4th CTS Injection

As you know you can post as often as you like in here. I'm always happier if I know what is happening to my patients. JB

Hello Dr Bland,

Thanks for your reply. I will update you on a regular basis.

Kind regards.

Hello Dr Bland,

It's now two weeks since my 4th CTS Injection. I last contacted you three days after the injection and since then, the progress has been good. I've suffered very little numbness/tingling at night, although I do continue to use a splint.
As you know, the symptoms had previously been returning, but this 4th injection has definitely had a beneficial affect.
I still suffer a little numbness whilst cycling but even this is less pronounced than previously.
I will update you again, probably in about four weeks from now.

Kind regards.

Sounds good so far. We'll just have to see, as usual, how long it lasts. JB

Hello Dr Bland,

Thanks for your reply. As you suggest, it's a good start. As always, I'll keep you updated.

Kind regards.

Hello Dr Bland,

It is now six weeks since I received the 4th CTS Injection. The results continue to be positive. Taking into consideration that I still (and probably always will) wear a splint at night, I'm very rarely troubled whilst sleeping. From time to time, I experience a little numbness, but on the whole, I'm most pleased with the progress so far.
Naturally, I will continue to update you on a regular basis, every two to three months.

Kind regards.

Thankyou again. As usual it is good to hear some success stories as well as the failures and catastrophes which inevitably tend to dominate discussion. JB

Hello Dr Bland,

Many thanks for your reply and interest, I'll keep you informed of any developments.

Kind regards.

Hello Dr Bland,

It is now four months since my 4th CTS injection (on 25th February 2013).

Overall, the beneficial effects engendered by the injection have been sustained. I still experience some numbness whilst cycling and occasionally at night (I continue to wear a splint at night, as a matter of course). However, my condition has not drastically worsened since the injection. I do feel that the 4th injection has been the most effective so far.

Since January 2011, I have been coming to see you every six months and also undertaking a Nerve Conduction Study. Personally, I would prefer to continue these appointments if possible, as I appreciate your opinion and advice. If you agree and consider it appropriate, could you please arrange a suitable date?

I last saw you on 24th January 2013, so perhaps late July or early August, if that's convenient for yourself?

Kind regards.

Hello Dr Bland,

I posted the above comments yesterday but they were not flagged up as a new post (with the red star), so I'm not sure if it came to your attention.

I may be in error about this but I'm hoping that this will show up as a new post today.

Kind regards.

I did see it and I've been thinking about it. I think the most efficient way to deal with this is only to book another test when the CTS starts to deteriorate again - ie when you feel that symptoms are taking a turn for the worse. The intervals between relapses after injection are highly variable and the clinic is so busy that I do not really have the luxury of being able to test people when their symptoms are in remission - though there is certainly some interesting data to be obtained from people who are in remission after injection. Just let me know when it starts to get worse and we will work something out then. JB

Hello Dr Bland,

Many thanks for your reply. I fully understand your position. I will take your advice and wait until the symptoms become worse before I again contact you. Hopefully, that might be quite some time! As I pointed out in my previous post, the results so far have been most encouraging. However, I will probably update you again at the end of the year, unless I have any significant problems before then.

My apologies for your receiving multiple messages on this subject, due to my misunderstanding the system of flagging the posts.

Kind regards.

No problem - and I'm always happy to see progress reports on here, good or bad. JB

Hello Dr Bland, It is now 9 months since my 4th CTS injection and 5 months since I last contacted you. You may recall that the 4th injection was most effective and that when I contacted you in June, you suggested that it was not necessary to attend the usual 6 monthly appointment as the symptoms had not been too adverse. Since that time, my condition has continued to be fairly satisfactory, with one or two exceptions. I still wear a splint at night, but did try on a couple of occasions to do without the splint. On those occasions, I was woken by the customary numbness and tingling. However, I have no problem with wearing the splint, so this presents no great difficulty. Also, as I have previously mentioned, I do experience some numbness whilst cycling. Again, this is not something with which I cannot cope at the moment. I would appreciate your advice as to whether an appointment to see you in the new year, effectively one year on from the last time, would be beneficial. Or perhaps you would recommend waiting until the symptoms worsen, if indeed they do. I would be happy with either of the above recommendations. Kind regards

Hello Dr Bland,

This is just to let you know that I previously (yesterday) had some difficulty in contacting you through this forum.
Consequently, I sent an e-mail to you on "Jeremy.Bland@nhs,net". However, I have again tried today and the above message has been sent successfully.

Kind regards.

I did get the email but I've been a bit preoccupied for the last couple of days. I would like to know more details of exactly what sort of problem you encountered with the web forum - we are always on the lookout for bugs and problems with the website code (though we can't always fix them). JB

Hello Dr Bland,

I originally attempted to send a communication to you on Monday in the usual way, via the web forum. The sending of the message was blocked and I was asked to enter some identification letters in a box. As I have not used the forum since June of this year, I assume that this is a new procedure? Despite entering the letters two or three times, the message continued to be blocked. Therefore, I sent an e-mail to you.

