Treatment Selected

Entirely reasonable. How would you like us to arrange injection - we can either try to get this done in general practice or you can drop back in to the neurophysiology department at the hospital for us to do it. JB

Thanks for the quick response. I think I would prefer to return to the neuro-department if that is ok.

Regards

Sarah

No problem - I'll ask Emma to get in touch and choose a convenient time for you both. JB

Would you like to come in on Tuesday, Wednesday or Thursday next week? EK

Thanks Thursday this week would be good, do I have to ring for a appointment time.

Regards

Sarah

2:30 pm would be good if that suits you. JB

2.30 pm would be good thanks. Will I be ok to drive afterwards.

Regards

Sarah

We haven't yet had anyone who has been unable to drive after injection in about 9000 injections so you should be OK. We'll see you on Thursday. JB

Hi it's been 6 days since I had my injection. I have perceived no difference in the severity of my symptoms, does that mean no improvement is likely with this type of treatment.

Regards.

It's not very promising, though I wouldn't give up on it quite yet as we do occasionally see late responses. Most people however improve in the first couple of days. This is grade 5 bilateral CTS so a poor response to injection is not a surprise. If it is not improving by two weeks we should probably think about surgery. JB

Hi Its now approaching two weeks since my injections and still no improvement so it looks like surgery the the next and only option. Could you tell me the current waiting time for this op, also I presume it is done on a one hand a a time basis and that the recovery time is around 4 weeks followed by the other hand subject to waiting list. Also I have come off Aromasin. as there seems to be a link to CTS documented in various medical studies. Am I right in thinking that if I continued this coarse of treatment, further damage is likely to occur. Another option is to switch to Tamoxifen that appears to cause less nerve damage. Any opinions you may or may not have would be appreciated as I don,t want further aggravate my already high CTS problem. I think it would be wise to weight up all options at this stage as my Oncologist is advising some form of preventative treatment although ultimately I know this must be my decision.

Regards.

All of the drugs which are essentially manipulators of your hormonal state probably increase the risk of CTS - it's just that the phenomenon has been best studied for exemestane. In general it probably makes more sense to treat the CTS rather than agonise too much over the drugs. We can probably arrange surgery for the first hand in about 4 - 5 weeks - I'll check the bookings tomorrow. Recovery takes  2-6 weeks depending on what you want to do with the hands - longer for more strenuous manual tasks - if all goes well.  Sometimes the second hand improves when you operate on the first one but if the second hand does need doing we will generally arrange it between 6 weeks to 6 months after the first. JB

For surgery we can do 18th August in Faversham, 20th August in Herne Bay, or probably earlier in Ashford. The booking system for Ashford is different at present so I can't be sure of timing but the surgeon involved tells me he has plenty of space at present so, allowing for time to make phone calls and for a pre-operative assessment you might well get in round about the end of July. JB

Thanks for your help for appointments. I have been given a date of the 20 August at Ashford that is the most convenient for myself. The last week or so my hands appear to be getting worse, more painful as the day goes on. Am I doing them more damage by trying to carry on as normal or do you think I should be resting them more.

I would probably try to rest them somewhat if activity is clearly aggravating symptoms. Of course that may not be entirely practical I'm afraid. JB

I have now moved on to post surgery on my right hand around 4 weeks since the operation. I have noticed a slight improvement strangely in both hands. I understand that it may take up to 12 months to fully ascertain the recovery of the procedure so the main reason for post is they are now suggesting I have the procedure done on the other hand. As I have had lymph nodes removed from this arm and at more risk from lymphedema what is the risk associated with surgery and should I wait to see what the final outcome of the first operation brings as my other hand seems to have improved with no intervention I am trying to balance the risks with the benefits. Over time is this hand likely to deteriorate.

Regards

Grade 5 can be quite slow to improve after surgery... and yes the non-operated hand can sometimes improve too, odd though that may seem.Whether you carry straight on and do the other hand should be largely up to you. You now know what you can expect from the surgery and only you can judge how much of a problme the other hand is for you. If you want to know whether the nerve is objectively improving as well as feeling better I can test them again for you and we can then think about how to deal with the second hand. Lymphoedema does not seem to be a problem for CTS surgery - there is a page of the website which covers this. JB

Thank you for your response, information, and advice I would like to be tested again if possible to see if there is any difference that can be measured as both hands feel marginally better. I feel if there is ongoing improvement I would rather wait before the second procedure and see how the final outcome pans out.. I am sure I will able to detect any deterioration of the non operated hand should it happen and revise my options.

Regards

OK I'll book a test - should be in about 3-4 weeks I think. Letter will go in the post today.JB