Discussion: Steroid injectons: Sudden new risks

The NYTimes this month began reporting a sudden new risk that accompanies steroid injections: Meningitis. This morning's article, reports that 14 000 Americans are at risk, and nearly 300 people have died so far. The disease is apparently caused by a Black Mold fungus that has contaminated unknown number of steroid batches produced at compounding centers.

Several of my friends are considering steroid injections for pain, and I have seen no discussion of its use on a/p. I would think that you may wish to delay any planned steroid use if possible. And if you have received recent injections you may wish to check with your doctor for any information he may have about the lot number that you received so that you can follow developments.

Before people get too scared, clark has typo-ed. Under 30 have died, with just under 300 contracting the disease so far. I hope no one we know is at risk.

Luckily you warned me. I was just about to bulk up!

Thanks Becks, sorry for the misinterpretation. For those that cannot access the article, here is the specific wording:

...About 14,000 people in the United States are in the same nerve-racking situation: knowing they might have been infected, waiting to see if they get sick. So far, 282 have contracted meningitis, and 23 have died...A few other patients have developed joint infections from having the drug, methylprednisolone, injected into knees, hips, shoulders or elbows....As the case count rises day by day, experts are racing to see if they can determine which patients among all those exposed are most likely to contract meningitis. If they can identify the high-risk patients, doctors can follow them intensively with spinal taps...

The problems, as far as I am aware, are exclusively with products from one compounding pharmacy in Massachusetts which has been completely shut down.

Yes, you're correct. They haven't yet traced every batch back to the pharmacy yet.

Personally I am somewhat surprised about number of people that have received steroid injections sourced just from one company. Which implies there are more companies producing steroids. Which implies that there are lot more people who receive steroids. I have had injuries and health issues here and there and I guess I have been lucky with my docs who always offered me to let my injuries heel naturally combined with physical therapy but longer vs. accelerated heeling will all sorts of injections. I am sure that there are legit cases when using steroids are the only option however this makes me wonder if too many people just want quick and easy fix.

* edited - removed "medical" to avoid misinterpretation of the message

In today's fast paced world, who has time to even live?

Further information in today's NYTimes reveals that altho only the Massachusetts compounding center has been cited for fungal contaminants so far, its steroidal drugs have been distributed nationwide. And records of repeated contamination at the center go back more than a decade.

I agree with Gil...try all non-invasive alternatives first, with a good measure of patience. Malpractice fears and profit-motivated medical care have forced clinics and hospitals to flog expensive drugs and procedures just to stay in business. Patients must be pro-active and educated to ensure they are not overtreated, overmedicated, and overcharged.

I think the issue is that patients don't want to be pro-active and pharmaceutical companies just offer patients what patients desire. Granted pharmaceutical companies spend lot of money in advertisement to promote new drugs to influence mindset of consumers. But it still puzzles me personally that many people would rather take pills then try adjusting their habits for the best. For example - once I worked with fellow who'd take pills to offset his bad habit of adding lots of salt to almost everything he ate.

Was it a salt tablet?

No - just regular salt from salt shaker. You could see his food covered with salt crystals.

I meant was the pill to replace the salt a salt tablet.

I did not ask but I don't think so.

Apply your tRicky filter when deigning to respond to tRicky's double meanings, irony, sarcasm etc!

Sometimes cortisone or similar is actually necessary to get rid of the last recalcitrant bit of inflammation - even when postural, biomechanical, etc issues have been addressed. Too often medical professionals opt for an injection for the hopeful quick fix through their own misunderstanding of causation issues. Sports Physicians generally excepted though.

I had to take a pill to reverse the effects of an overexposure to Tooms.

But it still puzzles me personally...

Why? Popping pills is waaaaay easier than changing behavior.

As tRicky just demonstrated...

Personally I think many of our current health issues, including joint deterioration, heart disease and even cancer, can be traced to the Obesity Epidemic; people have accepted an overweight condition as normal...even healthy.

Thanks to PG's brief "Lost and Found" program two years ago I lost 15 Kg (33 lbs) and have never felt more healthy. How can people worry about a sore knee or bad back, if they've loaded those joints with dozens of unneeded pounds? IMO stopping eating in excess should be the first undesirable habit to change.

