# Warning @ Banamine injections(IM)



## Camelotcavs (May 18, 2010)

This is specifically about a big horse but I have had horses for 30+ years and never heard about this before. I have permission to post photos.

This is how he looked:







This is an AQHA Champion stallion who was kicked during breeding on May 10th and was injected with Banamine.
















He has dropped nearly 200lbs in weight during this ordeal and more lacerations were made this morning (this photo was taken yesterday).

This has definitely been a learning experience and he is still in real danger of not surviving.

Following is an article from horse.com:

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by: Tracy Norman, VMD

January 11 2006, Article # 6466

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If you have horses, you've probably at one time or another found yourself in the following situation. You arrive at the barn to feed for the evening and your gelding, who is usually a chow-hound, doesn't come up for dinner. After you bring him up to the barn, you notice that he's been rolling, and he paws and looks at his sides. Concerned by these signs of colic, you call your veterinarian, but she's on another call and won't arrive for at least an hour. His continued signs of pain worry you, and you remember that there is a bottle of Banamine in the tack room medicine cabinet. You want to give this effective pain reliever to your horse, but don't feel confident about giving intravenous injections, and know that missing the vein can have very serious side effects. You remember hearing that Banamine can be given by the intramuscular (IM) route, and the label on the bottle indicates that this is an approved route. Moreover, you feel comfortable giving an IM injection, as you have seen hundreds of these shots given, and you and your veterinarian have discussed how best to administer IM injections. You wipe the top if the bottle with an alcohol swab, draw up 10 mL of Banamine using a sterile syringe and needle, and head for your horse's neck, ready to give the injection.

Now it is time to STOP: DON'T GIVE THAT BANAMINE SHOT IM!

Why Not Inject?

IM injections in horses are fairly easy to administer, and many horse owners find this route convenient, especially when a veterinarian is not available to give an intravenous shot. Vaccines, hyaluronic acid products, some antibiotics, sedatives, vitamins, antihistamines, and some anti-inflammatory drugs are labeled for IM use in the horse.

Product labeling is not a guarantee of safety, however, and it is important to remember that any invasive procedure carries with it some degree of risk.

Specific to IM injections is the risk of a disease known as clostridial myonecrosis (also known as "gas gangrene"). This is an uncommon condition that can be associated with any penetrating soft tissue injury in the horse, including a needle puncture. When it occurs as a complication of an IM injection, it is usually associated with the injection of a relatively large volume (greater than 5 mL) of an irritating substance.

Injectable ivermectin, antihistamines, and flunixin meglumine (Banamine) are the drugs most commonly associated with the disease (1,2,3). In the case of flunixin, this risk is probably associated with its very high frequency of use, rather than the product itself. Although flunixin is only available through a veterinarian, many barns have bottles sitting on the shelves, sometimes for long periods of time. Owners and trainers, either while awaiting the veterinarian or as a first line of treatment, often give horses with fever or mild signs of discomfort IM flunixin meglumine. Although this practice is very common and usually uneventful, the potential consequences can be devastating.

What Is It?

Clostridial myonecrosis is a rapidly progressive, often fatal infection caused by a number of clostridial organisms, most commonly Clostridium perfringens and C. septicum. These bacteria can be found everywhere in the environment, and they are in especially high concentrations in soil and manure. They exist in the environment in an inactive, or spore, form that is very resistant to environmental conditions and antiseptics. In order to grow, they require an anaerobic (oxygen-free) environment.

It is unclear whether the organisms enter the skin at the time of puncture, or if the spores already exist within the horses' muscles. There is some evidence that sterile preparation of injection sites does not reduce the risk of developing clostridial myonecrosis (4) and that clostridial spores can be in the muscle tissues of horses that do not have myonecrosis (2).

However they arrive at the puncture site, the bacteria germinate in the anaerobic environment that is created when the tissue is damaged and the blood supply is interrupted, either by trauma or by the introduction of an irritating substance. Once the bacteria begin to germinate and release toxins, there is often a very rapid onset and progression of clinical illness.

Clinical Signs

Identifying a case of clostridial myonecrosis early in the course of disease is important to increase the likelihood of a successful outcome. Signs might appear as soon as several hours following an injection, or might not appear for two to three days. Horses might have a fever or be off of feed, and there is usually painful swelling at the site of injection or injury. There can be crepitus (audible and/or crackling) palpable in the skin if the gas produced by the bacteria is trapped under the skin. Swelling might be extensive and extend down a leg, and there could be associated lameness (Figure 1).

