Dear Dr. Donohue: I am writing about severe thigh-muscle cramping. I am 52 years old, six feet tall and weigh 210 pounds. I am currently on enalapril, simvastatin and Lipitor. I try to take a long walk at a decent pace three to six times a week. The walks vary from half an hour to two hours.
When I climb steep hills or walk a long time when hunting, that involves slow, controlled leg movements. I sometimes get severe cramps in my front and inner thigh muscles. Sometimes it's just one leg; sometimes both. The cramping usually stops after a few minutes. However, they are increasing in strength and have been accompanied by cold sweats and nausea. The last time, I actually passed out. I have told my doctor, and he recommended a muscle-relaxant pill. I would rather avoid pills. I have had many heart tests, so I'm not worried about a heart attack. Any ideas?
J.C.
You must get something straight with your doctor. You're taking two statin pills, Zocor (simvastatin) and Lipitor (atorvastatin). For a few people, statin drugs cause muscle trouble. A double dose of them might be responsible for your cramps, but I cannot find cramping as a side effect. At any rate, you do have to get this settled with your doctor.
One explanation for cramping is dehydration and an imbalance of sodium and potassium.
Such things happen mainly in hot weather. As an experiment, why not try this: Half an hour to an hour before your walk/run, drink a litre of a sports drink like Gatorade. Don't gulp it down; take your time. If it makes you too waterlogged, split the drink. Drink the second half midway into your walk-run. You'll have to do this a few times before you dismiss it as a flop.
Muscle overload is another reason why muscles cramp. A muscle that has partially shortened and then is forced to contract more brings on a cramp. It sounds like this is happening when you hunt. At the first inkling of a cramp, stretch your legs. If caught early, you can keep it from becoming a fullblown cramp.
It's said that pinching the skin between the bottom of the nose and the upper lip quickly ends a cramp.
Dear Dr. Donohue: In June 2011, my wife slipped at work and twisted her ankle. I drove to her workplace and noticed her ankle was swollen and had a knot on it. I took her to the emergency room, where X-rays were taken. The doctor placed her in a boot, advising follow-up with an orthopedic surgeon. He did an MRI, which was normal. He put her ankle in a cast. When the cast came off, the pain persisted. She saw a neurologist and was prescribed Lyrica, which did not ease her pain. She has had a bone scan, nerve conduction studies and seen two more orthopedic doctors. No one has an answer. We don't know where to turn. We both need some help.
M.P.
Your wife might benefit from seeing a physiatrist (fizz-EYEuh-tryst). (The word is often confused with "psychiatrist.") A physiatrist is a specialist in rehabilitation and physical therapy. Your wife could have complex regional pain syndrome. It's a persistence of pain after an injury, and the injury can be a minor one. A sprained ankle often is the introduction of complex regional pain syndrome. It can last for a very long time.
Physiatrists are found in all hospitals. They are in charge of the physical rehab programs. If your town happens not to have one, you will find one at any nearby larger hospital.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him at P.O. Box 536475, Orlando, FL 32853-6475.