It is proven that those with Body Mass Index around 20 have the longest heathiest life....what's your BMI?

23.8

Does that mean I might die tomorrow?

This is so judgemental. There are also people who have had to deal with chronic pain for a really long time. After years of physio, dietary changes and meditation, resorting to medication, steroids and surgery should be understandable. I really feel like the people being critical here don't understand what it's like to have pain that affects almost every aspect of your life for years.

cj, can you not recognise a troll?

No :( I should now better by now, but I don't.

Thing is, a lot of people think like the trolls. I'm with you, Carol! :-)

...a lot of people think like the trolls...

See...name-calling and avoidance of reality are the reasons that PG prematurely discontinued the L&F program. A bunch of fat young people, determined to remain that way. So unfortunate, especially when many people like me were becoming educated, and actually CHANGING our living habits for the better, by simply stopping eating.

This is REALITY folks...I'm just dealing with FACTS. Steroids, and drugs in general, are not necessary for healthy people.

chitownclark, they are not necessary for healthy people, but there are reasons other than lack of exercise that make people unhealthy, frequently completely out of their control. If the drugs will get them healthy again to a point where lifestyle decisions will keep them there, why be so negative?

ctc, you had been quite reasonable for a period of months. Did you really have to spoil it? I am not aware of there being a bunch of fat young people in the orienteering community. I certainly didn't see any at NAOC.

Drugs may not be necessary for healthy people. What a wonderful world it would be, if all of us were healthy people. Unfortunately, some of us are not. And we may occasionally resort to doctor prescribed medical procedures in an effort to regain our health.

Do doctors always prescribe the best course of action? Most certainly not. Do patients always make best health decisions? Nope. Are there real downsides to most drugs? Absolutely.

There are obviously some people out there who are flippant with their health decisions. But it's offensive when you imply that the young people on this board are in that boat. You might be surprised how hard some of these people have had to fight to get themselves healthy.

Time to move on?

The orienteers I know of who have received therapeutic injections of this sort have been healthy active people without weight problems who have had joint problems as they got older. The treatment has involved a combination of physical therapy, mechanical aids, and medication. There are also others who have received steroids due to severe allergic reactions. There may be people who receive steroids as a "quick fix", but they aren't the people I know.

...I certainly didn't see any...they aren't the people I know...I am not aware of there being a bunch of fat young people in the orienteering community...

From my own experience, before L&F caused me to become educated, with a BMI > 25 I was indeed "fat." No one looking at me would have thought I was fat. Least of all my Finn wife, who applied her Nordic standards. No one told me I was fat, including my own doctor. But thanks to L&F, I was forced to admit that with a light bone structure (thumb and middle finger overlap when encircling the smallest part of your wrist), I was above weights regarded as healthy by the new, more stringent insurance tables. I was fat.

During the sign-up phase of the L&F program, I think jjcote and walk were two of a very few orienteers who were given a free pass. But as I recall, there were dozens of others of us who voluntarily committed to L&F for weight reductions during the early months of 2011. So I guess there were indeed many orienteers who, like me, also discovered themselves to be overweight...or even fat. It was a great learning experience. As L&F taught me, nothing tasted so good...as it felt to be thin.

Doctors tend to downplay side-effects of the drugs they prescribe. As we're coming to understand, just by losing extra weight pains and illnesses can sometimes be eliminated without drugs. Because most drugs do have dangers. My original post was to alert a/p'ers about a new danger of steroids; to consider postponing injections, and trying other options. I didn't intend to be deliberately provocative, or a "troll." If I've offended anyone during our ensuing discussion I'm sorry.

veins popping.

I read somewhere that sniffing cocaine induces emaciation. I think it was the NYT health section. Maybe you should give it a try.

See...name-calling and avoidance of reality are the reasons that PG prematurely discontinued the L&F program. A bunch of fat young people, determined to remain that way. So unfortunate, especially when many people like me were becoming educated, and actually CHANGING our living habits for the better, by simply stopping eating.

I'm pretty sure 'stopping eating' is not healthy, FYI.

