Leg cramps.... Why now?

fuzzy96 wrote:

SHUD UP Ya drunken squirrel!!

fuzzy96 wrote:

Well shoot, Fuzzy, was my explanation that bad??
Okay, read it again. V-e-r-y~~S-l-o-w-l-y ~~~!!

Cassandra wrote:...Pickle juice...

Often recommended for those eating very low carbohydrate for exactly the same reasons you site here. Most don't consume low-sodium V8 to compensate for the electolyte loss 'cause you pee so much in the beginning as average blood sugar levels drop for those with impaired glucose or outright diabetes (each glucose molecule is always surrounded by 4 water molecules...that's a lotta water).

Cassandra wrote:I will second the calcium, magnesium, potassium and vitamin E that everyone else has suggested and add my own anecdotal home remedy.

Pickle juice!
...

While this is entirely experiential, I can corroborate that it makes sense. I've found it also helpful for GERD. I know - it doesn't make sense, but it works for me.

Hi,
Try drinking more water! I know that if I don't drink enough water I often wake up with leg cramps, sometimes very painful.

Muse-Inc wrote:

Cassandra wrote:...Pickle juice...

Often recommended for those eating very low carbohydrate for exactly the same reasons you site here. Most don't consume low-sodium V8 to compensate for the electolyte loss 'cause you pee so much in the beginning as average blood sugar levels drop for those with impaired glucose or outright diabetes (each glucose molecule is always surrounded by 4 water molecules...that's a lotta water).

Totally makes sense! Thanks, Muse.

Cassandra

Hi

I started a couple of threads on this topic & SWS provided some very insightful responses. I went to my doctor to discuss this cramping issue (he is a professor of medicine at a nearby university so I tend to trust him) & he said cramps during activity are typically caused by iron deficiency but nocturnal cramps are a bit more complex. But, for me, the issue is ongoing but I have this odd way around the cramps - I switch cpap machines !!! - He had prescribed quinine as one solution but that same night I switched cpap machine (from Vpap Adapt SV to Bipap Auto SV) & the cramping dissipated so I haven't yet tried quinine.

I have no in depth explanation, just some theories.

-- a CO2 imbalance is known to cause muscle cramping hence my idea to swap SV machines based on the possibility that one may cause a differing level of CO2 build up that triggers cramping

-- flight or fight stress can cause an over production of adrenalin & iwhen not used it drains into the legs & can cause tingling & cramping (just bought another car after 2 weeks negotiations so had a trigger for some stress, the deal was a bit on & off but completed today)

-- There is always the iron imbalance issue but lots of magnesium tablets were not solving this for me

Anyway, good luck with your search.

DSM

Complex theories aside, it's also possible that you need to stretch those babies!

millich wrote:Complex theories aside, it's also possible that you need to stretch those babies!

I think it is a given that if anyone is doing exercise (jogging, running) that before and after the exercise stretch exercises are a very good idea

DSM

I get leg cramps when I don't get enough calcium. I need to take at least 600 mg calcium+D two times a day. If I only take 1 calcium tablet per day, I will get leg cramps. I am not a milk drinker. I don't think the leg cramps have anything to do with cpap. Hope this info helps.

You could try Hyland's "Leg Cramps with Quinine." Get at health food store, or some online/catalog vitamin suppliers. Must be taken under the tongue. I tried for awhile taking with water like a regular pill and had no results. Didn't want to try sublingual because I thought they would be bitter or something...but actually, almost completely tasteless, and effective. Be careful, some people are allergic to quinine; better experiment first. But they do stop my calf cramps. Also, plantar fasciitis boot will keep your foot at right angle (literally) to stop cramp. And if you sleep in your back, putting a bolster of some sort under the sheet at the foot of the bed will keep pressure of bedclothes from pushing foot down. I am just reading this forum--find it very helpful, and sometimes even entertaining! Will sign up with my info later. Y'all keep up the good work, ya heah?

Follow up re quinine use.

