACIP. However this would take time and an open mind. Neither of which you have.
     
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  21. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member SDN Administrator 7+ Year Member

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    Name 1 that has more evidence for use than vaccines.
     
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  22. MatCauthon

    MatCauthon 7+ Year Member

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    One of my side hobbies, however, is researching functional medicine and other promising alternative therapeutics. This is a fascinating world and there is a lot to learn.

    Off the top of my head, however, there is evidence of vitamin D being an important factor in preventing flu outbreaks. Also, there is a trial of bovine colostrum and for the prevention of flu. It is biologically plausible since colostrum contains all of the passive immunity factors that could block the flu.

    Other promising immune boosters include compounds rich in certain polysaccarharides such as mushroom extracts and olive leaf extract.

    Again, trials are often limited by who funds them. I wish we could get more trials for these things, but I have heard from 1st hand sources that it is a political nightmare to try to get funding for these studies at the NIH.
     
    Last edited: 09.22.14
  23. sb247

    sb247 wait...you mean I got in? 2+ Year Member

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    it hurts me to disagree with a name from wheel of time, but I don't think any of that counts as evidence
     
  24. zelman

    zelman 7+ Year Member

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    Cut him some slack on the colostrum. I mean, who could disagree with the fact that a liquid full of antibodies helps protect against their corresponding antigens? Unless some misanthrope made that liquid in a sterile lab environment. Then it's poison. Cow teat is the way to go.
     
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  25. Old Timer

    Old Timer SDN Advisor SDN Advisor 7+ Year Member

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    Name one that has ANY evidence.

    We are being over run by

    [​IMG]
     
  26. Unchained

    Unchained 5+ Year Member

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    Sambucol. Not hard to do given that there have been no double blind placebo controlled studies performed on the flu vaccine. They won't perform one because they know it doesn't work.
     
  27. Unchained

    Unchained 5+ Year Member

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    Yes because drug companies would never manipulate data or bring a harmful drug to market. Vioxx, phen-fen, thalidomide, bextra. You can keep adding to the list if you like. Like I said just keep being a good corporate shill and do as you are told.
     
  28. Old Timer

    Old Timer SDN Advisor SDN Advisor 7+ Year Member

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    First of all it does work. It's not 100% percent effective, but it does work. Those who get the vaccine get the flu less than those that don't. Those who get the vaccine and get the flu anyway have shorter duration of symptoms and less serious outcomes. ALL public health advocates and all medical and governmental organizations recommend it. I wasfor the vaccine before I worked for a fortune 15 company.

    And while also recommend Sambucol to treat flu symptoms, it does not prevent the flu. Your tin foil is clearly showing.....
     
  29. zelman

    zelman 7+ Year Member

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    Unchained ---> here
     
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  30. oldstock

    oldstock Banned Banned

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    it is from the Onion... lol ;)
     
  31. MatCauthon

    MatCauthon 7+ Year Member

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    Prevention of Influenza Episodes With Colostrum Compared With Vaccination in Healthy and High-Risk Cardiovascular Subjects
    The Epidemiologic Study in San Valentino

    http://cat.sagepub.com/content/13/2/130.short

    I am not saying it is the best evidence, and I am certainly not saying it is actually better than a flu shot. But you guys are are too quick to rip me for having no evidence whatsoever.
     
  32. Old Timer

    Old Timer SDN Advisor SDN Advisor 7+ Year Member

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    Do you even understand what you post? This is not a study that compare Colostrum with Vaccination.
     
  33. oldstock

    oldstock Banned Banned

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    dang, and I thought you all are pharmacists here... :)
     
  34. MatCauthon

    MatCauthon 7+ Year Member

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    The study has 3 groups: vaccine, vaccine plus colostrum, and colostrum. A direct quotation from the study:
    "The aim of this study was the evaluation of
    the use of oral colostrum in preventing flu
    episodes linked to winter compared with anti-flu
    vaccination, and also the consideration of a com-
    parable group subjects using no prophylaxis."

    Like I said, this study only piqued my interest. It obviously has its weaknesses. I would like to see more. But the authors did says that they have a larger trial in place already. The conclusion is also interesting:

    "The present study suggests a safe and cost-
    effective method which still needs more evaluation in
    specific groups, particularly high-risk
    cardiovascular patients that may be considered
    at least an important clinical alternative to vacci-
    nation. There is evidence that in some situations in
    which vaccination is contraindicated, the use of
    colostrum may be not only more effective but the
    only practical solution"

    We can pour over the data all you want. This study may not be great evidence, but it is a form of evidence. I am not even trying to be advocate of this study, but it makes for an interesting debate. We do not need to resort to insults here.
     
