Restless Legs Keeping You Awake?

Do your legs ache, squirm, feel antsy and seem to want to MOVE to get comfortable when you try to go to sleep at night? How about during the day- do you need to get up and walk around to relieve that same irritating sensation in your legs when you are supposed to be sitting in a meeting or parking yourself in front of a computer? Does walking around or at least moving your legs relieve the discomfort? If so, you may be one of the estimated 3-15% of the population with a disorder known as restless leg syndrome (RLS).

This disorder can be a sign of underlying issues such as iron deficiency, pregnancy, kidney problems or  drug side effects, but also may be an isolated medical problem. About half of the time, there is a family history of other blood-relatives having the restless leg syndrome. The incidence increases with age, and is more common in Caucasians.

How is RLS diagnosed?
Restless leg syndrome is primarily diagnosed by your history, with focus on four issues:

• Strong urge to move your legs
• Symptoms worse at rest
• Symptoms worse at night
• Urge relieved by movement, but come back quickly with rest

Your doctor may need to do blood tests to determine if you have a low iron level (ferritin) and/or low red blood cell count (anemia), and occasionally a formal sleep study may be necessary to fully identify RLS.

How is RLS treated?
If there is an identified cause, such as a medication or iron deficiency, then the treatment obviously targets that trigger. Medications that are more likely to cause RLS include antihistamines and decongestants, antidepressants, anti-nausea medications, seizure medications and stimulants.

If no cause can be identified, then there are several different medications which your doctor may try.
For very intermittent symptoms, a drug traditionally used for Parkinson's disease (Sinemet) can be taken on an "as needed" basis. For people who suffer from symptoms the majority or every night, other neurologic medications (Requip, Mirapex, Neurontin, Lyrica, or Neupro) may be tried on a nightly basis.

What about alternative therapies? There's always SOAP...

BOTTOM LINE: If your squirming legs are keeping you from restful sleep, don't suffer in silence- talk to your doctor and find out if you have restless leg syndrome!

Sneeze, Cough, Stuffy Nose...and LOTS of Medicines

Allergy season is in full swing, and there are so many allergy remedies out there. How do you decide what you need? Do you understand the difference between an antihistamine and a decongestant? And where does an expectorant fit in? It's often tough to figure out when to take which drug might help. Here are the basics:

1. Decongestants simply narrow the blood vessels in the lining of the nose, allowing air to pass more easily. Use these when your nose is "stopped up". Caution: do not use if you have high blood pressure, as they can potentially raise your pressure.

2. Antihistamines block the release of histamine, the chemical in your body that cause cells to swell and leak fluid, resulting in itchy eyes, sneezing, and runny nose. Use these to DRY UP (but not when you are simply "stuffy")

3. Expectorants are all medications that include guaifenesin. This drug breaks up mucus, allowing it to drain down from sinuses or be coughed up from your lungs. It wont work if you are dehydrated, so drink extra water- especially if you are also taking an antihistamine, because they DRY UP mucus and that makes it tougher to break up and clear. Use these when you have sinus and ear pressure, or if you have a cold "go to your chest." There is little evidence-based medicine to support the use of these, but clinically I have seen them help a great deal to relieve head congestion, and often avoid the use of antibiotics.

The AAFP a great website with more detail: http://familydoctor.org/online/famdocen/home/otc-center/otc-medicines/857.html

BOTTOM LINE: Don't always grab the "do everything" medicine for your stuffy, sneezy, coughy, itchy symptoms- understand which drug works for which complaint!

April Showers Bring May...ALLERGIES!

Greetings from Austin, Texas, where-ACHOO!-those of us with allergies are collecting sneezing our heads off! In our case, the scant April showers still managed to kick up the MOLD pollens enough to wreak havoc on allergy sufferers, so I thought today I'd talk about seasonal allergies.

What are signs and symptoms of allergies?

At the risk of sounding like an antihistamine commercial, it's sneezing (often in fits of sneezes), itchy eyes, itchy throat, scratchy throat, drainage down the back of your throat (which creates early morning sore throats that often fade mid-morning), stuffy eyes, ear pressure and the lovely dark circles under your eyes.

What is recommended for treatment?

We usually start with the non-sedating antihistamines,which used to be prescription but are now available over the counter (OTC). These include Loratadine (Claritin), Fexofenadine (Allegra), and Cetirizine(Zyrtec), to name a few of the most popular. Which is BEST? In my experience, they are clinically equal. What works for you this year may not work as well next year, and there is not great science to explain why. Antihistamines will DRY you up and STOP ITCH. If you are mainly stuffy, you are better off with just a decongestant such as phenylephrine (Sudafed) or if you have both, grab a combination product.

If you are suffering regularly in a particular season, or perhaps year-round from something like molds, your doctor may recommend more preventative therapy such as nasal steroid sprays. These sprays are prescription, and they are not "addictive" like the OTC ones. The OTC sprays that give immediate relief are fine for a day or two, but beyond that, you will get rebound nasal congestion and be chasing your tail with symptoms/spray/more symptoms/more spray. Nasal steroids are minimally absorbed (so no turning into Arnold, gaining weight, or weakening your bones.) They are very safe, and decrease swelling while creating kind of protective barrier against entering irritants, so you don't turn on the histamine system that causes allergy symptoms.

What more prevention can you do?

Well, it's May 1st, so like every first of the month, I recommend changing out your home's air filters! That disgusting air filter pictured above came out of our home this morning- yuck!This "central" or "media filter" type should be changed at least three or four times per year, despite manufacturer recommendations of annual replacement. Yes, that is expensive, but cheaper than many allergy medications, and no other side effects! If you look at your filter (set your calendar to remind you) and you see it looking like this- CHANGE it! HEPA air cleans and vacuum bags are of unclear efficacy, but may help. Limit your outside exposure (get on the exercise bike or treadmill indoors.) If you really suffer, consider getting rid of carpet and drapes in your home, and restricting pets to outside the bedroom.

BOTTOM LINE: If you can't stop sneezing or are having other signs of seasonal allergies, schedule an appointment with your doctor and find out what she can do to help! There are many interventions before considering allergy shots- though for severe sufferers, those shots may be an excellent option.

Stuffy nose, itchy eyes, and sneezing?

There are so many allergy remedies out there. How do you decide what you need? Do you understand the difference between an antihistamine and a decongestant? And where does an expectorant fit in? It's often tough to figure out when to take which drug might help. Here are the basics:

1. Decongestants simply narrow the blood vessels in the lining of the nose, allowing air to pass more easily. Use these when your nose is "stopped up". Caution: do not use if you have high blood pressure, as they can potentially raise your pressure.

2. Antihistamines block the release of histamine, the chemical in your body that cause cells to swell and leak fluid, resulting in itchy eyes, sneezing, and runny nose. Use these to DRY UP (but not when you are simply "stuffy")

3. Expectorants are all medications that include guaifenesin. This drug breaks up mucus, allowing it to drain down from sinuses or be coughed up from your lungs. It wont work if you are dehydrated, so drink extra water- especially if you are also taking an antihistamine, because they DRY UP mucus and that makes it tougher to break up and clear. Use these when you have sinus and ear pressure, or if you have a cold "go to your chest." There is little evidence-based medicine to support the use of these, but clinically I have seen them help a great deal to relieve head congestion, and often avoid the use of antibiotics.

The AAFP a great website with more detail: http://familydoctor.org/online/famdocen/home/otc-center/otc-medicines/857.html

BOTTOM LINE: Don't always grab the "do everything" medicine for your stuffy, sneezy, coughy, itchy symptoms- understand which drug works for which complaint!