SELF INJECTION, INFECTION, ABSCESS & SURGICAL MANAGEMENT
CAUSES OF INFECTION/ABSCESS IN ANABOLIC STEROID USERS
• Injections not taken under clinical unit or under medical supervision.
Obviously you cannot expect a non-medico person to inject steroids at par with the clinical standards or medical supervision protocols.
• Use of non-pharmaceutical grade injections.
Common with the persons who don’t take steroids under medical supervision. Non pharmaceutical grade injections are just the duplicate,most dangerous & risky products.
INJECTIONS & INFECTIONS
Physicians have been put under tremendous pressure not to prescribe steroids to individuals for purposes of physical enhancement, thus diminishing the availability of steroids through proper channels. American pharmaceutical companies have also greatly decreased production of anabolic/androgenic steroids. It just isn’t financially practical if physicians can no longer prescribe them to a broader market. This has lead to a boom in black market products, most of which are of questionable quality and are often produced under unsterile manufacturing conditions. Most bodybuilders do not have the means or education necessary to recognize counterfeits or have all of their drugs tested in a laboratory for purity. As a result, people are gambling with their health by using steroids they procure from black market sources. Sometimes the product is fairly pure and the user experiences the expected results. Then again, how often do you hear about a bodybuilder doing a cycle and experiencing none of the expected gains? Usually the guy feels too foolish to tell everybody, “Hey everybody, look at what a fool I am. I just spent a ton of money on steroids, bought them from someone I didn’t know personally, and they turned out to be fake! In fact, I have no idea what I just injected into my body over the last several weeks!” This is not the kind of thing an aspiring young bodybuilder brags about.
INFECTION IN INJECTION VIAL (of steroids)
Sometimes the mysterious oil in the bottle is innocuous, sometimes it contains infectious agents such as rare bacteria and toxic chemicals. There are several reports in the literature of bodybuilders getting abscess’ from “atypical bacteria”. Atypical bacteria are ubiquitous in the environment, are able to survive for prolonged periods without nutrients, such as in a vial of steroids, and are very capable of causing difficult to treat infections at the site of injection.
If you surf the bodybuilding message boards you will undoubtedly find numerous questions from novice drug users. The anonymous writer usually wants to know, “how much should I take?”, “When will I start seeing gains?”, or “what should I combine with it?”. It is not very often that someone asks, “how do I avoid infecting myself with my own skin flora?” or “what should I tell my physician to test for when this thing gets infected?”. All to often the excitement of having that precious little bottle of dreams in their hands makes them throw caution to the wind.
Then there are the experienced users who simply get careless. It is this population that is perhaps more at risk simply because of the greater volume of drugs they use throughout their bodybuilding career. You will not usually get wind of a well known bodybuilder suffering from injection related infections. It’s not that they don’t happen, it’s simply that you don’t hear about them. Drug paraphernalia and prescription laws in many states, which are intended to curtail illicit drug use, decrease access to sterile injection equipment even for experienced users. Many times when darts and vials are scarce, they are shared. This greatly increases the risk of contracting blood born pathogens such as HIV, hepatitis C and hepatitis B. There are documented cases of each of these diseases being contracted after injecting steroids.
Infection can be a potential complication of any injection, due to the very nature of traversing the protective barrier of the skin when injecting. It is imperative to inject under strict sanitary and sterile conditions, to avoid transmitting infectious organisms/ foreign particles into the body. Common infective complications of those injecting Anabolic Steroids include cellulitis and abscesses.
The word ‘cellulitis’ literally means inflammation of the cells (not to be confused with cellulite – the lumpy fat often found on thighs, and buttocks). It generally indicates an acute spreading infection of the skin (dermis and subcutaneous tissues) resulting in pain, erythema (redness), oedema, and warmth of the affected area.
Cellulitis can spread in the skin and involve the lymphatic system causing lymphangitis. Swollen glands (lymphadenopathy) may also be present. It can be caused by many different types of bacteria, but the most common are Streptococcus and Staphylococcus aureus. Specific oral antibiotics are given to control the infection, and analgesics may be needed to control pain. Elevating the infected area to minimize swelling and resting until symptoms improve, aid recovery which usually takes 7 to 10 days. In severe cases the patient may need to be hospitalized and receive antibiotics through the veins (intravenously).
