Arm swelling and pain--ow!! Any advice?

[Adormidera]

Hello all, I am new to the site so be gentle! :o

SWIM is freaked out this week because she has a really weird swollen area that is super painful on her arm. Now she's used IV for years so we're pretty familiar with all this kind of crap but this is different--for one thing it's not in a spot where she's actually tried to shoot any time recently, so it's not infiltration and I wouldn't think it could be an abscess either. It is a large (maybe 4" by 2") swollen area on the "pinky side" of her elbow, right under tourniquet level, warm and pinkish and blanching with pressure, but no red streaks or anything. There is no hard center or anything like an abscess often has. It is several inches proximal to an area she had been hitting pretty hard lately. It throbs and she says it's really painful to straighten her arm out all the way. It's been there for about three days without getting much better or much worse. People come to me with things like this because I work in health care, and I really want to help, but I am stumped, and a little worried about her.

Any ideas?? Could she have tied the tourniquet too tight or left it on too long? Could it be some kind of weird collapsed vein thing, or maybe an infection even though she didn't shoot there? It is swollen around a lot more than just the vein itself so I don't think it's phlebitis. Most importantly, what can I do for her? I recommended ibuprofen and Neosporin, and leaving that area alone of course. She says it feels like cold would feel good on it but I don't know if that would be a good idea. She has some clindamycin stashed away, would that maybe help? {Don't know if it would even be the right kind of antibiotic.) Thanks--any help or advice is much appreciated!
________________
-adormi
"I used to just have thoughts. Now my thoughts are having thoughts."

[shaunclo]

Adormidera, If this thing has been there for 3 days and is not getting any better, I would go to the ER and have a doctor look at it. It doesnt sound like anythign I have ever heard of before. PLEASE HAVE A DOC LOOK AT IT!! It might be something very serious.

[TTD]

Red means inflammation typically, and it is possible to get foreign matter under the skin even distant from the actual IV site, typically this just causes a hard area of tissue that feels like a lump.

If after 3 days you dont see a reduction that doesnt really mean anything, some inflammation takes a week or more to go down. However any other symptom along with the red inflammation is in fact something i would have checked like shaunclo said.

If its inflammation it could also be caused by a substance that causes tissue necrosis, lots of fillers in pills can do this, some drugs can do this, promethazine is one of them, and a lot of things in street heroin could easily cause tissue necrosis.

If you see red streaks like you said, this is probably blood poisoning and very very serious. I would not wait until this point, but dont flip out just because its sore.

Ive had blood poisoning before, they kept telling me they were going to operate on my hand the next day, but it responded quick to a pennicillin relative. It wasnt drug related, my cat bit my damn hand :)

You absolutely cannot start taking antibiotics without a culture, taking a gram positive or negative antibiotic with an anerobic bacteria (for instance) would cause a false sense of safety and by the time you noticed it wasnt working youd have a serious infection in your blood.

DO NOT take for granted that any antibiotic will work in a random case, there is absolutely no way to know what it is if its an infection, even a broad spectrum antibiotic may not work, there are some that just dont work on certain bacteria.

[bandido]

dude, dont panic!!! very common seen it myself, usualy from well lets say for lack of a nicer word hygenicly challanged situations, now to the cure, one dont panic and wait two weeks with touching syueezing ect, other poke verry center with rig and put a hot poltice on it over night, 99.9 % sucess rate, one more go to farm supply store, get a bottle of antibotics for cows or horses (injectable is fine) have some myself in my fridge, pen v I think, cut dose down to human weight and wam, exact same as at the pharm sells, even has human label on it, just lets farmers get it without crying to and paying a vet 200 bucks when bessy has a slice on her hoof, totaly safe, been doin it for a longtime.

[poppy]

Bandido, you're a braver man than me. I just can't imagine injecting any medicine designed for cattle unless the world as we know it had totally changed eg. post apocalypse or something along those lines!
Isn't it easier to just see a doctor? which is what I'd do if I was in Adormidera's friends situation. Still each to his own and all that. Having said that thinking about it I regularly inject street heroin which as we all know is cut with god knows what so who am I to talk!!!

