Alimta

"The glory of medicine is that it is constantly moving forward, that there is always more to learn."--William Mayo

Relief for RLS

Great news for the millions of sufferers whose legs kick at night. A recent issue of Neurology reports that the drug called Neurontin relieved symptoms of even severe restless legs syndrome, and with few side effects.

"There is little wrong that you can do with Neurontin, and it is easier to use than a dopaminergic drug," says study author Dr. Diego Garcia-Borreguero, director of a sleep disorders unit in Madrid, Spain, and medical advisory board member of the RLS Foundation.

We asked Dr. Garcia-Borreguero about the Neurontin dose tested in the clinical study.

"We used a higher dose of Neurontin than in previous trials," he explains. "Earlier studies on RLS used dosages of approximately 900 to 1,000 milligrams. We used a mean of 1,850 milligrams. We gave roughly one-third of the dose at noon and two-thirds a little before bedtime--8:00 p.m. was the time of the second administration. The main part of the dose was given at night in order to avoid the main side effect of Neurontin, which is sedation."

Left untreated, iron deficiency and other metabolic problems can exacerbate RLS symptoms, advises Dr. Garcia-Borreguero. The body stores iron in the form of an iron-phosphorus-protein complex called ferritin.

"When we see patients, we make sure that no metabolic abnormalities are present," he says. "We do a blood panel, looking for specific metabolic factors like ferritin. There is an increased risk of RLS when ferritin is below 45 mcg/L. In addition, we look for transferrin, a protein that binds and transports iron. Other factors that we consider are blood levels of thyroid hormones, vitamin [B.sub.12] folic acid, and magnesium."

On another front, Dr. James Connor of the Penn State College of Medicine has discovered that there is a difference in the RLS brain and the non-RLS brain.

By comparing autopsies, the researchers found no evidence of brain deterioration, but they found that cells in the midbrain were not consuming enough iron.

The iron deficiency that resulted wasn't enough to kill brain cells, but they believed the iron deficiency might be enough to cause the cells to malfunction.

They reported that patients often experience relief after taking iron supplements. As one grows older, the brain may not be processing iron as well.

At our Society, we have done much research on [B.sub.12], folic acid, and magnesium, and we have found that there is no reason for senior citizens not to supplement, since these are such essential nutrients. As the lining of the gastric mucosa ages, it is less likely to absorb as efficiently as in a younger person's.

Restless legs syndrome is just one of the many problems that may occur more frequently after middle age. To ensure good health, folic acid, [B.sub.12], and magnesium are safe precautions. Iron supplementation should be taken under direction of a physician.

Readers Share Remedies for RLS

Dear Dr. SerVaas:

I read the letter about restless legs by Judy Reader. We are not all alike when it comes to cures, but I rub my legs with Sports Cream, which I get at the WalMart store. Massage well on the back of the thigh and calf of the leg, as well as the knee joint. It gives me almost instant relief, and I can sleep all the night long. I also do exercises to help. I place my hands on the wall at arm's length, raise myself on tiptoe, hold a second or two, then power down with a bouncing motion. I do this about 12 or more times. I then stand about 14 to 16 inches back from the wall, and with my left foot behind the right, I touch the wall with my forehead, keeping both legs stiff--this stretches the thigh and calf muscles. I then do the next exercise with the left foot behind the right, with my right knee bent and keeping the feet fiat on the floor. Repeat for 10 or 12 counts, switch feet, and repeat the procedure. This also stretches the thigh and calf muscles.

If the person who tries this gets relief, I would like to know. It works for me, especially the Sports Cream.

Earle M. Schad

Mount Ary, Iowa

Dear Dr. SerVaas:

I really appreciate the "Medical Mailbox" pages of the Post. In the latest issue, someone wrote about restless legs syndrome. I have found that taking about four ounces of tonic water with quinine before bedtime has relieved my symptoms. The lady who does my massage told me about this remedy.

Virginia Long

Fostoria, Ohio

Dear Dr. SerVaas:

I read an article in the July/August 2003 Post regarding RLS, restless legs syndrome. I suffered severe RIS for approximately ten years until my doctor finally realized what I had (RLS).

I wanted to offer another option for the writer who was seeking help: Mirapex. This medication is typically prescribed for Parkinson's disease, but is often prescribed to those with RLS. I have been taking Mirapex for several years, and it is completely effective approximately 90 percent of the time.

Shawn McDowell

Reno, Nevada

We are happy to hear that Mirapex works for you. The anti-Parkinson's drug has some of the same effects on nerve cells as the naturally occurring chemical dopamine. See page 88 for further information.

Flu Shots Are Good Medicine

In fall 2002, we not only reported on preliminary research data linking flu shots to a reduced risk of cardiovascular disease, but we also invited readers to complete the accompanying Heart Disease and Stroke Prevention Survey. Now, new research helps confirm the protective benefit.

