I’ve had restless legs for 30 years. What can I do? Here’s the fix,
- Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk
I am 82 and have had restless legs for 30 years. It leaves me unable to sit through the theatre, travel on long flights, or sleep properly at night. I’ve read about different drug treatments but the possible side effects put me off. What do you advise?
Dr Ellie replies: Restless legs syndrome is a distressing condition to treat and the underlying cause is not fully understood, which makes finding an answer difficult. Sufferers usually have an irresistible desire to move their legs, particularly at night, which impacts sleep, comfort and even being able to sit down and enjoy an activity.
If somebody has a condition that is significantly impacting their quality of life for a number of years then it is worth considering medication or treatment, even if there are potential side effects.
The side effects could be worth accepting if they bring relief. It is also very possible that medication will not cause side effects in some individuals and will only bring benefits.
Sometimes, restless legs are associated with iron deficiency in which case iron supplements will help: a GP can order a blood test for ferritin (iron stores), not just iron, as low ferritin has been proven to worsen symptoms.
Trialling an iron supplement may then help, as can reducing caffeine, alcohol and smoking. Specific walking and stretching exercises can also improve things – and for the elderly, a GP can make a physiotherapy referral.
Medication options include Parkinson’s disease drugs such as ropinirole as well as nerve-painkillers such as gabapentin or pregabalin. These are all NICE-approved medications for restless legs syndrome.
They may indeed have side effects but it is worth a trial for relief. Doctors can also prescribe rotigotine, which can be given in patch form and lasts a long time. If treatment is unsuccessful then seeing a specialist is appropriate: this would usually be a consultant in sleep medicine or a neurologist.
I suffer from a large incisional hernia. It causes no pain but has left me with a much bigger waistline. My specialist says surgery is possible with mesh, but it’s a big operation with risks, a long recovery, and no guarantee of success. I’m 82. Should I go ahead?
Dr Ellie replies: It is always a big decision weighing up whether to have an operation. For both patient and doctor it boils down to the benefits and the risks, which can include complications such as infection and injury – and the chance that surgery doesn’t actually work.
This can be the case with hernia surgery. The benefits you need to weigh up are a reduction in any symptoms you have, and these benefits are much greater if you have very significant symptoms. The older somebody is, the bigger the risks of surgery, so if you have no pain and there is a long recovery period, it might be there are not big benefits to be had.
A hernia is a weakness in the muscle walls which makes a gap or opening that internal organs can push through, causing a bulge. With an incisional hernia this happens at the site of a previous surgical wound. The bulging can cause pain or discomfort and there is always the risk that internal structures can get trapped in the bulge. Repairing the hernia pushes any inside contents back into their normal place by closing the gap and sometimes this is done with mesh sewn over the weakness.
Surgery usually stops it from getting any bigger but also prevents complications like the bowel being trapped.
It is also possible to treat a hernia without surgery by using an abdominal binder to hold everything in place, which is like a belt with some pressure. You would also be advised to avoid constipation with medication if necessary, as this relieves pressure on the hernia.
I have unsightly bunions on both feet. A private doctor has recommended surgery, but I’ve heard it can be very painful. What should I do?
Dr Ellie Replies: Surgery is the only way to actually remove bunions – but there are non-surgical options that can help ease symptoms.
Physiotherapy exercises can improve mobility in the foot and reduce pain.
There are also special insoles that cushion the bunions inside shoes, and splints worn at night to keep the big toe straighter, which can prevent symptoms from worsening.
That said, many patients do opt for surgery.
There are more than 130 types of bunion surgery, each with pros and cons. A surgeon should explain why a specific procedure is being offered and what the risks are. In general, complications occur in around one in 20 cases, and about one in ten patients report not being satisfied afterwards – usually because discomfort persists, not because the surgery itself has gone wrong.
On the NHS, surgery would be offered only if bunions are causing daily pain and significant difficulties for the patient. For milder cases, non-surgical measures may be the best first step.
Don’t race to beat fat jab price rise
I’ve heard alarming stories from private practices where patients are demanding to be given several months’ supply of the weight-loss jab Mounjaro after the manufacturer announced it was raising the price.
Around 1.5million Britons pay for these drugs, which cost around £250 a month. But the US pharmaceutical firm Eli Lilly has said it was going to double the price of the injections. As a result, private clinics are now getting hundreds of requests from patients attempting to stockpile the jabs before the price increase next month.
I would urge patients to hold off contacting their doctor. In many cases, doctors can’t prescribe these drugs months in advance because the strength of dose they need will change over time. Moreover, there is already limited supply of the jabs, meaning most clinics are unable to hand out bulk orders.
Gut Supplements can relieve IBS
I’m fascinated with growing research suggesting that over-the-counter gut supplements can help relieve painful irritable bowel syndrome (IBS) symptoms.
The condition is a common issue that triggers tummy pain and digestive problems. While GPs prescribe treatments, like laxatives and painkillers, it’s mainly down to patients to manage it themselves.
Recent studies show that daily probiotic supplements – drinks designed to improve the amount of healthy bacteria in the gut – can have a significant impact on IBS symptoms. The most well-known of these is called Symprove. It’s certainly not cheap, costing as much as £50 a month. However, many high-street pharmacists have their own generic versions that are cheaper and just as good.
Have you tried a gut supplement and found that it improved your IBS symptoms? Write and let me know.
