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Injecting Copaxone into arm?

I just have a quick ? for all of you expert Copaxone users.  When the nurse taught me how to inject into my arm, she said to stand with my arm held straight out, elbow extended, palm up.  Then inject into the "bat wing" area of fat that hangs down.  I have done it this way each time without any problem, but everybody seems to talk about how difficult it is to inject in the arms.  Am I doing something wrong?  

Katie

p.s.  Just a side note to let everyone know how wonderful I think you are.  I don't usually comment on other people's posts, mostly because I'm newly diagnosed, and don't have much to add.  On the other hand, I am here daily and I appreciate all of the great advice that is given to everyone!  I have learned so much and am very grateful!
37 Responses
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667078 tn?1316000935
You were hitting the ulnar nerve, funny bone, Try a two and do not get the side of the arm where the elbow is. Go higher and on the side. If that does not work take the arm out of the rotation I did. SS can't tell you that because they have to follow the script from the FDA. You can ask your doctor first to be sure.

Alex
Helpful - 0
667078 tn?1316000935
You need to change the setting to a two for your arm. Do not get near the elbow. Make sure you use the back of the arm. You hit the ulnar nerve that is your funny bone and it hurts. You might even have to take the arms out of the rotation if you keep hitting the nerve. I had to. SS has you do it exactly as they did in trials. that is what the FDA says they have to. You do not have to if it does not work. The flu like symptoms are just your body's way of saying this is new.

Alex
Helpful - 0
Avatar universal
Tonight was my second injection which I did in my right arm.  My SS nurse was here for my 1st injection into my abdominal and had a slight sting and then big bubble 10 min after.  I got flu like symptoms and nausea 4 hours after though.  She instructed me to use a setting of 6 but told me I had very little fat. Tonights injection into my right are was brutal! Serious pain to the point I wouldnt even move my arm for 1 1/2hrs. After reading all the info on this site I know I should try a 5 for my arms.  Thank you all for such great info.  Sometimes it's hard hearing half the info when your newly diagnosed so having this site is like a refresher course.
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Avatar universal
Tonight was my second injection which I did in my right arm.  My SS nurse was here for my 1st injection into my abdominal and had a slight sting and then big bubble 10 min after.  I got flu like symptoms and nausea 4 hours after though.  She instructed me to use a setting of 6 but told me I had very little fat. Tonights injection into my right are was brutal! Serious pain to the point I wouldn't even move my arm for 1 1/2hrs. After reading all the info on this site I know I should try a 5 for my arms.  Thank you all for such great info.  It's hard hearing half the info when your newly diagnosed so having this site is like a refresher course.
Helpful - 0
2063887 tn?1337829746
I only use the autoject on my arms and hips.  I prefer shooting "naked" because I control the speed the medication goes in at.  I called the nurse at Shared Solutions because I was having pain in my breast on the side I shot my arm.  She said to lower the number I was using and that helped SOOO much.  No more pain!  It sure helps  reading everyone elses comments because it answers other questions I've had!  I stumbled on this forum too and I'm so glad I did!!
Helpful - 0
Avatar universal
Just wanted to say that I have this problem sometimes also. I do the manual injections and sometime it feels like I am pressing really hard on the plunger and it the needle is plugged or something. (I'm afraid because if I inject too fast, I can actually see bubbles come up adjacent to the injection site and they hurt.) If I withdraw the needle a little and go back at a different angle, then the copaxone will then go in without all the pressure on the plunger. Maybe a pc of scar tissue plugs the needle?
Helpful - 0
1045086 tn?1332126422
If there is scar tissue you should be able to see or feel it there.  It would explain why the drug doesn't inject easily.  It won't be absorbed correctly either.

If this is only happening in one area there must be a specific reason.  Is it difficult for you to get the proper angle for injections in that arm?  It is possible the drug is not being deposited deep enough into the subcutaneous fat, isn't absorbed and then scar tissue forms around it.

But it is also possible this is lipoatrophy, a place where the subcutaneous fat has been destroyed following injections.  I'd advise you to avoid further injections into that arm until you can get your physician to examine it and tell you what is happening.

Mary
Helpful - 0
Avatar universal
First of all, I wanted to say that this is a great site...I just stumbled across it and I've learned so much that I had no idea about. I've been using copaxone for almost a year now, and I'm experiencing a lot of problems with my right arm. These past two weeks, the injections don't penetrate like they use to...it seems as if the scar tissue is preventing the injections from properly going in...is this possible?? Or am I just doing something wrong???
Helpful - 0
Avatar universal
"Shoot naked"  I love it .... thanks for the laugh for the day!  That said, I have to admit that I would be afraid to do it that way.  I like the not seeing the needle because it is hidden in the autoject.  I also don't think I have the steadiness of hand to keep the needle still after letting go of the skin pinch before plunging.  I'll stick with the autoject for now until something changes.  

