Muscle cramps: Prevention remains the best remedy
Dr Ravinder Chadha

Muscle cramps are extremely common and almost everyone experiences them at some stage in life. These cramps are caused due to the sudden uncontrolled contraction of a muscle. The contracted muscle does not relax, leading to symptoms varying from mild-discomfort to agonising pain.

Typically, an individual suffers sudden painful sensation in the leg while sleeping this leads to this getting awakened. The duration of a cramp varies from a few seconds to 10 minutes or even longer. The commonly affected muscles are :

(i) Calf muscle

(ii) Hamstring (back of thigh)

(iii) Muscles of feet, hands, etc.

Causes

The exact cause of muscle cramps is not known, but it is believed that muscle fatigue, hyperexcitibility of the nerves and inadequate stretching leads to abnormalities in the mechanism that controls muscle contraction. The following may be the causes:

Exercising in intense heat, dehydration and depletion of salt and minerals. Muscle exhaustion depletes a oxygen supply leading to the accumulation of waste products and spasm.

Muscle fatigue from sitting or lying for an extended period in an awkward position or any repetitive use.

Leg cramps can be due to the lumbar nerve root involvement, metabolic disturbances as in diabetes mellitus, thyroid disease, etc.

Certain medicines, too, can cause muscle cramps like diuretics — Lasix causes vigorous removal of the body fluid thereby causing the depletion of electrolytes. Similarly, patients on dialysis often complain of leg cramps.

Poor circulation to muscles can also cause cramps as in intermittent claudication. Poor circulation results in decreased oxygen supply to the muscles, leading to severe pain. The most common muscle involved is the calf muscle.

Leg cramps are common during pregnancy, especially after second trimester. The likely reason is leg muscles getting fatigued from carrying the extra weight of pregnancy. The other reason can be circulation problems in the legs when an enlarged uterus puts pressure on the blood vessels that return blood from the legs to the heart. A low level of calcium and magnesium can also cause cramps. To avoid cramps during pregnancy, one should avoid sitting or standing with crossed legs for a long period.

Try these steps when cramping occurs:

l Walk on or move the foot up and down and then elevate it.

l  For a calf muscle cramp, pull up the toes towards the head with the legs as straight as possible.

l  Repetitive activities like writing and typing may produce cramps of the hands due to muscle fatigue. For immediate treatment, pressing the hand on the flat surface will stretch the cramping finger muscles.

l  Massage of the muscles is very useful in treating cramps as it increases circulation to the muscles, which helps in its relaxation.

The most important aspect of dealing with the muscle cramps disorder is prevention. The important preventive measures are:

Persons undertaking vigorous physical activities must do adequate warm up and stretching before the event.

Cramps associated with dehydration due to vigorous physical activities can be treated with fluid and electrolyte replacement. Therefore, drinking water before, during and after physical activities is very important.

Quinine is very effective in treating cramps as it decreases the excitability of muscles. Excessive intake can cause nausea, vomiting, headache etc.

Calcium, magnesium and Vitamin ‘E’ supplements prevent cramps. Calcium intake of at least 1 gram daily is required. Magnesium in a dose of 50-100 milligram daily is required. Magnesium is present in grains, fish, meat, banana, nuts, etc.

Doing calf-stretching two to three times just before going to bed can prevent night cramps. Also stretch calf muscles regularly throughout the day.

Place a blanket at the foot end to prevent the toes and the feet pointing downward while sleeping to avoid the shortening of the calf muscle.

Cramps are very common in people who suddenly increase their exercise. Therefore, one should gradually increase the training intensity. The best way is to increase exercise only by 10 per cent of the previous week’s regimen.

The following exercises can prevent muscle cramps:

Calf muscle stretch —Stand about two to two-and-a-half feet away from a wall. Place both hands on the wall. Move one foot forward and bend at the knee without raising the heel of the back leg. A stretch can be felt at the calf. Stay for a count of 15. Repeat three times.

Hamstring muscle stretch — Lying on the back, keeping the legs straight, lift one leg and pull it towards the body by holding at thigh. Stretch can be felt at the back of the thigh muscle. Hold for a count of 20 and repeat three times.

Quadriceps muscle stretch — While standing, hold your ankle with the hand from back and gently pull the heel towards buttocks. Hold for a count of 15 and repeat three times.

Most of the cramps are benign in nature, with no serious complications. Cramps, which are severe, frequent and not responding to the usual modes of treatment must be investigated properly.

