Corticosteroid Injections: A Pain In The Butt?
Asthma is a pain in the butt, sometimes. Sure, that’s probably true for asthma in and of itself, but I’m referring to systemic corticosteroid injections. Those of us who have had a systemic corticosteroid injection down there know exactly what I mean.
So, you’re having an asthma attack
You make the right decision to visit an emergency room near you. You are probably given a nebulizer breathing treatment, probably with albuterol (even if you have a nebulizer that you already used at home). The attending doctor then decides to give you an injection of a systemic corticosteroid before you go home.
You probably already know what this is, and why it’s needed. The most common systemic corticosteroid used in emergency rooms where I live is methylprednisolone (Solu-Medrol). It can be given in your IV, if you have one. It used to be that all asthmatics would get IVs. The old thinking is we needed to be hydrated.
But, more often than not, we asthmatics don’t get IVs anymore. And, if that’s the case, and the attending physician decides you would benefit from some systemic steroids to end your flare-up and control your asthma…
Chances are it will be in your butt muscle
Yep, the good old gluteus maximus. It’s a good sting, surely enough. But the worst part is it causes a dull pain that lasts for several hours, maybe even a few days, after the injection. For some reason steroid injections do that.
Again, this is nothing we asthmatics can’t deal with. It’s, as my mom would say, a good sort of pain. It’s good, sort of like feeling sore the day after a good workout. As mom said, it means you are making progress. In our case, the progress is the inflammation in your lungs will go down, helping you breathe easier.
Corticosteroids, more often called simply steroids, reduce the immune response that causes airway inflammation. When you are exposed to your asthma triggers, this inflammation may worsen, and this is what causes asthma symptoms.
Inhaled corticosteroids (ICS) usually help to lessen this inflammation. So, if you are already taking an ICS every day, and you end up in the ER, you might be thinking: Why do I still need to use systemic steroids?
Well, the answer is that, while ICS reduce airway inflammation to control asthma, sometimes, when we are exposed to one of our triggers (such as a respiratory virus), the ICS is not enough. You see, ICS contain a very low dose of steroids. Sometimes our lungs need a boost. When our doctors think this is the case, we get an injection of systemic ICS.
So, here you are in the emergency room
Your doctor decided, that to help you get over your asthma attack, a steroid injection is necessary. If you already have an IV, you will probably not even feel it. However, if you don’t, the medicine must be injected into a muscle. The most common injection points are the deltoid muscles (the side of your shoulder) or your gluteus maximus (your butt).
I have no idea how a nurse will decide which spot is best. But, quite often, it’s in the but. And, this reminds me of a story.
There was one time when I was, I think, 21 years old. I was having a pretty bad asthma attack, and decided I could just drive myself to the emergency room. I did. Among other things, I was given a steroid shot in the left butt cheek.
Boy did it ever sting.
But, worse than the initial sting, was that the injection site hurt like crazy.
The nurse didn’t want me to drive home. But not because my butt cheek hurt, more so because I was given a shot of Sus-phrine (my last one ever before the product was discontinued), and a couple Ventolin breathing treatments. (This was actually the day I was introduced to Ventolin solution. Before this time I was using Alupent).
But, she did allow me to go home. On the way, however, my butt hurt so bad I actually had to, sort of, stand with my butt cheek off the seat. It was hard to drive this way, but I managed.
Steroid shots hurt like that
I know it’s not just me, as I have had many, many, many asthma patients over the years confirm this for me, after they were given their shot by various nurses.
And it has nothing to do with technique by the nurse, in my opinion. Steroid shots just hurt. They are a pain in the butt, or arm, if you got the shot there.
Recommended site of injection: arm.
You don’t have to sit on your arm.
It was after this ER visit that I decided I would never drive myself to the ER again. And I never have. I have been to the ER, but have never driven myself since that day.