For the past couple of week I have had multiple leg cramps every night. Saw this as an opportunity to do some testing & for the nights prior to last night I stayed with the Vpap Adapt SV (I have previously commented that for reasons I don't have a clear answer for, the cramps seem to go away when I switch to a Bipap AutoSV - I have theories on this but that is all).

For 4 of the most recent nights prior to last night I took 1 magnesium tablet + 1 calcium & magnesium tablet + lots of water. My observation was that these made *no* discernible difference.

Last night I opened the bottle of quinine tablets I have had sitting on the shelf & took 1 & the result was not a single cramp last night. I still had a few occasions when I woke & did a stretch (this would normally be followed by a cramp in one or other leg in the calf muscles), but the stretching did not result in the usual predictable cramps.

My conclusions then are that for me quinine made a difference.

DSM

Having posted the above, I did a search on cramps & quinine & discovered this alarming warning from the Australian Government health website.

Whilst it has been deleted the implications are still serious.

http://www.tga.gov.au/adr/aadrb/aadr0410.htm (search on the page for "Quinine indications - cramps deleted"

As a consequence of the risk of thrombocytopenia (currently 228 ADRAC reports; 6 fatal),1 quinine is no longer approved in Australia for the treatment of nocturnal cramps.
Reference
1. ADRAC. Quinine and profound thrombocytopenia. Aust Adv Drug Reactions Bull 2002;21:10.

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The above links to the story below

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Quinine and profound thrombocytopenia

ADRAC has published 2 previous Bulletin articles about quinine and thrombocytopenia but continues to receive reports of this serious problem.1,2 Since 1972, ADRAC has received 571 reports of suspected adverse reactions to quinine (sulfate or bisulfate), including 198 reports of thrombocytopenia, 4 of which had a fatal outcome. Twenty of these have been received since the beginning of the year 2000. The reactions generally occurred within 3 weeks of commencing quinine although two with intermittent use had a longer time to onset. In two cases the reaction occurred soon after the first dose. Seventeen of the 20 reports documented a platelet count which ranged between 0 and 14 x 109/L and most described hospitalisation and treatment with platelet transfusion, corticosteroids or immunoglobulin. Five reports described a positive quinine antibody test.

A recent illustrative report involved a 25 year old woman who had been taking quinine intermittently for nocturnal cramps. She had been taking about two tablets a week for 2 months. She presented with a generalised purpuric rash, and was found to have a platelet count of 5x109/L. Quinine was ceased, and she was hospitalised and treated with prednisolone and immunoglobulin. Her platelet count recovered to normal within a week. Drug-induced anti-platelet antibodies were detected.

Prescribers should consider the risks and likely benefits before prescribing quinine for nocturnal cramps, and should also consider other causes of cramp (for example, salt depletion particularly in summer, electrolyte disturbance, peripheral vascular disease, motor neurone disease). Meta-analyses have found that quinine prevents on average one or two cramps per week compared to placebo, without reducing the duration or severity of cramps.3 In 1995, the American FDA withdrew the indication of nocturnal cramps from all quinine products, because of a lack of evidence of efficacy, and the Australian Medicines Handbook recommends against its use for this indication.4 Daytime passive stretching of the calf muscles may be effective in preventing nocturnal cramps.5

As illustrated in the case report above, thrombocytopenia usually recovers within a week of stopping quinine, but treatment with platelets, steroids or immunoglobulin may be required. Since quinine-induced thrombocytopenia occurs via an immune-based mechanism, patients should in future avoid all quinine-containing products, including drinks such as tonic water and bitter lemon.
References

1. ADRAC. Cinchona alkaloids - the bite's as bad as the bark! Aust Adv Drug React Bull 1988; December.
2. ADRAC. Quinine, cramps and cricket. Aust Adv Drug React Bull 1991; 10: August.
3. Anonymous. Quinine and cramp. Prescr Internat 2000; 9: 154-7.
4. Australian Medicines Handbook, 3rd edition, Adelaide: AMH: 2002. p. 585
5. Daniell HW. Simple cure for nocturnal leg cramps. N Engl J Med 1979; 301: 216.