An affected horse will usually suffer a rapid deterioration of health and might show signs of colic, poor circulation, and toxemia; many untreated horses die within 48 hours of the onset of clinical signs.

Usually, a history including a soft tissue puncture or injection and physical examination findings are enough to raise a veterinarian's suspicion. Other diagnostic tests that are helpful in confirming the diagnosis are ultrasound, complete blood count, blood chemistry, and clotting profile.

Ultrasound can show gas deep within the tissues and the loss of normal muscle architecture as it becomes necrotic (Figure 2). Complete blood counts are useful to assess the state of the horse's immune response and can help in evaluating for other potential effects of the clostridial infection, such as low platelet counts and hemolysis (red blood cell destruction). Blood chemistries can guide treatment by giving information about the horse's body systems and hydration status. The degree of muscle damage is often not accurately reflected in increased muscle enzymes in the bloodstream, as blood flow to the affected area is often very poor. Clotting profiles can help to determine the stage and severity of disease and will help guide treatment by prompting intervention before clinical signs of clotting disorders appear.

Horses with clostridial disease can have exaggerated clotting responses, forming clots inappropriately in vessels. This can lead to organ failure by disrupting the blood supply to different parts of the body. If systemic clotting factors become depleted, the horse's blood will not clot properly, resulting in excessive bleeding.

Clostridial organisms cause disease by producing damaging enzymes and toxins known as exotoxins. The type of toxins a given bacterium produces determines its classification. The various toxins serve to destroy cell membranes, dissolve collagen, destroy DNA, and inactivate the immune response of the host.

Swelling with edema fluid can be dramatic and exert pressure on surrounding tissues, further impairing blood flow.

The result is a perpetuation of the disease process with extensive tissue destruction and expansion of the anaerobic environment. Large areas of tissue can become affected rapidly, with extensive sloughing of skin and muscle (Figure 3). Toxins released into the horse's bloodstream affect the ability of the heart to circulate blood effectively. Poor blood flow damages the body's organs, and shock and septicemia might ensue. Cardiovascular compromise can rapidly lead to death, even with aggressive supportive treatment by a veterinarian.

Treatment

It appears that C. perfringens might be more successfully treated than some of the other clostridial species, but the approach to treatment is the same regardless of the causative agent (2). An aggressive approach to treatment, including both medical and surgical therapy, is warranted in all cases.

The cornerstones of treatment are the use of antibiotics that are effective against anaerobic bacteria and surgical removal of devitalized tissue. There is some controversy and debate among veterinary researchers about which antibiotic regimen is best, but regardless of the drug selected, early intervention is crucial.

Many horses will require intravenous fluids to correct dehydration and provide cardiovascular support, and all will require pain management. The affected area should be surgically opened to allow exposure of the tissues to oxygen, reduce swelling, remove dead tissue, and allow drainage (Figure 4). In some cases, removal of large amounts of tissue might be necessary. Following these procedures, careful wound care and monitoring are indicated, and the procedures might need to be repeated in several days. Some horses will require other treatments if complications such as clotting disorders, endotoxemia, laminitis, pericarditis (inflammation of the membrane surrounding the heart), or diarrhea develop.

Horses that develop clostridial myonecrosis often face long, expensive hospital stays, and even with appropriate care, approximately 40% will die as a result of their disease (2). Those that survive often face intensive care, prolonged wound management, and high treatment costs.

Case Examples

"Daisy," a 2-year-old Thoroughbred race filly, was given 10 mL of Banamine in the muscle to treat signs of mild colic. Her colic resolved uneventfully, but two days later she developed a large, painful swelling at the injection site, edema that extended down her neck, and signs of severe systemic illness. She was admitted to the hospital, and the injection site was ultrasounded. On ultrasound, it was clear that the underlying muscle was being destroyed, and gas in the tissues clinched the diagnosis of clostridial myonecrosis. Bloodwork revealed that Daisy was indeed quite ill. Surgery on the necrotic muscle was performed immediately, and Daisy was placed on IV fluids, antibiotics, anti-inflammatory drugs, and local oxygen therapy. Daisy made a full recovery with minimal scarring (Figure 5), but sustained a hospital bill of several thousand dollars.

