Legs “We were in a movie theatre watching Bluff master. Halfway through the film I grappled with a sense of suffocation in the fully air conditioned room. My legs hurt like hell. No, hurt is not the right word. It was as if a current was passing through my limbs from the bottom of my feet to my butt. I couldn’t bear to sit in the place a moment longer.” I am your average homemaker. My life revolves round my family, cooking, cleaning, packing lunch dabbas, ferrying the kids to school and back. Only in the afternoons do I surface to take a breather. Then I settle down in front of the easel and lose myself in the swirls of oil paint. Art is not just a hobby but a vocation. I specialize in portraits. One day a week, on Tuesdays, I try to instill some of that passion in special children at the Shicshankar Shikshan Sansthan Schools in Ghansoli an Turbhe, Navi Mumbai, where I teach art. It’s through my paintings that I express a side of me that is otherwise submerged in the mundanity of living. Art and, I would add, driving. I was the one who took turns at he wheel when Mahash, my husband, needed rest during our road trip to Manali in 2004 . I enjoyed shouldering the challenges of night driving, taking on the steep slopes.
A LEG UP Sometime in early 2000 I found myself vexed by a funny tingling sensation in my toes. Attributing it to the aerobic classes I had lately taken up I resorted to my usual band of remedies hot ad cold compresses, a light massage. I also cut back on the high impact moves and took up yoga. My GP, Laxman Advani (who happens to be my uncle) suggested vitamin D supplements and Combiflams if there was pain. Nothing worked. Over the next 12 months, the tingling traveled up the back of my leg to my right butt. I tried not to let it affect me too much, and went about my work as usual. Often it felt like my legs were crying for some rest. The mornings area a race against time, but after the rush was over, I’d sit back with relief and give my feet a nice long soak in a warm tub. In May 2001, I was in the middle of an aerobics class when I felt a paralyzing pain shoot up the back of my right leg. I stopped immediately and stepped out to drink a glass of water. After a 15 minute break I returned to the class. As I bent over for a hamstring stretch the room swam around my head and I passed out. Back home I slapped hot and cold compresses on the ill used right leg. My aerobics trainer Nuri Khan suggested that I’d probably strained the hamstring and advised me to take a 2- week break from all exercise. Those were terrible days. My morning chores usually kept me on my feet for at least 3 to 4 hours. Now I couldn’t stand for more than 5-10 mins before my right leg started twitching. Sometimes it felt as the nerves in my feet were burning in reaction to contact with ed chillies. At other times I had this odd feeling my right leg was sinking into the ground. Every time I was on my feet I desperately longed to sit down and rest. Yet sitting brought no relief, because after 5-10 mins, all I wanted to do was lie down and stretch out. The biggest ordeals were climbing stairs, sitting cross legged on the floor and bending over to pick up things. After bravely hiding the pain from my family, I was eventually persuaded to hire a maid to help me around the house. I consulted orthopedist Dr. Ram Chedda in Mulund. His physical examination of my spine and leg turned up nothing. I sought a 2nd opinion, then a 3rd , and a fourth. Over the next 6 years I wandered from specialist to specialist in an effort to pin down the source of the twitching feelings. No two doctors seemed ot be in agreement. Some offered painkillers, others, like orthopedist Ashok Motwani, pronounced income prehensible medical terms like “blocked perforators” in my right calf that only seved to alarm me more. Orthopedist Dinesh Dedhia was of the view that it was aciatica. He said the numbness and tingling sensations were the outcome of compressed nerves in the L4 or L5 regions and advised immediate spinal surgery. The prospect of undergoing an invasive back procedure was terrifying, especially since none of the specialists could assure me that it would well and truly solve m problem. I stuck to swallowing Combiflams. “The nocturnal limb movements appeared to be playing havoc on my sleep too, because I often woke up feeling fatigued, dull and irritable. I became prone to panic attacks for no thyme or reason” FRESH TROUBLE In August 2005 my husband began complaining that I was thrashing around too much in the nights and that he was losing sloop as a result. Then I stared experiencing a new sensation. My tight foot would turn cold and numb in the nights and I’d often wake up Mahesh