As these problems often correct themselves, I tried again yesterday (Tuesday). I was again asked to enter the identification letters and this time the message was sent with no problem. Unfortunately, I had copied and pasted the text from the e-mail that I had previously sent to you and had failed to remove my name from the bottom, apologies for that.

I can only assume that the problems on Monday were a glitch.

Going back to my original communication, I wonder if you can advise me as to whether you think it appropriate to make an appointment in the new year, or perhaps to wait and see if the symptoms become worse.

Kind regards.

OK I recognise that. If you have been reading this forum a lot you might have noticed that 6 months ago we were getting a lot of 'spam' postings - adverts for dodgy goods or just gibberish postings - which I was deleting manually as I found them. Recently we have been using a spam filtering system to block these called Mollom. Mollom screens all attempted postings in the forums, automatically rejects those which it is certain are spam and when it is uncertain it presents the person trying to post the message with a 'captcha' - the text entry questions which are designed to be a task which can usually only be done by a human being, as opposed to a computer program. If you successfully translate the distorted text it is suppose to allow your posting to go through, if not then it will block it. Presumably some phrasing that you used in your posting was considered suspect by Mollom - it uses fairly sophisticated analysis of text to distinguish spam from real messages but no such system is infallible.

As regards the need to see me again. I think one of the advantages of this means of follow up is that we can stay in touch very easily (Mollom permitting) without having to meet in person and I only need to see you if it becomes necessary to check your nerve conduction studies or do something else that requires personal contact. I'm quite happy to simply allow things to rest until such time as your symptoms become sufficiently troublesome for you to want something done. JB

Hello Dr Bland,

Thanks for explaining the reason for my problems earlier in the week. As a matter of interest, the message that I posted yesterday went with no problem at all, I was not even presented with a "captcha".

Could I ask you to remove my name from the message that I posted on Tuesday. As I mentioned before, this was a mistake made when I did a copy/paste from the e-mail that I had previously sent to you.

I'm very happy to be advised by you and wait until my symptoms worsen until I ask for another appointment. With any luck, they might remain manageable. In any event, I'll update you in about 3 to 4 months.

My thanks again for your help and advice.

Kind regards.

Name edited out. Happy to hear from you anytime. JB

Hello Dr Bland,

It is now one year since I was given my 4th CTS Injection and three months since my last communication to you. Therefore , I felt it appropriate to give an update to you on my progress.

There has, in fact, been very little change. I continue to wear the splint at night and only occasionally suffer some numbness.
I still have a little trouble whilst cycling, but this is tolerable.

In conclusion, my condition appears to be reasonably under control at the moment.

I'll update you again in six months, unless my symptoms become worse before that time.

Kind regards.

Thanks for the update. It is of course a pleasure to hear from someone whose symptoms are adequately under control. JB

Hello Dr Bland,

It is now six months since my last communication to you, and 18 months since I received the 4th CTS Injection.

My symptoms are virtually unchanged and still under reasonable control. As I've previously reported, I continue to wear the splint at night. I have tried leaving the splint off, but this usually results in some numbness. However, I have no problem with the wearing of the splint. I still suffer some symptoms whilst cycling, but as mentioned in the past, these are not unacceptable.

So, although I'm still aware of the condition, I feel that it remains tolerable.

I do feel that I would like to keep you updated on a six monthly basis, if you are happy with the arrangement. I will, of course, be in touch if my condition changes, for better or worse.

Kind regards.

I'm completely happy to follow-up this way. Much more convenient and less costly than out-patient appointments and tests when you are well but at the same time it allows me to know how patients are doing.. We've just switched on version 2 of the website so you may notice some slight changes in the interface but most of the functionality is the same. JB

Hello Dr Bland,

Many thanks for your reply. I'll send an update in six months, unless I have any problems.

Kind regards.

Hello Dr Bland,

It is now two years since my 4th CTS Injection, and six months since my last communication to you.

Thankfully my condition has changed very little, as has been the case for some time. I continue to wear a splint at night and occasionally suffer minor symptoms. However, the CTS is at a manageable level at the moment.

I hope that you are still happy to receive the six monthly updates, as I feel more comfortable keeping this line of communication open, in case the symptoms become worse at any time.

Kind regards.

Thankyou again for the update. We are currently proposing a deliberate follow-up study of all the patients we started out treating with steroids in 2007. If everyone were kind enough to provide occasional updates like this there would be no need for such efforts so thankyou. Glad to hear it is still under control. JB

Hello Dr Bland,

It is now two years and six months since my 4th CTS Injection, and six months since my last communication to you. At that time, your reply indicated that you welcomed these updates. So, unless you advise otherwise, I will continue in this fashion.

My condition remains stable. As I have mentioned in previous communications, I still need to wear the splint at night and continue to occasionally suffer minor symptoms, such as when riding my bike. However, these remain at a level which is acceptable.

I will, of course, contact you before the six months period if my symptoms worsen.

Kind regards.

As always the update is welcome - thankyou. We have now got most of the replies back from our 2007 cohort of injected patients and we seem to have managed to track down and obtain infomration from about 65% of them so far - about 10 or so have declined to provide any follow up info which is disappointing. It is looking as though there are a significant number of patients who will not need surgery in the medium to long term after 1-4 injections - we'll be aiming to publish the results and I'll summarise them on here once we have done that. JB

Hello Dr Bland,

Many thanks for your reply. I will look forward to reading the results of your follow-up study.