Have extracted the below couple of points to highlight some interesting comments from the prior posts.

(Aust Govt Health Website)
1.
Prescribers should consider the risks and likely benefits before prescribing quinine for nocturnal cramps, and should also consider other causes of cramp (for example, salt depletion particularly in summer, electrolyte disturbance, peripheral vascular disease, motor neurone disease).

2.
In 1995, the American FDA withdrew the indication of nocturnal cramps from all quinine products, because of a lack of evidence of efficacy, and the Australian Medicines Handbook recommends against its use for this indication.4

3.
Daytime passive stretching of the calf muscles may be effective in preventing nocturnal cramps.5



DSM

Another interesting set of comments re nocturnal leg cramps (seems there are varying thoughts on use of quinine) ...

http://www.healthcaresouth.com/pages/as ... cramps.htm

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Q: I have night time leg cramps that wake me up. What can I do?

A: Nocturnal leg cramps become increasingly common with age. They are also common during pregnancy.

Leg cramps affect the muscles in the calf or along the sole of the foot. The cramp usually goes away within a few minutes. You can help relieve the pain by grasping your toes, pulling toward you, stretching your calf muscles.

Prevention - stretching, exercise

Night-time muscle cramps are often caused by tight muscles and inactivity. The best preventative treatment is regular stretching and exercise. If you suffer from regular nocturnal leg cramps, you should stretch your calves and affected areas as part of your bedtime ritual.

The ‘‘runner's stretch'' involves leaning against the wall and stepping forward, leaving the back foot flat on the floor. The ‘‘stair stretch'' requires standing on the edge of a step and dropping your heels while holding on to the banister. It is important to hold these stretches for at least 30 seconds.

Other treatments

Despite the frequency of this problem, there is limited understanding and treatment for leg cramps. Supplemental potassium or calcium is not effective because electrolyte abnormalities do not cause nocturnal leg cramps. Magnesium is only helpful in pregnancy. Bananas do not help. Hydration does not help this kind of muscle cramp.

The following treatments do not help all people and should complement your stretching regimen.

A tonic for cramps

Quinine is one of the few treatments shown to help reduce nocturnal cramps. Quinine is found in low concentrations in tonic water (one-tenth of prescription dose). Drinking eight to 16 ounces at night can be a simple remedy.

Quinine is available in a stronger dose by prescription. Quinine is considered safe when used at low doses. Quinine can interact with medications including digoxin and warfarin (coumadin). It should be avoided if you are pregnant or have kidney, liver or heart disease. Quinine can cause rare side effects including tinnitus (ringing of the ears), visual changes, vertigo, nausea, decreased platelets (needed for clotting), and heart arrhythmias. Potential interactions and side effects prompted the FDA to remove it as an over-the-counter treatment in 1995.

Other treatments that may be helpful but have not been studied extensively include: the muscle relaxant, orphenadrine (Norflex), the anti-seizure medicine, gabapentin (Neurontin), and the blood pressure medicine, verapamil. Vitamin B complex may be helpful. Vitamin E is often recommended but studies show that it may not be helpful.

It is important to differentiate leg pain from cramps. Neuropathy (nerve damage), sciatica, as well as clogged arteries in the leg (vascular disease) can cause leg pain. These types of pain, tend to occur throughout the day and not just at night. Vascular disease also causes cramping with walking. In vascular disease, nighttime pain is relieved with hanging the foot over the bed so that gravity draws more blood into the feet. Poor circulation also causes poor healing that results in persistent sores (ulcers). Leg cramps that occur at rest may have a different cause and treatment than cramps associated with activity.

Nocturnal leg cramps must be distinguished from restless leg syndrome, which is a crawling, uncomfortable sensation that forces you to get up and move the legs.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.