Welcome to GP2Health Injection Therapy

To understand the nature of the issue requiring any injection therapy and whether it is appropriate and safe, a clinical story and physical examination must be done prior. An investigation may also be required. This is called the "Work-up". If you have already received a work-up for example from your physiotherapist and can demonstrate evidence, we may proceed direct to injection therapy. 

Most commonly these are given for pain and swelling associated with the soft tissues. In some cases it can support healing. It can be used to inject in or around soft tissues such as tendons, ligaments, cartilage, bursae, nerves and joints. 

A full description of risks will be explained and written consent taken prior to any injections. You will be given time and space to give informed consent. 

How often these reactions occur is difficult to say. Large Cochrane studies have found that there is a similar number of side effects in placebo and Cortisone injections.

Some of the common risks and side effects are:

1. Temporary Pain: Mild pain or discomfort at the injection site is likely to occur but will usually rapidly resolve over 2 days.
2. Infection: Though rare, there is a small risk of infection at the injection site. This occurs typically after 3 days and will be red, angry, sore and swollen. If you experience any of these issues please let us know ASAP or contact 111. There are also reports that injections may increase the risk injections such as shingles, urinary tract infections and pneumonia (lung infection).
3. Tendon Weakening: Repeated injections close to tendons can occasionally lead to weakening or a tear in the tendon. We limit the number of steroid injections at one site to 2 per year.
4. Advancement of Arthritis: Repeated Cortisone injections into a joint can result in the development and progression of osteoarthritis. We limit the number of steroid injections at one site to 2 per year.
5. Allergic Reaction: In rare cases, some individuals may experience an allergic anaphylactic reaction to the Cortisone. It is important you know what your allergies are. We will have equipment on site to deal with this scenario.
6. Bleeding or Bruising: This is more common in patients who have blood clotting disorders or those taking blood thinning medication. We will explore your medical history and medications during the consultation prior to any injection.
7. Skin discoloration: Occasionally patients will develop a discolouration of the skin at the injection site. The fat underneath the skin may shrink which can also cause a dimple. These issues generally resolve with time but not always.
8. Altered Diabetic Control: Patients with diabetes should have good control of their diabetes prior to a Cortisone injection. The risk of infection after surgery or injections with poorly controlled diabetes is huge.  We will ask for your latest HBA1c (long term diabetic control marker in blood). If you have not had one in the last 6 months we will insist this is taken before proceeding. We will not inject or perform surgery if your HBA1c is over 65.

• Shortness of breath and a Racing Heart

During exercise, it is normal to experience some shortness of breath and a racing heart because there is an increased demand for oxygen in your body. If you are iron deficient, your blood may not contain enough oxygen for your muscles to do everyday activities such as walking.

Your body tries to make up for this by increasing your breathing rate to get more oxygen into your body, and by increasing your heart rate to help move the oxygen around your body.

• Sore tongue or dry mouth

Iron deficiency can affect the surface of your tongue making it feel sore for no apparent reason.

Likewise, you may have an uncomfortably dry mouth even if you have been drinking plenty of liquids.

• Cracks and ulcers in your mouth

Iron deficiency can also cause the appearance of sore, red, flaky cracks at one or both of the sides of your mouth. This feels more extreme than when your lips are chapped due to cold weather.

Mouth ulcers are sore white patches on the inside your mouth. There are many reasons why you might have mouth ulcers, including biting the inside of your mouth, stress and being run down, but another reason could be iron deficiency.

• Cold intolerance or cold hands and feet

If you feel the cold easily or regularly have cold hands and/or feet even in warm environments, it may be that there is not enough oxygen being delivered in your blood to your hands and feet, which could be a result of iron deficiency.

• Craving to eat non-food items

Craving certain foods from time to time is normal, especially during pregnancy. However If you have cravings to eat ice or non-food items such as clay, dirt, ash, and starch this could be a sign of iron deficiency.

This kind of eating disorder is also called “pica”. If you are eating ice regularly you may also want to discuss this with your dentist as frequently chewing ice can damage your teeth.

• Restless leg syndrome

Restless leg syndrome is a disturbing need to move your legs when resting, such as when you are in bed. This distressing feeling often goes away when you move your legs.

It is possible to have restless leg syndrome but not be iron deficient, but if you are iron deficient you are nine times more likely to experience restless leg syndrome than the general population.

• Hair loss

It is natural for some hair to fall out when you are washing or combing it, but if you are losing clumps of hair, or more hair than normal, it could be caused by iron deficiency. Increasing your iron levels could stop or reduce your hair loss.

• Brittle or spoon-shaped nails

Brittle nails chip and crack easily. Spending a lot of time with your hands in water or using some nail polishes can lead to brittle nails, but brittle nails can also be a sign of iron deficiency.

