Severe bilateral leg cramps

[Irishscribe]

In the past month, I've had 3 episodes of incredibly severe bilateral muscle cramping in the calves, thighs, and buttocks.  I've had your normal foot or calf cramps many times in the past, but this is way beyond that.  Twice I've ended up on the floor, unable to do anything except cry out for help.  The spasms simultaneously affect both calves, the back and sides of both thighs, and both buttocks.  Afterwards, it feels as if I have severely strained or torn muscles in my calves and back of thighs. The last incident was yesterday morning, and I've been limping since then.

I've recently had extensive blood workups to address recurrent chest pain.  Potassium levels are normal, cardiac crp is high, HbA1C is high.

Any thoughts you may have will be much appreciated.  

[jcverive]

How high is your A1C, and how long has it been high? Since it is a long-term indicator of blood glucose level, I suspect you've been getting treated for diabetes. Is it type 1, type 2, or unknown? (my certified diabetes nurse instructor told me that mine was type 1 1/2, due to low insulin production and poor utilization)

Diabetes can affect electrolyte levels, and magnesium ought to be checked as well if you are having symptoms of neuropathic disease (including cramping). If you are exercising to help control your diabetes, make sure you take enough time to warm up and cool down slowly. If you are not exercising regularly, consider walking each day, at least 15 minutes. However, if you are on your feet most of the day, you might want to consider a different exercise modality. And while we're on the subject of walking and/or standing, make sure your shoes are giving you support without straining your leg muscles.

Finally,ask your pharmacist about quinine or hydroquinine supplements (or foods containing these ingredients). Some people report relief from cramps after drinking tonic water (check the ingredients to make sure quinine or hydroquinine are included, as some bottlers have removed quinine and/or hydroquinine from their tonic water products).  A chinese herbalist or health food store might be able to help as well.  And as crazy as it seems, one prominent media doctor recommends placing a bar of soap in a sock, and sleeping with this by your legs as a potential cure for cramps (at least the nighttime variety).

No matter what, eat healthy foods, drink plenty of water, restrict your caffeine and salt intake, and converse with your doctor regularly.  I wish you a lot of success!

[Joyce K Lee, MD]

Dear Irishscribe,

Thank you for submitting your question.
Please be informed that I cannot offer you a definitive diagnosis based on your history of symptoms.
I am extremely limited in not being able to perform a full neurological examination on you.
This is solely for educational purposes and should not be substituted for a formal neurologic evaluation.

Muscle cramping is a very common problem and has a multitide of causes.
They can be caused by nerves that malfunction. Sometimes this malfunction is due to a health problem, such as a spinal cord injury or a pinched nerve in the neck or back.
Other causes include the following:
Straining or overusing a muscle (e.g. over-exercising without stretching appropriately)
Dehydration
A lack of minerals in your diet or the depletion of minerals in your body
Not enough blood getting to your muscles
Muscle cramps are also part of certain conditions such as thyroid or hormone disorders, diabetes, hypoglycemia and anemia.


I would start by doing the following:
*If you do exercise, stretch after cardio exercises.
*Stay hydrated!
*Take a multivitamin
*Avoid sustained postures for a long period of time (crossing your legs, indian style sitting)

To evaluate for the other more complicated causes, start off my seeing your primary care doctor.
He can evaluate you for a vascular cause (ie. PAD=peripheral arterial disease, which is where you are not getting enough blood to your legs) by a simple peripheral pulse exam or order PVR studies (to look at the arterial circulation in your legs.)

If you are having back pain or have a history of back problems, you may want to inquire about an MRI of the spine to rule out a pinched nerve or spinal cord stenosis.

While you are undergoing a work-up, talk to your physician about medications (like a low dose of muscle relaxants) or outpatient physical therapy to relieve your pain.

Hope this helps,
Best of luck,
JKL, MD