Restless Legs can Disturb Your Sleep

A beautiful place in Kananaskis to dream, relax, listen to music, dance and sleep. (Dr. Noorali Bharwani)
A beautiful place in Kananaskis to dream, relax, listen to music, dance and sleep. (Dr. Noorali Bharwani)

Before we talk about your legs and how they are connected to your sleep, let me tell you what others have to say about sleep. If you are a person who believes in meditation then you would agree with Dalai Lama, who said, “Sleep is the best meditation.” I believe in that.

If you are a George Bernard Shaw fan then you will agree with him, “Marriage is an alliance entered into by a man who cannot sleep with the window shut, and a woman who cannot sleep with the window open.” I won’t tell you where I stand on that.

If you tell your doctor you are constantly tired, have day time sleepiness, have difficulty falling asleep at night, have to move your legs at bedtime to find comfort then you probably have restless legs syndrome.

A syndrome is a group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.

According to an article in the Canadian Medical Association Journal (CMAJ November 19, 2013), restless legs syndrome is a neurologic movement disorder that may adversely affect sleep, and thereby result in daytime fatigue, somnolence and a reduced quality of life.

The article goes on to say, “This condition has also been associated with hypertension and cardiovascular disease. The pathophysiology of restless legs syndrome is incompletely understood.”

Restless legs syndrome is common, affecting five to 15 per cent of the population. Making a diagnosis is not easy. The National Institutes of Health state that four criteria are essential for diagnosis:

  • An urge to move the legs usually accompanied by, or caused by, uncomfortable and unpleasant sensations in the legs;
  • Unpleasant sensations that begin or worsen during periods of rest or inactivity;
  • Unpleasant sensations that are partially or totally relieved by movement;
  • And unpleasant sensations that are worse in the evening or at night compared with during the day or that only occur in the evening or at night.

There is no specific laboratory test or treatment to conclusively confirm the diagnosis or treat it. Management by a sleep specialist is required. Avoiding alcohol, caffeine and cigarette smoke may help.

According to the article, the American Academy of Sleep Medicine has recently published detailed management guidelines – available online.

If I remember correctly, Marilyn Monroe was said to have trouble sleeping. I wonder why. She said, “The nicest thing for me is sleep, then at least I can dream.”

That’s it for today. Think big, laugh a lot, sleep well and have sweet dreams.

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Preventing Stroke Important for Independent Lifestyle

Tranquility - One way to relax and meditate. (Dr. Noorali Bharwani)
Tranquility - One way to relax and meditate. (Dr. Noorali Bharwani)

“There are many ways of breaking a heart. Stories were full of hearts broken by love, but what really broke a heart was taking away its dream – whatever that dream might be,” said Pearl S. Buck (1892–1973), a bestselling and Nobel Prize–winning author.

What stroke does to a person is to take away a dream. But where there is a will there is a way. Two basic things required for any kind of success are: patience and perseverance. With appropriate help from family, friends and caregivers much can be achieved, although it may take time.

What is more important is to prevent stroke in the general population and especially people who are at a high risk.

A commentary in the Canadian Medical Association Journal (CMAJ November 19, 2013) titled, “Stroke prevention in older adults with atrial fibrillation,” by Michiel Coppens, MD and colleagues, discuss the use of new oral blood thinners that reduced the risk of bleeding in the brain by 30 to 70 per cent compared with warfarin. The new medications were at least as effective as warfarin in preventing stroke due to reduced blood supply to the brain.

People with atrial fibrillation have irregular heartbeats, which make them prone to forming blood clots. Warfarin is the most commonly used drug (also used as rat poison) as a blood thinner in humans to prevent blood clots. The main drawback is that the patient has to have regular blood tests to make sure the blood is not too thin. It may cause internal or external bleeding.

The new oral blood thinners (dabigatran, rivaroxaban and apixaban) are approved in more than 80 countries for stroke prevention in patients with atrial fibrillation. Patients do not require blood tests to check if the blood is dangerously too thin.

According to the CMAJ article, the key points to remember are that many patients do not receive recommended blood thinner treatment. The new oral blood thinners offer consistent benefits over warfarin in older (age 75 years or older) patients with atrial fibrillation.

