Archive for January, 2006
Carpal Tunnel Syndrome
What is the role of steroid injection in carpal tunnel syndrome?
Injection of corticosteroid into the carpal tunnel has been used as a treatment for some years. But what does the published evidence have to say about whether it works or not?
In my own experience, injection of steroid and / or local anaesthetic into the carpal tunnel area is effective in about half of the patients that I see. Some of them gain lasting relief of the carpal tunnel symptoms and others find that the symptoms of tingling in the median nerve skin area return a month or two after the injection.
Recent Studies on Steroid Injection for Carpal Tunnel Syndrome
Two small but quite good quality studies have been published recently. These are what is known as randomised controlled studies and the results of this kind of study are usually (but not always) reliable.
Both studies showed that injection with steroid into the carpal tunnel produced benefit with about a month of the injection. The benefit was sustained in many of the patients.
The studies compared carpal tunnel steroid injection with placebo injection. Placebo injection is when both the doctor and the patient think that an active drug is being injected but when – in truth – only an inert and inactive liquid is in the syringe.
The patients who were given the active drug typically reported an improvement in their symptoms of about 70% – compared with improvement of about 15% in the patients who were given a placebo.
The risks of steroid injection into the carpal tunnel are small but not zero. Some people find the injection to be very painful for two or three days afterwards. There is a small risk that the injected liquid may enter a blood vessel or may be injected into the median nerve itself. This last problem is rare but can potentially be very serious.
January 9th, 2006
Wet the bed?
Bedwetting Treatments
Bedwetting Tablet
New research has moved us closer to discovering the true cause of bedwetting and thus to providing a more effective treatment.
It used to be thought that bedwetting at night was caused by having too small a bladder. Old fashioned treatments included stretching the bladder by “bladder retraining” techniques. These treatments for bedwetting did not work well.
We now know that bedwetting is not caused by having a small bladder. The problem often truly relates to the fact that some children produce too little of a hormone called ADH or anti-diuretic hormone. ADH is produced by the brain at night to shut down the kidneys and lessens the flow of urine. Children with too little ADH will produce too much night time urine.
A nasal spray or tablet called Desmopressin helps resolve this ADH problem.
Desmopressin can also treat many men who urinate frequently at night, and do not have a prostate infection or cancer. Lack of antidiuretic hormone is genetic because fathers and mothers have children who also are bed wetters.
Wetting the bed is very common in children up to eight years old and most children who wet the bed develop into entirely healthy adults who have no such problems.
Children who are still wetting the bed after age five should see a doctor for some tests. They need to be checked for kidney infection or for kidney abnormalities. Sometimes other tests are required. No cause is found in most cases. There is no good evidence that bedwetting is related to emotional or behaviour problems
Research has shown that desmopressin spray is effective for bed wetting but the most recent studies point towards the fact that the desmopressin tablets are even more effective
If your child is a bedwetter then you should discuss these options with your doctor
January 9th, 2006
Treatment for Bedwetting
Bedwetting Cure
Families often struggle to deal with a bedwetting child. The child too can find the going very tough – both physically and emotionally. Frustration, despondency and sometimes anger can all occur in the face of a serious or frequent bedwetting situation. The problem can be eased however if both parents and child can be well enought informed about bedwetting to see things clearly for what they are. Reassurance can go a long way to defusing a fraught situation
Bedwetting children often seem to be deeper sleepers than other children – some also suffer from sleep walking, nightmares or night terrors.
These are some common causes of bedwetting in an older child (remember that bed wetting in a younger child is simply part of normal growing up and does not need specific treatment)
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smaller than average bladder
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over production of urine due to high fluid intake
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physical causes are rare
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spinal cord lesions are very very rare
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congenital malformations of the genitourinary tract can be picked up by special x-rays
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infections of the urinary tract
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diabetes may need to be excluded if the problems persist
The most important aspect of treatment is to reassure the child. Tell them repeatedly that its not their fault and that things will get better with time. There’s some evidence that bedwetting runs in families – perhaps the child can speak to someone else in the family who has dealt with it in the past
Treatments for bedwetting include
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padding at night to allow normal social interactions – sleepovers etc.
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fluid limitation before bedtime
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lifting and toileting before the parents go to bed
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buzzer alarm and pad systems
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hypnosis
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medication
Whatever method you choose to help your child over this hurdle in life, the most important thing to remember is that bedwetting can have a devastating effect on their self-esteem. It is so important to make sure that they know that the fault is not theirs, there isn’t anything that they have done to cause this and that they will grow out of it.
Resources
Baby Gifts and Diaper Bags
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Cloth Diapers
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All About Baby® – Personalized and memorable gifts for infants and children.
January 9th, 2006
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January 9th, 2006
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