Contact:
Mike Goodkind
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Health Tips from Stanford University Medical Center September 1997
TAKE A SYSTEMATIC APPROACH TO SOLVING BEDWETTING
Hormone replacement may help a child stop sleep-wetting, but consider other approaches first if your child can't stay dry through the night, says a pediatric urologist at Stanford University Medical Center.
"Recent evidence indicates that sleep-wetting may result from the inherited lack of a hormone -- most active at night -- that normally stimulates the kidneys' collecting ducts to reabsorb water and help keep the bladder from filling up," says Dr. William A. Kennedy II, acting assistant professor of urology and associate chief of urology services at Stanford and at Lucile Packard Children's Hospital. "In any case, a nasal spray containing a synthetic hormone -- desmopressin acetate, or DDAVP -- has been found in a limited study to stop sleep-wetting in 70 percent of cases."
But before rushing off to get a prescription, Kennedy says, parents need to approach their child's bedwetting problem systematically, as hard as that might be after repeated mornings of frustration and washing sheets.
If you're responsible for a child who wets his or her bed, it's a good idea to bring up the following issues with your pediatrician or family physician in order to determine what should be done next, Kennedy suggests.
* Is the problem simple bedwetting?
At any age it's important to determine if the real problem is sleep-wetting or a more complex medical problem requiring a different strategy. Common sleep-wetting, or nocturnal enuresis, occurs only at night. If the child also wets during the day, if the bedwetting appears related to a urinary tract infection, or if it occurs along with persistent constipation, then the problem may be more complicated and should be discussed with your family physician. The doctor can complete a health history and exam and, if necessary, can provide a referral to a pediatric urologist.
* How old is the child?
No one starts life toilet-trained, and there is no single age at which all children are expected to gain full bladder control, Kennedy says. But generally, "the accepted time to start thinking about some special strategies is when the child is about 6 and/or both the child and parents are concerned about the problem.
You might start at 4 or 5 if both the parents and child are anxious about the problem, or wait until 7 or 8 if the child is not ready until then to participate in the treatment, says Kennedy. Boys, by the way, because of their "plumbing," tend to gain control a bit later than girls, he says.
* What are my choices?
If the child is old enough and the problem is simple sleep- wetting, parents are faced with three alternatives:
1. Wait. Kennedy notes that the problem will almost surely go away eventually. While 10 percent of 6-year-olds suffer from sleep-wetting, the problem is down to 1 percent by age 18, when the sufferer surely will be motivated to cooperate with a treatment strategy.
2. Behavior modification. Some older children who don't control urine at night can benefit from using a home remedy such as a bladder alarm. "Versions of these have been around for almost a century, Kennedy says. For under about $100, parents can purchase one of these devices, which make a ringing or similar sound to awaken the child up at the first sign of wetness. There is some evidence that kids suffering from sleep-wetness aren't aware that the bladder is full, so a device that awakens them can help condition them to the need to recognize bladder fullness."
3. Medications. While the desmopressin acetate (DDAVP) nasal spray appears to be the most promising medication for simple sleep wetness, physicians have other options to meet special circumstances, including stress or emotional problems that may contribute to the problem, Kennedy says.
"It's extremely important to provide emotional support for a child who is sleep-wetting. Remind the child that the problem is medical and almost always unintentional on the part of the sufferer."
LSD CAN PRODUCE SYMPTOMS YEARS LATER, SAYS DRUG REHAB EXPERT
Whether taken under a lava lamp in the '60s or swallowed under the glow of a computer screen in more recent times, LSD and related drugs can cause visual hallucinations, such as geometric shapes or flashes of color, long after a user has become drug-free, says a Stanford University School of Medicine psychologist.
This is important information for persons who may be suffering residual perceptual disorders from hallucinogenic drugs without knowing why, says Robert Matano, director of the Stanford Drug and Alcohol Rehabilitation Program.
Matano, a clinical psychologist, says experiences with patients at Stanford and several recent studies indicate that some persons who have taken these drugs experience one or several visual hallucinations long afterward. These may include geometric shapes, objects whose images persist although no longer in the field of vision, objects that appear to trail or shadow a real object, flashes of color from no apparent source, and a wavy field of vision.