@chitownclark - I get what you are saying. Seems to me that others are jumping to wrong conclusion that you are 100% against any drugs, steroids, surgeries or other medical interventions which I don't think you are - you clearly stated that "Steroids, and drugs in general, are not necessary for healthy people.". Initially I thought you are pro-steroids since you started this thread but clearly you are not.

Despite CTC’s rant about the obesity epidemic, let’s not lose sight of the important points he raises:

1) Given the problems with the supply, anyone considering a steroid injection should do his/her due diligence. These contaminated drugs were distributed in all states except MO. Also, this is not the first time or the first compounding pharmacy that has distributed contaminated steroids that caused meningitis and death (e.g. N. Carolina in 2002)

2) Steroid injections tend to be overprescribed in the US-at least that’s been my experience. Typical scenario (and this has happened with several different MDs) is to go to Ortho with some sort of “–itis” or “-osis” and first round is usually RICE, PT, NSAID. After four weeks or so of no improvement (which seems to coincide with expiry of insurance approval of PT), the option of the needle usually comes up. I have to admit, the allure is tempting as I’m frustrated with limit of activity, loss of fitness, possible weight gain, etc.
But I’ve always resisted for two main reasons:
a) These shots can damage otherwise healthy tissue, notably cartilage and tendons. That is why most doctors limit # of shots. So you may help the current problem but could be setting yourself up for bigger problems down the road. And I’ve had doctors explain to my how they use just the right amount and specifically target the problem area or how 1 or 2 shots is okay but I remain skeptical
b) The shot may alleviate the current situation but it may not correct the underlying problem (e.g. poor mechanics). In several months, the problem may reoccur if the underlying cause is not addressed.

See, for example, NYTimes do-cortisone-shots-actually-make-things-worse/


For me, with the help of a good physio the problem has eventually corrected w/o the needle. Not saying this will work for everyone and there may be a time in the future when I will go for the shot but it will likely be the last resort before surgery.

Also, point out that any team member or anyone considering being a team member should check WADA/USADA rules on the use of glucocorticosteroids to see if and when a therapeutic use exemption is required. Injections directly into a joint, tendon or spine seem okay while intramuscular is considered systemic and therefore prohibited “in-competition”.

For the love of all things dear, when are we going to get discussion filters?

How about a Chrome extension that culls posts by certain people? I could be persuaded to try.

Yes!

But then you miss the best posts.

I have a baby blocker on facebook that's a chrome extension. It's pretty awesome, works on keywords though, not face recognition.

http://www.geektown.ca/2012/08/unbabyme-replaces-b...

Could someone please explain what is so annoying about a discussion of the risk/benefits of steroid injections, particularly in light of recent events?
Much less serious things have taken many more lines. I'm being serious here and trying to understand what I'm missing.

Where's the discussion of the risk/benefits of steroid injections? This thread seems to be mostly about judging people.

I am impressed that the mysterious sammy has been motivated to help express the simple point of this thread: steroid injections should be avoided right now, and other options should be considered to treat sore joints.

I suggested taking off a few pounds because it worked for me. I don't know whom I may have judged. Indeed, could someone please explain why for some people the suggestion that they might lose some weight seen as a personal attack? Isn't this exactly the way we've reduced the habit of smoking or not wearing a bike helmet in the last few years? By publicly expressing disapproval?

I can only speak for myself, but I found the discussion that you had with Gil following this remark fallacious and condescending. A short list of the logical fallacies:

1. The number of people at risk for meningitis (14,000, according to the article) is higher than you anecdotally expected, therefore people taking steroids are looking for a quick and easy fix. The rationale was that if you begin by assuming people are looking for a quick and easy fix rather than changing their lifestyle, you can conclude that people are looking for a quick and easy fix rather than changing their lifestyle. Did you even bother looking up for what purpose the steroid, Methylprednisolone is used for? I bet those patients receiving treatment for autoimmune diseases are total pansies. Reasonable objections to your hasty generalization were pointed out to you.

2. Obesity is known to have medical side effects; you affirmed the consequent to conclude that "many of our current health issues, including joint deterioration, heart disease and even cancer, can be traced to the Obesity Epidemic." Where's your evidence? Oh yeah, you don't really do that. Where's the relevance of the carcinogenic potency of fatness to a post about risks of steroids to a generally athletic audience?

