Ask the Doctor - April columns

Sunday 25th April - Carpal Tunnel

I have pain and numbness in my hand often at night, what is it? David, Morningside

Mr Chris Oliver is a Consultant Hand Surgeon at Spire Murrayfield Hospital. He also runs the Edinburgh Hand Clinic. For more information, visit his website: www.orthodoc.aaos.org/chrisoliver/

Night pain and tingling in the thumb, middle and index finger may be carpal tunnel syndrome. This occurs when the median nerve is compressed where it passes through a short tunnel at the wrist. It commonly affects women in middle age, but especially with pregnancy, diabetes, thyroid problems, fractures and rheumatoid arthritis. Often the cause is not found. In advanced cases the fingers may be continuously numb and thumb muscles may waste. Sometimes nerve conduction and blood tests are required to confirm the diagnosis. Often splints at night may help. Surgery is often required. The simple operation needs a small cut and opens the roof of the carpal tunnel to reduce the pressure on the nerve. The surgery may be performed under local anaesthesia. The hand can be used for light activities immediately. The outcome is often dramatic with relief of night pain. Tingling usually disappears within a few months. It generally takes about six months to regain full strength and a fully comfortable scar.

Sunday 18th April - Blastocyst culture

My husband and I are currently considering IVF treatment and have heard that blastocyst culture increases your chance of getting pregnant. What is a blastocyst? Gillian, Kirkcaldy

Caitlin Delaney, Lead Embryologist at IVF Scotland. IVF Scotland is a subsidiary of Spire Edinburgh Hospitals, Murrayfield and Shawfair Park.

A blastocyst can be made up of anywhere between 30-100 cells; one group of cells will develop into the foetus, and the other cells will make up the placenta. Human embryos should develop into a blastocyst five days after fertilisation.

Many IVF clinics in the UK put embryos back into the patient two or three days after fertilisation.  However, sometimes it is very difficult to choose the best one or two embryos for transfer at this stage.  By waiting until day five, when the embryo should be at blastocyst stage, the strongest embryos are more evident. Transferring at this later stage can increase the likelihood of embryos successfully implanting in the uterine wall and leading to a healthy pregnancy. 

Worldwide studies confirm that blastocyst culture and transfer can significantly increase a patient’s chance of getting pregnant. However, blastocyst culture is not suitable for all patients. At IVF Scotland, blastocyst culture and transfer will always be recommended if  we believe that it will increase a woman’s chances of pregnancy. 

Sunday 4th April - Bowel cancer

What should I do if I have a family history of bowel cancer? Mark, Edinburgh

David Bartolo is a Consultant Colorectal Surgeon at Spire Murrayfield Hospital.

Bowel cancer is relatively common, affecting around 4% of Scots males and 8% of those aged 80 plus. The relatives age plays key role when assessing familial risk. A single relative affected in later life poses only a minor increase in risk, whereas an affected relative under 45 years may suggest increased hereditary risk. Genetic testing may identify faulty genes that allow errors of DNA replication. Colonoscopy is also advised to identify polyps that could become cancerous.

Symptoms to watch for include rectal bleeding, especially dark blood, and significant change in bowel function.  

A healthy lifestyle is important. In Japan, the increased adoption of a Western meat-eating diet has seen incidence of bowel cancer rise four-fold in four decades. Smoking, alcohol excess and obesity are risk factors.
Exercise and a healthy diet are beneficial. Salicylates found in fresh fruit and vegetables, are thought to be protective.

Early diagnosis is key and a national screening programme is now established. This gives us the opportunity to diagnose and treat tumours at an earlier stage of the disease.