Question: I have severe cramps in my legs at night. I have been told various remedies, including eating bananas at night and taking large doses of magnesium tablets. What do you think of these remedies, are they safe?
Magnesium has been known for many years to help nocturnal cramps, and provided it is not taken in extremely high doses, is quite safe. The main side effect of excessive magnesium compound ingestion is diarrhea, and it should not be used in the elderly who have poor kidney function. Bananas are, of course, quite safe—I cannot imagine anyone eating enough of them to cause any harm.
This is one situation where doctors have to use common sense. If the patient finds that a particular, unorthodox treatment helps, then the patient should be encouraged to continue the treatment—provided there are no long-term side effects or dangers of which the patient may not be aware. The doctor may even try the treatment on other patients, and if they also find the treatment successful, s/he may write a paper for a medical journal so that other doctors are made aware of the breakthrough. In this way, apparently unorthodox treatments become accepted into mainstream medicine.

Question: Every night, I am woken between midnight and 2 am with agonizing pain in my left leg. I can’t cope with this any more, and nothing seems to help. What can cause my leg muscles to go into spasm?
Night time leg cramps are a very common problem. It worsens with age and pregnancy, and most commonly they occur after heavy exercise during the day. Some hours after ceasing the exercise, the muscles in the leg go into painful spasm, causing you to leap from your chair or bed. Stretching the affected muscles by standing on tip toe or pushing against an immovable object often eases the pain.
The spasms are caused by a combination of minor muscle injury, a build up of waste products in the muscle and dehydration—all of these problems being caused by the exercise. Prevention is better than cure, and taking adequate amounts of fluid during and after the activity may wash away excess waste products and prevent dehydration.
If this simple measure is insufficient, medications can be prescribed to be taken after sport to prevent the cramps. Quinine and Akineton are the drugs most commonly used. The two methods of prevention can be simply prescribed if tonic water or bitter lemon is drunk after exercise. These drinks contain quinine to give them the bitter taste, and so acts to prevent dehydration and muscle spasms.

Question: After having a knee replacement on one of my knees, I can’t bend my knee completely, and this stops me riding a bike. Is there anything I can do?
It’s delightful to hear that someone who has had a knee replacement wants to ride a bike, as most people who have this operation are well over 60.
Unfortunately, a replacement knee is never as good as the young original, but most people can eventually bend their knee to a right angle. If this is not possible within six months of the operation, it is unlikely that any significantly greater movement will be achieved. Regular physiotherapy in the first few months after the operation is essential to gain the maximum mobility in the new knee.
Considering the fact that the old knee would have been very painful and had limited strength and movement before the operation, most patients find a replacement knee a marked improvement. I trust that you have adjusted the bicycle seat to give the knees the least possible necessary flexion, but other than this I regret that I cannot offer any further advice for your problem.

Question: I am 76 years old and two years ago I had a knee replacement operation. It was not a success, and after two years of pain and not being able to walk any distance, my surgeon wants to open it up again and cement it. I am very apprehensive about this operation, and would like your opinion on how necessary it is.
Unfortunately, not all operations turn out the way that the surgeon (or patient) would wish. Knee replacement operations have a very high success rate, and often give dramatic relief from chronic, severe arthritis. People who have been barely able to walk find themselves to walk freely for long distances within a few months of the operation.
You have been one of the unfortunate failures. This is probably a matter of bad luck, not incompetence on the part of the surgeon, nurses or hospital. After two years, your knee is not going to improve, and it is reasonable to let the surgeon try to correct the problem that has developed. Loosening of the joint, so that the artificial joint is not firmly cemented to the bone, is one of the commonest complications, and can usually be corrected without too much trouble.
Without further surgery you will continue to suffer constant knee pain. With surgery, you have a chance of significantly improving the knee discomfort, and possibly recovering completely. At worst, the operation cannot make your knee more painful than it is now.