Kind regards.

Hello Dr Bland,

It is now 3 years since my 4th (most recent) CTS injection, and 6 months since my last communication.

My symptoms are relatively unchanged and remain manageable. As detailed in my previous e-mails, I continue to wear a splint at night and occasionally suffer numbness, especially when cycling.

As long as you agree, I will keep up the six monthly updates. Unless, of course, my condition becomes worse.

Kind regards.

Absolutely, please stay in touch. At some point we might arrange to test you again to see what objective change there has been in nerve function but we're going through a pretty busy period at present. JB

Hello Dr Bland,

Thanks for your reply.

I'd be very happy to be tested again. As you are busy at the moment, perhaps in six months time, when I'll be in contact once more?

Kind regards.

Sounds like a good plan. Stay well! JB

Hello Dr Bland,

It is now 3.5 years since my 4th CTS injection and 6 months since my last communication. My symptoms have remained fairly stable during that period. In short, I still suffer minor problems but my condition is manageable, although it remains necessary for me to wear the splint at night.

When I last contacted you, you indicated that it might be helpful for me to come in for some more tests, but that you were very busy at that time. Therefore, I suggested that I wait a further 6 months, a suggestion with which you agreed.

Would it now be convenient for you to arrange for an appointment?

Kind regards.

I have a series of academic meetings in September/October but if we can aim for a slot about mid October that would be an interesting time to check it and see how it is doing - would that be OK for you. JB

Hello Dr Bland,

That would be absolutely fine for me. Can you make an appointment for me now, or would you prefer that I contacted you again early October?

Kind regards.

I've booked a slot for mid October and we'll put a letter in the post. See you then. JB

Hello Dr Bland,

It is now 5 years since my 4th CTS injection. Also, I had an appointment to see you last October. My symptoms continue to be largely unchanged. I still wear the splint at night, which is no hardship to me. I do experience some symptoms such as numbness and tingling (but no pain) from time to time, but these are manageable.

I will continue to give you a six monthly update, unless you suggest otherwise. Is the six month gap between communications appropriate for you, or would you prefer a longer or shorter period of time?

Kind regards.

Hello Dr Bland,

My apologies, in my previous communication, I indicated that it was 5 years since my last CTS injection. It is , in fact, 4 years.

Kind regards.

It is indeed four years and I will be delighted to receive continued updates indefinitely. As you know I remain passionately interested in the long-term outcomes of treatment for CTS with steroids. Glad to hear it is still under control. JB

Hello Dr Bland,

Many thanks for your reply.

I will continue with updates every six months unless, of course, I encounter any problems.

Kind regards.

Hello Dr Bland,

It is now 4.5 years since my 4th CTS Injection. As with my last few communications, my symptoms remain virtually the same. I continue to wear a splint at night and occasionally experience numbness, usually early after rising and also whilst cycling. However, these symptoms are manageable and the wearing of the splint does not bother me to any great extent. I did come in for an appointment to see you sometime ago. As always, I'm happy to be guided by you as to the appropriate time for another appointment. I don't feel too bad at the moment.

Kind regards.

It all goes to show that CTS can remain a fairly static and not very troublesome problem for long periods - despite some surgeons appearing to believe that it is an inevitably progressive disorder which will always require surgery. Of course it would be even better if it resolved entirely leaving you with no symptoms at all, but I'm quite happy to simply observe until such time as you decide for yourself that it need further attention. JB

It all goes to show that CTS can remain a fairly static and not very troublesome problem for long periods - despite some surgeons appearing to believe that it is an inevitably progressive disorder which will always require surgery. Of course it would be even better if it resolved entirely leaving you with no symptoms at all, but I'm quite happy to simply observe until such time as you decide for yourself that it need further attention. JB

Hello Dr Bland,

Many thanks for your reply.

Unless my condition begins to deteriorate, I will contact you again in six months time.

Kind regards.

Hello Dr Bland,

It is now (incredibly) 5 years since my 4th CTS injection. As in the recent past, I have experienced no significant change in my symptoms. I continue to wear a splint at night and occasionally suffer mild periods of numbness/discomfort, especially when cycling, but nothing that is not manageable.

I will continue to give six monthly updates unless you advise me otherwise, or my condition becomes more problematic.

Many thanks,

Kind regards.

As usual I am delighted to hear that it is still under control and thankyou for letting me know. I'll keep my fingers crossed for the next update, though you have a long way to match my longest documented remission of 48 years :-)  JB

Hello Dr Bland,

Many thanks for your interest and comments.

As always, I will update again in six months.

Kind regards.

Hello Dr Bland,

It is now 5.5 years since my 4th CTS Injection and 6 months since my last update. As has been the case for some time now, no significant change has taken place in my condition since my last contact with you. The symptoms still exist and I continue to use the splint at night. I suffer some numbness from time to time during the day, especially whilst cycling. However, the condition is manageable.

Unless you think otherwise, I will update again in 6 months.

Kind regards.