Went For A Flu Shot, Got A Shoulder Injury Instead

I’ve had a flu shot many times. No one really wants to get a flu shot, but many people generally consider it worthwhile if it keeps you from getting the flu. I have no time to be sick, so I usually get vaccinated each fall.

While the girls were already vaccinated, I had yet to get my flu shot this year. I meant to do it at my doctor’s office visit last month, but then forgot to ask about it. So a little over a week ago, when I heard of more flu cases creeping into our area, I decided to get my flu shot at Walgreens while I was picking up a few other items. Cordy was with me, too, and I thought it might be good for her to see me getting a shot, to reinforce that it’s not a big deal.

I answered the pharmacist’s questions and paid my $28 for the vaccine, then waited in the little cubicle they had set up for vaccinations. The pharmacist walked in and asked which arm I preferred. Seeing how I was already seated with my right arm to the wall, I said I preferred my left. It was my non-dominant arm, and I know from experience that the muscle is sore for a couple of days after the shot.

He opened an alcohol pad and cleaned off an area on my arm. Or rather, my shoulder. I noticed the area he chose seemed awfully far up on my arm. As an RN, I never gave shots that high up on the deltoid. But I’ve also been out of clinical practice for a few years, so maybe there was a new technique I wasn’t familiar with? I didn’t say anything, because I didn’t want to sound bossy and tell this young pharmacist how to do what he was surely well-trained to do.

The pharmacist stood beside my chair and quickly gave the shot, right at the area he had swabbed on my shoulder. I felt the initial poke of the needle through my skin, and then felt nothing else. “All done,” he said. I blinked. There was no pain, not even a slight burning sensation that has always accompanied a shot. I didn’t feel anything from the injection. Weird.

I tried to rationalize my confusion, and settled on believing this young pharmacist was a master at flu shots and somehow found a way to make them completely painless. I called to Cordy, who was standing nearby, scared at the idea of me getting a shot and unable to watch, and told her, “See? I’m done. And it didn’t hurt at all.” My smile to reassure her was genuine.

Later that night, my arm felt a little sore, which I knew was common with the flu shot, and I didn’t think anything of it. The next morning (Monday), my arm was significantly more achy when I moved it in certain directions. The ache felt different from how I remembered the muscle pain from a shot before. I attributed it to faulty memory. Monday night, I noticed that sleeping on my left side was uncomfortable.

Tuesday morning, the pain was worse. I was unable to move my arm in certain directions without a sharp shock of pain. I could lift my arm directly ahead of me, but couldn’t cross it over my body, and I couldn’t lift it out to the side by more than 45 degrees without the pain keeping me from going further. I had noticed the ache occasionally traveling down my upper arm into my elbow, too. And I was starting to develop some occasional tingling and numbness in my left hand and fingers, too. Tuesday night I had to sleep on my right side or back – the left side hurt far too much, and woke me up several times when I shifted in my sleep.

At that point I started to be concerned. Muscle soreness is typical with a flu shot, but this went beyond soreness. It was now the third day after the shot, and I should have been feeling better by now. Instead, I was counting the hours between ibuprofen doses and trying to search online for why my shoulder and upper arm were reacting in this manner.

By Thursday, the sharp pain had lessened quite a bit, but the intermittent numbness and a constant low-level ache had set in. I was also starting to develop some “popping” in my shoulder when I moved it. Prodded by conversations with a few people, and by some scary information from Dr. Google, I made an appointment with my doctor for Friday.

My doctor listened to the whole story with concern, then carefully examined my shoulder and arm, trying different motions to see which movements were uncomfortable and which didn’t cause any problems. She knows I’ve never had a shoulder injury, too. (Knees are another story.) Surprisingly, she agreed with Dr. Google: I have bursitis in my shoulder, with an outside possibility of a small rotator cuff tear, too.

When the pharmacist gave the injection, he was too high on the deltoid muscle. My doctor said that a lot of women don’t have a significant amount of muscle mass at that spot on the deltoid, and directly under it is the subdeltoid bursa, a pocket of fluid that is part of the shoulder joint, designed to reduce friction in the joint.

Deltoid muscleThe deltoid muscle, in red. (Source)

So when he administered the injection too high on my arm, he went through the deltoid completely and punctured the bursa, injecting the flu antigen into the bursa. That would be why I didn’t feel any pain or burning when it was injected, and it’s also why I’m experiencing all of my shoulder pain symptoms.

