I know this sounds weird, but over the almost 10 months I've been on Enbrel I've got really severe stomach upset shortly after my injection. This has happened about 5 times now, so it's not frequent. I use the sureclick auto-injectors and they go straight in--IDK how long the needle is, but I'm wondering if the needle penetrates my intestine. About 3 hours after my injection on Friday I started getting horrible stabbing pains in my lower abdomen. And, no, it wasn't gas. Those pains turned into cramps and bloating , which I still have, 2-1/2 days later. (Oh, and it's not a bowel obstruction because I've been able to "go"normal bms.) It doesn't feel like a stomach bug and I don't think it's a food allergy--I can't think of any food I've ever been allergic to. So, I'm wondering if the injection has something to do with this upset stomach? The other few times it was severe cramps and diarrhea, which came on a couple days after my injection and only lasted a few hours.
Anybody else have this happen?
Grandma J, I've had a variety of sure-click type pens and pre-filled syringes for methotrexate and two different biologics (as well as having free-fill insulin syringes for the animals) and I really don't think the needle in any of them is long enough to pierce the layers of cutaneous skin, subcutaneous tissue and fat, muscle and stomach wall and then find a loop of intestines. The only sensitive area all the meds say we shouldn't inject into on the tummy is around the belly button. I'm not a medic but I feel pretty certain if this was a risk then either we wouldn't have them to inject at home, stomach injection would be prohibited or there would be great big red lettered warnings on all the packaging.
Have you recently had a read of your patient information sheet that comes with your sure-clicks? I wonder whether you're in the small number of people who have GI side-effects ... the percentage given is just over 18%.
I know you like to make sure you're getting into a fatty area but you really can inject into the tops of your thighs as well, I expect there will be a diagram on the information sheet, it may be a bit more uncomfy for a few seconds but soon passes. These are subcutaneous meds and that simply means 'under the skin'.
Ha, ha I hate doing my tummy, although I'm 'forced' to at the moment because of the leg problems I've developed thanks to sulfasalazine. I try to laugh ... 25 days taking it and 52 days later I'm still dealing with the s/e's.
Haha, Jules, my daughter laughed at me when I brought this up to her--she told me the same thing you did. She wants to give my injection next time she's here.
Several years ago I had IBS, but I figured out what caused it and avoided getting it for years (which was a food allergy, but I'm not allergic to that anymore). So it just seems weird my stomach would act up now. But, it's not after every shot--it's not even once a month. But, yes, maybe it's an occasional reaction to the shot.
I did inject into my thigh the first few months, but it hurt and always bled. Into my tummy it doesn't hurt or bleed at all. I'm not afraid of the pain, but it is highly recommended to inject into the stomach.
I'll just chalk it up as nothing to be concerned about and hopefully it (the stomach cramping) continues to be a rare occurrence!
I think I'd be inclined to tell my doc it's been happening at my next review but I wouldn't make a specific appointment unless it was really troubling me physically or I was particularly worried ... I think this is what it says in the patient information as well. Don't forget that you also have an information resource in the Enbrel helpline nurses ... details on the website.
You would have to try awful hard to mess a shot up. Just follow instructions on the box. If you are scared, get someone else to help administer…
I'm not scared, and I've already given myself nearly 50 injections. I'm just stupid about human anatomy. My daughter said the layers of skin and fat and muscle are thicker than the length of the sureclick needle. My argument was, when you press the injector down wouldn't the fat be pushed aside thereby enabling the needle to go into whatever is beyond the fat? Makes sense to me because isn't body fat similar to animal fat? If I pushed on animal fat, my finger would go through to the meat.
I am sure about what the box says, but if you pinch first you problem isn’t even a problem. I hate those sure clicks, so much easier with a more realistic needle.
No grandma j you can’t go into the intestines with the size needles we use. When we try to go into the intestines with a needle it takes a special length needle to get that deep. I am. Or sure what you mean by pushing animal fat it pushes aside. I have given tons of shots to humans and animals and neither have fat that pushes aside. I have done autopsies on both also and when you press on fat and muscle on either it will compress between your push and the bone or table underneath it. Incidentally that is how the injury bed sores begin, with compressed flesh, ok maybe more than anyone wants to know…
A bigger problem is with horribly skinny patients. I have had my needle poke out the other side and land the medicine on the table when there is not enough flesh. A really disturbing even but certainly not a problem with my body!
