IF SYMPTOMS PERSIST
By DR. JOSE PUJALTE JR.
“Restless tonight and ill at ease” – Frances Louisa Bushnell (1834-1899), American poet, “In the Dark,” in Stedman’s An American Anthology (1900)
This affliction reminds me of a classic Monty Python sketch (“Ministry of Silly Walks”), although there is nothing funny about it at all. Imagine an uncontrollable urge to move the legs when at rest because of – as patients describe it – a “creeping, crawling, burning, tingling, pulling, painful” sensation. Moving the legs eases the pain or discomfort but only for a short while.
Definition. In primary Restless Legs Syndrome (RLS), the cause is unknown but it tends to run in families. Over time, specially if RLS began in childhood, it becomes worse and occurs more often. Secondary RLS is due to another definable cause such as:
- Diabetes mellitus.
- Rheumatoid Arthritis.
- Iron Deficiency (with or without anemia).
- Parkinson’s Disease.
- Kidney Failure.
There are also some medications that can trigger RLS. These are anti-seizure and anti-nausea medicines, antidepressants, and even some cold and allergy preparations. If RLS is present, beware of the worsening effects caused by caffeine, alcohol, and tobacco (life’s little pleasures for many).
Diagnosis. See your favorite doctor or a neurologist. Criteria-wise, there are four conditions the must be met to make a diagnosis of Restless Legs Syndrome. These are:
- An unpleasant feeling in the legs giving an irresistible urge to move them.
- The urge to move the legs gets worse if the legs are kept still.
- As long as the legs are moved, the unpleasant feelings are relieved.
- The urge to move the legs and the unpleasant feelings are worse at night (and may cause insomnia).
Treatment. The goals of treatment are to relieve symptoms, uncover and then treat underlying causes of RLS if it is secondary, and to improve sleep if RLS is causing chronic sleep loss. The doctor may first want you to make lifestyle changes such as avoiding life’s little pleasures (caffeine, alcohol, tobacco), moderate exercise, using ice or heat packs, and good old-fashioned therapeutic massage. If these afford no relief, and with RLS symptoms clearly identifiable, the doctor may need to prescribe drugs that lessen leg motion (levodopa), strong pain-relievers (narcotics for severe pain), and sedatives for the sleep deprived. Iron supplements may also be given.
Living with RLS. These are some recommendations from the US Restless Legs Syndrome Foundation (yes, it exists! http://www.rls.org):
- Don’t fight it – don’t suppress the urge to move the legs.
- Keep a sleep diary – attempt to find patterns in sleep disruption and episodes of leg movement. Document duration, frequency, and severity which can be volunteered information to the doctor to adjust or stop medications.
- Occupy your mind. Keeping the mind engaged in chosen activities can lessen obsession on RLS
- Start the day with stretching. So it may not be so bad to try a few sessions of yoga or Pilates.
Restless Legs Syndrome can seriously undermine a person’s life to an extent that career and social activities are sacrificed. As in many unusual but existing conditions, it must first be recognized and then brought to medical professionals. One question is – is there room for malingering? Let’s put it this way, many of us have moved or shaken our legs in tense or idle moments. It may be conscious or involuntary but sooner or later, we stop it. But consider the RLS patient who has no control over these movements. Malingering is a possibility but a small one to be sure. There are other things to fake, not RLS. It certainly won’t get you a month of sick leave (!).
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