Harm Reduction Missed shot (goofball,) characteristics indicative of abscess? Seeking guidance

[Phobicgadfly]

(Originally posted this as a comment in the IV info/complications MegaThread, but I feel like it may get overlooked for several days there, and it's kind of a time-sensitive issue. Sorry for the repetition.)

Recently shot into the same site on my right forearm several times, the first day it was registering with a nice red plume, next day (possibly bc of dehydration) it was more of a dark dark red... jellyfish tentacle looking shape.

Anyway, the last shot definitely did that spot in, it's red, swollen, tender. The thing that is freaking me out is that its *soft*, as if filled with liquid. Not at all like the lumps and bumps that have come from missing with heroin or even coke. (The substance I injected on that last one was meth. I don't think the whole thing missed, but even if it all entered at a good spot I'm pretty sure I tore up the vein by repositioning over and over, so a portion at least leaked out into surrounding tissue.)
It's not particularly painful, tender maybe, and there's no localized warmth. I'm looking for indications that it's an infected abscess and if so, do I absolutely have to get on antibiotics/have it lanced and all that? I'm sure there's some of you who have lived through the life cycle of an abscess without seeking medical care.. does it significantly alter healing time/scarring between going to the ER and not?
Anyway, once I noticed that this site was different than what I was used to, I applied triple antibiotic ointment, hot compress followed by cold compress followed by a gauze wrap soaked in witch hazel overnight (thank you dognasher, this tip seriously helped speed up the recovery of a huge lump in my bicep in just one night.) Honestly it doesn't look or feel much different today.

Any other suggestions, insights? What should I do, what should I look out for, how long should I expect this to last before it resolves, can it do so without prescription abx, supplements/salves/creams to speed up the process? Also it's only an inch or two away from my wrist, and it's been 90-100 degrees where I live for the past couple days. My car has no AC. Any tips on covering it up besides long sleeves, like a wrap or something that wouldn't be too conspicuous?

Edit: Upon inspecting my other lumps and bumps, I have a smaller one on the other arm that is squishy in the same way. It is not tender or painful whatsoever, and has been there longer, by about a week. Doesn't seem like an abscess to me, but why is it so soft? What's in there???

 

[dognasher]

Is this the vein that goes sort of across your forearm about two inches north of the wrist? I've had some weird things happen to this vein myself. I think it's sort of near a valve for most people and it's easy to miss if you shoot near a valve. I replied to this question in your other thread and I think you just missed and tore up the vein from repositioning the needle. I found on this vein I would register really easily but then I would miss like half the shot.

Do you re-register to see if you're still in there halfway through the shot? I know some people say this is bad but I always did it because A) I could see if my shot of coke was too strong and stop halfway through if I got a bellringer and B) I slip out of veins easy

On that particular vein I always seemed to slip out halfway through. It was frustrating. Leave it alone for a few days and look at a vein chart to make sure you're not messing in an area that is near a valve.

I think if you were gonna abscess, especially with meth, it would be inflamed by now so just keep an eye on it and keep it clean.

 

[Phobicgadfly]

Anyway, the last shot definitely did that spot in, it's red, swollen, tender.

It is red, and inflamed. not getting worse, but not better either.

 

[Phobicgadfly]

Is this the vein that goes sort of across your forearm about two inches north of the wrist?

I can't quite envision this bc i don't know which way you're referring to as north. I'll try to describe which one it is.. my right arm, about an inch or two up the forearm from the wrist, the vein runs parallel with my arm (up/down, not across, at least in this spot) and its on the far right side. Like, if the width of my forearm was 10, 1 being left edge and 10 being right edge when viewed from above, the vein's position is 9.

Phew. That was quite a description Lol

 

[dognasher]

Ok, yeah, that one! I have had some trouble with that one too. I overall have hit or miss (literally) luck with my forearm veins. As of late I have been forced to go there because my main garbage chute on the crook is cashed and my hands are cashed. Have you tried the vein that is right above your elbow like on the side? That has historically been a good one for me.

By north I meant towards your heart, sorry.

I just feel like I have had way more lumps and bumps when shooting stims because after the first few shots, your veins get all constricted and it's hard to find a good place to shoot. Which makes it all so much more frustrating because you're just trying to get a hit somewhat like your first of the day.

Whew. Gonna have to take a breather from talking about shooting because it makes me want to go back to it...SERENITY NOW!!

Have you tried the one by your ankle? It's pretty big and you can get away with tracks there because nobody looks.

 

[dognasher]

It is red, and inflamed. not getting worse, but not better either.

Sorry, I missed that part of your post.

Do you have an urgent care nearby? Doesn't hurt to go and get some antibiotics just in case. I am sure since you have been on a pretty hardcore run your immune system is probably pretty worn out....

 

[dognasher]

Hey Phobic! I sent you an email. Your inbox is full.

 

[Phobicgadfly]

Update: The abscess(??) is the same size as two days ago. There is no pain, that has also stayed the same, or even better - it's not tender at all unless touched.

