Restless Legs Syndrome: Everything you need to know from symptoms to soap

Article by: Jennifer Clark, PA-C, MPAS

Do you ever complain of an uncontrollable urge to move your legs? Or perhaps you feel what may be described as a gnawing, or pulling, maybe even a creepy, crawly sensation in your legs that seems to happen when you rest? Does it seem to improve with movement?  If so, you may be suffering from Restless Legs Syndrome (RLS), a condition affecting 1 in 10 Americans. Many people suffer from these symptoms but don’t realize that it is in fact a known medical condition.

There is a significant amount of research out there looking for the cause of this condition, and it has not been nailed down to one particular cause. It has been found to run in families, and seems to affect women more than men, especially during pregnancy. There is thought that it is also due to an imbalance of a substance called dopamine, which is a chemical that is responsible for transmitting signals between the nerve cells in the brain. Anemia and low iron levels can also make these symptoms worse. Certain medications such as antihistamines, calcium channel blockers (used to treat high blood pressure and heart disease), and antidepressants can also provoke the symptoms.  Interestingly, research has also found that a large number of patients who suffer from RLS have an underlying venous disease such as venous insufficiency where the valves in the veins are not working correctly. The patients that seem to be impacted the most by both conditions are very similar: women, individuals over 50 years old, people who have standing professions, obese individuals, and those with a family history of the condition. In our practice we have found that 80-85% of the patients that complained of symptoms of RLS improved significantly after treatment of their venous disease.  By meeting with your primary care provider and discussing your symptoms he or she can review your symptoms, medications and lifestyle habits to help make the diagnosis and search for a possible underlying cause.   Simple blood work can determine if you have conditions such as anemia or iron deficiency.

Treatment for RLS ranges from treating the underlying cause, lifestyle changes, to medications and even surgical intervention to correct venous insufficiency. Here are some lifestyle changes you can try to help alleviate your symptoms:

·         Keep a regular sleep schedule.

o   Fatigue often makes symptoms of RLS worse. Try to go to bed and wake up the same times during the day to help your body get into a routine. Also avoid falling asleep with the television or lights on.

·         Compression hose

o   Wearing during the day when you are on your feet can help improve your symptoms, especially if you have underlying venous disease

·         Exercise in moderation

o   By maintaining aerobic fitness symptoms often improve, however intense or extensive training such as running a marathon can sometimes provoke symptoms

·         Stop smoking and drinking alcohol

·         Cut back on caffeine

·         Take a multivitamin

o   Often deficiencies in magnesium, iron, folic acid, and vitamin B can cause symptoms of RLS

·         Weight loss

·         Yoga

Lastly, I would like to leave with you with an anecdotal remedy. I will forewarn you, as I do with all of my patients I tell this to in clinic, that it may sound ridiculous! Are you ready? Place a bar of colored soap at the foot of your bed underneath your fitted sheet. Some people have even placed a small bar of soap, similar to the size you find in hotel rooms, in each sock when they sleep. It is not known how or why this works, but we have found that 70-80% of our patients that try it notice significant improvement of their symptoms. I always say, as silly as it sounds, it is certainly worth the cost of a bar of soap to try!

                 

Let's Talk About PAD

Article by: Jennifer Clark, PA-C, MPAS

Peripheral arterial disease is a very common condition affecting between 8-12million Americans. This number is expected to increase even more so as our population ages. Interestingly, only about 15% of those people have been diagnosed with peripheral arterial disease (PAD), while many people continue to attribute their symptoms of leg pain to “old age.” So what is the big deal about PAD anyway? Why is this so important to prevent? The arteries in our body are responsible for carrying oxygen and nutrient rich blood from the heart and lungs to the rest of the body for the organs and tissue to use. PAD is a narrowing of the arteries which is caused by a build-up of plaque, a waxy material made up of cholesterol, calcium and fibrous tissue. When the arteries are narrowed, this decreases the amount of blood flow to the body. When we exercise our muscles demand more oxygen, and when the arteries have narrowing it prevents them from getting this oxygen they require. This can cause weakness or painful cramping in the hips, buttocks, thighs or calves that resolves with rest which is called claudication. As the disease progresses people can develop severe symptoms such as rest pain or formation of ulcers to the legs and feet. Eventually this disease can progress to the point where the artery can become totally occluded and often times patients may require amputations.