Katie
Helpful - 0
338416 tn?1420045702
Shooting without the autoject isn't all that bad.  After my blood clot I had to self-inject with Lovenox, and they don't give you an autoject for that one.  After I got used to sticking myself with the needle, I was more comfortable with it.
Helpful - 0
1045086 tn?1332126422
No, there is no requirement to use the autoinjector.  Several people here "shoot naked" as the saying goes (and if it doesn't get bleeped out).  I've done it both ways and found I prefer autopilot programed by my preferences, for reasons I've given earlier in this topic.

There isn't an absolute ten second requirement.  People who don't use the autoinject tend to inject slower to begin with.  It's one of the reasons people prefer it.  There can be less trauma to tissue because a slower injection means a less forceful stream out the end of the needle.  

The tiny bubble of air that follows the medication into the site can also serve as a type of 'plug' preventing backflow.  If you don't wait to withdraw the needle but don't get more than a surface drop of liquid, there is no problem in saving a few seconds at each dosage.  I haven't thought much about it.  Guess I really am accepting that my life moves in slow motion now.

If you decide you want to try the autoinjector, make sure the doctor includes a script for one when he orders the DMD.

Mary
Helpful - 0
1532707 tn?1312155924
Do you have to use an auto injector? If you don't do you still have to wait for 10 seconds. I haven't started yet but 10 seconds seems like a long time.
Helpful - 0
989689 tn?1333548520
The arms were the worst for me cause your not supposed to inject yourself over tattoos and I have both arms sleeved. There was only maybe 2 places on each arm that was light enough for me to do. I'd have to skip an arm each week. Made being on a schedule hard.

Chad
Helpful - 0
1045086 tn?1332126422
by katie4242, 3 hours ago
Hmmm.... I do get pretty sore after injecting, but I guess I thought that was just par for the course.

It's another one of those things that could be, but isn't necessarily.  That's the part that makes this whole disease so frustrating for me.  I like to be sure of things (so I feel like I'm in control, no doubt).  You will build confidence as you try variations on the theme and find what works best for you.

Here's something to keep in mind to determine proper depth of injection.  You want to inject into subcutaneous tissue.  That's the tissue under the skin that can be pinched up with your fingers.   How deep that is varies between people and between our own individual body parts.  

To see how deep you can inject without reaching muscle, pinch up some skin over the area.  (This is generally much harder over areas like the hip and thigh unless you are extremely thin.)  Between your fingers you hold a double layer of SC and fat tissue.  Your needle should pierce no deeper than 1/2 that measurement when the skin is flat, which it is when we use the autoinject.  (My preference these days because I can avoid the mild tissue trauma of a pinch.)

You can inject at various depths of the SC tissue.  Deeper injections may be less painful.  I've wondered if lipoatrophy increases with deeper injections that deposit more drug in fatty tissues but I have nothing other than personal rambling thoughts to support that idea.  

I find it easy to test various depths for comfort by using the autoject settings.  Heard of the Sleep Comfort Numer bed?  This is my personal comfort number setting for Copoxone.  Thigh, hip, abdomen and arm all have their preferred number setting.  I don't have to think about it anymore.

BTW, injecting into muscle isn't harmful to the muscle but it can change the speed of absorption of the drug.  The blood supply is greater to muscle than SC tissue, so drugs injected there will usually absorb faster.  Copaxone is meant to be absorbed slowly over 24 hours.  That's why we're instructed to massage an injection site AFTER 24 hours.  Let it absorb slowly for 24 and then rub out any residual so scar tissue doesn't develop at the site.

Hope something in here helps and doesn't just cause more confusion.  I'd hate to see you slide back into silence.  Every member contributes to make this forum what it is.  People who "read only" are always welcome.  Still, it's been nice finding out you are with us.

Mary
Helpful - 0
Avatar universal
Hmmm.... I do get pretty sore after injecting, but I guess I thought that was just par for the course.  Maybe I'll try compressing the autoject with one hand, and triggering with the other when I inject my thigh this morning.

Thanks for the help!

Katie
Helpful - 0
1045086 tn?1332126422
Thanks Meg for the rubber band trick!  I used it tonight with much success and it did make things so much easier on my hand that is weakened with the one-two punch of OA and MS.

I think you are doing fine Katie.  The safety lock is designed to keep us from trigering the unit to fire before we are ready.  I personally do believe it takes too much pressure to release it by pressing on the skin.  That's why I use the technique I described and enjoyed the rubber band technique.

As Jen says, it is easy to inject too deeply in the arms.  I would have thought we would hear you complaining about sore arms if that was happening when you inject there.  If you have doubts about your technique, ask the nurse in your doctors office to go over things again or watch your technique.  Nurses vary in their experience and willingness to stray from scripted teaching instructions.

