What could this be??

[MuscleMedicineMD]

I have a painful, swollen lump on my upper left glute, approximately where my belt line is, just hair lower. It’s not red, but it hurts deep, like a bad wasp sting. There’s no blemish on the surface of the skin, it feels deep. Could maybe be a boil but there’s no redness on the skin
My first thought was bad injection. Because I had injected 3ml into my left glute last week. Pain popped up about 5 days later. Only thing is, I don’t inject that high, it’s several inches from injection site and didn’t hurt until 5 days later anyway. Been taking amoxicillin since Wednesday abd it’s gone down some but still hurts.

1. "along the belt line" (ie. the waist) In medicine, a circumference defined anatomically & demarcated by the tips of your 2 Iliac crests. which are bony points bilaterally, atop of you ilium, that, along with your sacrum, as well as you ischium inferiorly forms your Pelvis. most anteriorly is the "ASIS"..
2. Dematology is easy, its all based on location. THIS is an ABSCESS bc you state its deep, well beneath dermal-SQ layers! v. Boil (that's superficial; redness being present or not has no baring here). (*see a textbook for a more detail)

3. Now, is it Sterile or infectious? The key identifiers spoke of before from a members medic training, are not defined in Pathology as "infectious" as was stated (nor does lack of fever rule out inf) but rather they are the 5 classic signs of INFLAMMATION. (which may or may not be caused by V/bac) Now CC & Physical Exam- we will take what he gives us..
*POS for PAIN? but on palpation (deep or superficial)? POS for TENDERNESS, deep. Denies Redness. Heat? reports "itchy" sensation..(bares no relation to definition or stages of infection) rather is a symptom of the Primary Mechanism of INFLAMMATION---> CYTOKINE release!
- Histologically, Histamine release is responsible for capillary leakiness, causing clinically the Signs of SWELLING..
-Histamine does many other things such as recruiting near by IMMUNE Cells via INTERLUKIN'S (IL-6, IL-1 etc) clinically seen as PUSS, even if sterile... its still an Abscess.

4. But MMMD, why is this ABSCESS "several inches away from where" one clearly injected?
Anatomically, I cant forget running my hands all along these special divisions within the GLUTEAL muscles and legs during cadaver dissections.. THese are FASCIAL PLANES. spread is most mobile and initial deposition to Abscess formation could be influenced simply by body position at night etc.
I also considered, Lymph node anatomy/drainage routes superficial to deep (burned into my memory)

5. 5 days from Injection ---> pain!. well 3-5 days is the time line one would expect in Abscess formation. pain results from several factors, which may only be clinically noticeable on 4th- 5th day.

Part 1 of 2... MUSCLEMEDICINE, MD

 

[MuscleMedicineMD]

CONT...Part 2 of 2 by MuscleMedicine, MD

If I go to a dr, do I go to a dermatologist or a regular dr? I don’t have insurance but I got a dermatologist that I go to that works with me.
I just wonder how long to give this thing. It sucks. Couldn’t do much for legs today.

1.DERM can handle this & may like the change of pace. But it all depends whats been worked out with the MD. normally their fee's for any office service is higher, esp procedurally speaking, so call, check.
2. I would call your family doctor and ask the office manager to quickly explain to MD, check costs
3. check near-by Hospitals to see if they have "SURG Clinic"? and Out of pocket cost for "walk-ins"
*DO NOT go to the ER, unless it is one.. FEVER? 100,4 in most cases, exceptions exist...anyone?

Complete DX and Treatment
Dx: Amox Rx and vanishing irritation + dec size may be related but far from diagnostic of infectious.
Dx= immediate biopsy and culture? MRI? hell noooo.. I look at it- judge it versus the 50 I've seen.
Rx: Antibiotics, compress, +/- I&D or Asp; covering obvious MC cause if infectious, Staph aureus. which Amox does on paper but wouldnt be trusted clinically due to resistance. Thus--->
-Cephalosporin is a fine choice here. Same case but during a brief Hospital stay, TB, etc..hell noooo
-does not cover stronger resistant strains of Staph ie. MRSA; Clindamycin is good here. Research.
Antibiotics w/ Bacterial-Infection, Enough? Usually not in my, largely Hospital based, EXP. lacks blood.
Sterile Abscess may simply shrink some and eventually become hard like a rock deep to skin; or
Abscesses may drain which would be a rare treat. If not...
Evaluate by Clinician (progress & your Signs/Symptoms locally or ANY systemically): often..
+ I & D or ASPIRATION: I've done Both. I usually make some attempt to Aspirate but when its deep its tough to judge how much remains... Incision & Drainage is where I take a disposable kit from the surg cart, grab a bunch of extra pads for blood, maybe a student to assist, put a drape down, shoot a local and do a small incision but deep until it starts discharging debris/puss! it's packed later.. I have them return to check it's healing well by secondary intention.