While the number of cases appears small, Matano says anyone who has taken hallucinogens should be alert for possible symptoms.
"We have had patients who have not taken a drug for 20 years who suddenly report these unusual visual symptoms," says Matano, although this degree of time lag is rare. Most of the problems subside within five years of the drug use, he says. "While there does not appear to be any cure, and we're not sure why these delayed symptoms occur, the positive news is that some of these symptoms can be managed with medication from a psychiatrist familiar with the condition. More important, the symptoms don't appear to signal loss of vision or more widespread psychological problems such as a prolonged psychosis," Matano says.
Once the source of the problem is identified, most individuals can manage their lives, taking into account their perception problems. The condition appears to stabilize -- and that, Matano says, might be some reassurance to patients and those close to them.
"We've had some family members come to us agitated because they think their loved one has resumed LSD use or is suffering from psychosis. Certainly neither of these need necessarily be true," he says.
Persons who experience visual hallucinations may need to refrain from activities involving hand-eye coordination. Some may be able to manage their symptoms. For example, Matano notes that some false visual clues are triggered only when a person moves form light to darkness, so persons with this problem might need to be careful with certain activities such as driving or even seeing a movie.
Current use of other drugs, including marijuana, appears to trigger the delayed LSD symptoms in some people, he notes.
For patients who have never tried a hallucinogen, the news of this side effect should serve as one of several compelling reasons to avoid these drugs altogether, says Matano.
GET OUT AND WALK, SAYS A CARDIOLOGIST WHO HAS ANSWERS FOR COMMON EXCUSES NOT TO
A Stanford cardiologist has some rousing advice for older patients at risk of a heart attack.
"Get up, go out the front door and start walking," says Dr. John S. Schroeder, professor of medicine (cardiovascular) and an authority on the use of cholesterol-lowering drugs and prudent diets in cardiac health.
"Your medications and your diet are also important, but for most people, 30 minutes of moderate exercise every day will do as much or more to reduce the risk of heart attack," he says.
"You don't need to jog; you don't need to lift weights. It's been shown that moderate exercise is all that's needed for most of the cardioprotective benefits of physical activity," Schroeder says.
"And if you suffer from hip or knee pain, try riding an exercise bike. An inexpensive bike from a discount store will work just fine. Or join a water exercise program in your community."
Schroeder has some practical suggestions to help people stick with a walking program or other basic exercise routine:
* Don't exercise so hard that you become uncomfortable and start breathing too hard. A good guide is that you should be able to carry on a conversation comfortably with someone while walking. If you can't, you're exercising too hard.
* If you've been totally inactive for a few months, start walking 15 minutes a day for a week or so, until walking the full 30 minutes is comfortable.
* Be sure to walk every day. A lot of physicians suggest walking three days a week. But it's a lot easier that way to miss days and get out of your walking routine. (Avid athletes may benefit by taking a day or two off a week to rest, but that's no excuse for the new, lighter exerciser.)
* Walk with a friend if you enjoy that, but if you prefer to be alone or can't find a partner just yet, get out there and walk anyway. Some people enjoy listening to a headset radio.
* Don't walk with the dog, or at least make it a final goal to make no more than one stop in your half-hour walk. The dog will make you start and stop too frequently.
* No time in the morning? Drink coffee if you like -- but don't eat breakfast -- before you go out to exercise. If you stop to eat first, you're more likely to be distracted by chores, the newspaper or whatever, and soon you won't have time for your walk. Walk first, then eat.
* If you have angina, bring your nitroglycerin along. Small "fanny" packs -- available at sporting goods stores or drug stores -- are a convenient way to carry not only your pills, but a water bottle as well.
* If you're riding a stationary bike in front of the TV (a fine idea for those folks who prefer television to walking), tell yourself that you can't sit back down in a chair until you've pedaled for 30 minutes.
* What if it rains? Bring an umbrella.
* What if it's too cold? Wear a jacket. There really aren't many locales, especially in the spring, summer and fall, where climate is so extreme that a quick walk is a problem.
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