3. BMI is a good metric for obesity. This isn't a logical fallacy, but it is wrong. For further discussion, see and consider reading this. I don't think your overdependence on BMI hamstrings your argument, but it does make it more absurd.

4. The people who brought about the abrupt conclusion of the L&F program are fat, young, and lazy. (The actual discussion.) Again, these objections were pointed out to you. I also signed up for L&F (unquestionably because I'm fat, young, and lazy) willingly; the main objection to L&F in the fall of 2010 was that people were being involuntarily signed up and that the very public program (rather than a private accountability group) with so many elite members created the impression that losing weight was the path to speed. This invites cultural epidemic that has had many adverse consequences, predominantly among young women. Herein lies a theme to discussions with you: just because there is a problem to which you cannot relate does not make that problem irrelevant.

Summary:
You began the discussion with a legitimate and welcome warning about a recent unusual risk associated with a certain class of glucocorticoids. However, you constructed a soapbox built on logical fallacies and speculation to lecture the AP community about how they should lose weight and learn from your invaluable example. You fail to recognize that the vast majority of us are not starting from the same initial conditions as you were, and "losing a few pounds" is not a panacea for conditions that might be treated with glucocorticoids. The number of erroneous, generalized or uncited statements in your arguments makes me want to follow you around on the AP forums and post citation needed after each of your posts. I leave as an exercise to the reader to find the uncited statements in comment_1, comment_2,, and comment_3.

Someone else put it very well: you have a tendency to "otherize" groups of people. To generalize, people who take glucosteroids, who drive cars (gasp), who don't obnoxiously troll forums are unlike chitownclark and must be convinced of the error of their ways. The problem is that this worldview is naive. The majority of people on attackpoint are athletes/athlete enthusiasts; this is not the target population.

Also, internet troll is a technical term, not a comparison to a mythical monster.

Bravo, Ian!

Ian is right, but I must admit, I sympathize with CtC, I do the same thing, as the better parts of my family remind me.
Is there a Soapboxers Anonymous ?

Unfortunately most of the links posted do not open for me. Probably because like me, my browser software is too old. I used this one to try to understand the fond names people were using....

As you may discover as you get older, medical science has no idea what causes or how to cure many of the chronic health conditions one develops as you age. So most doctors fall back on opinion, personal profit considerations, and salesmanship...try telling them "citation needed" when you've just been diagnosed.

I recently returned from a three-day medical conference in Los Angeles. It is an annual event for us older, pro-active guys, because treatments and thinking are changing rapidly, back and forth. For example, during one panel discussion the 9 doctors on stage were all strongly expressing different recommendations for the same patients...drugs, surgery, radiation, hormonal manipulation, do nothing...

So yes...you tend to become a bit cynical about all of it. And fall back on doing everything possible to stay out of the clutches of modern medicine, and seek only to improve your own health. To give your body the best chance to remain strong, fend off or minimize disease, and keep everything working. IMO losing that 33lbs, biking or walking everywhere, and posting something active on my a/p log every day, have been the largest factors in my current good health. That's the perspective of this 70+ year-old, rendered without judging or "otherizing" anyone else.

I'd love to count how many posts are left on the internet if someone made a Chrome extension that blocked ones without citations.

@iansmith - my friend - why are you (and others as well) failing to notice that myself, CTC and Sammy are not for banning steroids. I would be hypocrite if I was since I have received them. Let me go on record that I do not judge people who take steroids for legit reasons. Seems to me that you, guys, read few lines from posts, and/or did not read through it with an open mind, did not really sit back and tried to understand what contributors are trying to say, singled in on phrases that you felt are offensive and run with them.

All what I wanted to express with my initial post - that I did not know that so many have people receive steroid injections just from one lab and I am surprised about such high number.

I still going to stand by my word that I do think too many people look for quick fix and doctors are too quick to prescribe quick solution. It's my opinion based on my personal experience and based on my personal observations. If you have hard facts proving me wrong - I'll be glad to review them and I do not have a problem to admit that I was wrong. Conclusions I made today are based on my current knowledge and some assumptions as well. What percentage of current steroid users are quick-fix seekers vs. legit cases - that I do not know. Are you saying that none of all of 14'000 injection recipients are quick-fix seekers? We can argue about what percentage of injection recipients are quick-fix seekers and who are legit but looks like we both don't know that. Personally I think that percentage of quick-fix seekers is high however if you have different opinion - I do not have an issue with that.

