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My wife, age 70, has a multi-tiered medical problem. One…

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My wife, age 70...

My wife, age 70, has a multi-tiered medical problem. One week after a January 2018, right hip replacement, she experienced an avulsion fracture of the right Greater Trochanter. 4 months later, the MRI and Xrays clearly show it is a non-healing fracture of 1 1/2 cm. The healing process is compromised by her severe Restless Leg Syndrome/ WED that manifests itself with violent leg convulsions every 32 seconds ( based on previous sleep studies) which totals 700 - 800 leg jerks per night. The orthopedic surgeon who performed the hip replacement said she also has osteoperosis in the hip area.

Doctor's Assistant: What seems to make the symptoms worse or better? Have you noticed any swelling?

Do you have specialists who can help reduce the RLS frequency and magnitude of the convulsions as well as treat or surgically repair the non-healing fracture of the Greater Trochanter with potentially thinned hip bone area?

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

My wife is 5'6" and 132 pounds. 3 weeks ago a doctor put her on a special diet to reduce the neurological inflamation that triggers the RLS. The diet consists of no sugars, grains, dairy, alcohol, simple carbs, no additives or MSG, almost all fruits. The diet adds fats including coconut oil, cods liver oil with Tobasco and Pepper, butter, olive oil, 5000 mg D3, 4000 mg magnesium L-Threonate, 1000 mg of Tumeric.

Submitted: 2 months ago.Category: Neurology
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Customer reply replied 2 months ago
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call.
Customer reply replied 2 months ago
Let me know if you need more information, or send me the service offer(s) so we can proceed.
Answered in 9 minutes by:
5/25/2018
Neurologist: drphophalia, Other replied 2 months ago
drphophalia
Category: Neurology
Satisfied Customers: 39,092
Experience: Regularly deal with musculoskeletal neurology, spinal issues, bowel and bladder dysfunctions etc.
Verified

Welcome to Just Answer.
Answers here are for education and information.

What are her present medications?

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Neurologist: drphophalia, Other replied 2 months ago

Is she on any medications for RLS and other issues?

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Customer reply replied 2 months ago
no. Her mother was on dopomene meds and experienced horrible rebound/ augmentation effects that only worsened over time. It was terrible. Since my wife has the same type of RLS/ WED as her mom, no dopomene based products are acceptable.
Neurologist: drphophalia, Other replied 2 months ago

Okay.

I am sorry, I cannot phone you but I am writing you the answer here.

It may take 5 minutes.

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Customer reply replied 2 months ago
ok. I am concerned about the fracture not being treated.
Customer reply replied 2 months ago
I just want to confirm that we are still connected?
Neurologist: drphophalia, Other replied 2 months ago

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, if not already done;

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 bedtime
3) Medications (which obviously she cannot take)
a) Pramipexole (Mirapex)
b) Ropinirole hydrochloride (Requip).

Following treatment approaches are recommended if Requip cannot be taken (called as refractory RLS):

1) Change to gabapentin

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

3) Change to a high potency opioid or tramadol

In addition to above nonpharmacologic 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.

For osteoporosis, she may need to take biphosphonates with vitamin D and calcium.

For osteoporosis, following are helpful;

a) A balanced diet rich in calcium and vitamin D

b) Weight-bearing exercise (such as walking)

c) A healthy lifestyle with no smoking or excessive alcohol intake

d) Calcium and Vitamin D supplements also should be taken.

The Vitamin D rich diet is;

1) Fortified dairy products,

2) Fish,

3) Oils,

4) Eggs

Sunlight (15 min/day for 3-4 days/wk) is the good source by which our skin makes the vitamin D.

Calcium-rich diet is;

1) Dairy products,

2) Fish with small bones,

3) Dark, leafy green vegetables (mustard greens, kale);

4) Corn tortillas,

5) Calcium-set tofu.

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.

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Customer reply replied 2 months ago
Thank you for your response. My wife and I know there is no cure for RLS. We need 4-6 months of calm so her non- healing fracture can mesh/ mend. Because of the 1 1/2 cm fracture, it may require surgery. I am concerned that typical plate and screws will not hold because of the thinned hip bone structure that may be compromised by the RLS.The diet, I described previously, that my wife has been on for 3 1/2 weeks seems to have reduced the frequency and magnitude of the RLS convulsions. The diet you recommended conflicts with the previous directions we were given. Again, my goal is to have the Greater Trochanter fracture heal so she can lead a normal life. I personally have experienced great success with Mayo and as such hold you in the highest regard.Do we need to visit?
Customer reply replied 2 months ago
What is the best approach to mending this non-healing fracture? Currently using a bone stimulator, but the mfgr reference material says it is usually only effective for fractures of 1 cm or less. She is at 1 1/2. The reason I contacted Mayo is because my wife's problem is complex. Please advise if addressing this type of problelem is in Mayo's area of core competency. If not, who would you recommend? Thank you
Customer reply replied 2 months ago
I am just confirming that we are still connected and awaiting a response.
Customer reply replied 2 months ago
How much longer for a response?
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