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Thursday, April 8, 2010

The curse of restless leg syndrome

You don't see it very often, yet the last time I worked I had a patient in the ER with Restless Leg Syndrome. Her chief complaint was nausea and vomiting, yet as the morbidly obese lady set their in semi fowlers sleeping, her legs were waning this way and that.

I tapped her shoulder, and she didn't wake. So I nudged her harder, yelled her name, and she woke up long enough for me to tell her I needed to do an ABG on her. As I set up to do the procedure, I noticed her legs were flailing this way and that, her left way up in the air that way, her right way up in the air this way. How she could sleep with her legs moving like this I had no idea.

"I'm going to poke you now," I said, needle ready to pierce.

She said nothing.

"I'm going to poke you now!" I yelled.

Her eyes popped half way open. "Yeah, that's fine."

"Well, I don't want you to fall asleep and whack me a good one with your foot," I said.

"Oh, don't worry, I won't."

Yet just as I said that her feet were up in the air, moving around like those of a one-year-old happily kicking.

"I'm poking! I'm poking!"

"Yeah, go ahead!" Her legs were calm a moment, her eyelids at half mast.

I poked. As the blood returned into the syringe I saw through the corner of my eye her old legs just-a-movin'. I wondered if this had something to do with Ondine's Curse. Or perhaps Ondine had a sister who was crushed by an obese sleeping man's legs, so she cursed him to never sit still while sleeping again?

I removed the syringe, held the site, and observed as she didn't even acknowledge my existence except for the occasional unintelligible utterance. She woke up briefly as I was exiting the room, and I asked, "Do you have BiPAP at home?"

"I have one, yet I hate that...," as she trailed off, she grunted briefly, and her legs were off to their business once more.

I remember reading once how restless leg syndrome was linked to cardiac disease. Another thing that was linked to cardiac disease was a crease on the ear lobe (I write about this here). As she slept, I glanced a peak at her earlobe. Yet, the crease was there. Perhaps there was some validity to this theory.

We'll investigate this further later (see here for more on RLD).

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