DEAR DR. ROACH: Don’t forget that although there are many medical causes of restless leg syndrome, varicose veins also can be a source of symptoms, and we have cured many people of symptoms with minimally invasive varicose vein treatments.
We always recommend that if you have visible varicosities or strong family history of varicose veins, you should get an ultrasound to determine if you have venous insufficiency. The treatments have essentially no down time and can mean one less medication for many people. In addition, just because you can’t see visible varicosities does not mean you do not have venous insufficiency. We have patients with beautiful legs whose ultrasound reveals large veins under the surface. — Melissa A. Sandman, M.D.
ANSWER: Thank you for writing. Many people also have written about other causes and treatments for restless leg syndrome, so I wanted to talk a bit more about this important subject.
In addition to the iron deficiency I mentioned and the varicose veins Dr. Sandman writes about, there are several other important causes, including kidney disease, usually when dialysis has started. Diabetics have a higher risk for RLS, which sometimes can be mistaken for diabetic neuropathy. Multiple sclerosis and Parkinson’s disease both are associated with RLS, and Parkinson’s is important because when medicines such as levodopa/ carbidopa (Sinemet) wear off, it can mimic RLS symptoms. When dopa drugs are used long-term for RLS, symptoms can get worse, a condition called augmentation.
Pregnant women are more likely to have RLS. Many drugs, especially antidepressants, can cause RLS. I had a reader tell me that hers was due to Benadryl she was taking for sleep. Magnesium defi- ciency is common in RLS, and several readers told me magnesium supplements stopped their symptoms.
The booklet on restless leg syndrome provides much more information on this common sleep disorder, and also offers advice on nighttime cramps. Readers can obtain a copy by writing: Dr. Roach — No. 306W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address.
DEAR DR. ROACH: I am 92 and have spinal stenosis in my lower back and neck. The neck stenosis is causing a balance problem. Who would treat and/or operate on this — orthopedist or neurologist? — J.W.
ANSWER: I would be very slow to recommend surgery on the neck at age 92. I would try other treatments, including medication, physical therapy and possibly injection, before considering surgery.
Balance problems may benefit from problemspecifi c exercises. A neurologist may be very helpful in evaluating whether the symptoms are indeed coming from the spinal stenosis, because balance problems can have many different causes.
If symptoms were intolerable despite everything that could be done short of surgery, I would find the most experienced surgeon around, which could be either a neurosurgeon or an orthopedic surgeon.
DR. ROACH WRITES: Quite a few people have written in to recommend nasal saline gel for people with dry nose and recurrent nosebleeds. It is worth a try, especially for those who don’t like petrolatum or for whom it isn’t working.
©2015 North America Synd.