Sound Advice on Snoring According to the National Sleep Foundation, about 90 million adults in the United States snore, which is almost 45% of all adults. Clearly, snoring is a phenomenon that cannot be ignored. It is difficult to imagine just what causes the variety of unusual and sometimes incredibly loud sounds that occur when a person snores. When we fall into a deep sleep, our muscles relax—including those in our upper airways such as the mouth, tongue and throat. This muscle relaxation can narrow or even obstruct the airway, creating a forceful airflow. This, in turn, causes tissue vibration—producing the sound of snoring. The narrower the obstruction, the louder the snore. There is a strong possibility that even if you did not snore as a younger adult, as your muscles increasingly relax during the aging process you likely will begin to snore. Occasional snoring is not a serious concern. However, habitual snoring could have health implications. Beyond the natural aging process, there are other factors that can cause snoring, including: Consuming alcohol in the evening or taking a muscle relaxant before bedtime. Nasal problems, such as a deviated septum or chronic nasal congestion. A deviated septum occurs when the thin wall separating our nostrils is crooked or off-center, causing reduced airflow through one of the two nasal passages. Other anatomical abnormalities. A low, thick soft palate, enlarged tonsils or adenoids, and a large uvula are all tissues that when too large can obstruct airways. Obesity. Fatty tissue around the jaw and throat can cause tissues to collapse into the throat, obstructing the airway. Sleep apnea. When this occurs, people actually stop breathing for intermittent, short periods. In many cases, snoring actually awakens the snorer, causing disruptive sleep patterns. This can result in a variety of complications in daily living. The most obvious is daytime sleepiness, which can have serious implications on mood, and how we function and concentrate. Relationships may also suffer if snoring is making it difficult for a partner to sleep. Sometimes a change as simple as sleeping on your stomach can help. Certainly, not drinking alcoholic beverages within a few hours before bedtime could also be a simple solution. Other more complex factors, such as the anatomy of your throat or nasal problems can be explored further with a visit to our office. One of the most serious causes for snoring is sleep apnea, a disorder affecting nearly half of people who snore. Breathing is interrupted while you slumber—in fact, you actually stop breathing sometimes for 10 seconds or more. Sleep apnea is distinguished by snoring followed by brief silence and then a loud intake of air. This can happen numerous times during the night. Sleep apnea can cause the percentage of oxygen in our body’s circulation to drop significantly, sometimes to dangerously low levels. As a result, our lungs work harder trying to compensate for an obstructed airway, and the heart must work harder to support the lungs’ efforts. Obstructive sleep apnea is the most common form, whereby the soft tissue in the back of the mouth relaxes to the extent that the airway is blocked. Central sleep apnea is caused by irregularities in the normal signals our brain sends out to control breathing. Many people may not realize they have sleep apnea unless it is observed by someone who watches them sleep. To definitively diagnose sleep apnea, patients undergo a sleep study conducted in a controlled setting in which they are observed overnight. Breathing, brain activity and heart rhythms are monitored. If diagnosed, sleep apnea can be addressed with a variety of treatments specific to a patient’s individual medical history. Treatment can vary from special pillows designed to prevent sleeping on one’s back or even devices worn to keep the airway open during sleep. In some cases a CPAP (Continuous Positive Airway Pressure) machine may be recommended. A CPAP machine blows pressurized air into a mask worn by the patient when sleeping. It is important to note that there is no general treatment—the protocol depends on an individual’s personal medical history. People who are chronic snorers are at an increased risk for hypertension, diabetes, heart failure and stroke. Also, researchers have found a strong link between loud snoring and heart disease. Although sporadic snoring may be a nuisance, keep in mind that if it is chronic, it could be an audible clue for an underlying health issue. For many diseases or disorders, we are not always as fortunate to have such an obvious symptom to remind us to seek medical advice.

