'Fraidy Cat Learns: IM Injections

So my birthday was a few weeks ago, and this year I decided to treat myself by getting a little work done for Charlie. Like ya do, right? Don't all "our" presents kinda end up being "horse" presents in the end?

the look of a horse who knows what's coming lol

Anyway, nothing was wrong with Charlie, generally speaking. Like, obviously we were fresh off two great horse shows where Charlie demonstrated his total and complete physical fitness for the job at hand. Obviously, that made me pretty happy, right?

But he was due for his hocks anyway, plus I was kinda interested in repeating the whole "overall wellness check" we did about 6 months ago. Meaning, the same vet came out and we repeated all the same flexions etc (omg soooo much jogging tho....) and compared notes against last June.

yep, that's a sleepy charlie!

Overall, the vet felt like Charlie was presenting better than he had last time, and she'd been generally pretty satisfied with his soundness and condition then anyway. So, ya know, that's nice to hear haha. Particularly, we talked about her feedback from last time on my approach to conditioning Charlie.

If you recall, she basically said last summer that my understanding of conditioning was kinda back-asswards. I was very preoccupied with low-impact work, and "protecting" Charlie from too much high impact. I had this idea of "saving" him, like limiting his jumping etc.

Which, the vet argued that this was not right. She said the purpose of conditioning a horse is to help prepare the horse's body for handling the work. So, if galloping and jumping are part of the work, they need to be part of the conditioning. Obvi you don't generally go full intensity (max speed / max height / max duration). But there has to be shades, ya know?

And... it made a lot of sense when she broke it down like that, right? If I haven't jogged in ages, the first time I go a couple laps around the block might make me pretty sore. But as I get used to introducing that type of impact to my body, all the joints and muscles and sinew become more adapted to that impact. That's uh.... how conditioning works lol.

post-injections restrictions means that homeboy was dying for a good roll!

So yea. Anyway, I made changes to our program since then. And overall the vet was happier with Charlie's general condition and felt like he was presenting a pretty good picture going into the off season.

We still opted to do his hocks, bc that's basically a standard element of Charlie's maintenance package anyway. Plus we added in his front coffins. This year was brutal for hooves with the ground being so hard for so long, and we've had a hard time keeping Charlie as comfortable as I'd like on his feet. Probably this particular treatment will not become part of the "routine," but it made sense given our current conditions.

and a good shake too, obvi haha. i just <3 his goofy face tho

We also spent some time talking about less invasive ways to continue promoting Charlie's health and soundness proactively. Particularly, I asked about feed through and IM supplements.

Like most vets I've talked to, there are very limited circumstances where they recommend most OTC feed through supplements. Tho we did talk a little bit about options like Equioxx, the vet felt like at this particular moment something IM might be a better fit.

She told me that recent research has shown that drugs like Adequan don't necessarily have any increased benefit when given regularly (like monthly, for instance). Rather, she's now of the opinion that doing one boxed treatment (7 doses given one per every 4 days) is sufficient for overall general support.

one box contains 7 doses intended for administration every 4 days

She suggested it's more cost effective to do a box once or twice a year, rather than routine monthly shots. And that this approach can help make the other treatments I'm doing for Charlie last longer and be more effective.

So I picked up a box during that appointment, and a couple weeks later we started the treatment. Which brings us to this post's whole point: administering IM injections.

My barn manager has typically handled Charlie's stabby-jabby needs for me (like the many doses of IM antibiotics he's needed over the years....) but this seemed, for whatever reason, like the right time to learn how to do it myself.

single dose vial. it's really not a huge amount, especially compared to to some of the syringes of excede charlie's had to get in the past!

It's honestly not typically considered a very big deal, in the grand scheme of things. Most of my barn mates are more than comfortable giving IM shots, and this particular drug has pretty low risks overall, even if you end up accidentally sticking yourself or injecting into the wrong spot.

Of course, there are other drugs where that is absolutely not the case. Like... If you accidentally stick your own self with depo or dormosedan, you're.... gonna have a bad time. And some drugs can be extremely dangerous to the horse if they end up going directly into the blood stream instead of the muscle.

It's kiiiiiinda hard to "accidentally" go IV vs IM (into the vein vs into the muscle), but still. Steps should be taken to avoid the drug going literally anywhere except where you want it. The very first (and most critically important) of those steps is: consulting a professional. End of story.

I am *NOT* a professional by any stretch of the imagination. I'm nowhere near qualified to provide guidance on this subject. But I'm into learning more about the horsey experience, and sharing those learnings with y'all. The general takeaway from this whole thing is: if you're interested in learning how to administer IM injections, it's actually pretty easy with the right instruction.

the whole kit 'n kaboodle

For me, the first step was familiarizing myself with the equipment. Meaning, using my own hands to put stuff together, rather than just watching. Bc let's be real, I learn with my hands.

