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Restless legs worsened by iron deficiency, lack of sleep

Dear Doctor: I am 56 and in menopause. A couple of months ago, I started having severe restless leg syndrome, which even included my arms. I am now taking ropinirole before bed every night -- I also take Pristiq for depression. Although the medication has eliminated my restless leg syndrome, I worry about potential long-term effects. Any idea what could cause restless leg syndrome?

Dear Reader: Restless leg syndrome (RLS) is appropriately named. The syndrome is defined by an uncomfortable urge to move one's legs or arms during periods of inactivity. Because most people are less active in the evening, these symptoms often are first noted at that time. People describe the feeling as a pulling, creeping, cramping, crawling or tingling sensation that makes them feel an urge to move in order to relieve it. The periodic leg movements can also awaken people with the condition -- or those who sleep with them.

Restless leg syndrome occurs more often in people of Northern European ancestry; it's rare in those from East Asia and from Africa. Overall, it affects 2 to 3 percent of the population.

There is no specific cause of RLS, although genetic factors can play a part. Forty to 60 percent of people with RLS report a family history of the condition. Low iron storage can also be a factor, as can alterations in the brain function of the neurotransmitter dopamine.

Certain medications can worsen RLS symptoms, such as the antihistamine diphenhydramine and antidepressants. Thus, the antidepressant Pristiq (desvenlafaxine) could make your symptoms worse, but there are no specific studies of its connection with RLS.

Because poor sleep can aggravate RLS, be sure you are getting good rest. Exercise also appears to decrease symptoms, as can reductions in caffeine. Doing mental activities during a person's evening "down time," such as crossword puzzles, can reduce the focus on symptoms.

Medication that binds dopamine receptors, such as the ropinirole that you're taking, can decrease the symptoms of restless legs. Such medications are started at night and, although they can initially cause drowsiness, this subsides after 10 to 14 days. One problem with such drugs is that they can lead to rebound symptoms -- that is, the restless leg sensations -- in the morning. An even bigger problem is that long-term use can lead to decreased effectiveness, a shorter duration of action, symptoms noted earlier in the day and a spread of symptoms into the arms; these problems can worsen with increased dosages. To reduce the likelihood of this, I'd recommend staying on low doses of the drug and not taking it on a nightly basis, if possible.

You might also want to consider the anti-seizure medications gabapentin or pregabalin. They may not be as effective as ropinirole, but there is less likelihood of rebound or worsening of symptoms. Benzodiazepines, such as clonazepam, can be used for RLS, but can lead to tolerance or even dependency.

In summary, have your doctor check your blood ferritin level, a marker for iron stores. If it's low, consider iron supplementation. Also, be sure to increase your levels of exercise, decrease your caffeine intake and try mental activities at night.

If you feel that your symptoms are worsening on the ropinirole, talk to your doctor further. You have other options.


International
AP
North Korea: Book's popularity foretells Trump's end

SEOUL, South Korea — North Korea has found good material to attack U.S. President Donald Trump: Michael Wolff's bombshell new book, "Fire and Fury: Inside the Trump White House."

The book paints Trump as a leader who doesn't understand the weight of his office and whose competence is questioned by aides. Trump and other White House aides have blasted it as inaccurate trash. But it was the top-selling book in the U.S. last week, and its numbers are likely to grow far higher.

On Thursday, the North's main Rodong Sinmun newspaper, run by its ruling Workers' Party, carried an article about the book's subject matter, how Trump reacted and why it is selling so well.

Its sales reflect "rapidly surging anti-Trump sentiments in the international community," the article said. "The anti-Trump book is sweeping all over the world so Trump is being massively humiliated worldwide."

The book's popularity "foretells Trump's political demise," the article said.

Last summer, Trump threatened North Korea with "fire and fury like the world has never seen" in an exchange of taunts with the North, which claimed it was examining plans to launch missiles toward the American territory of Guam.

Trump and North Korean leader Kim Jong Un have since traded threats of war and crude insults, as the North conducted nuclear and long-range missile tests.

Trump called Kim "Rocket Man" on a "suicide mission." Kim called the 71-year-old American president "the mentally deranged U.S. dotard." In his New Year's address last week, Kim said he has a "nuclear button" that could fire weapons anywhere in the United States, and Trump responded that he has a much bigger and more powerful "nuclear button."

Recently, North Korea has taken steps toward improving ties with rival South Korea in what critics call a tactic to divide Seoul and Washington and weaken U.S.-led international pressure and sanctions on the country. On Tuesday, it had its first formal talks with South Korea in about two years and agreed to send a delegation to next month's Winter Olympics in the South and hold military talks aimed at easing front-line animosity.

But North Korea hasn't stopped its rhetoric against Trump. Last week, the North's state media called Trump a "war maniac" and "madman."

After Tuesday's inter-Korean talks, Trump said during a phone conversation with South Korean President Moon Jae-in that the United States was open to talks with North Korea "at the appropriate time, under the right circumstances," according to a White House statement.

"Fire and Fury" was released last Friday and sold 29,000 copies through Saturday, NPD BookScan told The Associated Press. Digital sales already top 250,000 and audio sales exceed 100,000, according to John Sargent, CEO of Macmillan, the parent company of the book's publisher, Henry Holt and Co. It has raised an initial announced printing of 150,000 to more than 1 million.


