DEAR DR. DONOHUE: For several years I have had spasms in my left leg at night while asleep. Now I get them in my right leg. They are intense and painful. My calcium is normal. I have taken magnesium and leg-cramp pills without results. I have put soap in the bed, used mustard and tried many other home remedies without any luck. I would be indebted for any other suggestions you might offer. — S.G.

ANSWER: Nighttime leg muscle cramps are another one of the joys of aging. Why? I don’t know. A cramp is a sustained, painful muscle contraction. In a very small number of people, low blood calcium or magnesium, an underactive thyroid gland and dysfunctions of the kidney or liver might be the cause. For most, a cause cannot be found.

Quinine was a favorite remedy. Now quinine has a limited use — only for malaria. It has potentially dangerous side effects that make it unwarranted for muscle cramps. Some find that tonic water stops their cramps. That’s fine that they do; the amount of quinine in tonic water is quite small. There is evidence that the heart and blood pressure drug diltiazem can be useful. Vitamin B complex — a mixture of the B vitamins, including B-6 — also has some support for its use.

Stretching the leg muscles three times a day and again before going to bed might prevent cramps. One exercise is standing on the lowest step of a stair with heels projecting off the edge of that stair. Raise high on your toes and then slowly lower yourself until the heels are well below the level of the stair. Hold that position for 10 seconds and repeat the exercise 10 times.

Some have found that a warm bath taken before heading to bed stops their cramps.

The booklet on restless leg syndrome and nighttime cramps offers a more lengthy treatment of this annoying problem. Readers can obtain a copy by writing: Dr. Donohue — No. 306, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have pulmonary arterial hypertension. I take digoxin, diltiazem and furosemide. I have not done well with other medicines. Revatio caused severe cramping and nausea. Tracleer was then suggested, but even with insurance paying a portion of the cost, it is just too expensive. The doctor says there are no other drugs. Your comment, please. — A.S.

ANSWER: Not many people are aware that they have two separate blood pressures, one for the body, the other for the lungs. Lung blood pressure is only about one-fifth that of the body’s pressure. The lungs are such delicate organs that they could not stand the same pressure that pushes blood through the entire body. High lung blood pressure — pulmonary hypertension — has many causes. Heart failure, sickle cell anemia, lupus and scleroderma are a few of the causes.

For many, however, a treatable condition isn’t found. Then drugs that affect lung pressure are used. Revatio is Viagra, the same drug used for male erectile dysfunction. Another drug of that family is marketed for pulmonary hypertension under the name Adcirca. Perhaps you could tolerate it. Letairis is closely related to Tracleer. Inquire about its cost. An inhaled medicine, Ventavis (iloprost), is another possibility for you.

DEAR DR. DONOHUE: You may consider me to be old-fashioned but I am bothered by the misuse of the word “surgery.” It is substituted for “operation,” the performance of a procedure. Surgery is a medical specialty that involves procedures called operations. When I have an operation, I want it performed by a surgeon who practices surgery and performs operations. — D.H.

ANSWER: Thanks for the correction. I believe, however, that my mistake isn’t a mistake. The second definition for “surgery” that appears in the American Heritage Dictionary is: “a surgical operation or procedure.” I have an editor whose command of English is superior to the world’s greatest English scholar. She saves me from all sorts of gaffes.

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. Readers may also order health newsletters from www.rbmamall.com.

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