The color has changed a little bit, from red to a darker red/purple. When I apply pressure off to the side of the lump, the center area turns white. It definitely feels/looks like there's liquid in there. The skin is shiny and tight.

I'd like to lance it open just so that it deflates, but I've heard that is dangerous for risk of spreading infection.

I'm still not quite clear on what I'm dealing with here, whether it's an abscess, whether it's sterile or infected.

Any input appreciated.

 

[Zerwas]

Seek professional medical advice. It is the only action that can give you certainty. The longer you wait the more problematic it can get.

 

[Phobicgadfly]

Last night, I had a conversation with a friend from rehab who insisted that, in his experience, pain/tenderness was a DEFINING characteristic of an abscess. "If someone had their hand around my arm and I had an abscess, I'd do or say anything they wanted so that they didn't squeeze." So, being that my arm wasn't painful at all, not even when touched at that point, and getting no results from my research besides the expected "go to a doctor" and gross youtube videos of junkies squeezing pus out of their limbs, I was pretty convinced it was not something I didn't need to worry about. Slapped a wide band-aid on it and didn't think about it again...

...Until mid-day today, when I uncovered it to check on it and what do I find! a black dot that wasn't there last time I looked! So I put my fingers on the outside of the inflamed area and squeezed in, and sure enough, it started to drain - a little bit of light yellow pus but mostly dark red - it even squirted at one point. (Gross, I know. I almost puked just from watching it.) I kept squeezing until the discharge went from thick, lumpy and plentiful to more watery, red and hard to express. Afterward I cleaned it with hydrogen peroxide, dabbed some neosporin on it and dressed it with a band-aid and ace bandage.
The whole process was surprisingly painless. If anything, it's starting to feel the tiniest bit sore now, after two sessions of manipulation today.

I think I got pretty darn lucky in that it came to a head and drained on its own, and in only a few days, no less - all I did to help was apply a heat pack a couple times a day. I'm sure it will take many more days to heal. The area is significantly deflated, but still red and warm and still soft, too =(

Questions...
Did I do the right thing by squeezing it? Should I expect it to drain again before it starts to heal?
Was this what they call a "sterile abscess"? Or a full-on infected abscess? Or something else?

 

[Phobicgadfly]

Sorry to bump my own thread, but can anybody put their two cents in on this?

I know that nobody on this site is a professional, take everything with a grain of salt, etc. However, even if it's anecdotal, or you know, hypothetically if one were to *not* go to the doctor, what would/could happen from this point forward? Hypothetically?

 

[Fig]

https://blackpoppymag.wordpress.com/2011/02/03/abscesses-sterile-or-infected/

I've never been an IV user so I can't speak to it from personal experience, but I have generalized medical training. The advice given in this link not to squeeze is good advice, and for the reasons given. Expression and drainage of infected tissue outside of a sterile environment, and in the absence of appropriate systemic antibiotics, is asking for a larger infection. Sepsis (blood infection) is a very real possibility and can lead to infection in your heart, brain and other organs. That's an extreme but not unrealistic potential outcome. You could also lose your arm or hand, or parts thereof. Joint degeneration. The list goes on. Personally, I would be concerned about a secondary inection, particularly MRSA. Folks who develop that on the heels of abcess often struggle for years to rid the infection and many times end up losing massive amounts of tissue in the process.

When you go to a doctor they will culture the bacteria to determine which antibiotic is called for. They will drain and flush the interior of the site with bacteriostatic agent. You will recieve instructions on proper self care to minimize risk of recurrant or secondary infection. None of this can be done at home.

I get that many, many people have successfully DIY an abcess, some far worse than yours. But just because they came away from it without major problems doesn't mean that you will, nor does it mean you won't. It does mean, though, that you are rolling the dice.

IMO your best next move is to keep it sterile with fresh bandages every 4-6 hours as needed, swabbing the area with an antiseptic solution purchased for this purpose. Do not use antibioptic ointments. Keep it dry. Most importantly, do not fuck with it, pick at it, squeeze it. Let it be. If it gets worse bite the bullet and go to the ER. It isn't worth losing your hand or arm over.

Best of luck. I hope you pull out of it without needing the ER. If you develop a fever don't try to fool yourself with tylenol. You can have no pain at the site and still be nursing an systemic infection.

 

[crzydiamond]

I have had those before--basically just do what you are doing. Keep it covered, if it needs drained again (and it may but you'll find it considerable less than the first time), drain it...stay away from the neosporin you don't want a resistant infection. Bacitracin is ok.

Usually within a few days you won't have anymore drainage and it sort of flattens out and starts healing. Now, if it keeps draining pus in equal/greater amounts over the next couple days or it feels hot/inflamed then go to the ER as you'll want oral antibiotics.

 

[the_ketaman]

I'd definitely be getting anti-biotics. I'm a Qualified nurse and a junkie so I know from both sides that if it's not getting better you need it looked at.

 

[Phobicgadfly]

IMO your best next move is to keep it sterile with fresh bandages every 4-6 hours as needed, swabbing the area with an antiseptic solution purchased for this purpose. Do not use antibioptic ointments. Keep it dry. Most importantly, do not fuck with it, pick at it, squeeze it. Let it be. If it gets worse bite the bullet and go to the ER. It isn't worth losing your hand or arm over.