Shoulder joint anatomyThe bursa is located just above the rotator cuff tendons, with the deltoid over all of it. (Source)

The bursa fluid isn’t meant to have a flu virus antigen mixed in with it. So it reacted with inflammation, pain, and stiffness in the joint. The numbness and pain into my elbow that I’m feeling is likely caused by the inflamed bursa putting pressure on the nerve.

My doctor thinks the symptoms should go away within a week or so. She recommended a conservative approach for now, and that we treat it with heat and ibuprofen. If it doesn’t get better within a week, then we may try a round of oral steroids to help it along. If that doesn’t fix it, then we’ll consider an MRI to see if the rotator cuff was damaged, physical therapy and begin thinking about long-term treatment plans.

That last sentence scares me. Long-term treatment. Long-lasting shoulder pain. I’m really hoping my doctor is right and it’ll resolve within a week. In doing research on this, I discovered that the government already has a name for this type of vaccine injury: shoulder injury related to vaccine administration, or SIRVA.

As of 2010, it’s a known type of vaccine injury, and a study on it found several identifying characteristics. In most cases, those affected were women, the person administering the injection was standing while the patient was seated, and the injection was placed too high on the arm, resulting in the injection being delivered into the bursa.

This led to the recommendation that “the upper third of the deltoid muscle should not be used for vaccine injections, and the diagnosis of vaccination-related shoulder dysfunction should be considered in patients presenting with shoulder pain following a vaccination.” (The Dept. of Health & Human Services accepted this recommendation, along with also recommending that the person administering the vaccine be seated if the patient is seated to reduce error.)

A report on this injury was given during a 2010 Advisory Commission on Childhood Vaccines meeting (pages 15-28 or so), where it was revealed that among those without prior shoulder injuries, only a third who developed SIRVA ever fully recovered. Meaning there’s a chance that an improper injection can lead to life-long joint pain in that shoulder.

And here’s the kicker: I still don’t have any immunity to the flu. My doctor said it’s unlikely that I gained any immunity from that shot, since it went into the bursa and not the muscle. I paid $28 to be given subdeltoid/subacromial bursitis, that has a chance of causing chronic shoulder pain. Lovely.

I don’t want anyone else to have to go through this, so here are a few tips for you the next time you have to have a flu shot (or any vaccine injected into your arm):

SIRVA: shoulder injury related to vaccine administration

1. If it seems too high of a position, say something! I wish I had followed my own advice here. A shot should not be given just under your acromion process (the knobby end of your shoulder), but should be given at least two finger widths down. Needle size should be carefully considered, too. Better to say something rather than be injured. Not sure how to bring it up? Try this as a starter when the alcohol pad is rubbed on the spot: “Huh, that seems really high on my arm. I don’t remember getting any other shots that high.”

2. Ask if you can stand while the shot is given. If the provider would prefer that you sit, ask that person to sit as well, so that you’re both at the same level. Injecting from above tends to result in the injection being given higher on the deltoid, which increases your risks. Trying to estimate two finger widths down while standing provides a skewed view of the site and means your shot will likely be placed too high.

3. For the flu shot, ask if you’re eligible for Flumist. The Flumist version of the vaccine is sprayed into your nose – no needles! Not everyone is a good candidate for this version of the vaccine, since it’s a live vaccine, but if you’re eligible you’ll prevent any needle injury by avoiding it altogether.

4. Consider who administers your shot. Pharmacies are convenient for flu shots, but how well do you know your pharmacist? Many may not have the experience of your doctor’s office nurse. On the other hand, you may have a better relationship with your pharmacist than your doctor’s nurse. Ideally, you want someone who has a good amount of experience in giving shots, and who gives them with some regularity.

However, one point regarding this: sometimes, you get a bad shot, no matter the person giving it. I’ve had my flu shot at Walgreens in the past, by one of their pharmacists, and didn’t have any issues. Nearly any medical professional has a risk of giving a bad shot, even if they’ve been involved in your care since you were a baby. That’s why it’s important to pay attention and ask questions if something seems wrong, even if the professional is someone you trust.

I’m not going to say that the solution is to never get another shot. But I do think we should all consider each shot as a careful medical procedure. Any medical procedure has the ability to help, but most also have the ability to harm if done improperly. We should be cautious in who we choose to give us a shot, and we shouldn’t feel dumb or bossy to speak up and ask questions if we’re uncertain.