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Gas, Constipation and other Irregularities Gastrointestinal (GI) discomfort, such as gas, constipation or loose stools, are issues everyone experiences at some point. However, if these issues are frequent or persistent, they should not be ignored. For some people, this may be easier said than done. Generally, talking about GI issues and discussing your bowel habits with your physician is outside of our societal norms and comfort zone. As with any health issue, the more details you share (especially family history) the better. How you interpret symptoms and how your physician interprets them may vary dramatically, thus having an impact on an appropriate diagnosis. Many factors can cause GI-related discomfort such as gas, constipation, diarrhea and cramps. Sometimes, we can have extreme discomfort simply because we ate a food that did not agree with us. However, when these symptoms are experienced with some regularity, the culprit may be a diet low in fiber, stress level, medication (including iron pills and narcotics), lack of exercise, travel or other changes in our routine. Interestingly, there is a direct connection between your brain and your stomach, and when you’re feeling stressed, your stomach reacts. Stress can present in many ways, from “butterflies in the stomach,” to nausea, diarrhea or constipation. Despite a vacation’s promise of relaxation and stress reduction, many people encounter intestinal discomfort when traveling. This can be the body’s normal reaction to a change in diet and daily routine (including regular visits to the bathroom). Furthermore, the air on board planes is extremely dry, which can lead to dehydration, and, in turn, constipation. It is important to keep well hydrated when traveling. Persistent diarrhea, abdominal pain and rectal bleeding are warning signs not to be ignored. Early medical intervention is essential to help diagnose—or rule out—a serious disease or condition. Following are examples of symptoms. It is important to note that the symptoms of these minor to very serious diseases can be similar, underscoring the importance of making an appointment with your physician. Irritable Bowel Syndrome (IBS): This disorder is characterized most commonly by cramping, abdominal pain, bloating, constipation and diarrhea. Although IBS can cause great discomfort, the intestines are not permanently harmed and it is not likely to lead to a more serious disease. According to the National Institutes of Health it is thought that people suffering from IBS have colons that are more sensitive and reactive to specific foods and stress. Inflammatory Bowel Disease (IBD): Crohn’s disease and ulcerative colitis are collectively known as inflammatory bowel disease with the following distinctions: Crohn’s disease This chronic disorder causes inflammation of the digestive tract, most commonly affecting the small intestine and/or colon. Ulcerative colitis Similar to Crohn’s disease, ulcerative colitis affects the large intestine, marked by inflammation and ulceration of the colon’s innermost lining. Symptoms of the two diseases are similar, including continual diarrhea, cramp-like abdominal pain, fever and sometimes, rectal bleeding. Celiac Disease: This autoimmune disease causes damage to the lining of the small intestine and prevents food absorption, depriving the body of nutrients. Damage results from a reaction to gluten, which is found in all forms of wheat and related grains like rye and barley. Symptoms may include abdominal cramping, intestinal gas, bloated stomach, chronic diarrhea or constipation, and anemia. Colon Cancer: This type of cancer occurs when cancer cells form in the tissues of the colon. Symptoms can include a change in bowel habits, blood in the stool, diarrhea, frequent gas pains, bloating and cramps. Gastric Cancer: When cancer cells form in the lining of the stomach, it is called gastric cancer. The disease forms in the innermost lining of the stomach and spreads outward. Early stage symptoms of gastric cancer may include indigestion, mild nausea, heartburn and loss of appetite. As is well known, early diagnosis for colorectal cancers is critical for a cure. Screening tests such as a colonoscopy have become a mandatory recommendation in preventive healthcare planning. Finally, taking a cue from our professional peer Dr. Mehmet Oz and what he calls the “no embarrassment zone,” it is a good idea to monitor your own bowel movements. Shape, consistency, color and odor can be a blunt assessment of your GI health. Anything outside of your norm could indicate a range of issues from simple food irritants to serious problems such as internal bleeding. Because the symptoms of many GI-related diseases are common with lesser disorders, patients often self-diagnose and treat their complaint with over-the-counter medications, which may be all that is needed. However, trust your instinct. If you think you should see a physician, you should! As with any medical condition, early intervention is optimal for the best treatment options.

