return of CTS

We probably should test that again before embarking on surgery as it's almost 9 months since we last looked at it. I'm glad the left hand worked out OK in the end at least. I can't see an early morning appointment for several weeks at present but Emma could re-inject it for you anyway if the symptoms are becoming a real nuisance and that probably could be done early in the morning. I'll ask her to make contact. JB

I have booked you in for testing 4.12.14 0900 and will put written confimation in the post. I hope this is a suitable date. If you would like an injection sooner than this then we can arrange that too. Glad to hear about your left hand. EK

Dear Dr Bland and Emma,

Thank you for your swift reply - it never ceases to amaze me just how speedy you get things organised in your department - wonderful - thank you!
Would it be possible to get the right hand injected before December please as the symptoms are really keeping me awake on-and-off every night? Symptoms are exactly the same as they were for the left hand so pretty certain it's CTS again as your first injection worked a treat. I'm certainly not opting for surgery in a hurry and hope I can have as many injections as I did for the left hand before we look at the surgery option!! Any slot you have first thing would be greatly appreciated.

Thanking you in advance

Would next Wednesday 12.11.14 be ok for you? 9am? EK

Dear Emma,

Do you have any other day free next week? Even if it's later in the morning or even in the afternoon? If not I'll try to get cover at school.

Dear Emma,

I am sorry but will now not be able to make Wednesday morning as it is impossible for me to get cover at school - hand is pretty bad and stopping me sleeping at night so if you have any appt Thursday or Friday for an injection, whatever time, I would really appreciate it.

Many thanks

I can do either Thursday at 9am or Friday morning or afternoon. Sorry for the delay in getting back to you. EK

Dear Emma,

Thanks for reply - really appreciate it. Could I please come in for the steroid on Thursday morning at 9am?

Many thanks

That is fine, see you Thursday morning. EK

Dear Dr Bland,

Thank you for seeing me on Thursday - the steroid has worked a treat! Unfortunately I have had the same reaction as I had some time ago to one of the steroid injections I had - burning red face all day which has felt as if it has been scrubbed with a brillo pad! Not nice and certainly not looked great either - my colleagues have thought I've looked as if I've had a temperature all day and all the parents have asked if I've felt OK - actually I have not felt great! Not sure if this steroid was a different batch to the usual ones - if so can you possibly make a note not to use this one again, please?!

Many thanks again for solving the carpal tunnel and please pass on my thanks to Emma too.

We have used the same steroid preparation for years but I can't tell if the manufacturers have changed it any way - used a different preservative or some such. We have two or three patients now who have reported this side effect - fortunately it seems to be a fairly short-lived thing. I wonder what the patient view is - is the temporary biurnig face worth it in exchange for the therapeutic effect of the injection? JB

Dear Dr Bland,

As is always the case - you are right! The burning face lasted for 2 days and although awful would not want the CTS back in exchange - however if there was a different steroid available I may opt for that!

Interestingly I wanted to ask if the steroid treatment may be answerable for my plantar fasciitis (which has troubled me greatly for about a year) having suddenly disappeared??!! Symptoms have literally gone since having the steroid for my CTS - any link?? Had thought that the steroid had localised effect but wondering if it may have cured my foot issue too?

Lastly (!!) as usual the effects on my blood sugars have been pretty awful - in the last 24 hrs have had to literally double my daytime insulin doses to manage my blood sugars. Guess this is normal too?

Thanks again for having cured both ailments!

The blood glucose thing is pretty much expected, but again not usually a big clinical problem. I don't know what to make of the foot though. There will be some systemic absorption of the steroid so the level in the bloodstream will rise a little after injection. I can't find an example of someone having measured the blood level after CTS injection to compare with the blood level after taking the same dose of steroids orally but it is likely to be a pretty small increase and I would be surprised if an inflammatory condition in the foot was sensitive to one dose of steroids. I would be more inclined to think that was coincidence! JB

Dear Dr Bland,

Afraid symptoms in right hand are back again - numbness every night and pain for first hour of day as if my hand is in a vice with little movement. Splint not providing any relief. Could I book in for another steroid please?

Thanks in advance

We'll have to have a talk about surgery but we'll arrange an appointment so that we can do that. JB

I have booked an appointment for you and will send it out by post. Please let us know if time/date are not suitable.EK

Dear Dr Bland and EK (sorry - don\'t know your title!)

Many thanks for sorting out an appointment - really appreciate your swift service - as always!

Dear Emma,

Many thanks for appt which I received today. Can I please check whether I will be able to have a steroid injection on the day (as apt is for testing and no mention of steroid) as I fear it is going to get significantly worse if I have to wait another month after the testing?

Thanks again for your help.

Yes we can usually inject on the day. JB

Yes, I am in on the day of your appointment. EK

Dear Dr Bland,

Am wondering if there is any way of being seen earlier as I fear the CTS is getting worse quicker than I had thought - every night is disrupted for several hours, so much so I ended getting up @ 3am today to make a cuppa (couldn't left the kettle due to severe cramp/pain in right hand). Any appointment where a steroid could be done at the same time would be very gratefully accepted (and yes I do realise this is a big ask and that you are already pushed to capacity).

Many thanks in advance

We'll have a look at the diary in the morning and see if anyone's cancelled. JB

We've found you an appointment in early May at the same time of day. I'll email you the details as well as putin them in the post. EK

Dear Emma,

Many thanks for your email and posted apt which I received today. I really cannot thank you and the team enough for slotting me in and I look forward to getting the wrist injected and getting a good nights sleep!

Dear Dr Bland,

Many thanks for seeing me on Thursday morning. Afraid steroid has not worked it's total magic like all previous ones :( I have tingling in ends of my fingers pretty much all the time (maybe it's not had time to work properly yet?) which is pretty annoying. I think it may be worth looking at operating as I think even I have to concede that enough is enough where the steroids are concerned. I'm really not keen on surgery again but as the left hand has been cured I am resigned to the fact that this is really the only route that sorts the cts out now!
Thanks again

It's probably worth deferring a decison for a couple of weeks but after that we'll make plans to operate on it. I think the issue is mostly about finding a convenient time isn't it? JB