I'll try pinching it and then injecting like mataribot says. That's what my diabetic sister used to do when she injected insulin.
I'm sorry, but my brain is constantly trying to make sense of things. I do get you, michael, about needing a longer needle to get into intestines, but I'm still confused about the compressed flesh. So if the needle is 1/2" long and my fat is 1/2" thick, would it not compress and become thinner when I press the injector against it, allowing the needle to go past the fat into whatever comes next? Muscle?
There is a space between fat and muscle with facian holding the muscle. That space is where you want the medicine to go. If you pinch the fat that is where it will go. You do not want to put it into fat as that is hard for the body to absorb. You are aiming for sub cutaneous which is that space. If it goes through that space and into the muscle it is then I’m o inter muscular. That is fine to but hurts a bit more. Sometimes with very thin people and 1/2 inch needle I bunch up the fat and aim at an angle instead of straight in. When you give an IM you use an inch or larger needle and you flatten the skin and fat instead of bucking it up. Does that make more sense to you?
Just a moments digression from the OP:
Ha, ha ... I'm glad it's not just me! I've done this a handful of times with very skinny diabetic cats who, unlike humans, cannot be asked to standstill so you're trying to restrain, tent skin, insert the needle through skin toughened by a lifetime of vaccine injections, feel for the needle going into the space and inject .... all with only one pair of hands.
And then a vet friend showed me a little trick .... the skin behind their elbows is very loose so easy to grab and tent a handful and very soft so they don't even feel the needle going in and best of all .... can be done when they are distracted with their heads in a food bowl. Voila! Unfortunately not an option with humans :(
michael in vermont said:
I have had my needle poke out the other side and land the medicine on the table when there is not enough flesh.
I know Jules, aren’t animals the worst! Like children they do not sit still. My father (a vet) use to tell me"if you can give a horse a shot without getting kicked then you know you have good technique!"
Yes, that helps. So, with an auto-injector I can pinch the fat to get it into the right place?
michael in vermont said:
There is a space between fat and muscle with facian holding the muscle. That space is where you want the medicine to go. If you pinch the fat that is where it will go. You do not want to put it into fat as that is hard for the body to absorb. You are aiming for sub cutaneous which is that space. If it goes through that space and into the muscle it is then I'm o inter muscular. That is fine to but hurts a bit more. Sometimes with very thin people and 1/2 inch needle I bunch up the fat and aim at an angle instead of straight in. When you give an IM you use an inch or larger needle and you flatten the skin and fat instead of bucking it up. Does that make more sense to you?
Yes, you can.
Pinch, locate sure-click pen, apply sufficient firm pressure on the pen to make the seal between skin and pen, press 'go'.
Let us know how it goes after your next injection ... and hopefully no tummy troubles either.
I forgot to let you know....I tried to pinch up the fat, but the auto-injector only seems to work when I stretch it flat. But, I did start injecting a little further from my belly button and slightly higher. There's no bleeding, and I think that is the key. I haven't had any stomach problems lately, and you guys and my nurse daughters convinced me my stomach troubles weren't from the shot!
Jules said:
Yes, you can.
Pinch, locate sure-click pen, apply sufficient firm pressure on the pen to make the seal between skin and pen, press 'go'.
Let us know how it goes after your next injection ... and hopefully no tummy troubles either.
The needles for sub q injection are about 1/4 of an inch. On the typical adult abdomen, there is a half an inch of fat, at least, followed by 1/4 inch of muscle. It would be VERY rare to puncture your intestine with that size needle. I even looked for sources on this and couldn't find any that even list this as a potential complication.
If you are concerned, some of the biologics allow for injection in the thigh.
Oh, and, if you managed to get the needle through the sub q fat and into the muscle, and injected the medication there, you would KNOW IT. Ouchie.
Hi, I think we covered the needle issue. I agree with most, I think it would be virtually impossible for the needle to impact your intestines. however, I wanted to mention that I have very similar intestinal issues. Mine do not correlate so well with injections or infusions. The debate is still on as however, I wanted to mention that I have very similar intestinal issues. Mine do not correlate so well with injections or infusions to whether it is IBS or PsA (which can be associated with intestinal inflammation. My doctor has prescribed a medication called hyosilamine (sp?)that does help when the cramping last more than a few minutes. Good luck!