DEAR DR. DONOHUE: When I retire for the night, almost as soon as I am in bed I develop peculiar sensations in my legs, and they keep me from falling asleep. If I do fall asleep, later in the night the same feelings waken me. I have to get up and walk around. I am losing hours of precious sleep, and I am tired all day. What is this? – W.B.

ANSWER:
Your symptoms fit the profile of restless leg syndrome – RLS. It is not a rare bird. More than 12 million other North Americans endure what you are enduring.

People describe the sensations as feeling like an army of ants is crawling in the legs; like pins and needles; or as though a carbonated beverage is flowing through the legs. This almost always happens when a person lies down or rests in a chair. In addition to the strange sensations, many people’s legs feel twitchy, and for some the legs repeatedly kick their bedmate. Those movements are called PLMD – periodic limb movement disorder. The sleep disruption caused by RLS makes people chronically tired.

In some RLS patients, an anemia or a low blood iron level exists. For them, iron supplements end the problem. Others might have kidney disease, nerve troubles or diabetes. Treatment for those people is directed at the primary problem. Most, however, have no associated illness. There are a few self-help remedies for RLS. Take a hot bath before going to bed. After (or during) the bath, massage your legs.

Medicines used for Parkinson’s disease can sometimes end RLS. Examples are the combination medicine carbidopa-levodopa, or the single-ingredient medicines pergolide, bromocriptine and the newer Parkinson’s drug ropinirole.

Contact the Restless Leg Syndrome Foundation at 1-877-463-6757, or home in on its Web site, www.rls.org.

Readers can obtain the pamphlet on restless leg syndrome and night cramps by writing: Dr. Donohue – No. 306, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I had vulvar cancer surgery. The doctor says he got it all. Is there any test to check that? I had stage 1. Is it curable? – R.M.

ANSWER:
Vulvar cancer is cancer of the external female genitalia. Ninety percent of those cancers are squamous cancers, and early removal of squamous vulvar cancer can often bring a cure. (Squamous cells are found in the skin and many such coverings.) A stage 1 cancer is one that is a little less than an inch (2 cm) at its greatest dimension and one that has not spread to lymph nodes. Stage 1 cancers are usually curable.

This cancer appears mostly in women over 65. It is often mistaken for a rash or a sore, and it usually itches, something not common with most cancers. There is no test, other than periodic examinations, for detecting a recurrence.

DEAR DR. DONOHUE: My primary physician turns her hospitalized patients over to a doctor whose sole job is to look after hospitalized people. I don’t know what title these doctors have. I am not comfortable with my care being entrusted to a physician I have never met. Have any studies been done on the level of care provided by these doctors? – B.B.

ANSWER:
Those doctors are called hospitalists, a brand-new medical specialty. The specialty arose for sound reasons. Being present in the hospital all the time, these doctors can oversee the care of hospitalized patients better than they could if they had to return to their offices every day. A physician with a busy office practice has a difficult time seeing hospitalized patients whose status changes hourly while having to see an office full of patients.

Studies have been done on the quality of hospitalists. The system improves efficiency of care without harming the quality of care. Many people feel exactly as you do. Hospitalists, however, are accepted by most patients without a peep.

DEAR DR. DONOHUE: In 1995, I was told by the Mayo Clinic that I had “monoclonal gammopathy.” I have a blood test for it every year, and the last test showed it to be a little more active. My doctor says it is not treated until it turns into cancer. How about it? Is there any other advice? – M.A.

ANSWER: “Monoclonal gammopathy” is often shortened to “MGUS” – monoclonal gammopathy of undetermined significance. It is an explosion in the production of globulins, proteins that attack foreign invaders. In this condition, the cause of the explosion is not a germ invasion. It’s something that happens for no known reason, and that’s one reason why the “undetermined significance” is part of the name. “Monoclonal” indicates that one cell line and its offsprings (clones) are responsible for production of this protein.

Three percent of healthy-looking and -acting people over 70 have this condition.

In some people, the process remains dormant, so no treatment is necessary. In others, globulin levels rise but no symptoms occur, so no treatment is necessary. In a third group, the process turns into a cancer called multiple myeloma, a cancer of bones and bone marrow. This, of course, requires treatment.

There is no reliable test to predict what course an individual’s MGUS will take. The doctors are watching you for any changes. Until they occur (if they ever do), treatment can be deferred.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.


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