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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 35709
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I am a 71 year old male, living in South Africa. I still run

Customer Question

Hi, I am a 71 year old male, living in South Africa. I still run my financial advice services practice, quite sterssful.
JA: What are all the symptoms you're experiencing (e.g. loss of appetite, fever, rash)?
Customer: I have been diagnosed with Diabetes type 2, suffer from Restless legs syndrome and Tinnitis. I underwent a triple by pass 9 years ago.I take a reduced amount of statins for high cholesterol levels and turmeric to make up the difference. I am taking the following medication/supplements:
JA: Do you know if your family has a history of heart disease? In general, how would you describe your health lately?
Customer: Aspavor 40mg
JA: Anything else in your medical history you think the doctor should know?
Customer: Apologies, I hit the enter button which results in info being sent before I'm ready!Bayer aspirin cardio 100mg Glucophage 1000mg Ci-lift 20mg Dazit 5mg Pexola .125mg Galvus 50mg Statchoice 150mg Diaglucide 60mg Vit D3 1000iou Centrum 50+ Vit b6 50mg Proviron x3 per day. I also use a CPAP machine every night.My problem is that I never seem to be able to shake a brain fog, even from early morning. I am really tired of feeling tired!
Submitted: 1 month ago.
Category: Medical
Expert:  Dr. Arun Phophalia replied 1 month ago.

Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

Expert:  Dr. Arun Phophalia replied 1 month ago.

What are the investigations done for tiredness?

What are the treatment done for restless leg syndrome and tinnitus?

Customer: replied 1 month ago.
Personal physician could not diagnose any specific cause. Tinnitis I believe nothing can be done. Taking Pexola daily for RLS
Expert:  Dr. Arun Phophalia replied 1 month ago.

Thanks for the additional information. I am writing the answer for you and will get back to you in 4-5 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

Expert:  Dr. Arun Phophalia replied 1 month ago.

You should be investigated for anemia which can explain all;restless leg, tiredness and tinnitus.

The most common causes of tiredness or fatigue are;

Thyroid disease

Connective tissue diseases

Chronic anemia

Neoplastic disease

Chronic infections like Epstein Barr virus

Endocrine diseases (Addison disease).

Chronic fatigue syndrome

Myasthenia Gravis.

You would need following investigations:

Complete blood count (CBC)

Liver function tests

Thyroid function tests

Erythrocyte sedimentation rate (ESR)

Serum electrolyte level measurement

Immunoglobulin M (IgM)/immunoglobulin G (IgG) coxsackievirus B titer

IgM/IgG human herpesvirus 6 (HHV-6) titer

IgM/IgG C pneumoniae titer

Autoimmune panel

Anemia panel.

Rest Leg Syndrome can develop as a result of certain conditions, particularly iron deficiency and peripheral neuropathy. Other causes of RLS are folate or magnesium deficiency, amyloidosis, diabetes mellitus, lumbosacral radiculopathy, or vitamin B-12 deficiency. Following investigations are advised;

1) A complete iron panel including iron levels, ferritin, transferrin saturation, and total iron binding capacity.
2) BUN,
3) creatinine,
4) magnesium,
5) thyroid-stimulating hormone (TSH),
6) vitamin B-12, and folate.

These investigation results will help to treat the primary problem so symptoms are benefited.

Following measures usually are helpful;

1) Avoidance of caffeine, alcohol, or nicotine (if one takes them).
2) Exercise before the bed time
3) Medications
a) Pramipexole (Pexola)
b) Ropinirole hydrochloride (Requip); which you are already taking.

Following treatment approaches are recommended, if Pexola is not helping (called as refractory RLS):

1) Change to gabapentin

2) Adding a second medicine like gabapentin, a benzodiazepines, or an opioid

3) Change to a high potency opioid or tramadol

In addition to above non pharmacologic therapy comprises of the following components:

1) Iron replacement therapy

2) Mental alerting activities such as video games or crossword puzzles, may reduce symptoms at times of boredom.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 1 month ago.

Was this information helpful to you? I would be glad to answer any further questions.

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Wishing you all the very best in life.