to massage it. I took to wrapping my right leg with crepe which didn’t help too much. Then I wore special stockings (recommended by a friend) since covering myself with 2 blankets in Mumbai’s humid conditions proved impractical the numbness affected only my right foot. The nocturnal limb movements appeared to be playing havoc on my sloop too, because I often woke up feeling fatigued, dull and irritable. I was unable to sit still for loge than 10 minutes at a stretch and this cut into my painting and driving, I actually gave up my art for a period. What puzzled my was that I became prone to panic attacks for no thyme or reason. In November 2005 I was having a shampoo at my regular salon. The stylist wrapped a towel round my head and turned her attention on another client. While I sat waiting to get dry, the room suddenly seemed to sway and the din and activity around me receded as I broke into a cold sweat and fainted. Fortunately I had asked Mahesh to pick me up at he salon. A month later in December 2005, another strange episode. This time we were in a movie theatre watching the Abhishek Bachchan and Prinka Chopra starrer Bluffmaster Haalfway through the film I grappled with a sense of suffocation in the fully air conditioned room. My legs hurt like hell. No, hurt is not the right word. It was as if a current was passing through my limbs form the bottom of my foot to my butt. I couldn’t bear to sit in the place a moment longer. Mahesh and the kids were really alarmed at my mysterious malady, and we hurried back home. For nearly a full year we debated the pros and cons of spinal surgery because we presumed that this was one more symptom of sciatica. I sought a close doctor friend, Jaishree Sharad to be my sounding board. Chary as I was about going under the knife, I had almost reconciled myself to it when she suggested I undergo one more MRI of the spine to confirm sciatica, To our combined surprise the report came out normal nothing wrong with the discs, no pinched nerve. That meant I didn’t need back surgery. I was relieved. But now what? And if it wasn’t sciatica, what was wrong with me? Combiflams and nightly massages with balms seemed to offer no respite from the unpleasant creepy crawly sensations. LAST RESORT Acting on a hunch, n early 2007 Dr. Sharad referred me to Dr. Pawan Ojha, consultant neurologists at L H Hiranandani hospital in Powai, and head of the Brain Center Neurology Clinic and Diagnostics in Vashi. A physical examination and a close hearing of my litany of complaints led Dr. Ojha to suggest that I may be suffering from Restless Legs Syndrome (RLS) and not sciatica, It was a brand new term and I had no idea what to make of it. It was not a final diagnosis, however: Dr. Ojha wanted me to undergo a series of tests to validate (or rule out) his diagnosis. In April 2007 I underwent a serum ferritin test to determine iron levels in my brain. Iron is essential for the production of the neurotransmitter dopamine, which is responsible for a number of critical brain function including eye movement, motor skills, learning, addiction among others. Simply put, the regulation of this chemical messenger is crucial for our mental and physical health. It’s primarily concentrated in the cluster of neurons situated in the basal ganglia. According to Dr. Ojha, dopamine levels may fall when ferritin, the protein that stores iron in the brain, runs low. This can cause that basal ganglia specifically the area called substantia nigra to experience pleasure and pain. Low levels of ferritin which is not the same as anemia, viz: low iron in the blood is believed to be one of the causes pf Rest;ess Legs Syndrome. Iron insufficiency in the brain and the spinal fluid is signified by symptoms such as prickly creepy crawly sensations running through the legs, involuntary leg movements during sleep. Normal levels of ferritin for a woman could be anywhere between 60 micrograms/dl to 150 micrograms/dl Mine were at 41 micrograms/dl. More tests were conducted for a conclusive diagnosis. An electromyography (EMG) and nerve conduction velocity (NCV) exam of my lower limbs determined electrical activity in the muscles and nerves. These helped rule out other neural disorders such as peripheral neuropathy and nerve dysfunction Since these tests and the description of my symptoms confirmed RLS, I didn’t have to undergo a poly somnography (sleep study). I worried that RLS was in some way linked to Parkinson’s disease, since the latter is also caused by low dopamine levels. Dr. Ojha clarified that though some of the drugs used ot treat the two conditions are similar (because the goal is to raise dopamine levels) they were in fact two separate ailments.
