*shudder*
*Gag* Not those kinds of shots. But man, how did we really survive college? Thin Mint Girl Scout Cookie shots or Tequila, and it had to be Don Julio. Like why on Earth were we that way!? Collegiate livers and brains are resilient, I tell ya.
Speaking of resilient - have I told you lately that resilient people are my favorite kind of people? Resilient people. Not whiny, miserable, victimy people. How has it taken me this long to put a Kacey Musgraves reference in a blog? No idea, but if you've never heard her music - give it whirl.. unless...
"You ain't happy unless,
You're miserable."
Let's play Never Have I Ever. Come on-All ten fingers spread out where y'all can all see them. Most fingers left at the end wins. Put a finger down every time you are guilty of any of the following:
Never have I ever taken on more than I can reasonably handle.
Never have I ever skipped hours of sleep to make up for "lost" time.
Never have I ever not eaten healthily because I "don't have time." (or money)
Never have I ever hated taking vitamins.
Never have I ever told my doctor to give me a steroid shot for a "sinus infection."
Never have I ever told my doctor I needed a ZPack for my "sinus infection."
Never have I ever skipped weeks or months of exercise.
Never have I ever felt exhausted every day and blamed my job or kids.
...........how many of y'all are down to 2 fingers left?
Never have I ever been frustrated when trying to lose weight or get in shape.
Never have I ever have I taken shortcuts to try to feel better faster.
How many y'all got?
I have 1 left. Never have I ever skipped weeks or months of exercise, because I'm one of those people that craves it.
In my opinion, and this could very well be backed by some type of research, the number one thing that patients ask their healthcare providers for (or demand if you're a Karen) issss...
drumrolllllllll...
A steroid shot.
Big meeting this week. Big trip this weekend. Big exam on Monday. Too many kids. Don't have time to be sick. "Can't you just give me a shot to knock it out?" Shoulder/Hip/Knee (insert _____ any location) has been hurting for 12 years and needs surgery or maybe to even not work as hard (take time off, lose weight, improve strength/flexibility), but, nope - I just want a steroid shot because it makes it feel better for a few months. And I can forget about it, so it's gone.
If you have ever been my patient, or your child has been my patient, we have had this discussion. There are many appropriate and valid uses, times, and situations that justify steroid injections. Your nasal congestion and frontal headache, even perhaps your full-blown spring cold - are not on the list of appropriate reasons.
Triggered. Tuh-riggered.
The most commonly used medications I've seen used or used myself in practice are Dexamethasone, Betamethasone and Methylprednisolone. These are usually called Decadron, Celestone and Solu-Medrol by "us", respectively. All three are in a class of drug called corticosteroids.
The way to think about it, is that there are eggs. If eggs are the main category of food you can pick from, they are the corticosteroid. Scrambled, poached, sunny side up are the specific menu options - they're all eggs, just look and chew a little different.
And, they all digest the same way.
Why am I writing about shots? Because you are being robbed. Not only are you being robbed, but you are asking to be robbed. And your provider is not giving you the shots mentioned in this blog because they know they will expedite your recovery from nasal congestion or your cold. They're doing it because they don't want you to get mad at them. They don't want to argue, or fight, and they want you to come back, and honestly, they want to be nice to you.
WARNING! Opinion ahead, and this is a big ole sunofagun: Just because your provider is "nice" - doesn't mean they are doing what is in your best interest. People can hide behind "nice", and not just doctors, nurse practitioners, etc...
... like Ted Bundy became who he became under the guise of being real nice and charming... you wanna be his girlfriend? I ain't doin it.
The first way most people will describe a healthcare provider was "Oh he/she was so nice!" Right? Makes you grin a little. A great provider, will be nice, AND they'll be honest. Most importantly - they'll tell you why what you're asking for isn't appropriate, and offer other options/solutions, or at the very least be able to know and document in your chart that you've been fully informed so you can't get all Karen @ them later. End of opinion warning.
Steroid shots make you feel better within the same day. That's why you want them. They energize you, relieve your congestion and body aches, and you believe you're cured.
PRAISE jams play in the back ground of your life.
