Night cramps are a problem readers often ask me about – they’re a common complaint and hitherto I’ve been at a loss to advise an effective treatment.
But a study, published in JAMA Internal Medicine, has shown that in adults aged over 65, vitamin K2 (also known as menaquinone) reduced both cramp frequency and severity to a significant degree, with no side-effects. At last we have something to recommend.
Vitamin K2 (also known as menaquinone) reduced both cramp frequency and severity to a significant degree, with no side-effects, in adults aged over 65
However, there is one caveat: it shouldn’t be taken if you’re on warfarin as this drug works by blocking vitamin K, which plays a key role in blood clotting. Vitamin K2 is available over the counter – in the study, the patients were taking one 200mcg capsule a day.
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After a giardia infection, it appears I’ve been left with reactive arthritis, which makes it difficult to walk and has left me with swollen, painful wrists. My GP has offered me steroids but says it has to be my decision because of the side-effects.
James Chalmers, Cheshire.
Dr Martin Scurr replies: Giardia is a parasite found in water – giardia infection (or giardiasis) is the most common waterborne tummy bug worldwide, but you don’t have to swallow or be in infected water to catch it: you can get it eating food washed in contaminated water.
Symptoms include diarrhoea, abdominal pain and nausea, although some people don’t show any signs of infection.
While it usually clears within a week with treatment (antibiotics) it can sometimes linger for months, even years, causing complications such as gastrointestinal discomfort, bloating, weight loss – and even arthritis.
‘Reactive’ arthritis is caused by inflammation in the joints in response to an infection
This is known as ‘reactive’ arthritis and is caused by inflammation in the joints in response to an infection. You mention raised inflammation markers in your longer letter, which are a sign of this ongoing effect.
You’re fortunate your GP spotted this, as it’s not something that’s usually on our radar.
I’ve seen many patients with giardia infection but never come across ‘reactive’ arthritis as a complication.
Yet a 2017 study concluded that it occurs more frequently than has been reported, showing that patients who’d had giardiasis had a 50 per cent greater risk of experiencing arthritis or joint pain. As your symptoms are taking a toll on your quality of life, I agree with your GP that suppressing inflammation with steroids is worthwhile.
Hopefully you’d become symptom-free rapidly, possibly within weeks, and the steroids could be progressively lowered.
Do not be over fearful about the side-effects of steroids – unless you already have other contraindications such as high blood pressure or type 2 diabetes. Strategies to reduce the potential impact include medication to reduce gastric irritation plus calcium and vitamin D supplements to help combat the risk of osteoporosis.
Once on treatment your inflammatory markers would be watched along with a careful diary of your symptoms so the dose could be adjusted. Whether this treatment would continue for weeks, months or even a year would remain to be seen – and why a programme to reduce any side-effects would be important.
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I was prescribed atorvastatin, clopidogrel and lansoprazole after a stroke two years ago. I feel the atorvastatin is affecting my balance and I’d like to lower my dose. I’ve already stopped the lansoprazole as I thought it was giving me diarrhoea, but what do you think?
Vernon Sharp, Ashford, Kent.
Dr Martin Scurr replies: This drug combination will be familiar to many people who have had an ischaemic stroke – when a blood clot or other blockage cuts off the blood supply to part of the brain.
Clopidogrel and atorvastatin have been prescribed to cut your risk of another stroke.
Clopidogrel prevents tiny blood cells called platelets from sticking together and forming a clot. Atorvastatin, a statin, lowers cholesterol and the risk of fatty deposits or plaques building up in the arteries. If a piece of plaque breaks off, it can lead to a clot forming or it can block the blood vessels directly.
Dizziness or unsteadiness as side-effects of statins are rare. They may be a consequence of damage caused by your stroke.
Lansoprazole reduces the production of stomach acid, to minimise irritation to the stomach lining caused by the clopidogrel, reducing the risk of bleeds.
It is possible that lansoprazole might cause diarrhoea – and stopping this to see if that helps doesn’t have such serious consequences as stopping the statin; as you’ve already done so, and if stopping has helped, it’s worth restarting the lansoprazole to see if the side-effect recurs.
As for your balance, I’d suggest asking to be referred to a physiotherapist.