"Lucy," a 6-year-old Thoroughbred mare, was given 10 mL of Banamine in the muscles at the top of her right rump to relieve signs of muscle soreness after work. Her right hind leg was so swollen at presentation that she was unable to bear weight on it. She had a fever and was showing signs of toxemia. She was treated in a very similar fashion to Daisy, but developed fevers that were not responsive to medication. After a week of intensive treatment, costing several thousand dollars, she died without warning.

Prevention is much simpler and more economical than treatment, and boils down to avoiding unnecessary IM shots. Flunixin meglumine is available in a granule for top dressing on feed, and an oral paste. If these products are not available, the injectable formulation can be given orally, and it has been shown in research to be well absorbed, reaching active concentrations in the blood in 15 minutes (5).

If possible, trained personnel should give injections intravenously rather than relying on the IM route as an alternative. Some injections, such as vaccinations and other drugs, can only be given in the muscle, but they are usually of relatively low volume and probably pose a lower risk. Shots in the muscle should always be given in areas that can drain easily, such as the neck, the pectoral muscles at the bottom of the chest, and the back of the hindquarters. The results of one study suggest that the neck region might be an at-risk location, and that the superior blood supply of the hindquarters makes it a better location1. Shots should never be given to horses in the top of the rump. Before giving any shots, check with a veterinarian to review the appropriate technique.

Again, in the case of Banamine, the injectable product can be effectively administered by mouth. Contaminated or expired medication should never be used via any rate. Careful monitoring of injection sites and prompt intervention by a veterinarian are key to catching problems early and increasing the chance of treating complications successfully, should they arise. Most importantly, the consequences of clostridial myonecrosis, although rare, far outweigh the perceived convenience of giving IM injections that could be avoided.

The author would like to extend special thanks to Drs. Noah Cohen and Joanne Hardy for their insight and support with this piece.


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## tagalong (May 18, 2010)

A very good warning for all of us.







> Injectable ivermectin, antihistamines, and flunixin meglumine (Banamine) are the drugs most commonly associated with the disease (1,2,3). *In the case of flunixin, this risk is probably associated with its very high frequency of use, rather than the product itself.*


As was mentioned on the article - this is NOT something caused by the Banamine - it is just used very frequently so the incidents of gas gangrene would thus be higher. It is far easier to give it by mouth anyway - that is what we do here....





Gas gangrene is a risk with any IM injection.





Thanks for the photos and report - I hope that stallion pulls through...


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## Lucky-C-Acres-Minis (May 18, 2010)

OMG! THANK YOU for posting this! I am now 99% sure this is what happened with our buckskin mare we lost back in 2006!

She was given an IM shot in her hip by the vet.. The next day there was a small bump at the injection site, I had my mother (I was away at college) call the vet and ask them, of course they told her that it was normal, at times shots can cause a small bump.. By the next day there was more swelling to the size of a softball, again called the vet and this time they came out and looked at it, said it was a reaction to the shot and put her on an antibiotic.. I came home the next day after classes to find her entire hip swollen, I then called and told them, yet again they said it was a reaction and that I needed to be patient and allow the antibiotic time to work, give it until Monday and if it wasn't better to give them a call, and to try cold hosing her hip to see if I could relieve some swelling.. Next day (4 days post injection) the swelling had spread to her hock and she was to the point she did not want to move.. I called THREE other vets (from other clinics), told them what was going on and all three said the same thing, just a reaction.. Sunday the swelling seemed to be going down, but when you ran your hand over the swollen areas it was as if running your hand over a giant bubble wrap bubble and you could hear the crackle sound.. I left Sunday to go back to classes, when I left she was up and walking/grazing the yard with her filly.. Monday morning I called home to check in on her only to find out that when my mom and sister went out that morning to feed they found her dead in her stall, leaving behind an 11 day old filly..

I was p*$$ed to say the least, I told my parents to get a vet out asap for a necropsy, as this mare had been 100% healthy up to the IM shot.. Upon necropsy we found that her liver and pancreas (I think) had been destroyed, and this vet suspected clostridial bacteria, but did not explain to us HOW/WHY she contracted the bacteria..


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## Marty (May 18, 2010)

Another lesson learned. Thanks for posting that.