The writer is a former doctor/physiotherapist, Indian Cricket Team. E-mail-

chadha_r2003@yahoo.co.in 

New modalities in radiation treatment of cancer
Dr Manishi Bansal

Radiation alone or in combination with surgery and chemotherapy plays a major role in the treatment of cancer. However, radiation is associated with both acute and late side-effects. These side-effects are due to the incorporation of normal tissues and organs in the radiation field. Although acute side-effects resolve with time and are reversible, late side-effects are bothersome, especially in patients who have achieved cancer cure.

Therefore, in order to minimise the complications associated with radiation, major advancement has taken place in the technology and delivery of radiation treatment. These include the development of newer radiation machines, computerised planning and precise execution of treatment. IMRT (Intensity Modulated Radiation Therapy ) is one such example of this high-quality radiation.

IMRT is an advanced mode of high precision radiation therapy that utilises computer-controlled linear accelerator (LINAC) to deliver a precise radiation dose to the malignant tumour or specific areas within the tumour. Treatment is carefully planned using 3-dimensional CT images of the patient in addition to computerised dose calculations to determine the dose intensity pattern that will best conform to the tumour shape.

Advantages of IMRT

(1) IMRT has the potential to increase the tumour dose, thus increasing local tumour control rates

(2) IMRT reduces treatment toxicities significantly by reducing the dose to normal structures.

(3) Another significant advantage of IMRT is that the patients who have previously received radiation can also be given further radiation, if required.

(4) IMRT is extensively used to treat the cancer of the prostate, head and neck, brain, esophagus and gynaecological malignancies

(5) It is equivalent to surgery and preserves the organ in the treatment of some cases like the cancer of the prostate and the larynx.

The writer is Senior Radiation Oncologist at the Pinnacle Cancer Centre, IVY Hospital, Mohali.

Skin a mirror of our internal organ system
Dr Vikas Sharma

Very few people are aware of the fact that many undiagnosed internal diseases can be detected with a careful skin examination.Skin is the largest and outermost organ system. Even small changes on it can serve as markers for undiagnosed or hidden diseases like thyroid disorders, diabetes mellitus, tuberculosis, sarcoidosis, liver disorders and kidney problems.

Therefore, it is necessary that we must get our skin examined by a specialist whenever we notice any changes on it.

Skin markers In diabetes

The presence of dark coloured patches symmetrically distributed on the skin of legs, forearms and thighs, starting as dull red-coloured oval-shaped skin lesions, gradually followed by superficial scaling and ending in thinned brownish scars.

White-yellow coloured patches in skin over eyelids.

Darkening and thickening of skin assuming a velvety texture over the sides of the neck, underarms and thighs with obesity. Darkness and thickening of the skin over hands and feet.

Thick curdy white vaginal discharge in females.

Pebbled or rough skin on the fingers and knuckles with the thickening of skin.

In thyroid disorders

Diffuse hair loss over the scalp. Dry and coarse hair.

Non-pitting swelling of legs and feet.

Skin puffiness over the face, thick lips, large and clumsy tongue.

Brittleness of nails.

Redness over palms.

In ovarian disorders

Increased hair growth over unwanted areas in females similar to the male pattern.

Hair loss over the scalp.

Severe acne over the face.

Weight gain.

Liver diseases

Generalised yellow colouration of skin and mucosae, first visible over the sclera of the eye and soft palate in the mouth.

Prolonged Itching over the trunk and limbs.

Sudden appearance of multiple red-coloured skin lesions over the neck, chest and trunk.

Thinning and partial loss of body hair.

Clubbing of nails and white colouration of nails.

Kidney disorders

Severe disabling pruritus.

Dry skin with the thickening of the skin around hair follicles/pores.

Bleeding spots on the skin. Darkening of the exposed areas.

Hard corn-flake like lesions over the trunk and the legs.

Dark coloured linear bands on nails.

Swelling over face/legs.

Internal malignancy /cancers

This is important because the skin findings precede the onset of symptoms referable to the underlying neoplasm by several months in certain cases, thus providing an essential clinical and diagnostic clue for the search of hidden neoplasm.

In 10 per cent cases with blood cancer, skin lesions in the form of violet coloured nodules over the abdomen and the back, known as leukaemia cutis, tend to appear before the diagnoses of systemic leukaemia is made.

Other skin signs which warrant a comprehensive search for the hidden cancer of internal organs include:

If a person notices sudden appearance of numerous wart like lesions over the neck, chest and trunk with or without pruritis.

Non-healing skin ulceration, especially over the leg and pelvic area.

Bullous skin lesions in the elderly.

Tightening and binding down of the skin and loss of elasticity. Thickening of the palms and soles with velvety or honeycombed appearance of hands and feet.

The writer is Chief Consultant Dermatologist & Dermato-Laser Surgeon, National Skin Hospital, Mansa Devi Complex, Panchkula. E.mail: drvikas.nscindia@gmail.com