            There are certain risk factors that make people more likely to develop PAD. This disease effects patients more commonly over the age of 50, in fact, the current statistics reflect 1 in every 20 adults over the age of 50 have PAD. Smoking or a history of smoking increases the risk of developing this condition by four times! Diabetes is a condition where the body cannot use sugar or glucose appropriately therefore there are elevated amounts of glucose in the blood. This causes the walls of the artery to become rough, which allows for plaque to form and build up within the artery. High blood pressure has a similar effect on the walls of the artery. Blood pressure is a measurement of the amount of force the blood pushes against the artery walls, the higher the blood pressure the more damage to the walls of the artery which allows for the plaque to build up. Uncontrolled cholesterol is a risk as well. Your body makes both good and bad cholesterol. LDL, also known as the “bad cholesterol” is a particle that carries cholesterol in the blood and deposits it in the arterial walls. The good cholesterol (HDL) helps to pick up excess plaquing from the artery walls. By understanding this you can see how if you have an elevated LDL and a low HDL this promotes plaque formation within the arteries. If you have any of the above mentioned risk factors or if you are experiencing symptoms of claudication then you should make an appointment with your primary care provider for further evaluation and treatment.

            Treatment for PAD begins with modifying risk factors such as the ones listed above. Controlling your cholesterol, Diabetes, and high blood pressure helps stabilize and improve arterial disease. Healthy diet and exercise along with stopping smoking benefits your body in so many ways. Walking programs often help improve the symptoms of PAD by promoting increased circulation. Various medications are also available to help improve symptoms. Interventional treatment with athrectomy and angioplasty may be required as well.

            PAD is a lifelong disease process, but early intervention and prevention can significantly improve quality of life. Knowing about risk factors and symptoms will help to identify this condition sooner so that treatment can be initiated sooner. 

When It Comes To PAD, Early Diagnosis is Key

Article by: Clark Stream, PA-C

If you are among the 24 million Americans with diabetes, you are approximately four times more likely to develop PAD than a person without diabetes.  PAD, (Peripheral arterial disease) happens when there is a narrowing of the blood vessels outside of your heart.  The cause of PAD is atherosclerosis.  This happens when plaque, a substance made up of fat and cholesterol, builds up on the walls of the arteries that supply blood to the arms and legs.  The plaque causes the arteries to narrow or become blocked.  While the primary early symptom of PAD is intermittent claudication, or leg pain while walking, the presence of diabetes reduces the likelihood of any symptoms at all.  To help prevent disability, amputation, a heart attack or stroke, early diagnosis and treatment of PAD are vital.

According to current treatment guidelines, diabetics over age 50 should undergo an ankle-brachial index (ABI), a test in which blood pressure in the ankle is measured and compared to that in the arm.  If the ankle pressure is lower than the arm pressure, a PAD diagnosis is likely. 

Patients with diabetes can greatly improve their chances of remaining PAD-free with preventive measures against cardiovascular disease, that is, controlling blood pressure (below 120/80), cholesterol (LDL below 100 mg/dl) and blood sugar (AIc below 7 percent) as well as quitting smoking.  

PAD meets modern Technology

Recent advances in technology have proved of great benefit to patients with diabetes and PAD.  In the past five years newer surgical techniques, called endovascular interventions have been used to treat patients with PAD.  By using devices like ballons, stents and atherectomy cathers to treat the plaque in the arteries, many patients are kept from having open surgical bypass procedues.  Artherectomy is a procedure in which plaque is removed from the arteries using a laser or rotational device.  With aggressive medical management, we are making the right steps toward preserving life and limb.

September is PAD awareness month. 

National medical guidelines recommend that certain individuals be tested for PAD.  Take this simple PAD quiz and make sure peripheral arterial disease doesn’t stop you in your tracks.

1.       I am under 50 years of age, have diabetes and at least one other risk factor:

a.       History of smoking

b.      Abnormal cholesterol

c.       High blood pressure

2.       I am 50 years or older and have diabetes

3.      I am 50 years or older and am a former or current smoker

4.      I am 70 years or older

5.      I have one or more symptoms of PAD:

a.       Fatigue, heaviness, tiredness or cramping in the leg muscles (calf, thigh or buttocks) that occurs during activity such as walking and goes away with rest

b.      Foot or toe pain at rest that often disturbs sleep

c.       Skin wounds or ulcers on the feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks)

If you answered yes to one or more of the above questions, talk to your health care provider about being tested for PAD.

Healthy Teachers=Healthy Classrooms

Article by: Clark Stream, PA-C

Few studies have been published on teachers’ health but most state that teaching can be a very stressful career choice.  It takes a special person with passion and a commitment to serve to choose this career in the first place.  According to the paper, “Healthy Teachers”, written by Robert Barwa, Ed.D. healthy teachers make for healthy classrooms. 

Back to school can be just as perilous for a teacher’s health as it is for students.  The active summer with outdoor activities, regular diet and exercise and relaxing time with the family are all about to come to an end.  Now that you are back into the classroom for hours with your students, keeping up your energy and maintaining your health is important.  Here are a few tips to help all teachers stay healthy during the coming school year:

Eat nutritionally.  Act like a kindergarten kid and have snack time.  Planning on a high protein and high fiber snack will not only give you more energy but also increase your mental clarity.  Carrots, grapes, apples and nuts are all good choices.