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## Ellen (May 18, 2010)

OMG. Hope all is well and she gets better soon. My vet reccomends Banamine liquid oral. It works like a charm. Thank you for sharing, I learne something new everday from this forum!


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## Margo_C-T (May 18, 2010)

That's a real object lesson; thanks for sharing!Poor horse; he has surely been through an ordeal; hoping he continues to survive AND returns to his former condition!I presume the slits in the neck were made due to the extreme swelling, to keep the skin from tearing? I've seen such w/ snake bites in people....

For many years, I gave Banamine IM, and never had any problems, BUT...I have always used it judiciously/sparingly, and have to say, I have sometimes shuddered when I've read posts where the first reaction is to grab and give Banamine, sometimes w/o consulting with one's vet; also, it seems more 'common'to read of giving multiple doses, days in a row--again, sometimes w/o consulting w/ a vet--but sometimes, on a vet's advice, and I have wondered what the vet's reasoning may be. I understand that there CAN be times when this may indeed be the best course of action, but...how often, really? And, is a full dose by weight always required? Questions to ask when speaking to your vet, IMO.

Also, I do NOT give shots into the neck, unless there is truly NO other reasonable choice. I give them by myself, always, and yes, the horses often react less to a neck shot, but I am nothing if not persistent, and with the minis, I have always managed to do it in the buttocks.Years ago, I was either told or read(don't really remember, it's been so long!), that the way the muscle fibers 'run' in the neck is not conducive to efficient drainage should a site abcess; also, when a shot causes severe soreness, it is a bigger 'issue' for the well-being of the horse if that pain is in the neck. Made sense to me, so I've stuck to butt shots whenever possible for many years.

Because I have previously heard and read about the dangers of the clostridium bacteria,which is clearly nothing to fool around with,I hasten to add that nowadays,if it is genuinely called for, I DO give Banamine orally. I try to preceed, if time allows; otherwise, to follow, with a dose of something to buffer the stomach, like ranitidine, since things like Banamine and Bute are known to be very hard on it, and prime risks to cause or exacerbate ulcers.

Margo


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## Miniv (May 18, 2010)

What a horrifying piece of information......but appreciated.

Just another reason to give Banamine orally. We are fortunate to have vets who give us the liquid, not the paste.


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## Kaitlyn (May 18, 2010)

That is frightening! Thank god I only give Banamine orally.

thank you so much for that information, it is very much an eye opener!


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## anyssapark (May 18, 2010)

How sad. I hope he will be ok.

I have had a similar situation about 5 years ago. I had a colt come down with colic, and he was treated for 3 days and was finally looking to be over the colic and looking good on that third day. He'd been on Finadyne (Australias equivalent to Benamine) for the pain, and i am very particular about cleanliness and sanitising the needle site, but come the AM of day 4 when i went in to let him out of his stable for the day, he was lame.

When i bought him out and had a look at him, he had a lot of fluid in his upper leg and down in to his hock. I called the vet back and was instructed to get him straight in to the hospital. So off we went. I stayed with him for many hours, they treated it agressively and kept it drained, but then the other leg started to show signs of the same, and he was having trouble walking. By 12 hours after i found him in his stable, i had to make the call to let him go.





Gas Gangreen moves FAST and is SO awful to watch them slipping downhill so rapidly. It is amazing (and SCAREY!) just how quickly this awful disease gets hold of our little horses.


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## valshingle (May 19, 2010)

My vet has told me never to give Banamine IM. She says either IV (not my cup of tea) or orally only. Maybe this is why.


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## Maple Hollow Farm (May 19, 2010)

This is what my buckskin Paint mare died from a few yrs ago. She got it from giving spring shots and she swelled up all along her left side of her back from the neck and all the way to her hip. We lanced it and were soaking her frequently but unfortunately lost her and had to bottle feed the foal she had on her side. This can happen with ANY vaccine which is more or less what this says, dont give unnecessary shots because it just increases your chances of getting those organisms in your horse. We have changed the way we give shots and what shots we give since then because of how horrible it was. Great warning, thanks for posting!


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## Little Hooves (May 19, 2010)

I didn't even KNOW about this. But I do think back on the day I told my husband to give my mare her vaccine. I remember watching from the window at the house when he stuck her. She bucked and ran and he couldn't hold onto her or the needle, and it flew into the dirt. I saw him pick up the needle and head for... my mare AGAIN! I flew out the door shouting, "NO, DON'T USE THAT NEEDLE! IT'S NOT SANITARY!"