Another sign of iron deficiency is ‘spoon-shaped nails’. These are nails that are dipped in the middle and raised at the edges to give a rounded appearance like a spoon.

• Headache

Headaches can occur for many reasons, such as colds, being dehydrated or eyesight problems. Repeated headaches could also be a sign of iron deficiency.

• Increased susceptibility to infections

If you seem to be picking up more infections than usual, such as coughs and colds, this could be a sign that you have iron deficiency. Iron is needed by your body to maintain a healthy immune system.

• Dizziness, irritability and loss of concentration

Feeling irritable, dizzy or losing concentration quickly could be due to iron deficiency. Iron helps your blood deliver oxygen around the body, and feeling irritable or dizzy may be a sign that your brain is not getting enough oxygen.

• Bruising

In iron deficiency anaemia, the bone marrow is ‘starved of iron’. As well as not being able to make enough red blood cells (anaemia), there can also be a reduction in platelet production. Platelets are the first step in blood clotting, so a reduction in platelets leads to increased bruising.

• Looking Pale

Haemoglobin is a red-coloured pigment. If you are iron deficient, there may be less haemoglobin in your blood and you may look pale. For some, this is most notable on their face, nails, inner mouth and the lining of the eyes.

If you pull your lower eyelid down, the colour of the lining should be a rich, red colour. If it is a very pale peach colour or yellow, this may indicate that you have iron deficiency or iron deficiency anaemia.

Your body contains about 4000mg of iron. You normally have about 1000mg of iron in reserve stored in Ferritin. So if iron deficient you are at least 1000mg behind. Changing your diet and taking iron tablets can slowly improve your iron stores at about 200mg each month as the body can only absorb a limited amount of iron per day and it may take months for you to feel better. By adding iron directly to your blood through intravenous infusion you can rapidly replace all your iron stores in one treatment and patients often report feeling better in days. How much iron you require depends upon your weight, ferritin levels and whether you are anaemic or not. 

There are numerous other reasons:

• In our experience, patients find it difficult to take long term oral iron due to common side effects like diarrhoea, nausea and abdominal pains. 
• It is very slow and there are restrictions to who is given an iron infusion within the NHS.
• Some patients simply do not absorb iron tablets / liquid very well and despite months of treatment they are still low deficient. 
• If you need to get your iron levels up quickly (eg. before major surgery, late in pregnancy or to avoid blood transfusion) this is the quickest method.
• Patients with chronic kidney disease or chronic heart failure have numerous reasons why they are low in iron and often can not meet their iron intake requirements. 

Generally, when side effects do occur, they are mild and settle down on their own. The most common side effects are temporary and include: 

• Headache, feeling sick or vomiting, muscle or joint pain. Slowing the infusion down helps.
• Changes in taste (eg. metallic). 3-4 people in 100. Disappears 15 mins after infusion.
• Skin staining (brown discolouration) may occur due to leakage of iron into the tissues around the needle (drip) site. This is not common but the stain can be long lasting or permanent. 
•  Other side effects that are rarer following treatment of iron include lowering of blood pressure, tingling, or numbness of the limbs, abdominal discomfort, muscular aches and pains, fever, rashes, skin flushing. 
• Although very uncommon, some people may have a serious allergic reaction. In rare cases this can be life threatening. We have medications on hand to manage this prior to an ambulance arriving. 

You will be closely monitored while IV iron is given with regular observations and for 30 minutes after. Sometimes side effects (e.g. headache, muscle or joint pain) can start 1 to 2 days later. Mostly they will settle down by themselves over the next couple of days.  

Overall, about 3% of people who receive intravenous iron do feel some side effects the vast majority of which are mild and self-limiting. The major risk (anaphylaxis) is calculated at less than 10 people in a million. 

This can be a very painful shoulder condition resulting in reduced movements of the affected shoulder. There are numerous causes which we can explore with you in consult. We inject the shoulder joint with sterile salty water (saline), local anaesthetic and Cortisone which stretches the joint covering (capsule) allowing greater movement and ultimately giving pain relief. We strongly recommend a course of physiotherapy to start ASAP after the injection to maintain the improved movement and pain.

Arthrosamid is a non-biodegradable injectable polyacrylamide hydrogel. This is a thick gel acts a "soft cushion" between the bones of the knee to relieve pain. More information can be found here: Arthrosamid Treatment. What to expect during your iron infusion is found below in the downloads section. 

Some fluid filled cavities or lesions contain think viscous gelatinous fluid like substances. Sometimes these cannot be aspirated with a wide bore needle. In this case a small cut can be made under sterile conditions to remove the fluid contents.