The article says the rate of internal brain bleeding, the most feared complication of blood thinners, is related to age and is sharply reduced by the new blood thinners relative to warfarin, making these agents particularly attractive for older patients.

Like any new medication, only time will tell whether the drugs are safe and superior to currently used warfarin or should I say rat poison? Talk to you again soon. Take care and don’t forget to listen to music, dance and laugh.

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Electronic Cigarettes are Not Regulated in Canada

A walk in the park is healthier than smoking cigarettes. (Dr. Noorali Bharwani)
A walk in the park is healthier than smoking cigarettes. (Dr. Noorali Bharwani)

Those who smoke cigarettes know quite well how addictive nicotine is. Over the years many methods have been used to help smokers quit smoking. But the success rate is not that great. The struggle continues.

The latest effort in this struggle is the development of electronic cigarettes, also known as e-cigarettes. An article in the Canadian Medical Association Journal (CMAJ November 5, 2013) says, “Electronic (e-) cigarettes are cigarette-shaped canisters used to simulate the action of cigarette smoking.”

The e-cigarettes are fluid-filled cartridges that contain varying concentrations of flavouring agents, propylene glycol, glycerine, water and other chemicals. The batteries within the canisters heat up contents of the e-cigarette.

Some e-cigarettes contain nicotine. The cartridge content varies widely according to the manufacturer and distributor, says the article. The act of smoking an e-cigarette is called “vaping,” because the user inhales vapour, not smoke.

E-cigarettes are not approved for sale in Canada. But that does not mean you cannot get them. They are readily available online. Smokers who use e-cigarettes may think that they are safe but they should remember e-cigarettes have not been evaluated for their safety. We don’t even know that they are superior to other methods used to help people stop smoking.

The CMAJ article concludes by saying that several pharmacologic and behavioural interventions have been found to improve smoking cessation rates. These strategies help patients manage nicotine withdrawal symptoms, learn behavioural self-regulation skills and provide instrumental social support.

Smokers wishing to stop smoking should discuss their options with their family doctor. As has been said before, if there is a will, there is a way.

What does a fish smoke? Sea weed. Talk to you again soon.

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The Controversy Around Homeopathic Vaccine for Preventing Flu

The Art of Relaxation (Dr. Noorali Bharwani)
The Art of Relaxation (Dr. Noorali Bharwani)

“Homeopathic vaccines hurt people and hurt our society. Warning labels will help but nosodes should be banned,” says Canadian Medical Association (CMA) president-elect Dr. Chris Simpson. He was expressing his thoughts on Twitter on the subject of homeopathic remedies.

According to Wikipedia, homeopathy is a system of alternative medicine created in 1796 by Samuel Hahnemann, based on his doctrine of “like cures like”, according to which a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people. Homeopathic remedies are found to be no more than a placebo, and homeopathy is widely considered a pseudoscience.

Those who believe in homeopathic therapy will not agree with what CMA or Wikipedia has to say. But I would like to summarize what their opinion is and let the readers decide what is good for them. Unfortunately, doctors cannot cure everything and people tend to go for alternative therapies. It comes down to personal choice.

According to CMA article, nosodes is advertised and sold in Canada to prevent flu and other illnesses but carry the potential for harm. Nosodes are ultra diluted forms of diseased tissue, pus, blood, or excretions of a sick person or animal that some homeopaths and naturopaths sell.

Health Canada has new guidelines for nosodes licensing. The guidelines require the packages to be labeled with a warning: “This product is not intended to be an alternative to vaccination.”

Members of the BC Medical Association and CMA have written letters to the federal government asking for stricter standards to be applied to natural health products to ensure what goes on the shelf is safe and effective, says a media report.

Health Canada says nosodes are not vaccines. It goes on to say, “Health Canada has not licensed any homeopathic medicines for the purpose of providing immunity to a communicable disease. Vaccinating yourself and your children continues to be the most effective way to prevent and control vaccine-preventable diseases.”

Get ready for the flu season. Do not forget to protect yourselves with vaccinations, healthy diet and regular exercise. Remember what Thomas La Mance said, “Life is what happens to us while we are making other plans.” I know about that quite well. Cheers. Talk to you again soon. Stay healthy.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!