I am 82 and have suffered from restless legs for the past 30 years. This condition prevents me from sitting comfortably through theatre performances, taking long flights, or getting a good night’s sleep. I’ve come across various drug treatments, but the potential side effects deter me. What would you recommend?

Dr Ellie replies: Restless legs syndrome is challenging to treat, and its underlying cause remains unclear, making it difficult to find a solution. Those affected often experience an uncontrollable urge to move their legs, especially at night, interfering with sleep, comfort, and even the ability to sit still and enjoy activities.

If a condition has been detrimentally impacting someone’s quality of life for many years, considering medication or treatment—even with possible side effects—might be worthwhile.

The side effects may be a fair trade-off if they provide relief. Additionally, it’s possible that some individuals may not experience any adverse effects from medications and may only gain benefits.

Sometimes, restless legs are linked to an iron deficiency, in which case iron supplements might help. A GP can arrange a blood test for ferritin (iron stores), not just iron, as low ferritin levels have been shown to exacerbate symptoms.

Trying an iron supplement could be beneficial, along with reducing caffeine, alcohol, and smoking. Specific walking and stretching exercises may also offer improvement—and for the elderly, a GP can provide a referral for physiotherapy.

Medication options include Parkinson’s disease drugs such as ropinirole as well as nerve-painkillers such as gabapentin or pregabalin. These are all NICE-approved medications for restless legs syndrome.

They may indeed have side effects but it is worth a trial for relief. Doctors can also prescribe rotigotine, which can be given in patch form and lasts a long time. If treatment is unsuccessful then seeing a specialist is appropriate: this would usually be a consultant in sleep medicine or a neurologist.

I suffer from a large incisional hernia. It causes no pain but has left me with a much bigger waistline. My specialist says surgery is possible with mesh, but it’s a big operation with risks, a long recovery, and no guarantee of success. I’m 82. Should I go ahead?

Dr Ellie replies: It is always a big decision weighing up whether to have an operation. For both patient and doctor it boils down to the benefits and the risks, which can include complications such as infection and injury – and the chance that surgery doesn’t actually work.

This can be the case with hernia surgery. The benefits you need to weigh up are a reduction in any symptoms you have, and these benefits are much greater if you have very significant symptoms. The older somebody is, the bigger the risks of surgery, so if you have no pain and there is a long recovery period, it might be there are not big benefits to be had.

A hernia is a weakness in the muscle walls which makes a gap or opening that internal organs can push through, causing a bulge. With an incisional hernia this happens at the site of a previous surgical wound. The bulging can cause pain or discomfort and there is always the risk that internal structures can get trapped in the bulge. Repairing the hernia pushes any inside contents back into their normal place by closing the gap and sometimes this is done with mesh sewn over the weakness.

Surgery usually stops it from getting any bigger but also prevents complications like the bowel being trapped.

It is also possible to treat a hernia without surgery by using an abdominal binder to hold everything in place, which is like a belt with some pressure. You would also be advised to avoid constipation with medication if necessary, as this relieves pressure on the hernia.

I have unsightly bunions on both feet. A private doctor has recommended surgery, but I’ve heard it can be very painful. What should I do?

Dr Ellie Replies: Surgery is the only way to actually remove bunions – but there are non-surgical options that can help ease symptoms.

Physiotherapy exercises can improve mobility in the foot and reduce pain.

 There are also special insoles that cushion the bunions inside shoes, and splints worn at night to keep the big toe straighter, which can prevent symptoms from worsening.

That said, many patients do opt for surgery.

There are more than 130 types of bunion surgery, each with pros and cons. A surgeon should explain why a specific procedure is being offered and what the risks are. In general, complications occur in around one in 20 cases, and about one in ten patients report not being satisfied afterwards – usually because discomfort persists, not because the surgery itself has gone wrong.

On the NHS, surgery would be offered only if bunions are causing daily pain and significant difficulties for the patient. For milder cases, non-surgical measures may be the best first step.