Me, Internal Med docs, are always worrying "what rare exception did I miss" that's going to harm??
There is a litany of exceptions, common to super rare complications! I cannot cover each here..that is why this is JUST my very best guide..
*This is straight from memory, no refs-paraphrasing, so one should always double check the most recent outlined guidelines regarding, but not limited to, treatment modalities*

Best-MUSCLEMEDICINE, MD.

 

[Jonjon]

1. "along the belt line" (ie. the waist) In medicine, a circumference defined anatomically & demarcated by the tips of your 2 Iliac crests. which are bony points bilaterally, atop of you ilium, that, along with your sacrum, as well as you ischium inferiorly forms your Pelvis. most anteriorly is the "ASIS"..
2. Dematology is easy, its all based on location. THIS is an ABSCESS bc you state its deep, well beneath dermal-SQ layers! v. Boil (that's superficial; redness being present or not has no baring here). (*see a textbook for a more detail)

3. Now, is it Sterile or infectious? The key identifiers spoke of before from a members medic training, are not defined in Pathology as "infectious" as was stated (nor does lack of fever rule out inf) but rather they are the 5 classic signs of INFLAMMATION. (which may or may not be caused by V/bac) Now CC & Physical Exam- we will take what he gives us..
*POS for PAIN? but on palpation (deep or superficial)? POS for TENDERNESS, deep. Denies Redness. Heat? reports "itchy" sensation..(bares no relation to definition or stages of infection) rather is a symptom of the Primary Mechanism of INFLAMMATION---> CYTOKINE release!
- Histologically, Histamine release is responsible for capillary leakiness, causing clinically the Signs of SWELLING..
-Histamine does many other things such as recruiting near by IMMUNE Cells via INTERLUKIN'S (IL-6, IL-1 etc) clinically seen as PUSS, even if sterile... its still an Abscess.

4. But MMMD, why is this ABSCESS "several inches away from where" one clearly injected?
Anatomically, I cant forget running my hands all along these special divisions within the GLUTEAL muscles and legs during cadaver dissections.. THese are FASCIAL PLANES. spread is most mobile and initial deposition to Abscess formation could be influenced simply by body position at night etc.
I also considered, Lymph node anatomy/drainage routes superficial to deep (burned into my memory)

5. 5 days from Injection ---> pain!. well 3-5 days is the time line one would expect in Abscess formation. pain results from several factors, which may only be clinically noticeable on 4th- 5th day.

Part 1 of 2... MUSCLEMEDICINE, MD

Thank you for taking the time to give all this info man

I did inject right before bed that night when I injected that region, so, laying on it could’ve moved the oil?

Looking forward to part two

The area was warm, a little itchy, and very swollen on Tuesday night when it was at its worst. It has improved since then, that’s when I began the amoxicillin, but it is still there and painful, just to a much lesser degree

 

[Jonjon]

@MuscleMedicineMD any ideas what could’ve caused this? Did I not go deep enough perhaps?

I can’t feel a knot there anymore. Just general swelling in the area.

 

[Jet Labs]

Doctor, always go to a doctor!

Bodybuilders/powerlifters always put their health on the back burner and that is something that has to stop imho.

 

[Adzg]

really? how so exactly? Seeing as it's Definitely NOT a boil. In medicine we have precise definitions, so sounds like or my little brain thinks, is useless. You fail.
"if it is several inches away from the injection site" How does this makes it any closer to being a Boil?
Simple. it doesnt. you fail. *if you know nothing, say nothing.
Guess you'd have to have dedicated YEARS studying/dissecting/taking exams, then Operating, to know all the Anatomical planes of the body, this specific gluteal region, and how infections spreads in every region of the body?!
It would require a Medical degree, not google. It cannot be faked. bought. or taken away.

BLb- Now STOP READING. People w/ no respect for Doctors & their time Do NOT go pass this point..