Sanitize and immunize.  Hand sanitizer and hand washing are both great ways to prevent the spread of germs.  Having a box of tissue nearby is another way to keep germs at bay.  Lysol type sprays are your best friend.  At the end of the day, spraying the door handles and other frequently touched objects can help everyone stay healthy.  Getting a yearly flu shot has been shown to keep teachers healthy and in the classroom.

Exercise your body.  Regular exercise helps reduce stress and improve you immune system.  If you cannot make it to the gym, try parking your car away from the school entrance.  The extra distance of walking will help keep you fit and trim.  One teachers website stated if you’re a high school teacher and your students like you, park in the student lot.  At most schools that lot is at least a mile from the front door!

Take care of your feet and legs.  Teachers consistently put stress on their feet and legs with prolonged standing.  Wearing shoes with good arch support is important.  With over 40 million Americans having varicose veins, a high percentage of patients are teachers, hairstylists and nurses.  Heavy, achy, tired, cramping and swollen legs are often caused by prolonged standing.  Wearing graduated compression stockings, knee high, are the first step to making your legs feel great.

Sleep at least 7-8 hours per night.  It is just as important for teachers to get enough sleep as it is for students.  Being well rested will help you combat illness and stress.  If restless legs keep you up at night, short walks, elevation and compression hose use during the day will help reduce symptoms.  If you cannot get to sleep, let me know…I have a 20^th Century Russian History book that if read, even just a few pages…will put the hardest insomniac to sleep.

Laugh often.   Humor is infectious. The sound of roaring laughter is far more contagious than any cough, sniffle, or sneeze.  Laughter also triggers healthy physical changes in the body.  Humor and laughter strengthen your immune system, increases endorphins, boost your energy, diminish pain, and protect you from the damaging effects of stress.  Best of all, this priceless medicine is fun, free, and easy to use.

Lymphedema, The Epidemic That no one Talks About

Article by: Clark Stream, PA-C


What is lymphedema?  Lymphedema is swelling that is caused by damage to the lymphatic system resulting in an accumulation of fluid in the tissues under the skin.  The word lymphedema is broken down into 2 words; Lymph, a colorless to milky colored fluid in your body and Edema, which means swelling.  Most often the swelling is in the arm(s) and/or leg(s).

Types of Lymphedema (There are two types of lymphedema.)
Primary lymphedema occurs without any known precipitating cause, and is due to inadequate or non-functional lymphatic vessels. Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels. In the United States the most common causes are surgery involving the lymph nodes, radiation therapy, trauma, and cancer. It is most often seen following surgery for cancer of the breast, pelvic area, and resections for lymphomas and melanomas.

Signs and Symptoms of Lymphedema
Extremities with lymphedema develop a chronic inflammatory condition stemming from the accumulation of fluid, resulting in fibrosis (hardening) of the tissues.  As lymphedema progresses, mobility can be severely impaired and joint movement often becomes restricted and painful.  This unhealthy state often leads to recurrent infections because the high protein lymph fluid is a good growth media for bacteria and fungi.  Each subsequent infection can further damage the already impaired lymphatic system

Treatment for lymphedema
The aim of treatment is to increase function by preventing further progression of the swelling.  Treatment should begin as soon as lymphedema has been diagnosed by your physician, with a certified lymphedema therapist.  Treatment can be effective even for people who have had lymphedema for many years.

Components of treatment:
The best and most effective treatment for lymph edema is Complete Decongestive Therapy (CDT).  It involves the following:

1.    Manual Lymphatic Drainage (MLD) is a gentle manual technique to move the fluid out of the affected area.

2.   Compression Therapy:  Compression bandaging is an essential component of lymph edema management to decrease the excess fluid, and help to soften the tissues.  After treatment, a compression garment can help maintain results.

3.     Exercising according to recommended CDT protocols can help stimulate the lymphatic system and get the fluid moving.                                                                 

4.     Meticulous Skin and Nail Care for the affected limb is crucial to keep skin healthy and protect against infections.

5.     Good Nutrition and plenty of water is important.  Eat lots of fresh fruits and vegetables.  Controlling weight is essential because being overweight can make the condition worse.

The LIVESTRONG foundation started by seven-time Tour de France winner Lance Armstrong announced its endorsement of H.R. 4662, the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 introduced by Congressman Larry Kissell (NC-08). This bill will require Medicare to offer fair treatment coverage for Americans afflicted with primary and secondary lymphedema.  The National Lymphedema Network has called lymphedema “the epidemic no one talks about.”  For further information you can look online at www.lymphnet.org or search for “Lymphedema in the News” on Facebook.