As of today (1 week, 2 days after the shot), my shoulder has almost a full range of motion again, although a few movements continue to be painful. A low-level ache is present nearly all the time (I’m told this is what arthritis feels like?) and I still can’t sleep on that side. I have occasional numbness/tingling in my fingers, but it’s less and less each day.

I have noticed a significant weakness in that joint now, so I’m taking it slow and easy with lifting anything or too much movement. And the “popping” in my shoulder has continued – with certain movements you can hear the pop across the room. I had a chiropractor recommended to me, and I will likely give him a visit to see if he can help. Hopefully it’ll be resolved soon and the only popping and ache will be the standard ones in my knees.

UPDATES

To see more about how I’ve been dealing with SIRVA, I’ve provided links to my update posts below:

An Update on My Shoulder – one week later

The Ongoing Shoulder Saga, Episode IV (A New Hope?) – one month later

Flu-Shot Shoulder Update – nine months later



2014: The Year of Enough

As we all shook off our New Year’s Eve sleepiness, I noticed a lot of friends discussing their word of the year. If you haven’t heard about this yet, it basically involves choosing a word that will be your focus for all of 2014. Sort of like a mantra to shape your goals around, only condensed down into a single word.

I really liked this idea, so I decided to try it for myself. Yes, today is January 4, and I’m just now getting around to choosing a word. Not that I haven’t been thinking about it for days. No, I’ve been thinking about it a lot, and have been completely stuck on choosing a word.

I had a list of words, all missing that spark of inspiration I was looking for. At one point, I was looking over my options and realized how insane this was to spend so much time agonizing over a word of the year. I mentally yelled, “ENOUGH!” – and that’s when it hit me.

My word of the year is enough. There are so many ways to interpret this word, and nearly all of them are applicable to my goals for the year.

Enough

First, I want to continue the work we’ve done in decluttering the house and reducing what we have. Because we have enough – more than enough, really, and I need to accept that we don’t need anything more. It’s so easy to develop the “wants” when seeing what others have, but will buying more stuff really make me feel better, or will it just contribute to more clutter and distraction? I’d like to be more mindful of my purchases this year, and consider if it’s a necessity, or if I should pass on it because we have enough.

I also want to use the idea of enough to cultivate a greater sense of gratitude. I’m thankful for my husband, for our two healthy daughters, and even for our pets. I’m grateful that our girls are growing up with a lot of extended family around them. We have a nice house, we have good jobs, we have our needs met and the ability to acquire some of what we want. We have enough, and I want to internalize that sentiment deep down so I can truly appreciate all that we have.

Gratitude is having enough

At the same time, “enough” can have a more stern interpretation, in the “enough is enough” variety. There are several nuisances that we tolerate because it’s too much time or effort to resolve them. It often takes a lot to push me to take action on these issues, when I should have put my foot down far sooner. There comes a point where you have to stop trying to go around a wall and make the choice to climb over it instead. I need to either change course to combat these irritations directly, or I need to drop them entirely and find alternatives.

I far prefer to live the easier life of following the rules and expecting people to do as they’re supposed to do in their jobs and lives, but I can accept that it isn’t always the case. When that happens, I have to decide that I’ve had enough and take action to change things. I had already started this in the fall with my outrage over the school district, and my feelings towards the district have only intensified. I’m done with bureaucracy and trite statements from those in positions of power that are meant to placate but accomplish nothing. I’ve had enough with the parent almost always being considered the least qualified person in the room to know what’s best for her child’s education. It’s time to advocate for those issues that are nearest and dearest to me.

Knowing when you've had enough.

And finally, I’ve reached a point in my life where I can begin to embrace that I am enough. I don’t need to compare myself to others, wishing I could have their talent, their experience, their looks, because they haven’t been on the same journey that I have, and it’s possible they’ve been through experiences I’m glad I missed out on. Comparing myself to others accomplishes nothing other than making me feel bad about myself, because my inner (high school bitch) critic will never admit to any strengths I possess.

I’m not perfect, or even close to it, I’m quirky, and there are plenty of weak spots I want to strengthen in myself, but I am enough for my family, for my friends, and for my colleagues. And quirky is the new normal.

Good enough

So here’s to 2014 providing enough for all of us.



