posted
My LLMD has me on Rocephin 2 gm/day 4 days per week IM. After 4 days of injections, I'm not sure how long I am going to be able to do this!! Because of the volume of lidocaine used with 2 grams, I have to do two injections (one on each side). I am a nurse and do every technique that I can think of to minimize the pain, lumps, bruising, etc.
After 4 days, I am so sore!! No major lumps but I don't know how long my poor hips can handle this. Plus, my LLMD wants me to do Bicillin IM on two of the off days.
Any suggestions? I was completely against IV Rocephin (due to being a labor and delivery nurse, 4 kids, etc.) but now I think I might be reconsidering. My insurance covered a month of the Rocephin powder and lidocaine with no questions. I worry that IV may trigger closer inspection by the insurance however...
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TerryK
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I'm not sure why you are so sore. I didn't start to get really sore until months in when I got big lumps that became inflamed. Prior to that I would be a little sore but nothing compared to my normal pain levels at the time.
I'm sure you know all about how to give a shot but you might try pushing the fluid much slower. Also be sure to pull the needle out at the same angle that it went in. My doctor suggested numbing the area with an ice pack an hour before the shot.
IM rocephin dropped my pain levels a huge amount for many months so for me it was worth it.
I hope you figure out a way to reduce the pain so you can tolerate the shots.
Terry
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Hoosiers51
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Before my Bicillin shots, I put on a numbing cream that is a combo of lidocaine and prilocaine. (then I cover the area with a gauze pad and tape it so I can pull my pants back up and not get the cream everywhere)
I know your shot has lidocaine in it, but maybe you would be getting better numbing results if you had the cream on for an hour and a half to two hours beforehand? That way the area is already numb prior to anything even touching it.
It might be worth a try.
However, when I got my first Bicillin shot without any numbing agents, I found that the pain was gone within 30 min, so maybe these shots really are just painful for you for some reason. I dunno.
Also, can you get someone else to give them to you? Because I get my Bicillin shots laying down, and I think that helps the pain, to have all my muscles fully relaxed (which is possible when laying as opposed to standing). I exhale right before the needle goes in. I have heard that the tenser your muscles are, the more it hurts.
These tips might not help, but I figured I might as well bring them up.
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quote:because of the volume of lidocaine used with 2 grams, I have to do two injections (one on each side)
Hmm I am not sure what this statement means. 2g/ day must certainly mean 1 morning/1 evening .As rocephin has short half life.
I did read ceftriaxone is not a good drug to do IM - it causes tissue irritation and because you have to do shots so often it pretty hard to do long term.
Bicillin should be better drug to do IM
Posts: 856 | From MA | Registered: Jul 2009
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posted
TerryK... Can I ask what size needles you used? I have been using 21 g 1 1/2". Also, I am doing 2g/day at one time. Should I be doing 1 gram in the a.m. and 1 at night? I didn't clarify that with my LLMD... How long did you take to push the Rocephin in? I'm sure that's one of the problems. I am impatient and tend to push it in over 1 minute or so.
I am doing Z-track and an airlock. Any other suggestions?
Coltman, I did try Bicillin for four months. Didn't do much for me.
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djf2005
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The slower you push it in, the less pain and lumping youll get later.
I did bicillin IM and other IM shots for about 6 months. My wife and I found that by sticking it in like a dart (as fast as possible) and then injecting it over 5 minutes produced the best possible outcome, for me.
IM bicillin stays in the blood longer and your system in general but only attacks one form of lyme ("L") and is not broad spectrum at all. Most LLMDs prefer it due to the aforementioned fact but some are switiching to ceftriaxone recently because it has a much broader spectrum which it covers.
