Dear Dr. Roach: I am an 82-year-old, reasonably fit woman. I am having cramps at night in my feet and legs, causing me to wake three or four times a night. Getting up and walking helps, as does applying a hot washcloth and using Voltaren on the cramping areas. However, I would prefer not to wake up so many times, which makes me feel exhausted all day. My father suffered from amyotrophic lateral sclerosis (ALS), and I would like to know if the cramps indicate ALS.
H.G.G.
ALS, sometimes called Lou Gehrig’s disease, is a progressive and incurable degenerative disease of the brain and spinal cord. The exact cause is not known. Most cases are sporadic, but 5% to 10% of cases are familial. It is most commonly diagnosed between the ages of 60 to 75.
The most common symptom of ALS is weakness, which can start in the hands or feet, usually with muscle atrophy and fasciculations (uncontrolled twitching of the muscles). This is considered a “lower motor neuron” symptom.
ALS has both lower motor neuron and upper motor neuron symptoms, such as muscle slowness and stiffness with poor coordination. Less commonly, speech and swallowing are affected early. The combination of both upper and lower motor neuron symptoms should lead to a consideration of ALS, especially when symptoms get progressively worse.
Leg cramps are extremely common in people with no muscle or nerve conditions, and cramps alone make me think ALS is unlikely. Light exercise and stretching before bed are helpful in preventing ordinary nighttime leg cramps. A neurologist is the expert in ALS diagnosis. About 80% of familial ALS can be diagnosed by genetic testing.
Dear Dr. Roach: I am an 86-year-old man. I had prostate cancer in 2018 and had 47 days of radiation treatment. My PSA is now very low. What can I take to help me be intimate with a woman again? Would Viagra help me?
D.K.
Men usually have sexual troubles after the diagnosis of prostate cancer. Psychological and physical factors both have a significant role. Some prostate cancer treatments can make the problem worse. Surgery can damage the nerve supply, and medications lower the testosterone level, making both sexual interest and the ability to get an erection problematic. Radiation treatment tends to cause less problems, but men who have had radiation treatment for prostate cancer can develop erectile dysfunction two or more years after receiving treatment.
Medicines like sildenafil (Viagra) work primarily with blood flow to the penis and are the first-line medication treatment for men with erectile dysfunction. These medicines do not work for everybody, but they are effective for many men and are generally safe. Viagra works best about one to two hours after being taken on an empty stomach.
If medications like Viagra aren’t effective even at the highest dosages, there are many other treatments available. There are physicians and clinics who specialize in this issue. There are additional medications and devices to help as well as therapists who are experts in the psychological side.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