Of course, reading this, I'm glad I did make it in time to stop him. I would have been so sad to lose that mare to this - we ended up taking the needle inside and sanitized it in a bath of alcohol. Of course, now I'll also be certain to sanitize the site of the injection, too!


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## krissy3 (May 19, 2010)

Beautiful horse by the way.... This is exactly why in Switzerland all medications are in the hands of the Vet and no other , even de wormers. It is forbidden to give an owner drugs of any sort to administer personally, and I tend to agree. We have very few overdoses, or improperly administered vaccines, usually the vets know what their doing. I would NEVER EVER EVER EVER give my horse an injection, I am not a nurse, or a vet..giving shots is NOT my job, its my vets , so is diagnosing horses, and they get real angry if you offer an idea of why your horse or dog, cat is ill.

I have seen a "stryl abcess " caused by a strangels vaccine given in the nose then immediatly after a IM vaccine given in the neck. It was confirmed by UC Davis that is was a *steryl abcess" and was caused by giving these 2 vaccines together ( on the same day) although it is rare. The vets agreed that these 2 vaccines should be done on different days. The horse looked very much like this one , although he had just one huge hole for drainage.

I hope this horse pulls through, it looks like he is getting the best care possible. and sorry for the misspelled words ... the longer I am here writing and speaking 2 different languages , the more I forget how to think and spell in English.


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## MyBarakah (May 19, 2010)

That's why I always squirt the banamine in my horse's mouths. And much easier to give that way also!


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## Bunnylady (May 19, 2010)

Margo_C-T said:


> I presume the slits in the neck were made due to the extreme swelling, to keep the skin from tearing?


The slits are done to provide drainage, and to get oxygen to the tissue, as a means of combating the growth of the microbe. Clostridium is an anaerobe, which means it grows best in an environment lacking oxygen.

A long, long time ago, I read an article about a Standardbred that had gotten a shot of Bute in the hip as treatment for a bout of colic. This infection happened to him, and by the time it was stopped, had spread all the way up his side. There was a picture of him, he had a double row of these slits running all the way from his tail to his withers. That gruesome image has stayed with me all these years. Incredibly, he did recover, and I believe even raced a few times after his near-miss.


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## Camelotcavs (May 19, 2010)

This shot was administered by a vet.

Dunny is having surgery today because of a lump at the base of his windpipe.

His owner is going through h$## over this - she has had him since he was a yearling and has all her hopes, dreams and money wrapped up in this guy. I hope it does not come down to a financial issue as his treatment is so costly. She has a lot of her "stuff" up for sale to help offset costs and locals are donating what we can to the vet clinic for his care.

What makes me so mad is this was all caused by a mare owner lying on a breeding contract. When she was told to come pick up her mare (while on speaker phone with witnesses) she stated that her mare had kicked a previous stallion causing injury. On this breeding contract she stated that her mare did NOT kick. If she had been honest then proper precautions would have been taken.


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## krissy3 (May 19, 2010)

HO MAN!!! this s**%cs that a vet did this... I would hope that the vet is helping with costs , or doing the treatments free. Sooo when will they start making vaccines orally?


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## Nathan Luszcz (May 19, 2010)

That's why I give injections IV. IM is NOT an appropriate injection route for large quantities, especially for a caustic drug like banamine. I keep telling people that and people keep doing IM.


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## mizbeth (Nov 1, 2011)

Wow, I have never heard of this either. I have had Vets give shots, and even some of mine cause a minor swelling at the injection site, but NEVER to this extreme. Gosh - this is horrible and so glad my horses were not seriously effected.

Do you prefer liquid banamine by mouth or the paste?


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## markadoodle (Nov 1, 2011)

Thank you for posting.


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## Genie (Nov 1, 2011)

Thank you for this post. We usually do the banamine orally but sometimes when we have a vet call they will inject.

No more


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## Sue_C. (Nov 1, 2011)

Horrid, poor horse!!!

Just another heads up on horse management...any shot, any time, can do this...and worse...whether vet administered...or not.