(ie-Penicillin (bicillin) vs. Cephalosporin (rocephin)
Rocephin is a 3rd gen (I think) Cephalosporin and is often more effective in short term relief of the symptoms of Lyme and Co but perhaps not the long term treatment (unless administered IV)
Also, there is much speculation as to whether the rocephin is actually killing spirochetes in patients or is having an affect on their brain (I can't remember the terminology) which makes them more functional temporarily. Dr. H talks about it in this lengthy presentation. http://www.viddler.com/explore/tamiduncan/videos/43/
Good Luck
Derek
-------------------- "Experience is not what happens to you; it is what you do with what happens to you."
quote:Originally posted by djf2005: IM bicillin stays in the blood longer and your system in general but only attacks one form of lyme ("L") and is not broad spectrum at all. Most LLMDs prefer it due to the aforementioned fact but some are switiching to ceftriaxone recently because it has a much broader spectrum which it covers.
First its not l-form -its spirochette they attack (which has outward cell wall). 2nd rocephin is "broad spectrum " - is effective both vs gram negative and gram positive bacteria due to its beta lactam ring passing gram negative outward barrier.
"broad spectrum" can be bad -as it causes more dysbacteriosis (by killing more gut flora)
quote: Also, there is much speculation as to whether the rocephin is actually killing spirochetes in patients or is having an affect on their brain (I can't remember the terminology) which makes them more functional temporarily. Dr. H talks about it in this lengthy presentation. http://www.viddler.com/explore/tamiduncan/videos/43/
I been wondering same thing lately. Because if beta lactams had significant activity on borellia people should not relapse so fast after being on them for months
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djf2005
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No, its (bicillin) only the L form, it has no measure on a cyst or other forms of the spirochete.
You can read about this in length in roesner's books, albeit some of his info a bit off IMO.
Rocephin is for gram negative and positive, and if you take enough probx youll be fine.
Agreed on Beta Lactams, although people relapse on all kinds of abx combos after prolonged periods of time. It speaks to the elusiveness and tenacity of this bug in general.
Hopefully research will uncover something soon.
Derek
-------------------- "Experience is not what happens to you; it is what you do with what happens to you."
posted
Having done both IM Bicillin and IV Rocephin, I must say that I'm loving the IV Rocephin. The PICC line is much less trouble than I had feared it would be.
It's easier on my body (my poor butt hurt!) and it's actually improving my condition. (Bicillin just didn't work for me.)
-AnnaL
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merrygirl
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I did IM bicillin for 14 months, i would suggest using the emla cream to numb it 1st. also a hot bath after seemed to help after the injections.
bicillin takes a long time to work.
my bum is fine now!
just in case you were wondering.
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Hoosiers51
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Isn't "L form" another name for CWD (cell wall deficient) form? Which is the form that goes inside other cells. So Bicillin should not hit that form. That is why you take something like Zithromax with it, to hit the L form.
Bicillin should be hitting the spirochete form, with the cell wall. That's what beta-lactams do.
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djf2005
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This is based on rosner's opinion, which is the little info available regarding these abx.
Dr B would contradict this I guess since he treated himself w/ ceftin successfully (cephalosporin)
Anyway, this is his theory, not mine:
All penicillins and cephalosporins are cell wall inhibiting drugs. (bicillin and rocephin)
They work by dismantling the cell wall surrounding Bb thus making it convert to cell wall deficient form and cyst form. So no, they do not work on the CWD form, they cause it. Bb can survive w/o it's cell wall.
Some argue these 2 classes of drugs are good for relieving some symptoms because of the state they put Bb in, but they don't address the long term issue of Bbs survival.
Usually combining Bicillin w/ a macrolide which inhibits the protein synthesis of Bb with 1 or more intracellular drugs as well will address most of the forms and hopefully some co infections.
Adding something for cyst such as flagyl or GSE is often needed as well.
If you look at it in brief, it's pretty much what everyone's protocol who chooses to use abx looks like at one point in time or another.
Best
Derek
-------------------- "Experience is not what happens to you; it is what you do with what happens to you."
posted
I've been using my hips. Wow - 3 injections per day. I'm so sore today!! What size of needle should I use?
Posts: 292 | From UT | Registered: Aug 2001
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posted
3 ml 25g 1 1/2 Why aren't you using the outer parts of your thighs? Got any orals you can alternate with?