Find the person and technique you feel comfortable with and stick to it.
Mary

Mary
Helpful - 0
338416 tn?1420045702
Hey, Katie - if you were injecting point down, then I think the pushing together of the autoject would be fine.  For the arm injection that you described, you might be going too deep into your arm.  Copaxone is a sub-cutaneous injection, which means it's supposed to go into the fat, not the muscle. You don't want to push into the skin too hard because you'll go through that layer.  I don't know how much subcutaneous fat you have - I have plenty, but it's still possible to compress it too much.

The safety lock on the autoject is meant to keep you from injecting unless you push it against the skin, but when I was taking Copaxone, I always held it together with my hand, then pushed the button.  This made it a two-handed procedure, though.  When I started Betaseron the nurse showed me the trick with the rubber band.  Works pretty well and I don't get a hand cramp or arm cramp from trying to twist around.
Helpful - 0
1453990 tn?1329231426
I just take the syringe and point the needle upward at a 45 degree angle and slide it in all the way to the hub over the triceps and inject.  No lumps, bumps or bruising.  Not having the same luck in my thighs.  Two hematomas out of four sticks.
Helpful - 0
Avatar universal
O-kay, now I'm confused.  My nurse told me to push the autoject into my skin to get the two pieces to come together.  Is that right, or is that too much pressure?  
Helpful - 0
620048 tn?1358018235
Hi Katie,

I am off the copaxone until we decide it is causing my hives or not.  My skin reactions never changed, but i didnt mind....and i have had no relapses for a very long time, that was a miracle !!

My nurse showed me how to put a large rubber band on the autoject so you could use one hand, you just wrap it around the top section, and twist it to the other section, this holds it down so you dont have to push it.

Good luck with it....

meg
Helpful - 0
1045086 tn?1332126422
Julie, I did use heat before and a cold pack afterwards on my thighs for a while.  It seemed to help.  I have had arthritis for years that responds well to heat application (love those parafin baths for the hands!) so I think there is a comfort association for me in heat application.  It doesn't have to have a "real" reason to work.

If the sting wants to hang around I will still use cold applications.  I have a net bag of those plastic ice cubes in the freezer that are perfect for the job.  (They are meant to keep a beverage cold like an ice cube without watering it down as they thaw.)  They conform like a bag of peas but I don't have the worry that someone will try to eat something that's been refrozen 50 times.

Remember the rules for heat or cold application:
Never place directly against the skin.
Never apply to areas with altered sensation.
Never use while sleeping.
Remove after 20 minutes for safety.
If needed long term, 20 minutes on alternated with 20 minutes off is more effective than constant use.

Mary
Helpful - 0
559187 tn?1330782856
Mary, you make a good point at the end in mentioning good instruction. Good instruction makes a lot of difference. Either I was a bad student or the nurse who came to get me started was not that great.  I had to have another nurse come back again because I had too much distraction the first time. My son and his GF were there trying to be so helpful.  These posts are sure helping as a refresher.

Julie
Helpful - 0
1045086 tn?1332126422
For my arms, I can hold the compressed barrell pieces together and stretch the tip of my index finger to the trigger.  I lightly touch the end to the skin of my arm and fire.  Once triggered, it doesn't matter if the barrel remains compressed.  I count to ten slowly and then withdraw straight out.

On days that my hands are too weak to do this, I push the syringe against the skin to release the safety, hit the trigger and then pull back immediately to make sure the pressure isn't forcing the needle deeper than I want it to be.

I set the autoinjector at only a four or five for the arm.  That's deep enough since the skin and subcutaneous tissue dangle away from the muscle there without the thicker layer of fat on the other injection sites.

I try not to push against the skin much with the autoinjector at any site.  Instead, I steady the tip lightly against the skin with one hand and trigger with the other.  After many months, I know the depth that works for me at each site.  This technique has given me a lot of consistency in giving myself the most comfortable injections.

I was told that if I see the round impression of the barrel on my skin immediately after the injection, it is a sign I have used too much pressure.

One more thing ---
Even though the large majority of my injections are pretty painless these days (still get some sting afterwards though) there is that initial piercing of the skin that can trigger a TOO BIG reflex jump.  It's like watching intently for the toast to pop up from the toaster, knowing it's coming ...... any moment now ....... ready ...... ready ...... and you still jump out of your skin when it happens.

I've found I can sometimes avoid that (and some discomfort) if I start to hum a little or just go ahead and begin to chant ow, ow, ow before hitting the trigger.  Seems if I ow about it first I can make a liar out of myself.  This has been especially helpful on my thighs where I had begun to anticipate pain.

As the routine gets more familiar, you can let your hands inject while your mind visits other places.

Katie, I've never had trouble with my arms either.  We must both have had good instruction.  You're doing fine!
Mary
Helpful - 0
338416 tn?1420045702
Oh, and I think the ice pack did damage my skin.  I would keep it on until it was completely numb, and sometimes the injection area looked a little frostbitten from the cold!
Helpful - 0
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