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    What causes severe pain and numbness in calf muscle at night?

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Posted on Fri, 27 May 2016 in General Health
Question: Dear Doctor,

I have the RLS problem from my childhood. I usually have severe pain in calf muscle during night time (even day time while sitting and travelling in bus) due to that I am not getting sleep properly.
If I sat down in the floor for more than 15 -30 mins, then numbness occurs from calf muscle to toes.

Also I have fatigue, elevated anger, low focus and concentration problem unable to learn new things as quickly and like everyone.

I have attached my reports in the sequential order. Please note this report is not diagnosed for RLS issue.

Since I am located outside of XXXXXXX I would like to know maximum number to possible test in a single shot to diagnose (like EMG) the RLS issue (which I prefer to diagnose in India).

Earlier I do have low vitamin D level and low iron after taking medicine now it has been improved to normal level.

Apart from this, my magnesium, potassium, TSH, PTH levels are normal.
I do had diabetes during childhood but now it’s completely normal, also i do have lipoma and kidney stones occurs sometimes.

Please advice
doctor
Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
RLS is a clinical diagnosis not obtainable by specific testing of any kind.

Detailed Answer:
Good evening and thank you for your question. You are mentioning a number of different problems which may or may not related to one another. It's hard to know exactly what's most important to you but since you seem to be talking a lot of RLS then, let me mainly address that issue. RLS is not diagnosed with any particular test. There is no EMG/NCV criteria that can diagnose RLS. We must rely on clinical criteria and we use tests to screen for OTHER TYPES OF PROBLEMS that may confound the picture and give some symptoms that may be similar to what is seen in RLS...but ultimately speaking we get to the diagnosis of RLS essentially by ruling out other possibilities for the symptoms. In your case, one of the main things that speaks AGAINST RLS as your primary diagnosis is the fact that legs seem to be bothering you at many times during the day that are well removed from just NIGHTTIME or AT BED. True RLS is recognized in one aspect by being present ONLY before bedtime...not during waking hours. There are other diagnoses that can also explain your symptoms aside from RLS such as radiculopathy or also compressive neuropathy which can explain why your lower extremities go numb after sitting for a short time since you are placing traction on your lumbar nerve roots at the sacral junction.

I've reviewed your blood work and believe you need to get some additional chemistries done looking at Vitamin D2 and D3. Your B12 at 296 is likely moderately low since standards have been raised over the past several years. You must get both a homocysteine and methylmalonic acid but no matter what they show I would simply recommend that your B12 be elevated to at least 450 if not higher. Also, your folate is on the lower than optimal side and should be raised as well. Iron is not necessarily going to help your symptoms but I agree that if it's low then, it should be normalized. I would recommend checking serum ZINC which if low needs to be normalized otherwise IRON will never be normal no matter how much supplementation. It is no longer considered to be the mainstay of any treatment for RLS...which as I previously stated I am not very convinced you have.

I recommend you obtain a good neurological examination with a neurologist. If EMG/NCV are indicated it would be mainly to diagnose either radiculopathies or neuropathies to explain your symptoms of numbness/tingling in the lower extremities when seated. You say that your TSH is normal....but you could also have latent hypothyroidism if you were to have normal TSH and low FT4 so you should get a FREE T4 level.

Recommended levels for Vitamin D are between 60-80 (you're almost there) as well just so you know. Many internists are satisfied with 30-40 but neurologists typically like higher levels. I also noticed that total testosterone is LOW'ish......I believe you need a FREE TESTOSTERONE level which may actually be low or low normal. Boosting this may help with fatigue, neuropathy, and thought processes which you mentioned are compromised.

Bottom line is this....I believe you have several metabolic issues that must be corrected and together form likely contributing factors that explain at least some if not the majority of your complaints and symptoms. This is why a person must know that metabolically and chemically they must be normal and stable before making diagnoses such as RLS which can only be made after knowing that no other condition could be responsible.

I hope this whirlwind of information makes sense to you and you focus on finding a good neurologist that has a more holistic sense about them to get at your problems instead just giving you a 5 minute prescription that will be ultimately useless in the scheme of the big picture.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. If so, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: www.bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult required 98 minutes total time of research, response preparation, and envoy.

Many thanks for using this service to ask your questions. Be well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 1 hour later
Dear Doctor,
Thanks for your quick response and detailed explanation.
Here are few things which are related to the above answers.
I have RLS in both night time as well morning sitting idle and travelling in bus
I will further check on D2 and D3.
I have been taking methylcobalamin (1500 mcg) for 2 ½ months but my b12 just elevated from 296 to 325. Is there any alternative way to increase it?

Similarly, I have taken zinc picolinate (30 mg) on the second time I got vomit and so skipped it. I heard zinc will cause lipoma (I already have couple of lipoma).

As you mentioned, the homocysteine level & FT4 results are available in the attached sheet.

HOMOCYSTEINE C.L.I.A 22.7 μmol/L                               0.01-29.9
FREE THYROXINE (FT4) C.L.I.A 1.38 ng/dl                               0.7-1.8
if I do exercise or run I will easily get tired in very few minutes, this may also due to low testosterone ?
doctor
Answered by Dr. Dariush Saghafi 14 hours later
Brief Answer:
RLS unlikely in my opinion

Detailed Answer:
Given the description of your legs and how they feel and move about during both the day and night as well as the fact that your B12 is definitely lower than what I would recommend my impression is that you do NOT suffer from RLS but rather some form of possible demyelinating phenomenon due to B12 deficiency in the spinal cord or in the nerve roots which control the leg muscles. It is possible that the low testosterone levels may also be contributory. Under this scenario it would be a mistake to diagnosis RLS UNTIL the metabolic aberrancies have been corrected and then, we have waited a good period of time to see if raising the B12, testosterone, iron, and other deficiencies for at least 4-8 weeks causes the symptoms to reverse or abate.

Please answer the following questions either YES or NO:

1. Symptoms are worse at night and are absent or negligible in the morning;

2. You feel a strong and often overwhelming need or urge to move the affected limb(s), often associated with numbness and tingling as well as prickly painful feelings in the legs

3. Your sensory symptoms are triggered by rest, relaxation, or sleep;

4. Sensory symptoms relieved with movement of the legs and the relief persists as long as the movement continues.

You really need to get the Vitamin D up to 60-80 with B12 reaching to at LEAST 450 if not 500-550.

Zinc is not a recognized cause of lipomas. Rather lipomas are believed to be caused by trauma or genetics....

Do you have a methylmalonic acid level with you? If not, that's what we want. Zinc is not known to exacerbate or cause the formation of LIPOMAS.

Whenever I replace B12 in my patients I do 1 g. WEEKLY for 4 days in the form of an injection usually in the arm or shoulder

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. If so, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: www.bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult required 160 minutes total time of research, response preparation, and envoy.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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