Restless leg syndrome

[Mike734]

The below was posted on another forum. I told him if the prescription disqualified him he should seek alternate solutions. I also told him to have it checked out to preclude a serious condition. Anything to correct/add?



I'm new to the site and I need advice on a reasonably desperate situation.

I have a doctor's appointment Thursday Morning (16 August) because my legs jerk when I'm falling asleep. I'm afraid it might be Periodic Limb Movement Disorder (PLMD), which is similar to Restless Legs Disorder. From what I've read, the prescription for this condition means a DQ for my FAA medical. I don't think I can even get a Class 3 if they prescribe it to me.

Here are my options as I see it:

1) Cancel the appointment and hope that no one ever finds out about it and let me wife sleep in the spare bedroom.

2) Go to the appointment and refuse any prescription, hoping bananas and magnesium supplements will work.

3) Go to the appointment, accept everything the doctor says, and if I never fly, I take it like a man.

Option 1 is most attractive to me, although if this issue comes up after I pay for training and then I can't fly, I'm fantastically screwed.

Option 3 is the least attractive because I sincerely doubt my ability to take having my dream snatched away from me with a modicum of grace or equanimity.

PLEASE - All feedback is most appreciated!

[ElyJs]

I am not trying to be a smartass but I always thought that RLS was an SNL skit about how out of control the pharm industry was. I mean come on RLS? I swear these companies are making drugs and then inventing the disease. Needless to say I would go for option 1.

-Jason

[My Flight Surgeon]

One needs to be certain they haqve the right diagnosis. Here are some criteria for diagnosis:

Four basic criteria for diagnosing RLS: (1) a desire to move the limbs, often associated with paresthesias or dysesthesias, (2) symptoms that are worse or present only during rest and are partially or temporarily relieved by activity, (3) motor restlessness, and (4) nocturnal worsening of symptoms.

f you think you may have RLS, consult your family doctor. Doctors diagnose RLS by listening to your description of your symptoms and by reviewing your medical history. Your doctor will ask you questions such as:

• Do you experience unpleasant or creepy, crawly sensations in your legs, tied to a strong urge to move?
• Does movement help relieve the sensations?
• Are you more bothered by these sensations when sitting or at night?
• Do you often have trouble falling asleep or staying asleep?
• Have you been told that you jerk your legs, or your arms, when asleep?
• Is anyone else in your family bothered by restless legs?

There's no blood or lab test specifically for the diagnosis of RLS. Your answers help your doctor clarify whether you have RLS or whether testing is needed to rule out other conditions that may explain your symptoms. Blood tests or muscle or nerve studies may be necessary to pinpoint a cause.
Your doctor may refer you to a sleep specialist for additional evaluation. This may require that you stay overnight at a sleep clinic, where doctors can study your sleep habits closely and check for leg twitching (periodic limb movements) during sleep — a possible sign of restless legs syndrome. However, a diagnosis of RLS usually doesn't require a sleep study.

Treatment

Sometimes, treating an underlying condition such as iron deficiency or peripheral neuropathy greatly relieves symptoms of RLS. Correcting the iron deficiency may involve taking iron supplements. However, take iron supplements only under medical supervision and after your doctor has checked your blood iron level.
If you have restless legs syndrome without any associated condition, treatment focuses on lifestyle changes and medications. Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

• Medications for Parkinson's disease. These medications reduce the amount of motion in your legs by affecting the level of the chemical messenger dopamine in your brain. They include pramipexole (Mirapex), ropinirole (Requip) and a combination of carbidopa and levodopa (Sinemet). However, people with RLS are at no greater risk of developing Parkinson's disease than are those without RLS.
• Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in too high doses. Some examples include codeine, the combination medicine oxycodone and acetaminophen (Percocet, Roxicet), and the combination medicine hydrocodone and acetaminophen (Vicodin, Duocet).
• Muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night. But these medications don't eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS include clonazepam (Klonopin), eszopiclone (Lunesta), ramelteon (Rozerem), temazepam (Restoril, Razapam), zaleplon (Sonata) and zolpidem (Ambien).
• Medications for epilepsy. Certain epilepsy medications, such as gabapentin (Neurontin), may work well for some people with RLS.

Needless to say, these drugs are disqualifying for flight duty but the FAA may allow one to use Atamet, Parlodel, Sinemet under a Special Issuance medical certificate.