NEXT...
PARTS 1&2: My basic WORK UP, straight Memory w/o pausing- you must do your own RESEARCH..

I had one doctor a few years back say I tore a tendon, physio said I tore the ligament instead, doctor number 2 said they are exact same thing.

Don’t know about other countries but doctors in australia have specialization.


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[CJ]

I had one doctor a few years back say I tore a tendon, physio said I tore the ligament instead, doctor number 2 said they are exact same thing.

Don’t know about other countries but doctors in australia have specialization.


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I would never see Dr #2 again, and I'd get an MRI instead of guessing.

 

[Robdjents]

We, insurance,bills,wtf,your government sucks fellas,in Australia you can walk into any hospital,er,doctors,medical centre and have that looked at,operated on,medicated, whatever it may need and won't cost you a damn cent,it's all paid for by government,Medicare,even if you might need a specialist and have to pay a fee you get rebated that amount back.good luck anyways brother.

Yes but who’s money are they using to fund such a thing?! We as Americans do not want the government involved in the healthcare system...no sane person wants this ...we are also taught here to deal with our own problems and pay our own bills ...different strokes...I did not know Australia had free healthcare tho so I definitely learned something new today...what are the wait times like? Is it like Canada or have they got it figured out?

 

[Adzg]

I would never see Dr #2 again, and I'd get an MRI instead of guessing.

Yeah I just compared my X-ray with pictures in the internet and noticed that my collarbone and shoulder blade were quite far apart. Acromioclavicular ligament I think it’s called.


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[Adzg]

Yes but who’s money are they using to fund such a thing?! We as Americans do not want the government involved in the healthcare system...no sane person wants this ...we are also taught here to deal with our own problems and pay our own bills ...different strokes...I did not know Australia had free healthcare tho so I definitely learned something new today...what are the wait times like? Is it like Canada or have they got it figured out?

Depends on the issue. Just to see a General practitioner you are looking at a day wait at most.
Seeing a specialist could take around a year.

I’m assuming it’s the amount of tax we pay that gets us “free health care” 1/3 of my pay is tax.


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[Robdjents]

Depends on the issue. Just to see a General practitioner you are looking at a day wait at most.
Seeing a specialist could take around a year.

I’m assuming it’s the amount of tax we pay that gets us “free health care” 1/3 of my pay is tax.


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That doesn’t sound so bad I get a 1/3 of my pay taxed and I don’t get shit for it lol

 

[Voodoopoo]

In Sydney I can walk into a medical centre and see any doctor within the hour,as for specialist,can take anything from month to six months,surgery is immediate if urgent and free,elective surgery has a short list of about 6 months or more,it's free, prescriptions are subsidised for the most part and cost around $6 to fill a script,if it's not on the PBS,like off script testosterone,then you pay around $80 script,non PBS that is.land of the free.love this country,it's the best all round.im a proud Aussie,I usually run things down here...lol

 

[MuscleMedicineMD]

I had one doctor a few years back say I tore a tendon, physio said I tore the ligament instead, doctor number 2 said they are exact same thing.

Don’t know about other countries but doctors in australia have specialization

Yeah I just compared my X-ray with pictures in the internet and noticed that my collarbone and shoulder blade were quite far apart. Acromioclavicular ligament I think it’s called.

I would never see Dr #2 again, and I'd get an MRI instead of guessing.

1.I know for a fact DR#2 knows the difference, for example he's had to dissect every joint in the body himself multiple times pointing out all rel. Ligs, Tendons, blood supply. he's had to ID them on Lab exam for a yr straight. of course reg course work includes anatomy questions on exams which are almost all clinical and include lots of joint injuries. so to not know just the definition isnt possible.

2. Reading the shoulder joint on XR is notoriously tricky just the fact that its an XR means angle can really effect interpretation. 1st thing you have to do is establish if its a PA or AP graph.

3. Far apart? IF the AC lig was effected what you must do is follow the clavical from origin to distal end where is should smoothly connect to the acromion which travels posterior to anteriorly. When this Lig is torn there is very little to note on XR, but when 2 LIGs are torn (coracoclav lig too) the natural movement is UPWARD due to the superior muscle attachments. Every 1st yr med student should know this its always tested bc its a classic case, specifically with the XR shown and clinical story of trauma usually someone young playing sports or a fall, and every lig and shoulder tendon is listed in various combinations together as choices A-through-K? <42 secs from the 1st word of paragraph to XR interpretation to the answer of AC & CC lig. (you will not have time to read the answers individually, you need to already KNOW the answer then scan quickly or you will fall behind, time fails more students than facts by FARRR).

