forward copy of proposed cure

[Guest guest]

This is the article that was sent to the rls list people. I wasn't sure if

everyone had a chance to read this... it sounds like some people were unable

to open it.

Cindy

Saturday Evening Post

“Nightcrawlers: victims of a hidden epidemic”

A patient gave me a copy of the above article about Restless Leg Syndrome

(RLS), knowing I would probably have some comments and suggestions. The

article was well written because it described the misery that so many

patients endure, while not being believed by family or most physicians. It

is one of those conditions that falls between the cracks, and consequently

not much has been done to investigate it. It is considered to be a

neurologic condition although it is not. It is termed a sleep disorder but

that is because they confused cause with effect. I have presented the topic

at several medical conferences, and there was little or no interest shown. I

wrote to several RLS support groups on the internet explaining the pathology

and its treatment, but I didn’t get a reply. I was not surprised to see

that some doctors consider RLS to be a hysterical manifestation in women.

However, men get it also, but in less than 10% of cases.

The good news is that it is a curable condition for almost all patients, but

the form or type of treatment wasn’t mentioned in your article. Personally,

I have not seen a patient who didn’t get complete relief from our treatment.

Conservatively, I would estimate that at least 85-90% get complete relief of

symptoms. We have been treating this condition since 1982.

We discovered the treatment of this disorder serendipitously, because our

research focus has been in vein disorders. Most particularly, with varicose

veins and related problems. The predisposing factors for RLS are the same as

for varicose veins, i.e. they occur mostly in women, and there is a

prominent hereditary factor as noted also in Mr. Yoakum’s artcle. There is

no question in our minds of the venous connection in causing RLS. Female

hormones, especially estrogen have a dilating effect on the veins. More on

this later.

The patho-physiology (or, How do things go wrong, leading to RLS). The

essence of all vein disorders is “reflux” (i.e. the blood flow in reversed

direction). More precisely, the blood flow is reversed, becoming “stagnant”

at rest, and stagnant blood is a powerful irritant to the muscles. This

means that when the patient lies down at night, or sits down in a chair to

watch a movie, or drive a car, they feel the “creepy crawler” effect of the

stagnant blood in their legs. RLS is a near-constant urge to move the legs

so as to prevent an increase in the level of this discomfort. When lying

down, this almost stagnant blood is moving very slowly backwards through the

leg muscles on its way through the “perforator veins” which empty into the

deep veins of the leg. And from there, with muscle contraction, the blood is

sent upwards towards the heart to be re-oxygenated in the lungs. It is the

severe degree of de-oxygenation and accumulation of lactic acid (and other

metabolites) in the blood while it is “refluxing” that causes the irritation

of the leg muscles. The patients move their legs automatically because doing

this hastens the pace of reflux (and therefor make it a lesser irritant).

For the same reason, patients always feel better when they are walking than

at rest. Some patents actually fear going to bed, because they awake with

muscle cramps and have to jump out of bed.

Stagnant blood is a powerful irritant in another venous condition called

“stasis dermatitis”(a cherry red inflammation of the skin) typically above

the ankle, which can progress to a loss of skin with an open draining ulcer.

And just as with RLS, few physicians know how to treat venous leg ulcers.

The information gaps described are due to the fact that there is no

meaningful research being done in venous diseases. This is a pity because

varicose veins and other associated disorders (swollen leg and venous

ulcers) are very costly to the economy in terms of lost production from days

off work, as well as being unsolved medical problems.

The concept of treatment of RLS is simple, i.e. eradicate the refluxing

veins. But its implementation is intricate. Sclerotherapy, is the name of an

injection treatment for the eradication of abnormal veins. However there are

many levels of competency or proficiency in sclerotherapy. Reflux must be

treated at its origin, and not downstream along the course of the vein, or

the patient will be plagued with recurrences.

Most doctors that we have shown the responsible veins to have commented that

they thought that those veins were only cosmetic. (But all of the patients

symptoms disappear when those “cosmetic” veins were eradicated). The point

is that those “cosmetic” veins are a wolf in sheep’s clothing because those

innocent looking veins contain the refluxing irritant. These veins dilate

and grow like weeds under the effect of female hormones. These veins often

give a marbled appearance to the skin. They are most important if found

behind the knee or in the upper calf. Spider veins grow from these veins,

but the spider veins are not symptomatic themselves. In men, the causal

veins are not so obvious, but they are usually what we call “high pressured

small vein disease”.

We routinely scan all of our patients with color ultrasound looking for

areas of hidden reflux deep to the skin. If all is clear then surface

injections are sufficient to eradicate the problem. If deeper sources of

reflux are found by ultrasound then we do venous flow mapping and begin by

treating the deeper reflux higher in the leg before treating the surface

veins. Patients remark how their legs feel lighter and stronger after

treatment. This is further practical evidence of the overall improvement to

their circulation from ridding the reflux. All refluxing veins are a burden

on the circulation. They are useless as future by-pass grafts We inject

sodium tetradecyl sulfate (Sotradecol) in varying concentrations depending

on the size and location of the abnormal veins. We prefer it to “saline”

(hypertonic saline) because the high concentration of salt will cause severe

muscle spasms, mimicing RLS and its attendant muscle cramps. (This clinical

feature can be seen as proof of the irritant blood as the cause of RLS).

Great care must be exercised with sclerotherapy because an excessive

inflammatory response can damage the skin, resulting in a chemical ulcer and

an open sore in the skin. This will heal but leave a scar or brown stain in

the skin. For most patients, this is a small price to pay for relief from

RLS. For further information and photos, you can check our web site at

www.veinclinics.com, then look under “Treatment” for RLS.

McDonagh, M.D.

Medical Director, Vein Clinics of America