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blinkie
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posted
I do Im injections. 4.5 CC's one in each cheek without lidocain. I used to pulse M,W,F. I was tolerating that ok. Now I do daily shots and my cheeks have bruises and they hurt.
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TerryK
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skrWolf- I used 23G X 1" needles. 2GM's per shot, 4 X's per week. I did get them in 2 shots sometimes but for a long time I got them in one shot.
My husband gave them to me and it took about 10 minutes. Anytime it hurt, he would go slower. He put the needle in like a dart, very quickly. It rarely hurt going in and didn't hurt much during the shot. I tried the topical lidocaine when the lumps got bad but that didn't help much.
I wonder if I would have had fewer lumps if I had used a longer needle? I guess I'll try that next time.
My LLMD won't give me bicillin shots. I think because I have the HLR genetic pattern for mold problems.
Terry
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quote:Originally posted by TerryK: skrWolf- I used 23G X 1" needles. 2GM's per I wonder if I would have had fewer lumps if I had used a longer needle? I guess I'll try that next time.
uhh 1"... - that is definetely ultra short for IM , unless you doing delts. One of the major factors in bumps is medicine leaking into subcutaneous tissues (or even injected there cause needle is too short) - it is absorbed worse there and irritates more. Even can cause necrosis
Ceftriaxone is apparently one of the worst offenders irritation wise so it will probably not help all that much pain wise, but bumps should be less (well they would be deeper)
I mean in fact there was a study that even 1.5 inch needles are too short in high % body fat cases
Needle length makes no difference pain wise, so why use short?
quote: My LLMD won't give me bicillin shots. I think because I have the HLR genetic pattern for mold problems.
posted
skrwolf - I was also very hesitant to have a PICC line inserted and do IV Rocephin. But, I went ahead with it and it's working out great. I've had the PICC 8 weeks with absolutely no problems. I hardly notice it's there anymore. Also, I became allergic to Rocephin in my 6th week and my LLMD switched me to Invanz, which is only made in IV form. My very basic HMO is covering these meds at 100%.
If you infuse the Rocephin, you'll be able to tolerate the Bicillin shots better. It sounds like a good protocal to me.
Good luck!
-------------------- Misdiagnosed with CFS for 7 yrs. Diagnosed by LLMD in 2009. Aggressive treatment for 3 years with minimum improvement. Posts: 120 | From FL | Registered: Jun 2009
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posted
I'm going to ask about doing IV today during my phone consultation. I think that if I did, I might ask for a port rather than a PICC. I am a labor and delivery nurse with 4 kids and it seems like a PICC would be a pain... Am I wrong?
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TerryK
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colt wrote: Needle length makes no difference pain wise, so why use short?
I used what I was told to use but I started out with the thigh and when I was told to move to the hip area, it didn't occur to me to change the length of the needle.
Ceftriaxone is notorious for causing the painful lumps based on the many people here who have had them.
colt wrote: Why would that matter? penicillin is not mold!
It is not the mold itself that makes peole with my genetics sick, it is the metabolites (mycotoxins). That said, some people can be allergic to the mold as well.
I'm not allergic to mold but I have difficulty getting rid of the metabolites of mold (the mycotoxins). I didn't go into a lot of detail with my LLMD but I assume the concern is that penicillin is a metabolite of fungi.
I've read that some consider it a mycotoxin and others don't. As a child, I was told that I was allergic to penicillin because it made me so sick. My LLMD tested me and I'm not allergic. In all liklihood I was either herxing due to lyme or I was sick due to the fact that penicillin is a metabolite of mold.
Terry I'm not a doctor
Posts: 6286 | From Oregon | Registered: Jan 2006
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posted
I was told to use 1" needles too. The first injection that I did was done in my hip. 1" wasn't nearly long enough to reach the muscle. The Rocephin ended up in my subcutaneous fat, caused a bruise that was 4 inches long and a painful lump. When I went to 1 1/2" needle, it made a huge difference. Think that I may go to a smaller gauge as well.
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