An abscess is a localized collection of pus in any part of the body, usually caused by an infection. Abscesses occur when an area of tissue becomes infected and the body is able to ‘wall off’ the infection to keep it from spreading. During this process ‘pus’ forms, which is an accumulation of fluid, living and dead white blood cells, dead tissue, and bacteria or other foreign invaders or materials.
The majority of abscesses are septic (i.e. caused by an infection) but sterile abscesses can also occur which are not caused by germs but by non-living irritants such as drugs. If an injected drug, especially oil based ones such as many anabolic steroids are not fully absorbed, it stays where it was injected and may cause enough irritation to generate a sterile abscess. Sterile abscesses are quite likely to turn into hard, solid lumps as they scar, rather than remaining pockets of pus.
Superficial abscesses are readily visible and are red, swollen, painful and warm. Abscesses in other areas of the body may not be obvious and may produce only generalized symptoms such as fever and discomfort. A sterile abscess may cause only a painful lump, for example deep in the buttock where a shot was given. If the abscess is small (less than 1 cm or less than a half-inch across), applying warm compresses/hot soaks to the area for about 30 minutes 4 times daily can help.
A culture or examination of any drainage from the lesion may help identify what organism is causing it. Most will continue to get worse without care. The infection can spread to the tissues under the skin and even into the bloodstream, resulting in septicaemia which can be very serious and life threatening3. Unlike other infections, antibiotics alone will not cure a well developed abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be cut open by a doctor in a procedure called incision and drainage.
ABSCESS IN ANABOLIC STEROIDS USERS:
Once the sore has drained, the doctor will insert some packing into the remaining cavity to minimize any bleeding and keep it open for a day or two. With time the cavity will heal and one can expect to be out of action for a number of weeks. The healing process will involve scar tissue formation, and this may lead to a residual weakness in that muscle.
Searching the literature I found a number of cases of abscess complications, a few of which are mentioned below to highlight the pitfalls which should be avoided.
Two cases of thigh abscesses were discovered in male and female professional weight lifters who injected a veterinary preparation of stanozolol contaminated with Mycobacterium smegmatis.
A staphylococcal abscess occurred in a 24-year-old bodybuilder who reported, for financial reasons, reusing needles on multiple occasions6.
Two case reports of staphylococcal gluteal abscesses developed in young bodybuilders 18 and 21 years of age. The steroids were injected by other weight lifters who were not familiar with sterile injection technique.
Pectoral and deltoid abscesses were reported in a 20-year-old anabolic steroid (AS) injector who had injected his AS preparation and then returned the needle to the vial to inject into another muscle group. The patient was thought to have contaminated his multi-dosage vial with skin flora and subsequently spread the infection8.
A counterfeit AS preparation contaminated with Pseudomonas spp was responsible for a deep gluteal abscess in one AS injector.
PRECAUTIONS TO TAKE:
1. Inject under strict sanitary conditions
2. Use correct injection technique
3. Avoid sharing or reusing needles
4. Ensure medication is legitimate
TREATMENT OF ABSCESS
Abscesses can be treated in a number of different ways depending on the type of abscess and how large it is.
The main treatment options include:
- Incision and drainage procedure
Your doctor may prescribe appropriate antibiotics to help clear the infection and prevent it from spreading.
INCISION AND DRAINAGE PROCEDURE
If your abscess needs draining, you will probably have a small operation carried out under anaesthetic. The type of anaesthetic used will depend on the size and severity of your skin abscess. However, it is likely you will have a local anaesthetic, where you remain awake and the area around the abscess is numbed.
During the procedure, your surgeon will make a cut in the abscess to allow all of the pus to drain out. They may also take a sample of pus for testing to confirm which bacteria caused the infection. Once all of the pus has been removed, the surgeon will clean the hole that is left by the abscess using a saline (salt) solution.
Your abscess will be left open so that any more pus produced can be drained away easily. If your abscess is deep, you may need an antiseptic dressing placed inside it to keep it open (gauze wick). The procedure may leave a small scar.
If your internal abscess is too large to be drained with a needle, or if needle drainage has not been effective in removing all of the pus, you may need to have surgery to remove the pus.
The type of surgery you have will depend on the type of internal abscess and where it is in your body. You may also need surgery if a needle cannot get to the abscess safely.