message for Dr Bland
I have tried the splints you gav me on the 26 July for amonth. I am afraid I do not feel any better- I think my hands are slightly worse than when I visited you one month ago. I am asking if I can be considered for injections as the next option you suggested. Can this procedure be done locally ie in the Canterbury area?. LC Taylor
I believe you now have a message from Dr Miles' surgery about his concerns about doing the injections in primary care. Is there another option?
Last time we discussed the issue of injection in a patient on warfarin we decided it could be done provided the INR was <2.5. I believe you are taking aspirin too and I felt it might be wise to omit the aspirin for 24 hours before injection. Ultimately however it has to be a judgement for the person who is doing the injection. There is no evidence as such to guide a decision. There are for example no reports of bleeding complications following carpal tunnel injection in people on anticoagulants and, arguing from first principles, the risk from a small volume local steroid injection with a fine needle should be les than that from taking a blood dample. We also do carry out needle electromyography in patients on warfarin occasionally when it seems to be clinically necessary and I am only aware of one report of bleeding complications - and needle EMG is considerably more traumatic than carpal tunnel injection. If we were to do this in hospital we would probably stop the aspirin for 24h and then keep you under observation (ie send you round the corner to the WRVS for a coffee) for 30 minutes afterwards before letting you go home. I am waiting for a further response from Dr Miles before we decide how to proceed. The other option of surgery is of course much more complicated by aspirin/warfarin. JB
I'm not too surprised to be honest as it was quite a bad CTS when we tested it. You are welcome to have it injected though I rather suspect that we may end up operating in the long run. Injection can be arranged by calling the surgery in primary care office tomorrow - give me an hour or so to update your records in the morning and then they will be able to book injection for you - the number is in the ontact pages here I have also edited your patient number out of your message as these should not be broadcast to the public- I can tell who you are from your registration on the site -JB