A to Z of Medical Conditions

Posted on A to Z of Medical Conditions

Less than one third of restless leg syndrome sufferers are getting an accurate diagnosis

Restless leg syndrome (RSL) is a neurological movement disorder that affects more than 37 million people worldwide. A recent epidemiology analysis on adult sufferers of RSL by GlobalData, a leading data and analytics company found that while a significantly high proportion of the general population in the West experience RSL, less than one third are getting an accurate diagnosis. 

Kasey Fu, MPH, Director of Epidemiology at GlobalData commented: ‘’Many studies suggest that a lack of awareness and knowledge in physicians is causing underdiagnosis of restless leg syndrome. This is an area that deserves more attention, given how many people report uncomfortable sensations that can severely affect their sleep and daily life’’.

Restless leg syndrome sufferers feel uncomfortable sensations in their legs, such as tingling and numbing, and the feelings worsen at night. The sensations provoke a strong urge to move the legs, which makes it difficult to have restful sleep and can adversely affect productivity, quality of living, and mental and physical health.

In the seven major markets (7MM*), there is variation in the active total prevalence of restless leg syndrome. The UK had the highest proportion of the population that had positive symptoms of restless leg (around 11%) and Japan had the lowest (around 2%). However, GlobalData observed that diagnosis is extremely low, where only 5–25% of those with symptoms have previously been diagnosed. 

It is not clear what is causing the low diagnosis rate in these countries. In a US-based study of 15,391 people, 81% of those who had positive symptoms fulfilling the IRLSSG criteria had discussed their symptoms with a primary care physician, but only 6.2% of those were diagnosed with restless leg syndrome. Similarly, in a UK-based study of 23,052 people, 65% had sought medical help for the strange sensations in their legs, but only 13% of those had been diagnosed.

The sparse landscape of the RLS marketplace:

There are currently two food and drug (FDA)-approved therapies for RLS, Mirapex (pramipexole dihydrochloride) and Neupro (rotigotine). Mirapex is delivered in tablet form, taken orally once daily, and Neupro is a patch that, when attached to the skin, delivers rotigotine, a dopamine receptor agonist, over a 24-hour period.

Magdalene Crabbe, MA, Neurology and Ophthalmology Analyst, at GlobalData adds: “The highest stage of development is Vifor Pharma’s Ferinject (ferric carboxymaltose), an intravenously administered iron replacement therapy in Phase III of the RLS pipeline. Many RLS sufferers experience anemia, caused by Iron deficiency. Fewer circulating erythrocytes reduce dopaminergic signaling capabilities, triggering restlessness and disordered involuntary movements. Iron replacement therapy has been proven to be effective in relieving RLS symptoms.

“However, the sparse landscape of the RLS marketplace mean that patients are sometimes left untreated and can suffer severe consequences resulting from electrolyte imbalances and deficiency of essential nutrients”.

*7MM = US, France, Germany, Italy, Spain, UK, and Japan

Posted on A to Z of Medical Conditions

Andropause – Understanding the Male Menopause

Person Holding White Medication Tablet

For the longest time, male menopause has not been a thing. In fact, the question of how to define it and if it actually exists is still in debate as seen in a NCBI study. But that does not negate the fact that more and more men are taking charge of their health. The internet has witnessed surges of men researching their health, dietary changes, healthy living and sexual issues. As one ages, andropause becomes a concern.

A Decline in Testosterone Levels

Testosterone is the primary male sex hormone responsible for regulating the development of male sexual characteristics. The production of this hormone increases during puberty and gradually starts reducing with increasing age. Increasing body hair loss and shrinking testicles indicate low testosterone levels. Naturally increase your testosterone levels by reducing your weight. Exercise regularly and change your diet to include more protein to achieve this result. If this is not a viable option maybe due to health reasons, consider Testosterone Replacement Therapy (TRT) or supplements.

Weakness and Depression

5% of the male population is affected by depression annually, and 17% during their lifetime according to a study by Pulsus.com. It is more frequent after the age of 40 years and highly correlated with the onset of andropause. If you have been in a depressed mood, insomnia and fatigue for more than 2 weeks, you are more likely depressed. Visit your doctor and get an antidepressants’ prescription to treat depression. Be very careful to mention medication you might be taking as it may not go well with the prescribed drugs. Try changing your diet to alleviate the weakness. Engaging in physical activities may also help manage the problem.

Sexual Problems

According to Today, about 5% of 40-year-olds experience erectile dysfunction compared to about 15-25% of 65-year-old-men. This can be attributed to age and genetics but also to the decrease in testosterone levels during andropause. An increasing occurrence of this symptom highly damages one’s relationship and can actually lead to stress or depression. The good news is that it is self-diagnosable. Speak to a specialist about it before it becomes a bigger issue as it can be treated by a medical professional. Increasing your testosterone levels either through TRT or lifestyle and dietary changes can also lessen the condition. Speaking to your partner about it is also advisable.

Male menopause is still an issue most people refuse to discuss even with their doctors. Acknowledging and knowing the symptoms is the first step towards solving it. Andropause is normal and as much as it may vary with genetics and lifestyle choices, it is important to embrace this natural process.

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Gilbert’s syndrome – what are the signs and symptoms of Gilbert’s syndrome?