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  35. oldstock

    oldstock Banned Banned

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    sorry to ask a quick question here, where is the control group (placebo) ?? Without it, this study is prob useless imho... (sorry it is late and I did not check and read the study...)



    agreed :thumbup::thumbup:
     
    Last edited: 09.22.14
  36. MatCauthon

    MatCauthon 7+ Year Member

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    My bad, I forgot to mention the 4th group that used no prophylaxis in the study. good point there
     
  37. oldstock

    oldstock Banned Banned

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    yeah, I was lazy... (sorry)... just checked it and it was there...

    "
    Abstract
    The efficacy of a 2-month treatment with oral colostrum in the prevention of flu episodes compared with antiinfluenza vaccination was evaluated. Groups included healthy subjects without prophylaxis and those receiving both vaccination and colostrum. After 3 months of follow-up, the number of days with flu was 3 times higher in the non-colostrum subjects. The colostrum group had 13 episodes versus 14 in the colostrum + vaccination group, 41 in the group without prophylaxis, and 57 in nontreated subjects. Part 2 of the study had a similar protocol with 65 very high-risk cardiovascular subjects, all of whom had prophylaxis. The incidence of complications and hospital admission was higher in the group that received only a vaccination compared with the colostrum groups. Colostrum, both in healthy subjects and high-risk cardiovascular patients, is at least 3 times more effective than vaccination to prevent flu and is very cost-effective."

    http://cat.sagepub.com/content/13/2/130.short
     
  38. oldstock

    oldstock Banned Banned

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    @MatCauthon : I am a bit confused here, what do they mean by "nontreated subjects" ?? Is it the same as "without prophylaxis" ??

    In part 1, according to the abstract, there were 3 groups that got reported: one without prophylaxis, one with colostrum, and one with both vaccine and colostrum. Where and what is the result for the vaccine-only group ?? or that they just did not mention it in the abstract ????

    I do not have access to full text article, and keep thinking about their samples (e.g. ages, sizes esp in Part 2, etc ??)... and why did they choose high-risk cardiovascular subjects for Part 2 ?? and why they did not have control group and the group which would receive both vaccine + colostrum in Part 2 (at least that is what I got from the abstract ??)

    just confused and curious.... :)
     
    Last edited: 09.22.14
  39. zelman

    zelman 7+ Year Member

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    A 2-month treatment? How frequent is this treatment? How many newly pregnant cows does it require? I have a feeling this is an impractical therapy.
     
  40. zelman

    zelman 7+ Year Member

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  41. sakigt

    sakigt Junior Member 10+ Year Member

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    Vaccines make sense. The literature is going to have to overwhelmingly disprove this to me before I go changing practices. Theres hardly any evidence to suggest multivits do a darned and millions still take them.

    Flu shot for 13+ years, never a problem. I call my pediatrician weekly to find out when theyre getting their supply in. I badger my husband to get his. Maybe Ill be proved wrong in 20 years, but for now, its the best info we have.
     
  42. zelman

    zelman 7+ Year Member

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    That's complete bull, and you know it! I can't believe you're taking the side of these horrible corporations! I demand that you show me a shred of proof to back up this ridiculous claim! Seriously, how can you consider yourself a medical professional?! Please reply to this post with ANY evidence you can find...showing that there is evidence suggesting "multivits do a darned".
     
  43. sakigt

    sakigt Junior Member 10+ Year Member

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    ????

    Im taking the side of myself, my family and my patients. Who makes more money? Supplement companies or vaccine manufacturers?

    No need to hollar:
    http://www.ncbi.nlm.nih.gov/pubmed/23255568
    http://aje.oxfordjournals.org/content/152/2/149.long

    Heres the evidence I mentioned.

    And just so were clear, my bash on vitamins was in jest. My point is that even though a few studies cant show benefit, they make sense so thats why we still take them. A few (crappier than what Ive posted) articles states flu vaccines dont work but its doing to take a lot more than that to make me change my mind about them.

    Chillax!
     
  44. zelman

    zelman 7+ Year Member

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    My bash on your post was also in jest. And one of those articles you linked found no benefit for vitamins, while the other found minimal benefit in ex- and non-smoking males only.
     
  45. icekitsune

    icekitsune 7+ Year Member

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    Anyways..update on the flu situation. The patient went to urgent care and got a medro dose pack and was told that it was tendonitis from the shot given too high.
     

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