4. Generally patients expect to be told whats going on after a brief chat and Phy Exam but with the cavoite that Imaging must be done since you dont have superpowers. Outpt MRI is costly and will take time to schedule if approved and for the Radiologist to get back to you to CONFIRM your clinical assessment (def not "guessing") hopefully and possibly add new insights which were impossible to know just via Exam/Experience.

Last, ALL DOCTORS SPECILIZE. Even if you must chose FAMILY Med bc of poor performance or desire, its considered a specialty w/ ind. residencies as you have to know a decent amount about everything from all childhood illness/pathology, cover GYN issues often, NEURO from vascular injuries to all demenias, as well as PSYCH since they often present to FAMily before anywhere, and a million things inbtw. IF you were looking to do ENDO or CARDIO or GI you better get into a good residency job specializing in INTERNAL MED which is crazy in scope dealing with the highest pressure/sickest patients/the toughest cases, often involving several subspecialties, but YOU are left with understanding & applying the tidbits of advice, following & treating the pt. + you better kick ass 24/7 x 3-4yrs if you wanna reach your goal.

Best- MuscleMedicine, M.D.


ps. OUR Health care system in AMERICA has 1 HUGE problem thats Unlike many other countries, certainly Australia... We have a GIGANTIC BURDEN of paying for untold amounts of Illegal Immigrants/new but financial unproductive citizens and their whole families who pay zero $$ who havent been paying into the system for generations but immediately TAKE from the system. Elderly arrive sick, need expensive care, children are born w/ nothing invested before hand, followed by 18yrs of free care, then as adults rarely make enough to HELP the system just have more children and TAKE. ++plus a HUGE segment of the citizen pop that's lazy, slow, greedy so they rob/steal who are on gov. medicaid/free healthcare, & happen to be the sickest, MOST neediest portion as well. Highest teen preg, HIV, STD, CVD & MI, Kidney disease, HTN, Obesity.. just to name a few! AGAIN wayyy more TAKE then GIVE. Solution: everyone pays, no handouts, boards security gets all NASA funds & military help.

 

[MuscleMedicineMD]

@MuscleMedicineMD any ideas what could’ve caused this? Did I not go deep enough perhaps?

I can’t feel a knot there anymore. Just general swelling in the area.

(4th post; see previous 3 above)

hey can you give me an update or update the thread? btw, what length needle did you use? do you normally inject 3cc and how often in that area?


FYI, infectious has obvious causes but both Inf & Sterile sometimes its just being unlucky if you do what you always do.& youve ruled out the actual gear. Sterile has been describe in Lit as a type 3-4 hypersensitivity reaction by the body to the substance, which I know doesnt help you much..

TIPS on INJECTING:
-naturally you should always clean the area with alcohol before hand.
- you should always heat the oil up before hand so that it dissipates more quickly/easily. I do this to both the oil itself as well as the syringe after its loaded. Crucial for smaller site injections.
-always rub the site injected vigorously afterwards to assist.
- always rotate sites.
-if it has a hard, knot like feeling under the skin before injection, use a different location, this area can be fibrous or otherwise affected.
-Never inject if its too difficult, oil should flow smoothly at a consistent rate unless you know before hand youre using too high of a gauge/thick oil.
*These may especially help prevent sterile abscesses I mentioned in my posts in which the cause is not always elucidated.

Best-MuscleMedicine, M.D.

 

[Gibsonator]

Musclemedicinemd, great job with quality info man.

 

[Jonjon]

@MuscleMedicineMD

I used a 25g One inch needle on the injection. I’ve used that setup hundreds of times for glute. Usually 1.5cc or less though.

I went to the dermatologist Wednesday. The area really flared up, and became more swollen and painful the night before so I knew I had to do something. Still no redness on the skin.

She said it wasn’t her area of expertise, but she thought I probably had injected subcutaneously instead of im

She prescribed me some doxycycline, and said it may or may not get better on its own. That wasn’t much help. She said she couldn’t drain it or anything because it’s too deep and nothing would come out.

The cephalexin arrived that same day so I started that Wednesday afternoon. I have not taken the doxycycline. It gradually got better and better each day, less painful and smaller.

Now it’s still a very firm area, and still swollen but not near what it was.