Best of luck. I hope you pull out of it without needing the ER. If you develop a fever don't try to fool yourself with tylenol. You can have no pain at the site and still be nursing an systemic infection.

Thank you Fig, for the link and response. Very informative and VERY helpful. Now that I've received your advice to not mess with it, I will stop attempting to drain it further.

.stay away from the neosporin you don't want a resistant infection. Bacitracin is ok.

I notice you're not the only one to advise avoiding antibiotic ointment, can I ask why? (Bacitracin is a component of triple antibiotic - there's bacitracin, poly, & neo sporin.)
You're right - it's flattened now (more or less,) and less angry-red - more of a resigned pink/magenta. I think I'm on the path out of mystery abscess land!

I'd definitely be getting anti-biotics. I'm a Qualified nurse and a junkie so I know from both sides that if it's not getting better you need it looked at.

Is there something about the progression that I described which indicates it's not getting better?
On a seperate note - what's the worst IV complication you've personally witnessed/treated? Also, does your employer and your coworkers know about your past, wouldn't that present problems? Are you still able to go to meetings and feel comfortable in your anonymity?

Have your ever had an abscess? (I'm curious about everyone's answers on this) or cellulitis, or phlebitis? Sepsis?
Which complications did you deal with at home, which ones did you immediately seek medical advice (sneaking suspicion there will be less than there ought to be) and in which case(s) did you initially attempt to treat at home, but ended up going to doctor, and regret not going sooner?

 

[crzydiamond]

I recommend avoiding the antibiotic ointment as I have been recommended to do so by a physician due to the antibiotic-resistant strains of infections that have evolved. Basically for the same reason parents aren't supposed to demand antibiotics for every runny nose a kid has. And then the antibiotics don't work when needed because the body has developed immune bacteria

I know that bacitracin is part of the triple antibiotic ointment. But I was told that one is ok to use on its own without the risk of germinating super-bugs

Oh and in my using days, to answer your other questions, I have had many abscesses. Particularly after some IV cocaine binges as well as one binge where the cocaine had been turned to base and one needed to use vinegar to IV...all I can say is those misses turned to some ugly red abscesses and almost-holes (don't know what you would call them) that filled in with these deep deep scabs. I never was treated for any, they all healed on their own. The ONLY one I ever had to be treated for was an infection on my finger that swelled up and kept draining pus and went from clear draining to greenish fluid with an odor. I knew that was bad, and it was getting worse rather than better. That one required antibiotics, though it was only a basic staph infection (fingers are in contact with so much it's easy to get infected)

Bottom line to me is, if it's something that is getting worse, I got it looked at. If it was improving or not worsening I kinda let it play out.

Never had any more serious issues. I did IV heroin and IV cocaine on and off for years. Currently been off for over a year. But anything else you want to know that I can help with just ask...

 

[dognasher]

Curious - does missing a shot of meth have more dire consequences than missing a shot of coke? I know that coke is more dangerous than heroin to miss, but I know next to nothing about meth. I was just wondering. Phobic - glad you got the nastiness out! I hope it heals up okay.

 

[NikkiStixx]

Jesus Christ, that's some scary shit, man! Three years ago I had a similar experience. But what happened to me is I hit an artery and didn't know it. Within a few days my arm began to swell like Popeye. Of course I sweared up and down that it was a spider bite, as I wasn't copping to shooting up. Y'know I stuck myself, pulled back, saw blood, and shot the shit (oxycodone). I damn near lost my arm. After 2 surgeries and 21 days in the hospital I was finally released. Had a waited much longer I would have lost my arm. So do you still have all your limbs?

 

[sm0kestack]

A year ago a needle broke off in my left forearm and got infected. It made small abscess which continued to pop and drain for a couple weeks. But right when the needle made its way out one day, it pretty much resolved itself almost immediately. Maybe my body was treating the foreign object as an infection itself? Cuz once I got it out, that's when it quit forming heads and pustules. There is a scar there as a friendly reminder. That needle was in my arm for 2 months before it made its way out on its own. The doctors at the hospital didn't want to dig it out because they knew it would come out by itself eventually, and because it was a long tipped syringe just below the surface of my skin, and had no real danger of entering a vein and lodging elsewhere in my body. That would have been serious.

 

[SKR]

^Good ol' surgical steel Smokestack - I won't ask how it happened though I'm curious (Re-used tip? Awkward shot and slipped fumbling etc etc), it's every IV users nightmare. The closet I got was after a shot I pulled out and as I went to recap the needle tip just fell off! Fucking bizarre, but it must have been the only faulty needle I had ever had the displeasure of using even after 1000's of shots I have never seen such a thing and despite rushing off my tits (300mg Meth) I still got the 'willies' as we say when I saw that tip fall off and thanked FUCK it didn't simply fall off into my arm. The good news is if you are to have a piece of metal in your arm you'd want it to be surgical grade.

Glad it resolved itself Smoke. Sheesh..