X marks the spot

Injury update:

It's been 72 days since the injury first reared its ugly head, up in Noosa (not that I'm counting!) In that time, I have had x-rays, a bone scan, and today it was a cortisone injection. The problem is the injury is not improving despite the very limited running I am doing - it still aches when I run, aches when I stop and aches in the middle of the night, or when I go down stairs, or just because it can. The periostitis is very localised - I can point to exactly where it is tender. For some reason, doctors and physios take great pleasure in applying some force to this particular spot and then asking, with a straight face, whether it hurts - one look at my face gives them the answer.

So the sports doc poked and prodded again today, muttering about how the symptoms still point to a stress fracture and debating whether I should have an MRI before the cortisone injection. However, we opted for the cortisone injection first, and then if it hasn't improved in about a week's time, I will have the MRI. This injury is going to send me broke!

Naturally I googled 'cortisone' before the visit to the doc today and came up with the following information:

How do cortisone injections work?
Cortisone is a powerful anti-inflammatory medication that occurs naturally in the body to controls and assists normal body functions. When therapists use cortisone to treat tendonitis, bursitis, and arthritis it acts as a potent local anti-inflammatory drug. Cortisone is useful in suppressing inflammation in the short term, and in the long term, dissolving scar tissue, stabilizing the body's defenses, speeding the healing process, and is very effective in causing certain cysts to disappear.

Cortisone is not directly a pain relieving medication, as it only treats the cause or site of inflammation. Your pain is decreased by a cortisone treatment because the inflammation is diminished and this is turn reduces the pain. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum.

What is cortisone?
Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisone is released from the adrenal gland when your body is under stress, and natural cortisone is released into the blood stream and is relatively short-acting. The absence of cortisone in the body is called Addison's Disease.

Injectible cortisone is synthetically produced but is a close derivative of your body's natural product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation. Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes).

Are there side effects to a cortisone injection?
Unfortunately yes. Probably the most common side-effect is a 'cortisone flare,' a condition where the injected cortisone crystallizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or two and is best treated by icing the injected area.

Another common side-effect is whitening of the skin where the injection is given. This is only a concern in people with darker skin, and is not harmful, but patients should be aware of this.

Other side-effects of cortisone injections, although rare, can be quite serious. The most concerning is infection, especially if the injection is given into a joint. The best prevention is careful injection technique, with sterilization of the skin using iodine and/or alcohol.

Also, patients with diabetes may have a transient increase in their blood sugar which they should watch for closely. Because cortisone is a naturally occurring substance, true allergic responses to the injected substance do not occur. However, it is possible to be allergic to other aspects of the injection, most commonly the betadine many physicians use to sterilize the skin.