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Diabetes And Aging – Know Your Risks By David S. Oyer, MD, FACE Many people have the perception that type 2 diabetes is a health risk only for overweight individuals. It is true that those who are obese account for approximately 60% of the 17 million adults with diabetes in the United States. However, aging also plays a significant role in increasing the odds of developing type 2 (adult onset) diabetes. As we age, our cells become more resistant to insulin. The onset of type 2 diabetes occurs more than 50% of the time in adults over 55 years of age, according to the American Diabetes Association (ADA). The hormone insulin is essential for enabling our bodies to use glucose (blood sugar) for energy. In type 2 diabetes, the body does not produce enough insulin or the cells ignore the insulin. Glucose is the basic fuel for our body’s cells and is created when our body breaks down the sugars and starches in the foods we eat. Insulin carries this blood sugar into our cells for energy. When glucose builds up in the blood instead, it can lead to diabetes complications. Certain factors besides obesity and age put patients at greater risk for developing type 2 diabetes. These include excessive fatty tissue around the abdomen, high cholesterol and glucose intolerance. Importantly, people with high blood pressure are more than twice as likely to develop type 2 diabetes than those with normal blood pressure. Today, doctors are utilizing a blood test called the hemoglobin A1C to help identify those individuals at risk for developing diabetes. This A1C test has been used for years to monitor blood sugar levels of patients who have already been diagnosed with diabetes. The general goal recommended by the ADA is below 7%, but higher or lower goals may be appropriate for a given individual. In January 2010, the ADA began recommending that physicians utilize the hemoglobin A1C to identify patients at increased risk of developing type 2 diabetes. The traditional normal range in non-diabetics for an A1C test is 4-6%. To use the A1C test to screen for increased risk of diabetes, the ADA splits the A1C results into three categories: normal (5.6% or less), prediabetes (5.7% to 6.4%) and diabetes (6.5% or more). The higher the A1C, the greater the risk of developing diabetes. Pre-diabetes in this context implies that the patient is at an increased risk of diabetes. However, this simplification does not take into account ethnic or genetic variability of A1C results. For example, A1C averages 0.3% higher in African-Americans and averages 0.3% lower in Asians. The A1C test can also be misleading in patients who have other medical conditions that make the result falsely low, such as bleeding or hereditary spherocytosis (a condition affecting the red blood cells that causes anemia, among other symptoms). So, sometimes the A1C result is only part of the story, and the fasting glucose or post-meal glucose has to be considered as well. The value of the new category of pre-diabetes (increased risk of diabetes) is that we have proof that diet and exercise can help reduce the risk of progressing to overt diabetes. The Diabetes Prevention Trial has shown that patients “at risk” for type 2 diabetes reduced their risk of progressing to overt diabetes by 60% through a program of diet and exercise; the benefit was primarily related to weight loss. If you have had an A1C test for screening for diabetes, your doctor will help evaluate the number for you and make recommendations. Whether your test results are normal, pre-diabetic or diagnostic for diabetes, you can do your part to optimize your health by eating a low carbohydrate diet and by getting regular exercise.

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Heart Attack Symptoms – more than just chest pain When most people hear the words “heart attack,” a dramatic image of someone (usually a man clutching his chest) typically comes to mind. This dramatic perception is what the American Heart Association calls the “movie heart attack.” And while it is true that many heart attacks are sudden and powerful, most begin with more subtle symptoms. Coronary heart disease is the number one killer of both men and women in the United States, according to the American Heart Association. In fact, more women die of the disease annually than men! Knowing your own risks, as well as the common signs of a heart attack—some of which might surprise you—are vitally important to your long term health and wellness. The most common symptom that can indicate a heart attack is some type of chest pain, pressure or discomfort. Chest discomfort with profuse sweating and a sense of dread in a 72 year old with high blood pressure and is a former smoker almost certainly indicates a heart attack. However, there are lesser known indicators that can also signal a heart attack. Many of these symptoms are rather common and nonspecific. Look for patterns. Upper Body Discomfort: Pain or tingling in other areas of the upper body besides the chest, including the neck, shoulder, arm, upper back, or jaw. Shortness of Breath: This symptom may occur by itself or accompany chest pain/upper body discomfort. Miscellaneous Symptoms: Nausea/vomiting, breaking out in a cold sweat or lightheadedness/ dizziness. Women are more likely to experience lesser known symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. Once heart attack symptoms occur, time is of the essence. Call 9-1-1 or the emergency response number for your community. Do not drive yourself to the hospital or wait for someone to give you a ride—the sooner you can be evaluated by emergency services personnel and brought to a hospital emergency room, the better your chances of survival. During a heart attack, blood flow to the heart muscle is reduced or obstructed. When heart muscle is deprived of oxygen-rich blood, it dies. Acting quickly when you first notice the symptoms can save your life and diminish heart damage. Treatment ideally should begin within 60 minutes of the onset of symptoms (called “the golden hour” by medical personnel). According to the American Heart Association, more than 83 percent of people who die from coronary heart