The bad news: There is no permanent solution for RLS. It can only be controlled by medications and certain lifestyle measures (Ed: see ‘Self Help’). I’m on iron pills (Orefore) to raise ferritin levels in my brain, and dopaminergic agents (Pramipex, Syndopa) to help normalize the neurotransmitter’s activity. The medications have to be taken by the clock, or symptoms can crop up. I make sure that I have a set of pills in my handbag as well as in my medicine box at home. One odd experience in 2007 knocked me for a loop. I had arranged to meet my friend Archana at her home in Vashi one afternoon in September 2007. As I was running late I left home after lunch without the drugs. On reaching my destination, for the life of me I couldn’t recall the name of her building, or the lane it was situated in, although I’d been there dozens of times. My brain felt fuzzy, unable to function. I had to speed dial Mahesh for directions. The following day, Dr. Ojha assured me I wasn’t going crazy at the grand old age of 37, I was merely running short of vitamin B12, which can cloud thinking. A three month dose say my memory and ability to focus return to normal. As my brain iron levels rose from 41 micrograms/dl to 65 micrograms/dl (indicated by a serum ferrintin test in August ’07), the restless leg symptoms eased considerably. Sleep improved not just mine, but Mahesh’s as well. I went back to my painting and driving. However Dr. Ojha has tabooed strenuous exercise, so I’ve taken up Power Yoga, which also helps relive RLS somewhat.. These days I’m practically symptom free.
Do you have RLS? According to Dr. Pawan Ojha, Neurologist at L.H. Hiranandani Hospital, Powai, Restless Legs Syndrome is diagnosed based on the basis of the following four criteria:
- You have an urge to move your legs, usually because pf uncomfortable sensations such as tingling, “pins and needles,” prickling, crawling, or pain. In some cases, you may not feel any sensations but still have an urge to move your legs or your arms.
- The sensations and the urge to move your legs begin or get worse during periods of rest or inactivity, such as when you are sitting or lying down.
- The sensations and the urge to move your legs are partially or totally relieved by movement. But relief may be temporary and only lasts while you are walking, stretching, or moving your legs.
- The urge to move your legs are worse in the evening or at night. But some people may have these sensations during the day as well.
Self Help If you’ve been diagnosed with RLS, try these strategist for relief.
1 move around. Lying or sitting still and trying to resist he urge to move is an un winnable battle, so don’t even try. In mild cases, just getting up and walking around for a bit can ease symptoms.
2 stretch. Stretching and massaging the affected muscles can relieve and even prevent RLS symptoms. Here’s one stretch that works well: Stand with your back to a wall and your feet shoulder width apart. Bend at your knees and hips until you look like you’re sitting in an invisible chair.
3 Take a bath. Many people find that a hot bath can relieve and, in some cases, keep the symptoms at bay long enough to let them drift off to sleep.
4 Exercise. In addition to its other benefits, regular exercise seems to lessen the frequency of RLS attacks. Try for 30 to 40 minutes of moderate exercise five times a week.
5 Avoid these vices. Swear off alcohol and caffeine, particularly in the hours before before bedtime. These not only disrupt sleeping patterns, but they make RLS symptoms worse. Nicotine does the same.
6 Check your medicine cabinet. Some medicines, such as antihistamines and cold medicines, can make RLS symptoms for worse. Antidepressants can do the same.
7 Shift your schedule. RLS attacks tend to occur at the same time of the day or night. If it’s possible to change your sleeping schedule so it coincides with a time when you usually don’t have symptoms, you may be able to get your rest.
Who’s At Risk? (1) A family history (in a parent or sibling) of restless legs syndrome (2) dopamine insufficiency (3) anemia and low iron stores in the brain (specifically blood ferritin below 60 micrograms/dl) (4) pregnancy (5) nerve disease (varicose vein or venous reflux) (6) folate deficiency (7) sleep apnea (8) kidney failure (unremia) (9)diabetes (10) thyroid disease (11) peripheral neuropathy (12) Parkinson’s disease and certain auto immune disorders like rheumatoid arthritis have all been liked to Restless Legs Syndrome.
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Hi, cool site, good writing
hi,
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