"Influenza may be even worse than we thought," said lead investigator Dr. Kristin Nichol of the Minneapolis Veterans Affairs Medical Center. "And flu shots might be even better than we thought."

Study results show that vaccinated individuals spent 19 percent less time in hospitals for heart disease and had half the risk of death (from any cause) than those who were unvaccinated. Hospital stays for stroke patients fell 16 percent the first year of the study and 23 percent the second. Results are published in The New England Journal of Medicine.

In the Post survey, 90 percent of readers reported receiving flu shots for each of the 1996 through 2002 flu seasons. Of that group, 58 percent reported no incidence of stroke, transient ischemic attack (TIA), heart attack, or angioplasty during the survey period.

"The NEJM study results offer even more reassurance and affirmation as to the importance of getting your flu shot annually," said Dr. William Schaffner, director of preventive medicine at the Vanderbilt University School of Medicine. Flu shots are recommended for adults 50 and older.

Reader Unnerved by Tinnitus

Dear Dr. SerVaas:

The very first thing I turn to when I receive my Post is "Medical Mailbox." I find all the questions and comments so interesting, especially when readers send in their own private remedies for medical problems. I never thought I would be writing you personally, but I have a problem. I have had ringing in my ears since childhood. It was only slight and not at all disturbing. Now I find that at age 71, the ringing has increased to such a loudness that it has started to unnerve me. I am in reasonably good health, take no medication, and get a check-up regularly. I exercise at the gym several times a week and eat healthy foods. I am about five feet tall, weigh about 120 pounds, and take lots of vitamins. Do you have any suggestions? Perhaps you might have a reader who would be willing to write in and tell what they did to get help. I retired at age 65 but found that I missed working so much, I went back to work two days a week and love it! Except for the very loud ringing in my ears, life is perfect.

Agnes Reader

Toms River, New Jersey

Have you had a hearing evaluation? Ear, nose, and throat expert Dr. Jack Summerlin responds to your question:

"Tinnitus is almost always associated with some hearing loss, usually in the high frequencies. A hearing evaluation can help determine the degree and type of loss. Once this is known, help can often be obtained by amplification or masking ambient noise when appropriate.

"Tinnitus can also be associated with impacted earwax, anemia, stress, high blood pressure, allergies, and tumors. In addition, some prescription medications, as well as over-the-counter drugs and supplements, can cause tinnitus."

Post reader George Morrow reported that one ginkgo biloba capsule daily relieved his tinnitus symptoms. Most supplements contain 60 mg of the active ingredient. But ginkgo biloba may interact with blood-thinning medicines, according to the 1998 Physicians' Desk Reference for Herbal Medicines.

New Hope for Common Lung Cancer

Pharmaceutical firm Eli Lilly and Company recently reported that the experimental drug Alimta shows promise in treating a common form of lung cancer.

Researchers are excited about the potential availability of a new drug to treat non-small-cell lung cancer, said Dr. Nasser Hanna, an assistant professor of medicine at Indiana University School of Medicine, who presented the study findings.

Earlier studies show that the drug lengthened the lives of patients with a rare type of lung cancer called mesothelioma. This aggressive cancer of the lung lining is linked to a history of asbestos exposure.

In the new trial, Alimta proved as effective as Taxotere, the only approved drug to treat recurring cases of non-small-cell lung cancer. In addition, Alimta caused far fewer side effects among the 571 lung cancer patients studied.

"Patients with cancer who are being treated in the second-line setting must heavily consider the risk-benefit ratio of another course of chemotherapy," said Dr. Para, Paoletti, Lilly vice president of clinical research for oncology. "It can be a difficult balancing act, but in this study, patients who received Alimta retained the chance of a benefit, but with fewer side effects, and that is important."

Lilly expects FDA approval by early 2004 to sell Alimta for mesothelioma. The company will now seek clearance for the drug to treat non-small-cell lung cancer, as well.

Altima (generic name is pemetrexed) is given intravenously. The synthetic compound targets key enzymes believed to play a role in the rapid growth of cancer cells. In the future, Altima may be tested for breast, pancreatic, colon, and gastric cancers.

Legs For Life

Ten million Americans have peripheral vascular disease (PVD), a potentially fatal disease caused by blocked blood flow in the legs. Symptoms include leg or hip pain when walking and a color change in the skin of legs or feet.

Free screening tests will take place September 7-13 across the country. A ten-minute exam compares the person's arm and ankle blood pressure to determine PVD risk. At select sites, participants will also be screened for an abnormal ballooning of the aorta known as an aortic abdominal aneurysm. Because the condition has no obvious symptoms, early detection is key. Overall mortality is 85 to 95 percent if an aneurysm ruptures.

For "Legs for Life" screening site dates and locations, visit www.satevepost.org.

Zelnorm for Constipation

Dear Dr. SerVaas:

Finally, someone has accepted the fact that gallons of water, fruit, vegetables, stool softeners, laxatives, etc., etc. are not the answer to all constipation problems that plague many of us, and some from early childhood. ["Medical Mailbox," Nov./Dec. 2002]

Please tell us more about Zelnorm. How does it work, is it habit-forming, and does it have side effects?