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Choosing words carefully

Dear Annie: I considered myself an average student after graduating high school in 1970, and I have been very successful in my 36-year career as an insurance investigator. I have dealt with a wide range of cultures. I feel I'm of average intelligence and probably below average in my English and grammar skills -- yet I find it amazing how most destroy the English language in everyday conversation. For instance, the use of the word "everybody." I usually dismiss any statement beginning with "everybody," because about the only time that it would apply is when saying that everybody has to breathe to live. At least 99 percent of the time, the mention of "everybody" or "everyone" is wrong.

I also have a problem with the phrases "I'll be honest with you" and "to tell you the truth." When a person is talking with you and all of a sudden he says, "well, to be honest," it is like, what has he been doing all this time, lying? Also, I can't stand it when I ask someone whether she would mind my doing something and she says "yes," when she really means that she would not mind.

These things occur in not only person-to-person conversations but also TV and radio commercials. Can you agree with this, or am I really below average and everybody is actually right? -- AAGG in Ohio

Dear AAGG: Do you know there are some people who can't stand the use of the word "like" as you used it? I say that not to shame you, but to point out that many of us have grammatical pet peeves (mine is the phrase "I could care less"). Few, if any of us, have perfect grammar. Keeping this in mind might make conversations more bearable.

Dear Annie: My wife and I had a fairly active and adventurous sex life for the first few years of our marriage. We've now been married for 10 years, and for the past several years, things have gotten pretty dull. Though we're still intimate regularly, it's monotonous. She seems fine with that. I've asked her to do certain things (that we used to do), but she's unwilling. I never try to force her, but I am feeling hurt and at a loss as to why she's changed. I am in shape and take care of my body. What could be the problem? -- Rejected

Dear Rejected: First, stop taking this as a personal rejection. It puts you in a place of self-pity and her in a place of defensiveness -- an impossible angle from which to communicate. Second, accept that you're not entitled to anything. Her not wanting to do something is reason enough. Preferences change, and just because she liked something 10 years ago doesn't mean she has to like it now.

Keeping all that in mind, have you tried actually asking her what's up? I mean really asking, not complaining. If not, that's a good next step. Do so at a neutral time, outside the bedroom. At the end of the day, what matters is that you love each other and communicate.


Entertainment
AP
More claim sexual inappropriateness against James Franco

NEW YORK — Several women have made further claims of inappropriate sexual behavior against James Franco in a Los Angeles Times article.

In the report published Thursday, two former student actresses described negative on-set experiences with the actor-filmmaker while being directed by him. Sarah Tither-Kaplan said in a nude orgy scene three years ago on the not-yet-released indie drama "Long Home," he removed plastic guards covering the actresses' groins while simulating sex.

Former students spoke of an unprofessional culture at Franco's now-closed acting school Studio 4, where he taught a "sex scenes class." Two women said Franco became angry shooting a strip club scene when no actresses, who were masked, would go topless. One topless scene filmed during class with Tither-Kaplan was uploaded to Vimeo, she said.

Violet Paley said that during a consensual relationship, Franco once pressured her to perform oral sex in a car and that the "power dynamic was really off."

On Wednesday night's "Late Night With Seth Meyers," Franco said the tweets by Paley and Tither-Kaplan were "not accurate" but he supported the women's right to express their perspectives. A lawyer for Franco didn't respond to queries Thursday. Franco's attorney, Michael Plonsker, disputed the allegations to the Times.

"There are stories that need to get out, people that need to be heard. I have my own side of this story but I believe that these people have been underrepresented getting their stories out enough that I will hold back things that I could say just because I believe in that so much," said Franco to Meyers. "If I have to take a knock because I'm not gonna, you know, try and, you know, actively refute things then I will because I believe in it that much."

Paley and Tither-Kaplan earlier tweeted about their past encounters with Franco after the actor wore a pin supporting the "Time's Up" initiative for gender equality at Sunday's Golden Globes. He won the award for best actor in a comedy or musical for "The Disaster Artist."

Actress Ally Sheedy also said in a since-deleted tweet that Franco was an example of why she left the movie business. Franco on Tuesday told Stephen Colbert on "The Late Show" that he had "no idea" why Sheedy said that. He directed her in a 2014 off-Broadway play.

Several of Franco's collaborators defended him from some of the claims. Vince Jolivette, Franco's production partner at Rabbit Bandini Productions, which ran Studio 4, said the school "was always run professionally" and that he was investigating the matter.

In a statement provided by Franco's publicist, Robin Baum, Cynthia Huffman, casting director of "The Long Home" said Tither-Kaplan's description of the orgy scene was inaccurate.

"I feel so bad that Sarah feels the way she does. She is part of our camp! All actresses were aware of the nudity scenes ahead of time," said Huffman. "I personally checked on all the actresses constantly to make sure they were ok and comfortable. I talked to them several times and told them if they were uncomfortable or did not like what was going on to come to me immediately and I would take care of it. I did not receive any complaints."

In 2014, Instagram messages showed Franco apparently trying to hit on a 17-year-old Scottish fan. Afterward Franco said he was "embarrassed" and said social media is "tricky." ''I used bad judgment and I learned my lesson," the actor said then.


Jordan Strauss 

Franco