Dr. Kevin Most: Heat management, allergies, Bell’s Palsy and RLS

Dr. Kevin Most on the Steve Cochran Show

Dr. Kevin Most joins the Steve Cochran Show for our weekly checkup. He reminds us to stay hydrated in this heat. Also, he addresses our lingering coughs and colds and the reasons are that we have moved from tree pollen to grass and the winds are moving it around, so anyone with a viral cold who has any allergies could be in the perfect storm, Virus, 10-14 days, end of tree pollen season 10 days- start of grass 10 days, next thing you know you have a “cold” that has lasted a month and no end in sight.

Bell’s Palsy

We think of muscles as things that help us lift, walk and run, but we have other muscles that are very important that do no hard lifting. Would it surprise you that we have 43 different muscles in the face? These muscles help support the contour of our face, they help us smile, frown, open and close our eyelids. They are much more complex than our biceps muscle. The interesting thing is that they are mainly controlled by one nerve, called the facial nerve.

So why all the anatomy today? Well there is a common condition called “Bell’s palsy” This is a condition that affects the nerve that controls the facial muscles. It is a form of temporary paralysis of this nerve that is caused by damage to the nerve, the damage may be caused by a virus or some other issue causing inflammation. Patients with Bell’s Palsy often think they are having a stroke as they have drooping of the face. The nerve that supplies the muscles is very complex and because of that there is a variation in the symptoms. Some people note mild weakness others will have complete paralysis. The symptoms may impact the eyelid, the mouth, taste, ringing in the ears, impaired speech, difficulty eating and drinking, all are possible symptoms. Seeing a physician if you have any of these signs is important as it can mimic a stroke and an evaluation is very important.

The cause is often thought to be a viral in nature, in some cases it will cause permanent damage to the nerve ending up with essentially lifelong changes in most cases however the inflammation is temporary and full recovery is expected. It is not uncommon as this impacts 40,000 American’s each year.

Bell’s Palsy is often treated with two medications, one is oral steroids, these are used to decrease the inflammation that is causing the nerve irritation. The other drug is often an anti-viral medication in the hopes of slowing or treating the viral cause. Probably more importantly is the protection of the eye as many times the eyelid is affected. The blinking eye protects and moisturizes the eye so if this not occurring we need to provide that with ointments or eye drops.

Over all most patients do well with Bell’s Palsy and recover within 6 months, most patients begin to get better within 2 weeks. However there are some patients who have symptoms for much longer.
Restless leg Syndrome

Many of you have probably heard of someone with Restless leg Syndrome as it is fairly common, with estimates of 10% of Americans have some degree of this. So what is it, Restless Leg Syndrome (RLS) causes individuals to have uncomfortable sensations in their legs and an urge to move them at times where exercise is not needed. These symptoms often occur late in the day and unfortunately when trying to sleep. The symptoms are often triggered by inactivity, so the individual who is trying to sleep will often find the symptoms and be forced to move their legs to relieve the symptoms.

Individuals who have RLS suffer from more than just the uncomfortable feeling, this syndrome also causes exhaustion, day time sleepiness and more importantly can be disruptive to personal relationships. Some estimates show a 20% decrease in work productivity for patients with RLS. Patients with RLS have a higher incidence of depression as well, often due to the social and physical issues. Unfortunately this is often a life long condition with no simple cure. It is more about treating the symptoms with the most effective and least disruptive therapy.

So what are the symptoms? Patients with RLS will have sensations in the legs that can range from uncomfortable, itching to painful. It can occur on either leg or both. The symptoms can also vary from day to day, in many cases it occurs just 1-2 times a week, in more severe cases it is noted daily. It has been shown to go into remission but will often return and unfortunately symptoms become more severe over time.

There is no specific test for RLS so the diagnosis is made is actually made by the doctor taking a good history, discussing the symptoms. Not only is there not a test to diagnosis it, we really don’t know what causes it. We do know in many cases there is a genetic component and unfortunately these are the individuals who note symptoms before the age of 40. You may think this is an issue with your legs or circulation but it is not, in fact this is an issue in the brain with the same chemical that causes issues with Parkinson’s disease. However a diagnosis of RLS does not mean that you have a higher chance of Parkinson’s or any other neurological conditions. There are a few things that can also increase your chances of ending up with RLS, alcohol and tobacco use increase the chance, we find it in patients who require dialysis, in diabetics, in patients with some anemias and is noted as a side effect of some medications.

So how is this frustrating disease treated? In some cases we need to correct the underlying cause, resolve the anemia and the symptoms resolve. Same with diabetics, get better control of the diabetes and the symptoms may resolve or diminish. But for most patients there is no simple cure, no single medication to resolve it. Often a change in lifestyle will help, refrain from alcohol and tobacco, getting on a regular sleeping pattern, adding a regular exercise program, taking a warm shower before bed, each of these has been shown to be helpful in many patients. There are some new FDA approved devices that essential massage or vibrate on the feet or legs that have been found to be helpful.

If all of the non drug therapies fail to resolve the symptoms, physicians may turn to medications. The types of medications do vary, it may be as simple as an iron supplement in some all the way to anti seizure medications or in some cases Parkinson’s medications may be helpful. In some cases a low dose of an opioid medication or anti anxiety medication may be helpful. Having the discussion an a treatment plan with your physician is key.

There is a lot of research going on in regards to chemicals in our brain that impact movement, Parkinson’s and seizures top the list of research in this field however scientists are hopeful that the advancements made in those areas will also impact RLS patients.