disease are over the age of 65. In this age range, women who have heart attacks are more likely than men to die within a few weeks. Still, men have a greater risk overall of heart attack then women do. The American Heart Association outlines some major risk factors that can be changed, treated or controlled by altering your lifestyle: Tobacco: The risk of developing coronary heart disease is two to four times greater for smokers. Cigarette smoking narrows the blood vessels to the heart, thus restricting the flow of oxygen. Every cigarette you smoke adds to the damage. High blood pressure: The heart is forced to work harder when you have high blood pressure, and increases your risk for stroke and kidney failure. Also, the pressure itself inside the vessels leads to plaque formation – just as with cigarettes. High blood cholesterol: The higher your blood cholesterol level, the greater your risk of coronary heart disease. Cholesterol is a waxy, fat-like substance that plays many important roles in our bodies such as maintaining cell walls. But when there is too much cholesterol, it builds up on the linings of our arteries, which slows or blocks the flow of blood and oxygen to the heart. Being overweight: Quite simply, when people maintain a healthy weight, their bodies function better—your blood circulates efficiently, fluid levels are maintained and you are less likely to develop heart disease and diabetes. People who are overweight have higher levels of fat in their body cells, which need oxygen to survive, requiring blood vessels to circulate more blood to the fat tissue. This taxes the heart, forcing it to work harder and contributing to high blood pressure. The presence of more fat also contributes to high cholesterol. Having diabetes: If your blood sugar is not controlled properly, the risk is even greater. Diabetes hastens the hardening of the arteries, which can restrict or block the flow of blood and oxygen to the heart. Heredity: Some risks cannot be altered. Children of parents with heart disease are more likely to develop it themselves. Know your family history. Research studies have solidly documented that regular aerobic exercise, including brisk walking, not only maintains and improves fitness levels but also aids in controlling many of the risk factors discussed, including high blood cholesterol, diabetes, obesity and high blood pressure. Being informed about potential symptoms and your risks for a heart attack, along with the changes you can personally make to reduce risk and improve overall heart health, are important ways that together we can proactively address this serious disease.

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Insomnia the Waking Game There is a reason for the phrase “I slept like a baby” when describing a good night’s rest. According to the American Academy of Sleep Medicine, once people reach adulthood approximately 30 percent have symptoms of insomnia. For people over age 60, that number climbs to about 50 percent. As people age, they have a hard time falling asleep, difficulty staying asleep and often wake up too early, unable to go back to bed. It’s no surprise that people who are sleep deprived don’t feel well-rested the next day. You may wonder why a baby—or even a teenager or college student— sleeps so soundly while nearly a third of adults struggle with insomnia. Simply put, older adults’ body clocks are completely different than the finely-tuned body clock that ticked inside us in our youth. Older adults are less likely to sleep for long periods of time. Sleep is not as deep, and there is a greater tendency to wake during the night. As we age, our body clock (actually our body’s physiological functions), may cause us to produce less of the hormone melatonin, which regulates sleep. Increased sensitivity to changes around us, such as lighting, noise or a new environment may cause us to awake more frequently. More than half of pre-menopausal and menopausal women are affected by insomnia. However, insomnia is actually more common in men than women. Aging may also bring on additional medical problems that can affect sleep. If medications are prescribed for other health issues, these can also be a factor contributing to insomnia. Contrary to popular belief, older adults still need seven to eight hours of sleep each night to function well—and safely. Lack of sleep or continued poor quality sleep can affect our daily routines, from making us moody, irritable and tired, to lack of concentration… all of which can lead to inadequate job performance or even contribute to accidents. Older adults should not despair, however. Lifestyle adjustments can be made to help promote better sleep—some more obvious than others. Avoid caffeine starting in the afternoon, as well as limit alcoholic beverages. Smoking is problematic, as nicotine is a stimulant that can interfere with sleep. Exercise in general will help you sleep better and stay healthy, be it as simple as walking, gardening or dancing, but avoid workout routines closer to bedtime. Bedtime rituals, such as a relaxing bath or shower, listening to soothing music or taking some time for quiet reflection can also help ready our bodies for sleep. Avoid liquid intake about 90 minutes before bed—this decreases the likelihood of needing to use the bathroom in the middle of the night and not being able to fall back asleep as a result. Sunshine may also contribute to improved sleep. Bright sunlight increases melatonin, the very sleep regulating hormone that our body produces less of as we age. We might also learn a lesson from the sleeping baby or toddler who is rejuvenated from a nap. Try a brief nap of between 15 minutes to an hour (no longer), in the late morning or early afternoon. Avoid napping later in the day or close to bedtime. When Insomnia is More Than Just a Symptom of Aging Although insomnia is common in older adults and may be mitigated by lifestyle changes, for some people it can be a serious problem or indicative of a more critical health concern. If you attempt to address your insomnia on your own without much success, contact us to see if we can come up with a plan that will work for you. Please do not lose any sleep worrying about it!