Adormidera Candy (one of the moderater people who's a nurse) should be able to give good advice on the best route to go down for your friend.

[devilsdrug]

unless ur allergic to penecilluim like myself, its a trip to hosp

[shaunclo]

dude, dont panic!!! very common seen it myself, usualy from well lets say for lack of a nicer word hygenicly challanged situations, now to the cure, one dont panic and wait two weeks with touching syueezing ect, other poke verry center with rig and put a hot poltice on it over night, 99.9 % sucess rate, one more go to farm supply store, get a bottle of antibotics for cows or horses (injectable is fine) have some myself in my fridge, pen v I think, cut dose down to human weight and wam, exact same as at the pharm sells, even has human label on it, just lets farmers get it without crying to and paying a vet 200 bucks when bessy has a slice on her hoof, totaly safe, been doin it for a longtime.

I think this is very dangerous info to give, in no way am I trying to start anything with you Bandido, but unless your a doctor or a medic or something I dont think you should be giving advice like this out.

[TTD]

I agree, i posted fairly accurate and helpful info NOT to use antibiotics, there are mutliple kinds of bacteria, gram positive, gram negative and anerobic if i remember right, there are multiple antibiotics for multiple bacteria, you dont know which one you have if any, and broad spectrum anitbiotics dont work for everything.

Veterinary medicine isnt dangerous, its all ACS grade stuff from pharmaceutical manufacturers but the fda requires far more testing for something used in humans, hence more money, licensing, clinical trials of even the most slight change to a formulation etc.

DO NOT wait 2 weeks if it gets worse, and absolutely do not poke anything with a needle, inflammation is not the same thing as fluid under the skin, even if it were a natural reaction to the irritant you dont want to screw with it like that.

In the absolute worst case if an infection has actually gone through the muscle or tissue they sometimes cut open the area, but this is ABSOLUTELY not something you can judge for yourself.

If your worried about the medical staff bitching about IV drug use they really cant do a whole lot, even if you told them it was IV drug use, using drugs is not illegal, neither is having drug metabolites in your body from use, it would just be a problem with medical staff not a legal problem.

Besides id rather complain and bitch to a social worker (or vice versa), than have blood poisoning, which can be very serious, even a local infection can kill nerves and damage tissue, ask exitwound.

[Curio]

dude, dont panic!!! very common seen it myself, usualy from well lets say for lack of a nicer word hygenicly challanged situations, now to the cure, one dont panic and wait two weeks with touching syueezing ect, other poke verry center with rig and put a hot poltice on it over night, 99.9 % sucess rate, one more go to farm supply store, get a bottle of antibotics for cows or horses (injectable is fine) have some myself in my fridge, pen v I think, cut dose down to human weight and wam, exact same as at the pharm sells, even has human label on it, just lets farmers get it without crying to and paying a vet 200 bucks when bessy has a slice on her hoof, totaly safe, been doin it for a longtime.
this is awesome that it has worked for you in the past, but I have to second and/or third the VEHEMENT warning to the original poster that I WOULD NOT RECOMMEND ANYTHING like treating yourself in this instance...esp. since this is a new problem for you and the underlying problem is not something definitive or understood at this time...
Bandido, no offense, but I think the poster even mentioned something about a pulsing or a throbbing....this says BIG WARNING sign to me as a medic....I would be concerned, VERY concerned, about a possible thrombosis/emboli and/or phlebitis.....
Thrombosis
The formation of a blood clot in a vein or artery that may obstruct local blood flow or may dislodge, travel downstream, and obstruct blood flow at a remote location.
Emboli
Something that travels through the bloodstream, lodges in a blood vessel and blocks it. Examples of emboli are a detached blood clot, a clump of bacteria, and foreign material such as air.
Pulmonary emboli are blood clots that have been carried through the blood into the pulmonary artery (the main blood vessel from the heart to the lung) or one of its branches, plugging that vessel.
Thrombophlebitis
Phlebitis (vein inflammation) related to a blood clot or thrombus.
Symptoms often associated with thrombophlebitis:
tenderness over the vein
pain in the part of the body affected
skin redness or inflammation (not always present)
swelling (edema) of the extremities (ankle and foot)
intermittent claudication (muscle cramping and/or pain due to decreased oxygen supply to an area)

