Guest guest Posted March 27, 1999 Report Share Posted March 27, 1999 RLS HISTORY My name is_nn (Juli) Peck____Age_37_I was first aware of these unusual sensations in my legs or arms_14__years ago. The following members of my family have RLS (i. e. mother, age 78): None known, although mother reports " achey " legs, which could be associated with Polio she had as child__________________________________________ I would describe my RLS and/or PLMD as (i. e. creepy, crawly feeling in my right leg and involuntary legs movements my spouse reports during sleep): Leg cramps w/involuntary movements ___________________________________________________________________ Please ask your spouse if they have noticed that you stop breathing during sleep to such an extent, it frightens him/her:_No, but breathe very labored________________________________ I was diagnosed with RLS and/or PLMD_______years ago and given or have tried the following treatments:_not diagnosed (just found out about disorder), treat w/ Advil or Tylenol 3____________________________________________________ I might have the following sleep disorder also: _____________________________ ___________________________________________________________________ I haven't been diagnosed with RLS &/or PLMD, but I have the following symptoms and have tried: ______________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ These treatment options didn't work: ____________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ The following treatment regiment really helps me (drug and non-drug treatments): ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ If you have not had your folic acid and B-12 levels checked in the past 12 months, do you have any one of the following conditions: long-term treatment with acid reduction or ulcer drugs, stomach surgery or have been diagnosed with peripheral or diabetic neuropathy (if so, your insurance carrier might pay for these): _Not that I know of_______________ _____________________________________________________________ Even if they will not, would you like your B-12 and folic acid levels checked (I advise they be and the cost is estimated to be $85-$100; see my write-up on RLS)? Yes___ No_x Budget does not allow___ I understand those whose budget cannot afford it. If you ferritin level has not been recently checked, your insurance carrier should pay for it being tested. I have had the following tests within the past 10 years (include where done and the physician who ordered or conducted it): brain MRI, spinal MRI, polysomnography (sleep study), electrical conduction studies for peripheral neuropathies, etc.: __None____________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ I am taking the following vitamins and supplements and prescription drugs (for survery perhaps stick to only those taking for RLS/PLMD?):________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ PLEASE DO NOT TAKE ANTINAUSEA PRESCRIPTIONS WITHOUT YOU CHECKING WITH ME FIRST. If you plan to have surgery, call me, if at all possible, beforehand so I can speak with your surgeon. Most antinausea drugs used in the U. S. frequently but not always, can aggravate your RLS symptoms. If in a bind, ask the physician prescribing the antinausea drug to also give a narcotic pain medication or OPIOID which might counteract the exacerbation of your RLS symptoms caused by the antinausea medication. Quote Link to comment Share on other sites More sharing options...
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