One patient came to OPD. He was continuously having discomfort in both legs, while resting, mostly at night. He had urge of moving the legs in order to get some relief. When he gets up from bed, the discomfort goes away. Also massaging the legs gives him relief. This problem was troubling him getting sleep also. His laboratory evaluation revealed low Vitamin D levels. He was prescribed Calcium + Vitamin D3 capsules, as well as Cholecalciferol 60,000 IU once a week for 8 weeks. But symptoms didn't go at all. He was later diagnosed with Restless Legs Syndrome, and was started on Tab. Ropinirole 0.25mg HS for 2 days, and then 0.5mg HS for 2 weeks. And then the symptoms went away, but for a brief period. Then dose was increased to 1mg HS. He was again symptom free for 4 weeks, but still after that he developed similar symptoms. Later Tab Ropinirole 1.5mg HS, as well as Tab. Carbamazepine 200mg HS was started, and patient is now totally symptom free. But now from past 1 week, when he gets up in the morning, or when he takes a nap in afternoon and gets up, he feels severe pain in the calf muscles, which gets relieved only by strong pain killers like Tab. Etodolac, and massaging. All his laboratory evaluation is normal. Hb is 16 gm%. Vit D is also within normal levels. What could be the reason for such pain after getting up from sleep (not only in the morning, but whenever he lies down on bed and gets up)?

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Peripheral neuropathy with intermittent claudication.Exclude DM.

Not diabetic. Already taking Carbamazepine for neuropathy, if any.
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Well in this case we need to look for trigger points spl in calf muscle . What is the built of the person normal or obese. Vitamin b12 is ofcourse major factor. . Stretching exercises will help a lot in relieving pain.and for long term management strengthening exercises for leg eg calf raises and hans and quads ex. Will help in relieving pain.

Well in this case we need to look for trigger points spl in calf muscle . What is the built of the person normal or obese. Vitamin b12 is ofcourse major factor. . Stretching exercises will help a lot in relieving pain.and for long term management strengthening exercises for leg eg calf raises and hans and quads ex. Will help in relieving pain.

Well in this case we need to look for trigger points spl in calf muscle . What is the built of the person normal or obese. Vitamin b12 is ofcourse major factor. . Stretching exercises will help a lot in relieving pain.and for long term management strengthening exercises for leg eg calf raises and hans and quads ex. Will help in relieving pain.

Intermittentclaudication

Check uric acid level if uric acid level rise treat accordingly Rx nortryptomer p sr Aceclofenec sos Febuxosta

S. Uric acid is 4.7mg/dl.. Aceclofenac is now not much effective to the patient. That's why shifted to Tab. Etodolac..
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Restless leg syndrome.

Already taking Ropinirole and Carbamazepine for RLS
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wats the pt age?

28 years male
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Did he have flat foot? What his occupation? Ref to vascular specialist to rule out any vascular problem!

No flat foot.
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check for varicosity. check the pherpheral pulsations.

No varicose veins. Peripheral pulses are good.
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