I am all up for healthy debate. I love healthy debate. Enlighten me where I am wrong. I love debating with people because often I learn something I did not know about the subject. Also I am OK if you and others disagree with my point of view but be respectful about it.

However where does expressing ones opinion equals passing judgement? It's a rhetorical question and you don't have to answer that.

One thing I would suggest to you and others that you should not assume that whoever posts their opinions on AP do it "fallaciously" and "condescendingly". We are not sitting in the same room while having this discussion, but - common - with exception of tRicky folks who hang around orienteering community are least snobbish groups of people I have encountered. Feeling that my and other posts were "fallacious and condescending" is on you.

Trying to get back to an earlier, and I think important, topic- Are cortisone shots helpful in the management of typical overuse injuries such as tendinitis?

Attached is a link to an article in The Lancet that addresses that issue. While not without limitations, it is good because it is in The Lancet (certainly a reputable publication), it is a meta-analysis (a study of other studies-in this case over 40) and it is relatively recent (<2 years old).

I urge everyone to read the full study but let me cherry pick some highlights

“strong evidence that corticosteroid injection is beneficial in the short term for treatment of tendinopathy, but is worse than are other treatment options in the intermediate and long term”

“challenges continued use of corticosteroid injections by providing strong evidence that they are worse in the long term than are more conservative interventions for tendinopathy”

“… side effects, including raised intratendinous pressure, tendon degeneration, and deleterious effects on ...cartilage might be attributable to a misplaced injection”

“urge patients and practitioners to consider…negative long-term outcomes and high recurrence rates.”

“Studies…are needed to assess whether physiotherapy can reduce the high rates of recurrence associated with corticosteroid injection”

Of course, everyone needs to make an informed decision based on his/her unique situation but it would be nice it an MD, when offering a steroid shot for tendonitis, would say “this will likely provide fast relief for your symptoms but current medical evidence suggests that you will be worse off in 6-12 months than if we did nothing.” I suspect fewer people with overuse injuries would opt for the needle but I may be wrong.

I regret saying anything in this thread (because I'm conflict averse), although I absolutely stand by my comment. I will probably also regret this comment.

I reacted personally to comments like "But it still puzzles me personally that many people would rather take pills then try adjusting their habits for the best" and '"medical" steroids' in scare quotes. I have had chronic pain for 5+ years, for which I take medication, including a recent oral steroid trial. Since I know the extreme lifestyle changes I have made, I shouldn't have let it affect me, but it's really hard for me not to react personally when I think about being in pain constantly.

I just wanted to add the perspective that people who do everything right from a holistic treatment point of view can still need medication and steroids. Of course I wish I wasn't so medicated, but it beats crying myself to sleep because I'm in pain.

Also, considering I've a BMI under the magic number 20 and I'm on the low side of the small frame weights in those 1943 insurance tables, I have no idea where Clark got the idea that I'm a "fat young [person] determined to remain that way." Internet conversations can be surreal.

@cjross - I should have replied to your post earlier because I do think you misread my comment and you should not have taking it personally since my comment was not meant for those who do need injections after everything else fails but for those who abuse injections or how I put it - are looking for quick-fix.

I was not aware that I used scare quotas by in my posts. In the light of Lance Armstrong fiasco I wanted to differentiate between PED type of steroids and steroids used for medical purposes.

I do apologize for unknowingly using scare quotas to you and all other that felt I am being fallacious and condescending.

* edited - EPO replaced with PED

Thanks. It's ok, I'm not really hurt or anything, because I know the measures I take for my health. I guess you associate medication and steroids with the people you've seen use them and I associate them with my own experience.

Honestly, I would give anything for a quick fix to my pain :(

I'm pretty sure EPO is not a steroid.

And it takes a lot of leverage to get me to wear a bike helmet.

Surely it takes less leverage since you cut your hair back?

When I had all that hair, a helmet would have been superfluous.

Attackpoint is not here to attack people.

thanks Soup. I did read above that someone said 'i'm sorry', and there was a great missed opportunity.