Christmas Day Surprise

The past few days have been a blur of cleaning and prepping for Christmas, followed by the flurry of activity going to Christmas parties and hosting some of my family here at our house on Christmas Day. We got everything ready in time, even though being “ready” partially involved throwing piles of clutter into closed off rooms or into the garage. And after everyone left, well, it was right back to clearing out the mess of the day.

Despite the chaos, there was the beautiful quiet of early Christmas morning, when it was just the four of us in our pajamas, gathered in front of the tree downstairs, the girls smiles shining through in the dim light as they waited to open their presents.

It was a very Frozen Christmas for Cordy and Mira. They both fell in love with Disney’s Frozen (we all did, really), and they have been talking about how much they want to meet Elsa and Anna someday when we go back to Disney World, assuming the two princesses are still there.

They went to Disney for the first time earlier this year. It was a fantastic family vacation, and we promised them that we’d go back again in two or three years, when we could save up the money for a big trip again.

A couple of months ago, I found out about the Type-A Workshop being held at Walt Disney World this spring. I registered for the conference, hoping we’d be able to find a way for it to also work out as a family vacation as well. Aaron and I studied our finances and started putting money aside, hoping we could make it work. We didn’t tell the kids, just in case it didn’t work out.

But it has come together and we’ve made the reservations for Disney. Aaron and I continued to keep the secret, planning to surprise the kids with the news on Christmas Day. Do you know how hard it is for me to keep a secret that big? I nearly slipped in front of the kids several times.

So early on Christmas morning, Cordy and Mira came downstairs to find a giant box under the tree, and they asked to open that one first, even before their gifts from Santa.

I think you could say our surprise was a success (apologies for my shaky-cam amateur videography skills):

They spent the afternoon showing off their dresses to family and telling them about how we’re going to Disney. They didn’t know at first that all of the family were in on the surprise until they started opening their presents and noticed that their great aunts and grandmother gave them Disney gift cards, too. (Aaron and I also received Disney gift cards to help cover the trip.)

It’s official: we’re going to Disney in the spring!

How was your Christmas?



Even Dogs Have Clothing Fit Issues

It’s been two years since we first met Cosmo and brought him into our family. And since that time, he’s grown from a lanky pup with gigantic paws into the solid dog (still with gigantic paws) that he is today.

 Cosmo as a puppyCosmo at 5mo old

Even though he’s nearly one hundred pounds now, he still gets cold easily. That large size didn’t come with a lot of fur. He’s got the ultra-short pit bull coat that is nearly bare on his underside, and he doesn’t have a large amount of fat for insulation. So when he goes outside on frigid days, he gets cold. It’s common to see him dash to the fireplace after a trip outside, trying to warm himself while he shivers.

Last year I bought Cosmo a sweater for the holidays. He didn’t seem to mind wearing it, but he didn’t seem particularly thrilled with it, either. And I felt a little like the crazy dog lady who dresses up her dog like a child.

But as fall arrived this year, I noticed that the cold did affect Cosmo. We had bought him a cute Superman sweater for Halloween, and I put it on him a couple of weeks ago when it was particularly cold. I’ve never seen a dog look so happy in a sweater. He seemed upset when I took it off of him. The next day, when I held it up, he practically put it on by himself, lifting his paws in advance of me taking them to guide them into the holes. I can’t feel guilty about putting him in sweaters anymore – he clearly likes it and wants additional layers of warmth.

Now, it’s not easy to find sweaters for Cosmo. He wears an XXL. I know, right? He’s not THAT big of a dog. But his chest and neck are so massive that nothing less than an XXL will fit across his front half.

I wanted to find something warmer for him for the freezing days ahead of us, so I looked online and found a sweatshirt for dogs. It came in XXL, and the description even mentioned that it was designed to fit dogs with a thick, muscular neck. I checked his measurements against the size chart, and he easily fell within the requirements. Even better, it opened in the back with velcro – if it was too loose on his back half, I could possibly add more velcro to make it tighter.

When it finally arrived this week, I pulled it out of the bag and Cosmo was immediately sniffing it. It was a nice heavyweight sweatshirt material, so I knew it would be plenty warm on him. Cosmo wouldn’t leave me alone, so I tried it on him right away.

Um…this is an XXL?

An XXL dog sweatshirt?
It fit without any trouble around his back half, but the top 4″ or so were impossible to close around his deep chest and neck.

