Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
My wife asks about enuresis. Enuresis is night bedwetting,
and it is extremely common. While occasionally due to
infection and rarely to problems related to the urinary tract
structure, most of the time it is due to the child not
responding to signals to empty his or her bladder while
asleep.
An article four years back felt that an alarm was the best
way to go. These are available commercially and wake up the
child when they sense wetness. DDAVP and other medications do
work, but when they are stopped, the problem returns.
Surprisingly, the best advice remains the old fashioned
advice. Positive reinforcement, not pressuring the child,
waking the child up to empty in the late evening, and having
the child strengthen the bladder valve muscles by starting
and stopping when he urinates seem to work the best.
Mrs. Q. (what does Q stand for?) asks about vaccines. When I
was small, vaccines against mumps, measles and rubella (MMR),
polio, DTP (diphtheria, pertussis and tetanus) were given.
Since then, the Hemophilus B vaccine has eliminated a major
source of death in children. Lately, hepatitis B recommended
for all children. In the U.S.A., children also get vaccinated
against Chicken Pox and Rotavirus, a cause of serious
diarrhea in children. Vaccines are crucial as most of these
diseases cannot be treated well if a person catches them.
However, there has been some concern about a preservative
that can be dangerous. In the USA, they deal with the problem
by recommending delay of the hepatitis vaccine until the
child is 6 months old. The Israelis are less concerned, so
they still give it at 2 months. As hepatitis B is unusual in
our community, I believe going along with the Americans is
worthwhile.
Elderly people need to be vaccinated against pneumococcus,
and the flu vaccine should be taken by the elderly and people
working in health care.
Residents and travelers to Israel will save themselves a lot
of problems by getting the hepatitis A vaccine.
There are some other vaccines that travelers should consider
based on the country they are traveling to. The Ministry of
Health of your country of residence should be able to advise
you.
The last important vaccine is rabies, which is the deadliest
disease known to man. Carriers of rabies in the U.S. tend to
be bats, foxes, skunks and raccoons. In Israel, coyotes and
foxes are the chief problems. Since bats may bite and go
unnoticed, it is recommended to get the vaccine, which is
good for at least ten years. In a particularly dirty wound,
tetanus might be given if it has been more than five years
since the last time. Write me in care of the Yated.
