Friday, August 1, 2014

The 411 on Getting Injections

I decided, since I got my monthly injections yesterday, it would be good to talk about what happens when you get them, what they feel like and what I do to make it through post-injection hell.

Disclaimer: If you are a squeamish person/hate needles, do not read this. It isn't for the faint of heart. 

If you had the chance to read my story, you have some brief understanding. (I try not to make myself too redundant but I'm sure not everyone that reads my blog reads everything and I don't want anyone to miss out!)

The day/night before: My goal the day before injections, since there is a chance I won't be mobile for days, is to try and get any pending chores/errands done that need to be done and shower. Try not to mentally freak out. I usually get a lot of anxiety the night before injections (and yes, I had been getting them since January and weekly). Get some sleep and eat something healthy because the next day is not going to be a good (healthy) eating day. Do not make plans for at least 3-4 days after injections. You really cannot commit to anything after you get them.

The day/morning of: Wear comfy, loose fitting clothes. (No crazy/super sexy undies either.) You'll be in a gown and chances are, your entire backside (short of your underwear) will be exposed to several different people including your doctor, several residents and whatever poor relative has to watch this happen.

I also usually bring these hilarious stress squeeze pigs along with me because it fucking hurts and sometimes I bruise my parents hands from squeezing them so hard.

That being said, always bring someone with you. Depending on where you get the injections, I could barely stand/walk/function and clearly am not fit to be driving my ass anywhere. I also got a form filled out from a doctor for a handicap tag to put in my car for those special hip injections days where walking was not happening. Once you are finally on the bed/table, before anything starts, request numbing spray. The initial penetration of the needle will be much less painful and makes a significant different when you're doing 15+ injections and acupuncture in one session.

So, before I go into what physically happens, I want to show 3 visuals to explain what trigger points actually are:
Here, you can see where the muscle band is taut, there is a contraction knot vs a normal fiber. 

When you have one trigger point and it is activated or pressed, the pain can spread to several other areas surrounding it. That is referred to as "referred pain". 

Depending on the trigger point, doctors don't always injection straight into it, but will use several other techniques to deactivate it.

Before my doctor starts, we have a chat about which "areas" we want to focus on and what spots have generally been hurting me the worst. I'll decide to focus on my sides, lower back and back of my thighs for example and that's where the injections and acupuncture will be concentrated. The needles are usually pretty long and filled with lidocaine solution, but can also be cortisone/steroid and dry needling (good for if you have an allergy to lidocaine) as well.

The technique (per 1 trigger point) usually works like this: I show him the general area where I am getting a spasm, he pokes around and when I feel sharp pain (that may also shoot to another spot), he sprays the numbing spray and injects 5 separate spots around the trigger point, twists the needle and lets it hang for a while, while simultaneously injecting the fluid to deactivate it. Sometimes when this happens I cry instantaneously, vomit, swear like a sailor, feel like I'm going to faint, or all the above. Sessions usually take at least an hour. Just an FYI, when lidocaine is being injected, it usually feels like something is hot and burning as it goes in. You can feel it.

(My doctor at Hopkins does injections differently and it is much more painful/traumatic. He takes an even longer needles and goes in and out of the muscle until it is violently twitching and then ceases. I hated this.)

At this point, I am a mess and completely fucking over it. I am ready to go home.

After injections: Once I get home, I am usually miserable and try to take a nap to compensate for what I was just forced to experience. I usually nap for an absurdly long time but when I wake up, the pain is usually worse and I am probably nauseous from having so much pain. But comfort food always makes me feel better when I am having pain. One time I asked a pain specialist at UPenn what I should do when I'm having so much pain and he said to me "eat well." Okay, dually noted, pain doctor. (I will have a post of food in the near future.)

Things I ate yesterday after my injections (for realz):
  • friend egg and cheese sandwich 
  • meatball parm sub from my favorite local pizza shop
  • lobster mac n cheese (my parents went out to dinner with my grandpa)
  • chocolate cake 
  • Drumstick ice cream cone
  • raisins and iced green tea (healthy for some reason? >> not normal)
No shame.

If you're home alone after you get them and no one can make you things, my easiest meal was leftovers. We always keep them in the freezer. It is really important though to drink copious amount of water though. Even though it may seem like a super good idea, drinking alcohol isn't a great solution (unfortunately). It dehydrates you and never actually makes you feel that much better anyway. Also, if you're feeling really nauseous from all the pain, I take something called Zofran. It's a pretty intense anti-nausea medication, but it works better than anything else I've tried. 

Distraction is key post injection days. For me, when pain is bad, it is hard to focus on anything. Shows about anything with an involved plot or complicated thought is usually out of the question. I keep it easy and end up watching shows as dumb as they get like Spongebob Squarepants, Rocko's Modern Life, Sex and the City (that show is dumb), Bob's Burgers, Family Guy, Too Cute! (if you haven't seen this show on Animal Planet, you need to.) or just any old cartoons you used to watch on Nick as a child, etc. (I plan on making a pain scale with equivalent, corresponding TV shows at some point for your reference in the near future.) 

Needless to say, make sure you have heat and ice if you need it and something to help you sleep. When I first started getting injections, it would freak out my entire body and then the rest of my body would start spasming after the injections (if that makes any sense--some of this shit is hard to articulate). I was and am still not sleeping well. Even though I surprisingly fell asleep relatively early last night (before 2 am) watching Too Cute!, I woke myself up from pain early this morning and was incredibly nauseous. The Zofran helps, but it's not completely taking the nausea away.

The other thing that helps: having (what I call) a "pain posse". This consists of a group of (at least) 2 dogs that will never leave your side.
These two laid beside me all day yesterday. 1) Because they're needy/a little clingy. 2) Because dogs rule. 
Usually the first and second day after injections are the worst and I always hurt the worst first thing in the morning and late at night. But, after three or four days I can tell I am slowly getting better. My best tip is to ease yourself back into doing things once you're feeling better. Don't, for example, go for a hike or take a trip 3 days after your procedure. I usually start off with, as sad as it sounds, going to the grocery store, baking something relatively easy or attempting to take my dog for a light walk. (She's insane so this isn't always my go-to thing.) The next day back at PT post injections is also a water therapy day to ease me back into exercising. (i.e. I got my injections on Thursday and the following Tuesday will be a water PT day, Thursday will be back to land exercises.)

This may all seem mundane, but it really is important to know if you have the unfortunate possibility of starting lidocaine injections. It took me a while to figure out but now luckily my recovery time is a lot shorter and lot less painful than it used to be!

Now, back to Rocko's Modern Life.

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