Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Is there any way to treat restless legs syndrome?

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Last year, the US Food and Drug Administration approved the first drug specifically marketed for restless leg syndrome, and earlier this year, Mayo Clinic researchers reported that the drug Requip can significantly improve the annoying symptoms and improve sleep for many of the 20 million Americans who have the neurological problem. A similar drug called Mirapex is up for FDA review now.

Restless legs syndrome is not fatal, but it can be a life-wrecker. When people with the syndrome are at rest, or trying to sleep, they get creepy-crawly feelings in the legs that can sometimes be relieved — for a short time — by movement. This means that sufferers may get only get a few hours’ sleep a night. The syndrome is believed to involve abnormalities in iron metabolism and production of dopamine, a neurotransmitter, in parts of the brain that control movement.

Requip and Mirapex (already on the market to treat Parkinson’s disease) increase activity in dopamine cells, said Dr. John Winkelman, medical director of the Sleep Health Center at Brigham and Women’s Hospital, who consults for the manufacturers of both Requip and Mirapex.

The leader of the Requip study, Dr. Richard K. Bogan, chief medical officer of sleep medicine at the University of South Carolina School of Medicine, said the 12-week multi-center study involved about 350 patients, roughly half of whom received a placebo, or dummy drug, and half, Requip. Neither doctors nor the patients knew who was getting the real drug, which proved significantly better.

Drug companies have funded most of the research into these medications; this study was funded by GlaxoSmithKline, the maker of Requip.

Do over-the-counter painkillers raise blood pressure?

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Yes, some do, at least in women.

In a study published last year in Hypertension, a journal of the American Heart Association, researchers from the Nurses’ Health Study looked at the records of more than 5,000 female nurses ages 34 to 77.

They found that those who took 500 milligrams or more a day of acetaminophen — such as Tylenol — were twice as likely to develop high blood pressure as those who didn’t. Women who took 400 milligrams a day or more of ibuprofen — often marketed as Motrin or Advil — were 60 to 80 percent more likely to develop high blood pressure than those who didn’t. Aspirin, on the other hand, was not linked with increased risk.

For men, the link between over-the-counter painkillers and hypertension is less clear. A report from the Physicians’ Health Study involving more than 8,200 male physicians was also published last year, in the Archives of Internal Medicine. It found no link between the onset of hypertension and the painkillers.

Overall, one in three adult Americans has high blood pressure, the heart association says, and many don’t know it, said Dr. Gary C. Curhan, an associate professor at Harvard Medical School and a co-author of the nurses’ study.

It’s not clear why the painkillers would be linked with higher blood pressure, Curhan said, but one theory is that the drugs may interfere with the kidney’s excretion of sodium, elevating blood pressure. The drugs may also hamper the ability of blood vessel walls to relax, raising resistance to blood flow and increasing blood pressure.

So, if you take over-the-counter painkillers, said Dr. Richard Lange, chief of clinical cardiology at Johns Hopkins Hospital, take the minimum needed to control pain — and get your blood pressure checked regularly.

What happens, mentally and physically, after a miscarriage and how long do these effects last?

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The aftereffects of a miscarriage, defined as the loss of a pregnancy before 20 weeks, depend on how long a woman was pregnant, and, to some extent, how much she wanted a baby.

If a woman misses a period, she may not even know she is pregnant, and miscarriage may be nothing more than an extra-heavy flow, said Dr. Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital. If she miscarries three to four weeks after a missed period, the bleeding can be quite heavy and the cramps, fairly severe. “As you go further along, say a miscarriage at 11 or 12 weeks, the bleeding can be quite heavy and the cramps, very severe. It’s almost like labor,” he said.

Hormonally, it can take a few weeks for hormone levels to return to a non-pregnant state, Schiff said. It can also take a week or so for bleeding to stop and several weeks for enlarged breasts to return to normal size.

Psychologically, the loss of a wanted pregnancy can take even longer to heal. Women should “treat it like a death. Don’t trivialize it,” said Schiff.

“In addition to feelings of loss, many women feel angry that their bodies aren’t ‘working’ correctly and guilt that they may somehow have caused the miscarriage, so support from family and friends can be especially helpful in letting go of self-blame,” said Judy Norsigian, executive director of Our Bodies Ourselves, a Boston-based women’s health advocacy group, in an email.

In years past, many women who miscarried had minor surgery, a D&C (dilation and curettage), to remove any fetal tissue left in the uterus. A study in August in the New England Journal of Medicine showed that a drug called misoprostol is nearly as effective as a D&C – 84 percent versus 97 percent in expelling fetal tissue.

According to womenshealth.gov, the website of the National Women’s Health Information Center, the first signs of miscarriage are vaginal bleeding and cramping. If a woman is pregnant and has either of these symptoms, she should call doctor immediately.

Are pets good for people’s health?

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Probably, though the data are mixed. In the 1980s, some studies suggested that pet ownership was indeed linked to better health in a number of ways.

