ArcaMax

DEAR DR. ROACH: I'm an 83-year-old female who's in good health. I don't take any prescriptions, and I'm not overweight. I donate blood regularly, work out at a gym, and hike. I started taking 50 mg of trazodone in January 2019 for its side effect of helping with sleep. It helped somewhat, so my doctor increased the dose.

One evening, I rose from my chair to take my first dose of two 50-mg tablets. I sat down for about 15 minutes, then got up to go to bed. On standing, I immediately had a sensation of heaviness in my lower legs, as if there were bricks in my calves.

I felt unsteady walking but liked the energy that I had while taking trazodone, so I continued to take it for a few months. Occasionally, I cut back to one tablet or none, but the unsteady walking continued. I also experienced an occasional loss of balance.

The feeling of unsteadiness is most pronounced on smooth surfaces. On hiking trails, grass, thick carpeting, and other rough surfaces, I walk without the high level of anxiety that I have on smooth surfaces, and I feel much less unsteady. On smooth surfaces, I have high anxiety even when using two hiking poles. I have no physical pain, just a sensation that something isn't right in my calves.

In May 2019, I stopped taking trazodone. I've had no improvement since. I've had two MRIs for a cervical spine in 2022 and 2024, which were both normal. Could trazodone have been the cause or something else? -- F.W.G.

ANSWER: I don't think that trazodone is a likely cause of the heaviness in your legs and the accompanying unsteadiness and loss of balance. The initial onset minutes after taking the increased dose isn't really plausible for a side effect. Although poor coordination and unsteady walking is rarely associated with trazodone, it should have gotten better within a few days of stopping the medicine.

Leg heaviness after walking is a classic sign of poor circulation, but you have leg heaviness without doing exercise and also have neurological symptoms that accompany them. The condition that I'm most concerned about is lumbar spinal stenosis. Pressure on the nerves that go to the legs can cause a heaviness sensation.

My suspicion would be strengthened if your symptoms improved upon sitting or, even more, upon laying down. Many people with lumbar spinal stenosis find that their symptoms are completely gone when they're pushing a shopping cart, as the slight bent-forward angle is enough to relieve pressure on the nerves. (When I see people who walk like they are bent into the wind, I suspect this diagnosis as well.)

An MRI scan of your lumbar spine would confirm or refute my hypothesis.

DEAR DR. ROACH: I'm a 73-year-old female. I've never smoked, and I don't have high blood pressure. I'm not diabetic, and I weigh 112 pounds. My coronary artery calcium (CAC) score in 2023 was 4. I don't have any diagnosed heart problems.

I saw a cardiologist who did a stress test, and the result was good. He suggested low-dose rosuvastatin and aspirin. My HDL cholesterol is 55 mg/dL, and my LDL is 63 mg/dL. In your opinion, would you advise the statin? Doesn't this increase the plaque in the arteries? -- S.A.W.

ANSWER: Assuming that your blood pressure is about 120/80 mm Hg, the MESA Score would estimate your risk of having a heart event (such as a heart attack or stroke) at 2.2% given your CAC score. At this low level, I don't recommend a statin. Statins reduce, not increase, the plaque in the arteries and would likely make your low risk even lower. But in my opinion, the benefit is so minimal that the small risk of side effects isn't worth it.

The new lipid guidelines are more likely to recommend statin drugs than they would've been in the past, but you're still not recommend one due to your low level of risk.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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