Overview of RLS

• Neurological sensorimotor phenomenon
• Affects up to 10% of adult US population, can affect pediatric population too
• Often under diagnosed or misdiagnosed as other peripheral neurological disorders, sleep disorders, depression, etc.
• Disturbs sleep onset; does not cause excessive daytime sleepiness

Pathophysiology

• Pathophysiological process not fully understood
• Believed to manifest as part of malfunctioning iron transport
• Primary vs. Secondary RLS
• Primary RLS is due to a genetic predisposition and more common in younger population; chromosomal link, autosomal dominant
• Secondary RLS is associated with renal disease, pregnancy, iron deficiency states and other peripheral neuropathic conditions

Assessment

• CGI—Clinical Global Impressions Scale
• Clinician rated scale used in many disease states to assess improvement, severity, therapeutic efficacy and side effects
• IRLS—International RLS Rating Scale
• Validated instrument for evaluating severity of RLS symptoms

Diagnosis

• Based on four clinical criteria
• Urge to move legs
• Symptoms begin or worsen at rest
• Symptoms are relieved by movement
• Symptoms worse in the evening or at night
• There is no diagnostic test, polysonography NOT indicated for diagnosis
• Periodic Limb Movements (PLMs) are not the same as RLS; PLMs very prevalent in the general population (>15-25 considered abnormal however)
• 80% of RLS patients have PLMs, but most people with PLMs do not have RLS

Non-Pharmacological Management

• Mental Activation (distraction)
• Wall Stretches x 10-30 sec each, for 5 reps, repeated 2x/day
• Deletion of aggravating substances/medications
• ETOH, nicotine, caffeine
• SSRIs, TCAs, sedating antihistamines, reglan and others that cross BBB

Pharmacological Management

• Replace iron with Vit C for at least 3 months if ferritin <40 (target ferritin of 45-50)
• Two FDA approved dopaminergic agents; Anti-Parkinson’s agents
• Requip
• Mirapex
• Take 2-3 hours before bedtime, peak concentration at 2 hours
• If needed, titrate dosage:
• 0.125 x 4 -7 days
• 0.25 x 4 -7 days
• 0.5 x 4 -7 days
• Side effect usually mild: headache, nausea, fatigue, somnolence; orthostatic hypotension, excessive gambling, hypersexuality and hallucinations (rare)
• Use lower doses or titrate slower in renal disease
• Can take with/without food
• Does not work for use in PLMs only

Business Meeting 

President Vicki Lewis opened the meeting by thanking our presenter, Dr. Rosser.

Secretary’s Report:

• The minutes were posted on the website and a motion was made to accept the minutes without any changes.

Treasurer’s Report: 

• Balance as of 11/15/07 statement: $11,920.03

Old Business:

• No old business topics to discuss

New Business:

• TNA sent out letters to NPs regarding TMA’s intent to take action to limit narcotic prescription writing and increase supervision of NPs in retail clinics (“Minute Clinics”), however, no way to ensure that these new restrictions would not affect NPs practicing in other areas. Therefore, all NPs should have their supervising MDs to fill out the questionnaires to document any issues they have with narcotic prescription writing, chart review and supervision protocols.

• Vicki proposed idea of organizing a committee vs. the executive officers laying out a proposed budget for 2008. Motion was made for executive officers to do this instead of a committee and then present to membership for review. Motion was passed unanimously.

• Some members are not getting email notices. Please make sure that your email address is correct on the Master List when you sign in and make sure your mailboxes are not full. Many members mail is returned to me because of SPAM blockers or full inboxes.
• Vicki proposed a committee to review and update the bylaws and also to post these on the website. Volunteers included Vicki Lewis, Jacki Hinshaw, Jennie Walls, Kathy Sharp, and Betsy Palmer.

• Forbes Magazine posted an article, “Who Will Be Your Doctor?” written by Mary Mundinger, MPH. It can be accessed at www.forbes.com/opinions. Members are encouraged to read, as it contains several false statements pertaining to the DNP issue that are not evidence based or backed. Members are also encouraged to respond to the article.

• There is a new DNP website: www.apn-dnp.com

• Advance.com has “NP pins” available for $3.99. Members are encouraged to purchase and wear.

• AANP has a 30 second Public Service Announcement available entitled “This Peaceful Moment” which promotes NP awareness. Kathy Sharp is going to contact Sara Diamond at WJHL to see if they are interested in showing it.

• If there is interest in a weekend coding update to cover the new Medicare guidelines, Vicki Lewis has a contact at Wellmont that is willing to do this for midlevels. Email Vicki if you are interested at lewisvir@gmail.com

• Tracey Luther announced that Salix Pharmaceuticals does not recognize NPs for signatures for samples. She cannot remember the specific drug (a GI med), but we need to be aware of these companies and in turn make them aware of their backwards policies.

• Mark Hossler is in the process of finding a new company to sponsor our webpage. Charter has been difficult to deal with of late and the website has been unavailable for months. More info to follow once a new company is established. Thanks to Mark for all his work.

Community Events:

• TNA Legislative Summit is April 2, 2008 at War Memorial Auditorium in Nashville.

Job Opportunities:

• Centerpointe Clinic in Kingsport seeks full time or part time NP. This position is ideal for an independent, autonomous NP. Local primary care clinic in Kingsport closed and has resulted in an influx of patients that need a provider at Centerpointe. Contact Kay Bone for more info or if interested. Please pass along to anyone interested.

• Full time ANP for a chronic care, wellness, prevention and acute care facility in Collegedale TN just outside of Chattanooga. This position offers a very competitive salary and full benefits. Beth Ratliff, Senior Director, Operations;
  Comprehensive Health Services, Inc.
  502 290-7647- Voice, 502-724-5903- Cell, 1-866-405-2813- Fax

• There is also another opening at Summit Health Services for an Adult or Geriatric Nurse practitioner for long term care. There is a great deal of autonomy and satisfaction working with the elderly. Please contact Cathy Forbes at cathywoodyy@charter.net and I will refer you to the contact person for the position.

• Dr. Pugh in Johnson City is looking for part-time or full time NP for her pediatric practice. She said she can be reached at her office number 929-2454 or her cell phone 677-2454.

Announcements:

• Membership dues are due in January for all members and can be paid to Paula Countiss in the amount of $35.

• Kathy Sharp, former NETNPA president, was awarded with a gift in appreciation of her exceptional work during her tenure from 2005-2007.

Next Meeting:

January 17, 2008
Location and topic TBA