[madnesscult]

It sounds really similar to an allergic reaction. I get allergy injections - they inject me with farily small doses of what I'm allergic to (cat dander, dust, etc) and eventually I won't be allergic anymore and will build up a resistance. ANYWAY...when I get the injections, I usually get a baseball-sized lump on my arm, which is neither hard, nor fluid-filled...it is usually white with a pinkish edge, and it hurts to move my arm or to the touch...putting ice on it usually helps with the swelling, although the extreme cold sometimes hurts more than non-irritated areas.
Is it possible that she might have somehow injected her self with something she's allergic to? My shots are all sub-q and not IV or IM. Either way I would recommend seing a doctor, or if that's not realistic due to money or whatever, many cities have nurse hotlines where one can call and get advice on medical issues...

Good luck.

[candy]

An abscess can form anywhere in the body and that is what it sounds like to me.
If going to the doc is out of the question, which is what I suggest, then treat it with antiinflammatories and heat to the area for 20mins.

There are things you can do to prevent infections and being in healthcare, you know that. Using clean equipment, cleaning the site of injection, good handwashing, using a new needle for each injection.

Obviously if the area gets worse, there is a fever, the area starts to drain and looks infected. With an abscess that has opened and is draining, keeping it clean and dry is important to avoid a secondary infection. This is why seeking medical care is important, especially if the abscess is draining and infected.

If you cannot get medical care and the abscess is opened and draining, you can care for it yourself:

Keep area clean and dry
Cover with sterile gauze and change the bandage 2 times a day. The gauze that touches the abscess should be soaked in sterile saline to prevent it sticking to the wound. If this gauze should dry out, wet it with enough sterile water so that you can lift the gauze off without pulling the new skin growth around the infected area. This can lead to delayed healing and scarring.
Continue to keep the area covered until the abscess is no longer draining and has closed.
You should however seek medical care if you continue to run a temp 101 and over and/or if the abscess gets worse.

An abscess can lead to systemic infections such as, Endocarditis and Osteomyelitis. It can also lead to other abscesses and abnormal tissue function underneath the infected tissue, and possibly gangrene.

[Zoop]

I think it's either an venous embolism or an abcess, either way, probably with an infection, could be gram positive (probably), but could also be gram negative (if it is, this is potentially FATAL)

SEE A DOCTOR, STAT! Go to an urgent care clinic or something, pay cash and use a fake name if you're afraid of getting put down on paper as an IVDU. Just get it looked at, for Christ's sake!

[Adormidera]

Sorry guys that I waited so long to update you all! I've been running on fumes with my own drug supply this last week and have been out of circulation, so to speak, but now my tank is full ;) and I realized I hadn't posted to tell all you helpful folks the outcome.

My friend flatly refused to seek medical attention unless it got worse; she also works in health care and was super-paranoid about her job and/or her doctor finding out about her IV use. She did promise to let me take her somewhere if she started to run a fever, though. Like many of you, I decided the clindamycin might well be useless since we didn't know what bacteria (if any) we were dealing with. So we decided to just watch and wait.

It took about a week, but it gradually got better. It never opened or drained or anything, and she didn't do anything to it other than take ibuprofen and stay the hell away from that arm. I told her about all your helpful advice and she was glad to know there are people out there who give a shit; she is much more paranoid and secretive than me but maybe I'll convince her to join the site too! I have told her to be careful shooting pills, with all the fillers etc., but neither of us know where to get syringe filters or which type/size to use--I will run a search on past posts for that, but if any of you want to advise me that would be welcome also! Anyway, thanks to you all for your advice.