But a review of more recent studies, published late last year in the British Medical Journal, disputed that. Researchers could not confirm, for instance, that pet ownership was linked to a lower risk of heart disease, that pet owners made fewer doctor visits or that owning a pet boosted the mental and physical health of older adults. The journal did report that kids who have pets miss fewer days of school and that swimming with dolphins can reduce human depression.

Even without a proven health benefit, though,pets “provide companionship, they are a source of comfort, and people who have difficulty communicating with other people can express themselves freely with pets,” said Dr. Leonard C. Marcus, a Newton-based veterinarian and people doctor.

Among other things, he said, having a dog means the human has to get exercise, too.

Perhaps the most intriguing research on pet-human interactions is a study from California published in January in the journal Integrative Cancer Therapies. Researchers trained normal, household dogs to diagnose with high accuracy and by only the scent in exhaled breath, which people had lung or breast cancer.

My personal bottom line? Get a pet. Human family members are great, in their place. But my cat is the only one who rolls around and purrs when I come home.

Are there any risks to colonoscopy prep procedures?

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Very few serious ones, though the preparations commonly recommended by doctors can cause nausea, vomiting, painful cramping, dehydration, electrolyte disturbances, kidney damage and even fainting. In very rare instances, a tablet called Visicol has been linked with seizures and a team of Columbia University researchers reported recently on 21 patients who suffered acute kidney failure after colonoscopy preparations.

A colonoscopy is a procedure, usually done under light sedation, in which a doctor examines the inside of the colon with a lighted “scope” or viewing tube.

Colonoscopies save lives by catching pre-cancerous polyps and removing them before they can become dangerous, said Dr. Anthony Kalloo, chief of gastroenterology and hepatology at Johns Hopkins Hospital. Overall, an estimated 155,290 Americans will be diagnosed with colorectal cancer this year and 56,290 will die.

To prepare for the exam, patients must clean all fecal material out of the colon, a process many people find more unpleasant than the exam itself. There are several ways to do this. One way is to drink a gallon of prescription solution such as GoLytely, Colyte or NuLytely . They are effective at cleaning out the colon, but can sometimes cause gastrointestinal upset, said Dr. Rosaline Barron, a gastroenterologist at Mount Auburn Hospital in Cambridge.

A second approach, which many patients find easier but which doesn’t always cleanse the colon quite as well, Barron said, is to use Fleet Phospho-Soda, an over-the-counter liquid that the patient takes in two 3-tablespoon doses, mixed with ginger ale. This method can cause problems for people with kidney disease or congestive heart failure, making it “basically a young and healthy person’s prep,” said Barron.

A third method is HalfLytely, which means drinking only half, not a full gallon, of solution, though the colon may not get clean enough. Patients also take two to four Dulcolax tablets.

Finally, for people who really can’t stand drinking the solution, there is a pill-only prep. The patient takes 28 to 32 pills of Visicol, but this carries the same risks as the Fleet Phospho-Soda and sometimes may not yield a clean enough colon.

Talk with your doctor about the most gentle and effective prep for you – regimens can usually be individually tailored for even the frailest patients.

Should I throw away my toothbrush after I’ve had a cold?

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No, nor should you waste your money on commercially available toothbrush “sanitizers” or special mouthwashes or disinfecting solutions.

Thoroughly rinsing the toothbrush with plain old tap water “does remove most of what’s caught there,” said Dr. Dana Graves, a professor of Periodontology and Oral Biology at the Boston University School of Dental Medicine. And leaving the brush uncovered so it can dry off between uses or using a toothpaste containing a disinfectant also helps reduce the amount of live bacteria and viruses on the brush.

It’s true that there are lots of bacteria, viruses and fungi that can linger on toothbrushes, but both the American Dental Association and the federal Centers for Disease Control and Prevention pooh-pooh the risk of re-infecting yourself by re-using the same brush. (You shouldn’t share a toothbrush with someone else, though, because they may have germs that your immune system is not revved up to defend against.)

The CDC notes that “no published research data documents that brushing with a contaminated toothbrush has led to recontamination of a user’s mouth, oral infections or other adverse health effects.” The dental association says “there is insufficient clinical evidence to support that bacterial growth on toothbrushes will lead to specific adverse oral or systemic health effects.”

You should get a new toothbrush or head for an electric toothbrush every three to four months, not for health reasons but because the bristles get frayed.

What’s the best way to evaluate medical information?

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There are four basic questions you should ask yourself to evaluate the promised benefits of a medical treatment or procedure, according to researchers at the Center for the Evaluative Clinical Sciences at Dartmouth Medical School: What is the assertion? If true, would you care? Who stands to benefit from the assertion? How good is the evidence, that is, does it come from multiple studies (or just one) and how good are those studies?

For example, if a study showed a drug helped lower blood pressure, but also caused other complications, it may not be as good as it sounds, said Dr. Elliott Fisher, a professor at Dartmouth Medical School, and a researcher with the Veterans Administration Medical Center in White River Junction, VT.