Where may we write for information to take to our doctors, please?

Flora J. McHenry

Walnut Creek, California

Experts say that Zelnorm, a prescription drug manufactured by Novartis, imitates the action of a naturally occurring chemical in the body called serotonin that helps coordinate nerves, muscles, and fluid in the GI tract.

New data show Zelnorm (tegaserod maleate) provides relief from chronic constipation symptoms, including abdominal pain, bloating, straining, and stool consistency.

"If approved for use in chronic constipation, Zelnorm would be the first treatment not only to improve bowel frequency, but also to provide relief of multiple symptoms in patients," said Dr. John Johanson, lead investigator and clinical associate professor of medicine at the University of Illinois College of Medicine in Rockford.

During clinical trials, some patients experienced headache and diarrhea.

The non-habit-forming medicine is already approved for the short-term treatment of women with irritable bowel syndrome whose primary bowel problem is constipation. Interested individuals can obtain additional information about Zelnorm by checking the SatEvePost Web site at www.satevepost.org.

Botox for Excessive Sweating

Dear Dr. SerVaas:

I have been suffering for years from excessive sweating. A doctor said my only option was surgery.

Please help me find something to stop those embarrassing stains. There must be something else for people like me.

Name withheld

Wadmalaw Island, South Carolina

A study recently published in the Archives of Dermatology shows that injections of botulinum toxin A (Botox) in the armpits dramatically reduced body odor in healthy men and women. Allergan, Inc., which makes Botox, plans to ask the FDA later this year for approval to market the drug for severe sweating, or hyperhidrosis. Research suggests the injections reduce sweating for several months.

The purified protein--first used for uncontrolled blinking--stops sweating by preventing the release of acetylcholine, a chemical messenger that causes muscles to contract and nerves to induce sweating.

Targeting Trigger Finger

Dear Dr. SerVaas:

I am interested in learning more about trigger finger. Someone told me I have it. Will it get worse, and what should I do about it?

Mariann Jagoda

Freeport, Illinois

Trigger finger, or stenosing tenosynovitis in medical jargon, affects tendons in the hand that bend the fingers and thumb. Tendons glide back and forth through a protective lining, or sheath. When the sheath becomes inflamed and swollen, however, the tendon may get "stuck" in the constricted opening, causing a painful snapping or locking of the fingers or thumb. Initial treatment involves splinting the finger and taking aspirin or ibuprofen to reduce swelling. If symptoms persist, physicians may inject a steroid in the tendon sheath. Surgery to release the tendon is required in some cases. People over 40 with diabetes or rheumatoid arthritis are most at risk of developing trigger finger.

Bipolar Disorder Research News

Dear Dr. SerVaas:

Do you have any information about lamotrigine as a therapy for rapid-cycling bipolar disorder?

Are there any bipolar disorder trials going on in which patients can enroll?

Martha Andrews

San Francisco, California

Bipolar expert and researcher Dr. Charles Bowden has told us of the safe and effective use of lamotrigine in preventing mood swings in patients with rapid cycling bipolar disorder. Study results were published in the Journal of Clinical Psychiatry.

Bipolar research is under way across the country. We are aiding Dr. John Nurnberger and his colleagues at Indiana University in unraveling the genetics of the mood disorder. For a copy of the Bipolar Illness Survey, visit our Web site at www.satevepost.org or write to "Medical Mailbox." Interested readers can check our Web site for information about other studies that are enrolling patients with bipolar.

Nasal Spray Remedy Has Merit

Dear Dr. SerVaas:

Some of my acquaintances make their own nasal spray to relieve nose and sinus problems. As recommended by a local doctor, they mix some kind of coarse salt with water, then spray it into the nostrils. Is there any merit in this inexpensive treatment?

Margie Van Zee

Pella, Iowa

"Irrigating the nose with salt water is a simple, inexpensive, and safe way to keep nasal membranes healthy," says Dr. Jack Summerlin, an ear, nose, and throat specialist based in Indianapolis. "It helps remove mucus and irritating allergens, and may also prevent dryness of the nose sometimes associated with the use of certain medical nasal sprays."

Salt-water, or saline, nasal sprays are available without a prescription. People can also choose to mix their own solutions for use with a bulb syringe.

"Products which contain normal saline, or 0.9 percent salinity, are best," advises Dr. Summerlin. "Some over-the-counter products are 0.65 percent saline and are also satisfactory."

To make your own saline, Dr. Summerlin recommends adding one level teaspoon of table salt to one pint of tap or distilled water.

"Normal saline can be used as desired all year around," he adds. "During the winter months, people may require more frequent usage in view of the drying effect from heating the home."

Readers may send their letters to 1100 Waterway Blvd., Indianapolis, IN 46202 or via e-mail: medicalmailbox@satevepost.org. Please include mailing address.

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