Too small dog sweatshirt

Cosmo's too-small sweatshirt

Poor guy. He was so excited to get new clothing, and it’s too small for him to wear. I feel your pain, Cosmo. Clothing never fits me right, either. Your chest, my hips – we’re not made for standard clothing templates.

Only in his case, there’s no option above XXL.

Is there a Big & Tall clothing store for cold dogs?



Eight Years and You’re Still Reading!

Way back in November 2005, I was a mom to one 14 month old girl. Due to work issues, I had switched to a part-time job just so our daughter wasn’t spending her entire time in daycare while we worked. I didn’t have a lot of friends with children, and most of the ones who did lived out of town.

Cordy & momIt was because of this that I found support and community in online groups and blogs, nearly from the day she was born. My virtual moms groups helped me get through the early days of parenting without a breakdown. It was through reading the stories that others shared online that I learned important things like Hey, my kid drools like a fountain, too, it’s normal! and Colic gets to the best of us. I’ve felt like abandoning my baby in a cornfield, too. It’s fine as long as we don’t act on it.

The online moms (and a few dads) that I visited each week shared their stories with the world, and I was one of the new parents benefiting from their experience and their willingness to be candid and open in sharing their lives. They were my lifeline.

I was already documenting my life as a new mom online, only not in such a public way. I had a LiveJournal account, that I had opened years before 2005, and used it to write the everyday moments I was experiencing as a mom. But most of our friends weren’t parents, so there wasn’t much advice to be had in that small corner of the internet.

So on this day, eight years ago, I took a deep breath and started my own blog. I had to try a few different blog names before I found one that wasn’t already taken.

an old, old headerOne of the earlier headers for my site, when Cordy was still the solo leading lady.

I made the decision to share my story for all. Of course, I figured “all” would be primarily my friends and family, and perhaps a few of the mom friends I had made online. Never did I guess that so many people would come to visit this site just to read about our life! But they have, and I truly appreciate those who stop by and take an interest in my story. Some of it is to help others know that they’re not alone in whatever funny, sad, heartwarming, difficult moments they’re going through, some of it is purely for discussion with the community or getting advice from others, some of it is sponsored to help with the costs of keeping the lights on (but always on topics I’m genuinely interested in).

And some of it is purely for me.  My space to let my thoughts be free on whatever topic is affecting me at that moment, or a way to remember certain milestones or events with Cordy and Mira. The topics have changed as they’ve grown older, and will likely continue to change and morph as we all grow and develop new interests. That’s the fun part of growing – you never stay the same, and growing doesn’t stop when you reach adulthood. In that same sense, this blog is alive and growing along with us, testing out new adventures and trying new things. It’s exciting.

Eight years ago, I could build a website in HTML, but my skills in blog design and coding were lousy. I’ve improved so much since then and even made my own transition from Blogger to WordPress without help, now helping others with basic code issues and changes. In those eight years, I also had a second child, got an autism diagnosis for my first child, picked up a degree and license in nursing, adopted a dog, went back into working in a technical field, where I first started, and celebrated ten years of marriage. It hasn’t been the most easy path, but it’s my path and, like many folks who have had a hard few years, I’ll continue doing the best I can to learn and grow from it.

I’m not sure if I’ll keep the name A Mommy Story forever, since I’m starting to outgrow the label of “mommy” with my own kids, but it’ll continue to be with me for the time being. Or at least until I can decide which name to switch to from the dozen or so domain names I have saved up. I may have a hoarding problem.

But what I appreciate the most about this blog is the community of friends and colleagues I’ve gained as a result. It’s not just a few virtual mom friends. I’ve met many of you in person now, chatted with others in long email threads and text chat, and still keep widening my circle of smart, talented people I’m proud to know. (And for some of you, work with!) I’m not a famous blogger with hundreds of thousands of pageviews each day (more like low hundreds only on an average day), but the people I’ve met as a result of this little blog are worth far more to me than fame.

Today’s my eight year anniversary of starting this blog, and I’d like to just say thank you for reading my often long, ADD-disorganized, not-always-eloquent thoughts. That anyone comes back repeatedly to read what I write (aside from Aaron, who I’m pretty sure is required to under the terms of our marriage vows) is a gift to me. I hope I’ll continue to write things you want to read, and that you’ll grow along with me.

Toast

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