The Dartmouth team has boiled down its tips for evaluating medical information onto a little plastic card that fits in a wallet. You can get a card free by e-mailing cecsweb@dartmouth.edu, or calling 603-650-1684. I’ve got one right on my desk.

“Although the card was intended to help doctors looking at medical studies, it would be great, if every American carried one” to use when reading newspapers or watching TV, Fisher said. “The card makes you think clearly about what someone is trying to tell you. If you are uncertain, don’t leap to the conclusion that you should take this new drug.”

Dr. Peter Pronovost, medical director of the center for innovations in quality patient care at Johns Hopkins applauded the idea of having easy-to-use cards available to teach patients to think critically about medical information. The challenge, he said, will be to get patients to use them.

The take-home message is that you don’t have to be a medical statistician to sort through complicated medical claims. A few common sense questions — and a hefty dose of skepticism — will stand you in good stead.

What causes canker sores and what can you do about them?

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Canker sores are extremely common, often painful, and rarely associated with serious disease, according to the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health.

Technically called “aphthous stomatitis,” canker sores are little ulcers that occur inside the mouth on movable structures such as the tongue and lining of the cheeks and lips.

Nobody knows what causes them, though allergies to foods like nuts or tomatoes or to a bacterium found in the mouth may be triggers. Unlike fever blisters (cold sores), which occur in the gums or near the outside of the mouth and are caused by the herpes simplex virus, canker sores are not triggered by viruses or bacteria. They can be caused by dental procedures or other irritation in the mouth, by stress and, in women, may occur at certain phases of the menstrual cycle.

“Although some people worry that canker sores may be a sign of oral cancer, true canker sores are not linked to cancer,” said Dr. Donna Mager [cq], a dentist at the Forsyth Institute in Boston. Canker sores usually heal within about two weeks.

But if you have a mouth sore that doesn’t heal, you should see a dentist because it may not be a canker sore but a look-alike problem associated Crohn’s disease, celiac disease or even oral cancer, said Dr. Timothy F. Meiller [cq], a professor at the University of Maryland Dental School.

To relieve the pain of canker sores, the American Academy of Family Physicians suggests ibuprofen or acetaminophen. You can also try topical, over-the-counter remedies such as Anbesol, Orajel or Orabase. For really stubborn canker sores, prescription steroids may be required.

Is it okay to listen to TV, music or tapes while falling asleep?

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I have been using books on tape or CD’s to help me fall asleep for years. The only problem I’ve found is that the book has to have just the right level of stimulation — not so difficult that I have to work to follow the thread, but not so exciting that it keeps me awake.

Sonia Ancoli-Israel psychologist at the University of California in San Diego, said that “falling asleep to a tape or the TV is not a bad thing if it helps you relax and fall asleep. The only time it becomes a problem is if, later in the night, you wake up from the noise of the TV or tape clicking off. The key is to do whatever you find relaxing.”

Dr. Lawrence Epstein, regional medical director of the Sleep Health Centers in Newton, disagreed, saying such habits could make it more difficult to fall asleep. Instead, he said, you should teach yourself to quiet down as bedtime approaches, go through the rituals — brush your teeth, get into your pajamas — and “then go to bed and turn off the lights.”

If you get too dependent (as I probably am) on a book lulling you to sleep, you can end up like a child who is used to being rocked to sleep, then can’t get to sleep without it, he said.

The other thing I have noticed is that I often incorporate bits of the stories I listen to into my dreams. The experts said this poses no problem. But it sure does make for some weird dreams.

I got a mass e-mail saying there’s a simple “smile” test to diagnose a stroke. Is this true?

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Not quite. There is indeed an e-mail going around that says it’s possible to detect a stroke by asking the victim to smile, raise both arms, and speak a simple sentence coherently. This quickie, three-question test is actually called the Cincinnati Prehospital Stroke Scale.

There was a small study presented in 2003 at a meeting of the American Stroke Association indicating that this quickie test was not bad. Volunteers asked the three questions of people who, unknown to the volunteers, had had a stroke and still had visible symptoms. The volunteers were more than 95 percent accurate in determining arm weakness and slurred speech; they were somewhat less accurate at detecting facial weakness (a crooked smile), according to the researchers, from the University of North Carolina-Chapel Hill School of Medicine.

But the test, while better than nothing, is troubling because of its inclusion of slurred speech as a criterion. In truth, slurred speech can be a sign not just of stroke but of multiple sclerosis, Parkinson’s disease, other neurological problems, or even simple drunkenness, said Dr. Megan Leary, director of the inpatient stroke service at Beth Israel Deaconess Medical Center.

The American Stroke Association does not like the test, either, because there are some warning signs it does not cover, said a spokeswoman, Bridgette McNeill. Stroke warning signs also include: sudden numbness or weakness of the face, arm, or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss or balance or coordination; sudden, severe headache with no known cause.

If you know someone with these symptoms, call 911 immediately. If a stroke caused by a blood clot is treated within three hours, damage from the stroke can often be reversed. As neurologists say, “Time lost is brain lost.”