Monday, 7 March 2016

Torment Carries a Timepiece

(or How do Spasms know it is Nightfall?)

Spasms seem to know when the sun is setting as they start up in earnest once evening arrives.  Another torment a spinal cord injury brings with it which in my opinion is worse than the paralysis.  Just when the day is over and you think you can relax. your physiology won't let you.  For me it starts with an increasing creepiness in one leg or the other.  The burning 'pins and needles' sensation increases to very uncomfortable levels - I don't know where to run...and I can't run anyways.  A tell-tale sign of what is about to follow.

Soon after the first spasm arrives.  A quick jerk of the leg.  The knee may just rise up off the bed slightly.  Soon after it is followed by another, and another and another as they grow in intensity.  At full throttle the entire leg can lift off the bed and crash back down, over and over and over.  Sometimes there is as little as 5 or 6 seconds between spasms, sometimes 10 or 15 seconds.  They are almost always rhythmic, uniformly keeping the period and the amplitude of the spasm.  I look at my leg and am reminded of a freshly caught fish jumping up and down on the dock, writhing in discomfort.

Spasms can last a few minutes but have lasted up to six hours.  If I tried to do leg lifts for six hours I wouldn't be able as fatigue would set in within a few minutes, yet the spasms seem to draw on some perpetual energy and keep on going, and, going and going.

How do you sleep when your leg is lifting itself off the bed repeatedly?  How do you get rest for work?  How do you keep your sanity?  I have thought of getting a knife and jamming int into the thigh muscle in hopes of turning off the mechanism!

The spasms have been so explosive and violent that they have thrown me from my bed.

So what causes them to occur?  An electrical impulse across nerve endings?  A persistent drip of neurotransmitter?  Does the spinal cord injury disrupt some sort of control or 'feed-back' mechanism which disperses the instigating cause when not intentionally needed by the person?

Why do they seem to start up at will and then after some variable period, shut down at will?  And most of all, why do they always seem to come on in force at nightfall?  Is there some change in body physiology that causes them to begin?

  • It doesn't matter if my legs have been in a sitting position or lying down on a bed all day, they will still come on.  I thought it might be some fluid accumulation that causes the muscles to contract to disperse this fluid.  Whether I drink lots of fluids or few, it seems to have no bearing on whether the spasms arrive or not.
  • Exercise also does not seem to affect the arrival, intensity or duration of spasms.  Whether I went to the gym, or walked with the walker, the spasms still occur.
  • temperature (circulation?) - at times my legs have felt normally warm or unusually cool but this does not seem to be linked to my spasms.
  • diet, weather, stress
  • putting pressure on the foot sometimes seems to lessen the spasms, other times seems to have no effect.
  • Why are spasms unilateral?  That is, only one leg will spasm at a time (thank goodness!), however there may be a few on alternate sides as they cross over if the don't end but decide to change sides.
  • What other factors am I missing? 
Baclofen, a drug taken for spasticity seems to have little or no effect on the 'jumping leg spasms'.  When I tried to gradually reduce the dosage, I found an increase in overall stiffness but the "spasms" remained the same.

I now dread the setting sun knowing that my leg will become creepy and start jumping over, and over, and over.....

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