Gilbert's syndrome

Gilbert’s syndrome

Introduction

In Gilbert’s syndrome, slightly higher than normal levels of a substance called bilirubin build up in the blood.

Bilirubin is a yellow substance found naturally in the blood. It forms as a by-product when old red blood cells are broken down.

Symptoms of Gilbert’s syndrome

Most people with Gilbert’s syndrome experience occasional and short-lived episodes of jaundice (yellowing of the skin and whites of the eyes) due to the build-up of bilirubin in the blood.




As Gilbert’s syndrome usually only causes a slight increase in bilirubin levels, the yellowing of jaundice is often mild. The eyes are usually affected most.

Some people also report other problems during episodes of jaundice, including:

abdominal (tummy) pain

feeling very tired (fatigue)

loss of appetite

feeling sick

dizziness

irritable bowel syndrome (IBS) – a common digestive disorder that causes stomach cramps, bloating, diarrhoea and constipation

problems concentrating and thinking clearly (brain fog)

a general sense of feeling unwell

However, these problems aren’t necessarily thought to be directly related to increased bilirubin levels, and could indicate a condition other than Gilbert’s syndrome.

Around one in three people with Gilbert’s syndrome don’t experience any symptoms at all. Therefore, you may not realise you have the syndrome until tests for an unrelated problem are carried out.

When to see your GP

See your GP if you experience an episode of jaundice for the first time.

The jaundice of Gilbert’s syndrome is usually mild, but jaundice can be associated with more serious liver problems, such as cirrhosis or hepatitis C.

It’s therefore important to seek immediate medical advice from your GP if you have jaundice. If you can’t get in touch with your GP, contact NHS 111 or your local out-of-hours service for advice.




If you’ve been diagnosed with Gilbert’s syndrome (see below), you don’t usually need to seek medical advice during an episode of jaundice, unless you have additional or unusual symptoms.

What causes Gilbert’s syndrome?

Gilbert’s syndrome is a genetic disorder that’s hereditary (it runs in families). People with the syndrome have a faulty gene which causes the liver to have problems removing bilirubin from the blood.

Normally, when red blood cells reach the end of their life (after about 120 days), haemoglobin – the red pigment that carries oxygen in the blood – breaks down into bilirubin.

The liver converts bilirubin into a water-soluble form, which passes into bile and is eventually removed from the body in urine or stools. Bilirubin gives urine its light yellow colour and stools their dark brown colour.

In Gilbert’s syndrome, the faulty gene means that bilirubin isn’t passed into bile (a fluid produced by the liver to help with digestion) at the normal rate. Instead, it builds up in the bloodstream, giving the skin and white of the eyes a yellowish tinge.

Other than inheriting the faulty gene, there are no known risk factors for developing Gilbert’s syndrome. It isn’t related to lifestyle habits, environmental factors or serious underlying liver problems, such as cirrhosis or hepatitis C.

What triggers the symptoms?

People with Gilbert’s syndrome often find there are certain triggers that can bring on an episode of jaundice.

Some of the possible triggers linked with the condition include:

being dehydrated

going without food for long periods of time (fasting)

being ill with an infection

being stressed

physical exertion

not getting enough sleep

having surgery

in women, having their monthly period

Where possible, avoiding known triggers can reduce your chance of experiencing episodes of jaundice.

Who’s affected

Gilbert’s syndrome is common, but it’s difficult to know exactly how many people are affected because it doesn’t always cause obvious symptoms.

In the UK, it’s thought that at least 1 in 20 people (probably more) are affected by Gilbert’s syndrome.

Gilbert’s syndrome affects more men than women. It’s usually diagnosed during a person’s late teens or early twenties.

Diagnosing Gilbert’s syndrome

Gilbert’s syndrome can be diagnosed using a blood test to measure the levels of bilirubin in your blood and a liver function test.

When the liver is damaged, it releases enzymes into the blood. At the same time, levels of proteins that the liver produces to keep the body healthy begin to drop. By measuring the levels of these enzymes and proteins, it’s possible to build up a reasonably accurate picture of how well the liver is functioning.

If the test results show you have high levels of bilirubin in your blood, but your liver is otherwise working normally, a confident diagnosis of Gilbert’s syndrome can usually be made.

In certain cases, a genetic test may be necessary to confirm a diagnosis of Gilbert’s syndrome.

Living with Gilbert’s syndrome

Gilbert’s syndrome is a lifelong disorder. However, it doesn’t require treatment because it doesn’t pose a threat to health and doesn’t cause complications or an increased risk of liver disease.

Episodes of jaundice and any associated symptoms are usually short-lived and eventually pass.

If you have Gilbert’s syndrome, there’s no reason to modify your diet or the amount of exercise you do, and the recommendations about eating a healthy, balanced diet and the physical activity guidelines still apply.

However, you may find it useful to avoid the things you know trigger episodes of jaundice, such as dehydration and stress.

If you have Gilbert’s syndrome, the problem with your liver may also mean you’re at risk of developing jaundice or other side effects after taking certain medications. Therefore, seek medical advice before taking any new medication and make sure you mention to any doctors treating you for the first time that you have the syndrome.

Medications that shouldn’t be taken if you have Gilbert’s syndrome, unless advised by a doctor, include some types of HIV med, some types of medication for high cholesterol, and some chemotherapy.