The box (part A in the above picture) included all the necessary parts plus a few spares. Notably, it included one extra needle (B1 and B2). I guess the idea is to have a spare in case you lose or contaminate one. My barn manager suggested that I use the spare as a "sacrifice" needle, tho.

The needle must pierce the rubber stopper in the vial (D) in order to pull out the dose, and this dulls it slightly. Rather than try to inject the horse with a slightly dulled needle, she suggested keeping one sacrifice needle to always use for pulling the drug into a fresh sterile syringe barrel (E), then using a fresh sterile needle (C) to inject into the horse. This way the horse always gets the sharpest (and therefore most effective) administration.

sacrifice needle marked by tape. should you happen to be ordering needles separately from your drug of choice, my BM recommended "luer lock" needles that have caps that screw/thread on to the needle vs these that pop on and off. the popping off can be a little challenging, or at least i thought so. 

Each needle tip comes in its own protective sterile casing, which can be used keep the "sacrifice" needle safe between uses. We marked this case with blue tape so it was always obvious which to use.

The vials themselves also have little plastic caps that you flick off with a finger nail to expose the rubber stopper that you see in the pic above. So the whole system is pretty well protected for this sacrifice needle that only ever comes out to punch those rubber stoppers.

fresh needle tip on syringe barrel that was filled using the sacrifice needle tip

I actually found that there was a bit of a learning curve to using the syringe barrel and plunger to pull the fluid out of the vial. It's not necessarily hard, it just takes me a couple tries of pulling the plunger down, then letting it rise back up again, then pulling down again, until eventually all the fluid is pulled from the vial and into the syringe barrel.

From this point, you just release any air trapped inside the syringe (again tho, my BM assured me there was no real risk to air bubbles -- that I could inject an entire syringe of air into Charlie's neck and he'd be totally fine. I, uh, obviously do not recommend testing this out).

Then I put the sacrifice needle back into its case (carefully!) and put a new fresh needle onto the syringe, leaving the protective case on until the last possible moment. Mostly, ya know, to avoid stabbing my own self lol.

the "TRIANGLE" plus shiny wet spot marked by alcohol wipe, where we administered the injection. please note my triangle lines are rough estimates based on my limited experience. please consult a professional for in-person guidance.

Honestly the hardest part for me is the act itself. I'm mostly pretty comfortable with understanding the right area in which to aim my injection, roughly the triangle above (again, please seek professional help before trying yourself!). The "triangle" is the space in front of the shoulder, above the spinal column and below the crest, where there's lots of nice deep muscle.

My barn manager suggested "marking" my intended location with an alcohol prep pad (F in the earlier diagram) used to clean the site. She said she likes to grab a pinch of skin both to tighten up the area plus sorta give the horse a bit of a warning. Then she knocks the site 2-3times with a knuckle, then boom. Stabby jabby.

The needle must go directly into the muscle, all the way. Which like, does indeed skeeve me out more than a little bit. Actually, for Charlie's first dose I chickened out at this point and made BM do it. The second time tho... I was determined that I *would* learn this thing.

So I did it! And? It was fine. The sharp needle really helps. Also it helps that Charlie's been stabbed and jabbed every way imaginable during his lifetime. He straight up does not care haha. Good boy <3

clearly he survived. this time.

Once the needle is all the way in, it's a good idea to do a little pull on the plunger to make sure you're not in a blood vessel. Again tho, it's kinda hard to do that by accident lol.

If that's clear, then plunge away. I wanted to go a little slower in pushing the fluid in than was called for - esp with such a thin liquid in such a small amount. If it were a fussier horse I'd definitely have to go faster. Tho if it's a higher viscosity drug (like excede) you can't go too fast or you risk blowing the syringe barrel off the needle tip.

And then... That's it! That's all there is to it. The used needle tip should go into a "sharps" bio-hazard container to ensure the safety of anyone handling waste materials down the line. But otherwise, the horse is good to go for another 4 days until the next dose.

In a way I'm really glad I'm finally learning this skill. I don't ever expect to keep horses at home, so some of these more delicate medical tasks can generally be left to the professionals managing the care of my horse at boarding facilities. And, for instance, I don't really have any undying urge to learn how to do an IV injection.

But IM injections are pretty accessible, relatively low risk (depending on the drug) and extremely common in day to day horse care and keeping. So it seems useful to at least be comfortable with the equipment and process.

Maybe you already know how to do them? Or are interested in learning in the near future? Or haha maybe the idea of stabbing your horse with a needle is an absolute no go???