Here are a list of approved uses from all 3 meds combined. Some uses may only apply to 1 of the 3 meds, but I'm not differentiating that here, that's too extra:
Intra-articular, intralesional, or soft tissue inflammation; acute exacerbation of Multiple Sclerosis; Cerebral Edema; Shock; Severe or incapacitating allergic conditions; Screening for Cushing syndrome; Multiple Myeloma; off label for Chemo-Induced nausea & vomiting; altitude sickness; spinal cord compression; tenosynovitis; peritendinitis, bursitis; dermatologic (zits and cysts); Rheumatoid Arthritis/Osteoarthritis joint inflammation; 6-12 day taper for allergic conditions; Status Asthmaticus; Airway Edema; Croup; Meningitis; Respiratory Distress Syndrome in premature infants; and soOooOoo many other "off-label" uses that you likely have never heard of. My Source: MedScape
Anecdotally, and from experience - active wheezing in a child or adult with asthma +/- an infection, is a great reason to give a steroid in order to AVOID Status Asthmaticus - scary stuff, mom & dad. Also, recently, a +COVID test with shortness of breath, lung history, wheezing and/or low oxygen level is a great reason to give a steroid injection.
So, class, what did we notice about that giant, ridiculous paragraph?
Sinus infection, cold, strep throat, ear infection, "not feeling right", nasal congestion, sinus pressure, big events coming up - may all be very uncomfortable, poorly timed, and inconvenient, but they are not reasons for you to receive a steroid injection.
The "common cold" or any other viral respiratory infection that we and our children get are both caused by a wide variety of viruses. "The common cold is caused by viral pathogens, such as rhinovirus, parainfluenza, adenovirus, RSV, and influenza."
Friends, there are dozens of little viruses that have made us mildly to moderately ill in the past, and will continue to do so in the future. If you are a person who must know, or have a good shot at knowing what is causing your child's illness - you can ask your provider to run a respiratory PCR panel, which is collected by yet another nasal swab... after precious angel, little shrieking Kourtleigh has just been swabbed for Flu, RSV, rapid strep and throat culture... what's one more right?!
"It's okay, baby, you're definitely getting donuts after we leave!! Be brave for Momma, okay?!"
Please be fully informed - even if this test gives you a positive result for a random virus other than Influenza A/B - it makes no difference in the course of illness, treatment plan or argument in favor of a "shot to knock it out faster." Please know that viral, upper respiratory illnesses will cause symptoms in your body for anywhere from 7 to 14 days, and this is considered n o r m a l. "Symptoms may last up to 14 days with an average of 7 to 11 days (J Clin Microbiol 1997;35:2864; JAMA 1967;202:158)." And we've known this since at least 1967.
Steroids combat inflammation. Inflammatory responses in our bodies are both good and bad things, depending on why they are happening. We require inflammatory processes in order to heal damaged tissues. When you are injured or cut, and you swell - swelling - you are seeing the results of your intact inflammatory process at work. Inflammatory processes could be considered "bad" when they are a severe allergy to a delicious food, or an auto-immune response, amongst others.
Pump the breaks. Put 'er in reverse.
Steroids......combat.....inflammation.
"INFLAMMATION
The inflammatory response (inflammation) occurs when tissues are injured by bacteria, trauma, toxins, heat, or any other cause. The damaged cells release chemicals including histamine, bradykinin, and prostaglandins. These chemicals cause blood vessels to leak fluid into the tissues, causing swelling. This helps isolate the foreign substance from further contact with body tissues."
This is why steroids relieve your sinus pressure, frontal headache and nasal congestion. Where in your body do you get swabbed for Flu, RSV, Respiratory PCR and COVID19?
In.....your.....nose. This is where these viruses set up camp. Your body is doing it's job to rid you of this infection in a week (And like, how many diseases are cured in a week? Remember awe and wonder? Have a little, would ya?). And here you go, power walking into your local urgent care or medical office telling your doctor (or provider) to give you a steroid shot!
Here's another thing - the drug's half life. A drug "half-life" is the amount of time it takes for your body to reduce the amount of drug swimming around in your body (by peeing it out in this case) after one full dose, by 50%. For decadron/dexamethasone, you will typically receive a dose, if you're an adult of 4 to 8mg, for an upper respiratory complaint, as an injection, into your muscle, one time. Decadron's half-life after an IM (intra-muscular) injection is 190 minutes. Just over 3 hours. Half your drug is in the terlit if you got a good liver. "Up to 65% of a dose of dexamethasone is excreted in the urine within 24 hours." (1) So, you might get 2 days at best of therapeutic effects from this particular shot?