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Do You Suffer From Seasonal Allergies? The National Institute of Allergy and Infectious Diseases estimates that more than 50 million Americans suffer from allergic diseases. Allergies are the sixth leading cause of chronic disease in United States. They arise from loss of the body’s natural resistance to allergens – substances that in some people the immune system recognizes as “foreign” or “dangerous.” These same substances cause no reaction for most people. An allergen can be almost anything as long as it provokes an allergic response in a person. If the onset of symptoms is rather sudden and these same symptoms occur at the same time every year, it is usually indicative of a seasonal allergy. If you are allergic, your immune system reacts very quickly when it encounters a certain substance, because it mistakenly thinks that substance is “dangerous” to you. Seasonal allergies are caused by pollen and spores. They can occur at any time of the year, but frequently they start in early spring through the end of May, when the primary cause is windborne tree pollen. This is followed by grass through mid-July and ragweed from late summer until the first frost. Mold spores typically peak in mid-summer and last until temperatures begin to drop. The problems are complicated by pollen and spores carried into your home on clothes or through open windows. How can I reduce the effects of seasonal allergies? Take off your shoes as soon as you enter the house to avoid spreading allergens. Keep your home and car windows closed, and run the air conditioner to keep cool. Avoid mowing the lawn, keep away from freshly cut grass, and try to limit outdoor exposure on windy days. Know the pollen count for your allergen and stay indoors when it is high. Treatment of seasonal allergies can include over-the-counter or prescription antihistamines, nasal steroid sprays, decongestants, as well as alternative treatments. Many of the medications have ingredients that can elevate your blood pressure and heart rate, so it’s medically important to ensure they are appropriate for you. I encourage you to discuss your symptoms with me.

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Headaches…Simple or Serious? There are many different types of headaches. They have their own names, their own symptoms, and their own best treatments. The sooner you can identify your type of headache, the better you will be able to manage it. Most people get tension headaches. Symptoms include soreness in the temples, a tightening vice-like ache around the forehead, and pain in the head and/or neck muscles. The pain is steady, continuous and very annoying. Most people get relief in an hour or two with an overthe counter pain reliever. Somefind the best relief comes from combining their analgesic medication with a long walk, a short nap or a good night’s sleep. If you get these headaches almost daily, then you may suffer from chronic tension headaches, which can be more serious and should not be ignored. Sinus headaches are also common. These headaches are caused by sinus congestion and inflammation called sinusitis. They occur when your sinuses (the air-filled cavities around your nose, eyes, and cheeks) become inflamed because of an allergic reaction or an infection. Bending down or leaning over generally makes the pain worse, as does cold and damp weather. Sinus headaches begin when you get up in the morning, usually because at night while you are lying down the mucus collects and drains. You may feel better by the afternoon. Sinus risk factors include a history of allergies, asthma, nasal polyps (noncancerous overgrowths in the nasal passages) or if you recently have been flying or hiking in high altitudes. Frequent swimming or diving can also produce symptoms. Generally, antihistamines or decongestants are recommended along with antibiotics if you have an infection. A migraine headache often starts with a dull ache, which progresses to a continuous pulsating, throbbing pain, usually at the temple and the front or back of one side of your head. For some people a warning aura is a signal of impending pain. Most commonly, there is a visual indicator such as a flashing light or black zigzag lines. Migraine sufferers are sensitive to light, noise, and even smells, and may becomenauseous. Migraine headaches frequently begin in childhood and worsen through adolescence. Although more young boys than girls have migraines, conversely more adult women than adult men have migraines. Over time, for both sexes the frequency of migraine onset diminishes and they become infrequent after age 50. Migraines have a tendency to run in families. In fact, four out of five migraine sufferers have a family history. If one parent has had migraines, you have a 50% chance of developing migraines, and if both parents have a history of migraines, the risk jumps to 75%. Rebound headaches can result when people take too much headache medication—more than prescribed recommendations or the label’s instruction—causing a recurrence. This is