My five-year-old daughter, who is otherwise well adjusted and happy, still wets her bed maybe once or twice a month. I would have thought it would be finished by now, as she learned bladder control long ago. She and I find it very unpleasant and embarrassing, and she doesn’t go to girlfriends’ homes to sleep over because she’s afraid her urine will seep out at night. Her pediatrician suggested that we try alarm or drug therapy, but there are disadvantages to both. Does it help to give her little prizes for each dry night? What do the experts recommend?P.T., Beersheba
Prof. Alan Apter, head of department of psychological medicine at the Schneider Children’s Medical Center for Israel in Petah Tikva, answers:
Psychological therapy – with sheets that sound an alarm when they become wet – would probably be the most effective. This trains the child to wake up when she has a full bladder. Medication should be reserved for older, treatment-resistant children. While most children improve with time, the problem could affect the child’s self esteem if left untreated. Moreover, I am not aware of any serious side effects associated with alarm treatment.Bedwetting affects up to a fifth of children your daughter’s age, and should be treated to prevent emotional, social and psychological problems. Ignoring involuntary urine loss at night could lead to worse problems. Some parents wake their children up in the middle of the night so they can go to the bathroom, while others limit the amount of liquids they consume at night. But bedwetting alarms seem the easiest and most effective tactic, and they certainly should be tried before medication.The Jerusalem Post recently ran an Israel21c article by Viva Sarah press about the health benefits of pomegranates. It was interesting, but nowhere was there a warning of the possible interaction of pomegranates with medications. I know that eating grapefruit or drinking grapefruit juice can interfere with certain drugs. As I am taking a statin for high levels of cholesterol, I was wondering whether I should eat a pomegranate in the morning and take my medication at night, or not eat pomegranates at all.E.N., Givat ShmuelVeteran pharmaceutical consultant Howard Rice comments:For centuries, pomegranates have been associated with many health claims – because of the very high amount of antioxidants and tannins found in the fruit. But the advent of medications has provided us with a challenge, since it also has an effect on enzymes in the liver, which metabolize many medicines and allow us to eliminate them – also known as cytochrome enzymes.Blocking or boosting one of these enzymes – of which there are many, with most having an effect on the elimination of medications from the body – can in some cases increase the effect of the medicine and in others reduce the effect. Indeed, this phenomenon exists with grapefruit juice.If a medication is less or more effective due to such foods, there is a danger that the medication will either not be effective or that it will cause an overdose.In the case of the statins for lowering blood cholesterol levels, the overdose can cause muscular pain, particularly when using oil-soluble statins (generically known as simvastatin and atorvastatin).Pomegranate juice affects the production of the cytochrome 450-34A enzyme, which is responsible for metabolizing most but not all statins, as well as the blood thinner Coumadin and heart/blood pressure medications known as ACE inhibitors. It is difficult to know how much juice can bring about this reaction, since we are all built differently. Most people would usually have to drink more than one glass daily to feel an effect, but this is by no means certain for each patient.You and your pharmacist or doctor must be the judge. Statins such as fluvastatin, rosuvastatin and pravastatin would be less affected by the juice. Pravastatin would probably be your drug of choice, since it is hardly broken down by this enzyme system. If you feel pain, stop eating pomegranates or drinking their juice. If you are taking Coumadin or ACE inhibitors, stop consuming pomegranates and tell your physician or pharmacist.Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000; fax your question to Judy Siegel-Itzkovich at (02) 538-9527; or email it to jsiegel@jpost.com, giving your initials, age and place of residence.