I would like to continue the cephalexin a few more days, but during this last night I started getting pretty strong pain in my abdomen below my right rib cage, and I think that’s the liver area. So I started reading up on cephalexin and saw where there had been a few cases where a person damaged their liver with that drug, so I’m gonna discontinue use.

I guess we’ll see what happens over the next couple days

 

[MuscleMedicineMD]

@MuscleMedicineMD

I used a 25g One inch needle on the injection. I’ve used that setup hundreds of times for glute. Usually 1.5cc or less though.

I went to the dermatologist Wednesday. The area really flared up, and became more swollen and painful the night before so I knew I had to do something. Still no redness on the skin.

She said it wasn’t her area of expertise, but she thought I probably had injected subcutaneously instead of im

She prescribed me some doxycycline, and said it may or may not get better on its own. That wasn’t much help. She said she couldn’t drain it or anything because it’s too deep and nothing would come out.

The cephalexin arrived that same day so I started that Wednesday afternoon. I have not taken the doxycycline. It gradually got better and better each day, less painful and smaller.

Now it’s still a very firm area, and still swollen but not near what it was.

I would like to continue the cephalexin a few more days, but during this last night I started getting pretty strong pain in my abdomen below my right rib cage, and I think that’s the liver area. So I started reading up on cephalexin and saw where there had been a few cases where a person damaged their liver with that drug, so I’m gonna discontinue use.

I guess we’ll see what happens over the next couple days

An experienced user using 1'' needle...she thinks you injected SUBQ lol YET at the same time says "too DEEP to I&D?? obviously this makes no sense whatsoever!

at this point its overwhelmingly obvious what is going on. Good thing you got the Cephalosporin.
But..STILL swollen &/or Painful...you do NOT STOP Rx as incomplete Tx of infection carries likely & serious complications. Good far out-weighs bad (see 2).

1. Cephalosporins are NOT metabolised by the LIVER or at all actually. Its RENALLY cleared unchanged. (I'd need more details but generally for the record actual liver pain is DULL and diffuse and ABOVE your LAST COSTAL MARGIN of your rib cage on the R.

2. You are much more likely experiencing ("pretty strong pain below R rib cage") gas-pains/abdominal distention irritating your diaphram &/or GIT/large intestine discomfort at the R.sided flexure 2ndary to Antibiotics (#1 most common side effect of Cephalexin).

Rx until tenderness on palpation is no longer noted.

Best-MuscleMedicine, M.D.

 

[Jonjon]

An experienced user using 1'' needle...she thinks you injected SUBQ lol YET at the same time says "too DEEP to I&D?? obviously this makes no sense whatsoever!

at this point its overwhelmingly obvious what is going on. Good thing you got the Cephalosporin.
But..STILL swollen &/or Painful...you do NOT STOP Rx as incomplete Tx of infection carries likely & serious complications. Good far out-weighs bad (see 2).

1. Cephalosporins are NOT metabolised by the LIVER or at all actually. Its RENALLY cleared unchanged. (I'd need more details but generally for the record actual liver pain is DULL and diffuse and ABOVE your LAST COSTAL MARGIN of your rib cage on the R.

2. You are much more likely experiencing ("pretty strong pain below R rib cage") gas-pains/abdominal distention irritating your diaphram &/or GIT/large intestine discomfort at the R.sided flexure 2ndary to Antibiotics (#1 most common side effect of Cephalexin).

Rx until tenderness on palpation is no longer noted.

Best-MuscleMedicine, M.D.

Cephalexin superior to doxycycline in this situation?

Thank you so much for your info!

 

[MuscleMedicineMD]

Cephalexin superior to doxycycline in this situation?

Thank you so much for your info!

YES. in this situation.

Your DERM is probably highly familiar with this drug for certain things and thus knows every possible use (which is a lot=its an extremely Broad-spectum AB). Yet for me, its not so common so I think bunch of rare skin and lung bacteria, alt choice with certain STDs etc. Not Skin but it is super Broad-spec & *interestingly will cover MRSA whereas Cephalexin Does NOT!

So save it if you ever get Lyme disease, need prophalaxis, or if another skin related infection pops up and your Cephalosporin is all gone or "seems to not be working" which could indicate resistance or the possiblity of a most rare bacteria.. then you'll be ready with DOXY!

best-MuscleMedicine, M.D.

 

[Methyl mike]

Zit pimple boil etc.