especially true if your medication contains caffeine, which speeds the effectiveness of the other ingredients but can also make your headache more likely to recur. Sometimes it is difficult to tell the difference between a tension headache, a sinus headache or a migraine without an office visit. A wide range of treatments have been proven to prevent or treat headaches. They range from prescription medications to over-the-counter analgesics… and in some cases may also include acupuncture, meditation, and a variety of selfhelp and life style therapies. Occasional headaches are common.But it is important to take headaches seriously. Please call our office if: You regularly have two or more headaches a week You take a pain reliever for your headaches every day or almost every day You need more than the recommended dose of over-the-counter-pain remedies to relieve symptoms Your headache pattern changes Your headaches are getting worse Seek medical help immediately if your headache: Is sudden and severe Accompanies a fever, stiff neck, confusion, seizure, double vision, weakness, numbness or difficulty speaking Follows a head injury Gets worse despite rest and pain medication

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Relief from Leg Cramps Leg cramps, those painful muscle contractions that occur so suddenly, usually strike during the night and shock you awake from sleep. Sometimes called “Charley horses,” they can also attack during the day while you’re driving your car, riding a bicycle, or participating in sports and other activities. Mostly they assault your calf muscles, though they may sometimes involve the muscles in your feet or thighs. Night-time leg cramps tend to increase in frequency as we age. Pregnant women are often more at risk. Fortunately, most nocturnal leg cramps are harmless and have no known causes, except in rare instances where there is an underlying condition (see “Causes” below). How to Stop a Leg Cramp You can do a number of things to get fast relief when a leg cramp strikes. You may have to experiment with various techniques before discovering which ones work best for you. For many, the quickest thing to do is what seems like the worst possible thing. Force yourself to stand up, place your foot firmly on the floor, and put all your weight on it. As unlikely as that seems, it usually works; and once you discover that it does, you’ll feel much more confident about doing it the next time. The Website www.WebMD.com offers these suggestions for stopping a cramp: Walk around. Jiggle your leg. Stretch your calf muscles (see adjacent sidebar). Take a hot shower or a warm bath. Rub the calf with an ice pack. Preventing Leg Cramps When it comes to prevention, there are various things you can do to avoid leg cramps. The Mayo Clinic’s Website, www.MayoClinic.com, suggests the following: Drinking plenty of fluids to avoid dehydration Wearing shoes that have proper support Stretching your leg muscles, or riding a stationary bicycle, for a few minutes before you go to bed Untucking the bed covers at the foot of your bed To reduce leg cramps and other discomforts of pregnancy, the Weight-control Information Network (WIN) recommends regular, moderate-intensity physical exercise. WIN is an information service established by the National Institutes of Health (NIH). We also recommend eating plenty of potassium-rich foods, such as bananas, tomatoes, potatoes, broccoli, cantaloupe, oranges, and grapefruit. What Causes Leg Cramps? In most cases, nocturnal leg cramps have no identifiable cause, according to the www.MayoClinic.com Website. Rarely, however, night leg cramps may sometimes be associated with: Addison’s disease Alcoholism Blood pressure medications Cirrhosis Dehydration Type 2 diabetes Diarrhea Diuretics Electrolyte imbalance Flatfeet Hypothyroidism (underactive thyroid) Kidney failure, chronic Muscle fatigue Oral contraceptives Parkinson’s disease Second trimester pregnancy Peripheral artery disease (PAD) Gastric bypass surgery If you think your leg cramps may be caused by any of these or other medical conditions or circumstances, please schedule an appointment with our office. You should also contact our office if cramps keep you awake so that you can’t function the next day or if you experience muscle weakness; and if you have severe and relentless cramping, call us immediately. How to Stretch your Calf Muscles You can stretch your muscles either while sitting or standing. While sitting, straighten your leg and flex your foot up toward your knee. It may help to place a rolled towel under the ball of your foot and, while holding the towel at both ends, gently pull the towel toward you while keeping your knee straight. While standing about two feet from a wall, lean forward against the wall. Keep the knee of the affected leg straight and the heel on the ground. Do this while you bend the knee of the other leg. These exercises stretch your calf muscles, and you will probably feel the leg cramp go away after a few minutes. Source: www.WebMD.com

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