Dear Dr. Roach: I give my wife an octreotide intramuscular injection monthly into the gluteal muscle. I was taught to pull back on the needle to be sure you aren't in a blood vessel. Sometimes, I am unable to inject the medication (just can't plunge the syringe) despite being sure the needle was working before injecting. If I try again in a different spot, it works. What's going on?

— N.R.

Dear N.R.: Intramuscular injections are among the safest, and anyone can be trained to do them. However, things can occasionally go wrong.

Aspiration is the term for pulling back a little on the syringe before injecting to be sure you aren't in a blood vessel. It is extremely unlikely that you'll hit a blood vessel, and the practice of aspiration is now discouraged by the Centers for Disease Control and Prevention for injecting vaccines. However, aspiration is still recommended for medications that would be dangerous to inject into the blood vessel. Octreotide is not dangerous to give intravenously, so I would recommend against aspiration for her. I suspect that you may be aspirating hard enough that the syringe is getting blocked. If you do aspirate, a light touch is sufficient.

It's also possible that you have inserted the needle deep enough to be pressing against the hip bone, although that's also unlikely. The hip bone is quite deep in most people. If you are unable to inject, try pulling back on the syringe a half inch or so.

Dear Dr. Roach: What is the current thinking on alcohol consumption and health? Is drinking 6 ounces of wine per day good for you? Is red wine better than white wine? Would you get the same benefit from 12 ounces of beer or 1.5 ounces of 80 proof spirits? Please ignore or separate the potential for abuse, weight gain, other negative repercussions, etc. This is important, but would cloud the answer to my question.

— D.C.

Dear D.C.: When discussing alcohol intake, "moderate" is usually defined as no more than two standard drinks for men daily, no more than one standard drink for women daily, with a standard drink being roughly 5 ounces of wine, 12 ounces of beer or 1.5 ounces of spirits, depending on alcohol content. People who drink moderate amounts of alcohol have a lower risk of coronary artery disease than people who drink none at all. This is true whatever the type of alcohol a person consumes. However, it remains unproven that the alcohol lowers the risk of heart disease. It may be that moderate drinkers, who often have many healthy habits, have lower rates of heart disease for other reasons than alcohol.

You can't separate the potential benefit from the bad effects of alcohol. Even at moderate drinking levels, there is potential for damage to the brain. A study from the U.K. showed higher dementia rates, even for moderate drinkers. There is also a slightly increased rate of cancer for moderate drinkers. Once a person exceeds the moderate drinking level, the risk dramatically increases for many causes of death, including accidents.

I do not recommend alcohol at all for health reasons. If a person chooses to drink, he or she should do so in moderation and with the understanding that it may be harmful for health, although the risk is small with modest alcohol intake.

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