And how long does your standard viral infection last? 7-14 days....
Better off with Celestone, if you still want it, and the place has it : "Anti-inflammatory effects may appear within 1–3 hours... and with IM administration: Anti-inflammatory effects or HPA suppression may persist for 7 days." (2) Good and a bad thing. At least you'll get potentially a whole week of fight out this thing, but.... what if you have a bad reaction? Steroids make some people "crazy", cause insomnia in many, acid indigestion, mood swings, anxiety, and also - elevated blood sugars. Like really elevated. If diabetes runs in your family. but you don't have it, especially in your parents and/or siblings, and you decide on a steroid injection - please know - this can send you into a fresh and unexpected Diabetic emergency called DKA, and you'll have a beautiful, skyline view of the city .... from the ICU. Along with some new prescriptions. I've seen this happen with my own 2 eyes.
Finally, in the event someone would give you an injection of Solu-Medrol, "Excretion [peeing out] of the administered dose is nearly complete within 12 hours." (3)
AND aaaanother thing! We know that this steroid is suppressing our inflammation / immune system response - so - if you picked the Celestone - you got that circulating in some amount for up to a week? It's like you're punching yourself in the face. How much good did you do?!
What is the classic saying? Make time to stay healthy now or make time to be sick later. Your pick, can't have both.
NEXT SOAPBOX!
This one will be quicker: B12 Shots.
I'll do all the links to sources in red for this section, just to be festive!
Y'all. I can't with this.
How much can't can a white girl can't if a white girl just literally could not?
"It is important to note that low levels are rare in most healthy adults because the human liver stores several years’ worth of vitamin B-12." (4)
What is the key word? R A R E. Of course you're a unicorn, you are special. But chances are, not that kind of unicorn. It is rare that a person other than the people listed below will have a B12 deficiency:
A person with pernicious anemia. "Pernicious anemia is a rare condition, with a prevalence of 0.1 percent in the general population and 1.9 percent in people who are older than 60 years" If you are an adult, and you are reading this, you would KNOW if you had pernicious anemia by now.
Vegans/Vegetarians. Why? Vitamin B-12 is found in: meat, poultry, shellfish, eggs, dairy products..."
People who have chronic intestinal diseases or who have had their digestive tract permanently altered due to things such as gastric bypass surgery, bowel resections, Crohn's, HIV, diagnosed Celiac disease (not "I have a gluten allergy because I feel better when I don't eat bread" - an actual tissue biopsy diagnosis), a genetic disorder that leaves you without a protein called Intrinsic Factor which is required to properly absorb the B12 in your body, and... for the finale... people with alterations in the pH (acidity) and bacterial flora that are normal for the stomach. Translation: CHRONIC use of antacid medications! Would you agree that there is half an aisle at every grocery and drug store dedicated to all the Prilosec's and Prevacid's? People take these things like candy and guess what - doctors and other healthcare providers prescribe them like candy. What about bacterial flora? Know a super popular flora-killer? You doooo... ANTIBIOTICS. (5)
People who have pernicious anemia or any of the other permanent conditions that cause a B12 deficiency have to be treated for the rest of their lives.
If you are paying a person to inject you with B12, the red stuff, please, stop letting them rob you. If you want to give me the money for those shots, I'll take it, because I told you the truth.
YES - FATIGUE is a real, hallmark characteristic of anemia in general and anemia due to B12 deficiency, but the fatigue you are having because you are overworked, underfed, under-slept, underpaid, over-caffeinated, and spread too thin - is not anything a B12 shot will cure.
I am going to close with this last little tidbit: :"Elimination: Following IM administration of 0.1 to 1 mg of cyanocobalamin, 50 to 90% of the dose may be excreted in urine by glomerular filtration within 48 hours, with the major portion being excreted in the first 8 hours." (6)
You might pee out your shot in TWO days. Ugh. I can't.
Whew. You might require a drinkable shot after all this TMInformation.
*Steps down from soapbox*.