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Treat Kid With OI  As a Kid

Dear Dr. Roach: My great-grandson was diagnosed with osteogenesis imperfecta. He had his first leg fracture before his second birthday. I understand there is no cure. How do we help him be the best he can be? — A.

Answer: Osteogenesis imperfecta is sometimes called “brittle bone” disease. There are several different forms, and the degree of severity can range extremely — from fatal at an early age to just early osteoporosis. Many, but not all, people affected by OI can have other features, including blue sclera (the white part of the eyes), short stature, hearing loss and dental problems.

Given the wide range, you will have to take advice from his specialist. My best advice is to treat him as normally as you can. He is likely to be seeing the doctor a fair bit, and there are treatments that can help prevent fractures. Physical and occupational therapy can be helpful. But especially as he gets older, he will appreciate being treated for who he is and not for his medical condition.

You have a friend in the Osteogenesis Imperfecta Foundation. You can find support and other resources on its outstanding website at www.oif.org.

Dear Dr. Roach: I had the laser green light procedure, and four months later it had to be repeated due to scar tissue in the bladder and urethra. It has been four weeks since the second procedure, and I am still experiencing pain during and after urination, weak urine flow and increased frequency at night, sometimes getting up every half-hour. I was told I have a bladder infection and am taking the antibiotic Cipro to relieve my symptoms. All the symptoms are the same as those from the first procedure. I have confidence in my doctor, but wonder if I should seek another opinion or if what I am experiencing is normal for this procedure. I am becoming very despondent and would like to know what I can do to get better. — J.P.

Answer: The “green light” procedure, also called photosensitive vaporization of the prostate (PVP), is a great idea for a lot of people with symptoms of an enlarged prostate but without prostate cancer. The laser removes tissue from around the urethra (the tube that drains your bladder and which, in men, goes directly through the prostate), creating a bigger tube to drain the bladder more easily. Unfortunately, even when the procedure is done perfectly, there is still a chance for complications. One is scar tissue. In this case, the new larger urethra can’t work properly because the scar tissue itself blocks the urine from flowing. That’s why you needed a second procedure. A second complication is a bladder infection, but it can be hard to tell what this is, since both have similar symptoms. I am concerned that it hasn’t gotten better in four weeks — that should be enough time for a bladder infection to have gotten better if Cipro is effective against the particular bacteria causing your infection. If there is no evidence of infection now, but you are still having symptoms, it suggests that the scar tissue wasn’t effectively treated by the second procedure.

Usually at this point, the surgeon would switch to another method, such as a HoLEP (a different type of laser procedure that removes more of the prostate), or a TURP or open prostatectomy, both of which are more traditional surgeries. You say you still have confidence in your surgeon: go back and discuss where to go from here.

Dear Dr. Roach: I have major back pain. I’ve been to the emergency room and seen many doctors. One gave me hydrocodone, then stopped and accused me of being an addict. I can’t do anything strenuous: just cleaning house leaves me in tears. Is an operation my only choice? — S.G.

Answer: In general, there are three kinds of treatment for low-back pain: medication, therapy and surgery. Medications include anti-inflammatories, Tylenol, and narcotics, but narcotics like hydrocodone are the least preferred due to both side effects and recent data showing that they don’t help over the long term. I am sure it must be very frustrating to try to find a medication to help you and be wrongly labeled an “addict.” It can take patience to find a medication that helps. By therapy, I mean physical therapy, but also acupuncture and chiropractic treatments.

Surgery is an option, but only for particular types of back pain (confirmed by MRI or other imaging) that aren’t getting better with other treatments.