By Trevor Shewfelt, Pharmacist at the
Dauphin Clinic Pharmacy
“I’m not as good as I once was, but I’m as good once as I
ever was.” I’m not sure if those words
by Toby Keith apply to me anymore. I had
a team of cyclists with me during the MS Bike ride from Dauphin to Clear Lake
and back. I had trained more for this MS
Riding Mountain Challenge than I ever had before. I felt ready.
However, I had trouble keeping up to one team member, Emily, my 12 year
old daughter. This was Emily’s first MS
Bike ride and she often left me in the dust.
After the MS Bike Tour, I went out to play Monday Night Hockey. I thought all that cycling would help my
skating. Nope. Younger guys were still skating circles
around me, and cycling didn’t give me magic hockey skills that I never had
before. On my anniversary, I had to call
my wife to kill a big spider in the shower.
I don’t like spiders. Emily said,
“You really aren’t the man of the house, are you Dad?” I told her I hadn’t been for years. I had the uncomfortable feeling I couldn’t
even see my lost machismo in the rear view mirror anymore.
Another uncomfortable feeling is Restless Leg Syndrome. Recently, I had a patient come in the
pharmacy and tell me her doctor was going to cure her Restless Leg Syndrome
with iron pills. I had never heard of
that treatment for RLS before, so I was excited to look it up.
Restless Leg Syndrome (RLS) is also known as Ekbom Syndrome
or Willis-Ekbom disease. RLS gives you
the strong urge to move your legs and often unpleasant feelings in the legs
like pulling, itching, tingling or aching.
When a person with RLS moves their legs, their symptoms get better, but
only for a short time. Usually the urge
to move happens when the person is inactive.
Often the urge to move happens at night.
That means RLS often disturbs people's sleep. It has been reported that up to 1 in 15 of us
will suffer from RLS.
There is no cure for RLS.
The causes of Restless Leg Syndrome aren't all known either. However levels of iron and dopamine in the
brain seem to be involved. As early as
1953, Nils Nordlander recognized that treating patients with iron injections
could reduce or eliminate RLS symptoms.
He even recognized that iron stores in the tissues could be low even
though blood levels of iron were normal.
More recent studies with spinal taps and MRI's have confirmed that the
brain can be low in iron even when the rest of the body has normal iron
levels. Dopamine is a brain chemical
that is involved in many systems from the reward system to Parkinson's Disease to
Schizophrenia. Even though we know we
can make RLS symptoms better when we use drugs that act like dopamine and we
can cause RLS symptoms if we block dopamine from doing its job, exactly how
dopamine is involved in RLS isn’t completely clear. It seems there might be lots of dopamine
production in the RLS brain, but not enough receptors to respond to the
dopamine signal.
Most drugs we use to treat RLS act like dopamine in the
brain. Pramipexole and ropinirole are
considered first line treatments. They
are relatively expensive. They have side
effects like nausea, dizziness, sleepiness and in rare cases compulsive behavior
like gambling. Levodopa is a much less
expensive treatment, but it has a larger chance of causing augmentation. Augmentation is when after being on the RLS
treatment for several months the symptoms start getting worse again. Worsening symptoms include symptoms happening
earlier in the day than before and symptoms happening just before the next
medication dose is due.
Can iron cure RLS? Iron
it isn't a miracle cure for everyone with RLS but in some cases if the RLS
patient also has low iron, it can at least reduce symptom severity. Your doctor should do blood tests to see if
your serum ferritin levels are actually low.
If you just take iron on your own, you could get iron overload, and that
can be dangerous. If your ferritin is
low, your doctor may recommend oral iron tablets. Depending on the type of iron, you may have
to take it 1 to 3 times per day. If you
take your iron with vitamin C, the iron may be absorbed better. Any time a text book talks about taking iron
tablets, they will say iron should be taken on an empty stomach, an hour before
meals. That is because iron is absorbed
best on an empty stomach. However, iron
tablets bother a lot of people’s stomachs.
My compromise with many patients is to tell them to take their iron with
the least amount of food possible. And
people shouldn't take their iron pills and their calcium pills together. Those two minerals will stop each other from
getting properly absorbed. Your doctor
will check your ferritin levels again in 3-4 months to see if it is normal. If not, they may decide to try injectable
iron.
Iron isn’t a magic cure all for RLS, but it is an
interesting and inexpensive avenue of treatment that you can certainly discuss
with your doctor. And this morning I got
to rescue my family from a raging inferno.
Okay Kraft Dinner. Eric was
trying to cook his single serving KD in the microwave. He forgot to put the water in with the
noodles. First there was a funny burning
smell. Then smoke started pouring out of
the microwave. I took the smoking mess
out of the microwave, poured some water over it in the sink and put it out on
the deck. Crisis averted. Maybe I can enjoy Toby Keith’s song again.
As always if you have any questions or concerns about these
or other products, ask your pharmacist.
The information in
this article is intended as a helpful guide only. It is not intended to be used as a substitute
for professional advice. If you have any
questions about your medications and what is right for you see your doctor,
pharmacist or other health care professional.
We now have this and
most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
Restless Legs Syndrom Foundation: www.rls.org
American Academy of
Sleep Medicine: www.aasmnet.org
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