Just three years ago I lost my newly gelded stallion to a SIMPLE (Vet administered) penicillin shot; yet I am not telling everyone to not use penicillin. One has to use common sense.


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## Taylor Richelle (Nov 1, 2011)

Oh my!!!! :shockedPoor baby! - Thank you so much for posting!


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## txminipinto (Nov 1, 2011)

Please note this was given IM, not IV. IV is acceptable and safe (if you know how to properly administer it, you want DARK blood, NOT BRIGHT RED). Orally is effective as well.


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## kaykay (Nov 1, 2011)

This is an old thread that someone necroed.

I will say though that years ago someone posted on here showing a mini mare this happened to. Pics were much worse than this one. She had gotten the shot in her chest and the whole thing swelled and had to be opened.


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## minimomNC (Nov 1, 2011)

Saw this happen to an arab mare about 15 years ago, so I am very careful with shots. Orally is the way I go if it can be used that way. This mares was caused by a rabies vaccine administered by a vet, so it can and does happen even in the best of circumstances. So now all of my yearling shots are given by my vet and if I need banamine its given orally. Oh the mare did survive but always had a huge dent in her neck where it had been opened and drained and it took almost a year to heal.


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## Mona (Nov 1, 2011)

Kay, I believe the one you are referring to was the LTD bred frame overo mare overseas. I remember those posts too. I cannot recall what caused it, but I do remember photos of her and the skin sloughing off etc.


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## midnight star stables (Nov 1, 2011)

Lucky-C-Acres-Minis said:


> OMG! THANK YOU for posting this! I am now 99% sure this is what happened with our buckskin mare we lost back in 2006!
> 
> She was given an IM shot in her hip by the vet.. The next day there was a small bump at the injection site, I had my mother (I was away at college) call the vet and ask them, of course they told her that it was normal, at times shots can cause a small bump.. By the next day there was more swelling to the size of a softball, again called the vet and this time they came out and looked at it, said it was a reaction to the shot and put her on an antibiotic.. I came home the next day after classes to find her entire hip swollen, I then called and told them, yet again they said it was a reaction and that I needed to be patient and allow the antibiotic time to work, give it until Monday and if it wasn't better to give them a call, and to try cold hosing her hip to see if I could relieve some swelling.. Next day (4 days post injection) the swelling had spread to her hock and she was to the point she did not want to move.. I called THREE other vets (from other clinics), told them what was going on and all three said the same thing, just a reaction.. Sunday the swelling seemed to be going down, but when you ran your hand over the swollen areas it was as if running your hand over a giant bubble wrap bubble and you could hear the crackle sound.. I left Sunday to go back to classes, when I left she was up and walking/grazing the yard with her filly.. Monday morning I called home to check in on her only to find out that when my mom and sister went out that morning to feed they found her dead in her stall, leaving behind an 11 day old filly..
> 
> I was p*$$ed to say the least, I told my parents to get a vet out asap for a necropsy, as this mare had been 100% healthy up to the IM shot.. Upon necropsy we found that her liver and pancreas (I think) had been destroyed, and this vet suspected clostridial bacteria, but did not explain to us HOW/WHY she contracted the bacteria..


I just wanted to say that I remember your mare. My heart still brakes for you. You did do all you could though, sometimes vets just don't listen.

This is why I won't give my on vaccinations.





This may be "old" but it is STILL very valid and current. I'm sure some one bumped it up with the recent "Doing your own vaccinations" thread...


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## kaykay (Nov 1, 2011)

> Kay, I believe the one you are referring to was the LTD bred frame overo mare overseas. I remember those posts too. I cannot recall what caused it, but I do remember photos of her and the skin sloughing off etc.


Yes that was the one! She had been given banamine injections in her chest. I do believe she lived though! Pictures were just horrible.

I didnt mean it was bad that this got brought up again just wanted people to know it was a year old thread as some were asking for answers from the OP so I thought they may not realize this is an old thread.


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## REO (Nov 2, 2011)

I thought this topic important enough to go in the LB "Best" forum.


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## Nathan Luszcz (Nov 2, 2011)

Banamine should be giving IV only, if using the injectable. Use the oral paste if using it orally! It works just as fast, and is meant to be used that way. Any IM shot of large quantity can result in what this post shows



Don't do it!


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## Lil Eowyn (Jan 16, 2013)

Thank you for sharing--I'll have to remember that.


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