October 11, 2023

Hope for a Better Future

By Daniel Amyx, RLS Foundation Member

My RLS started very gradually – I really didn’t think much about it at the time. About 15 minutes into my meditation, I had this creepy-crawly, gnawing feeling in my legs. I found I could tighten my leg muscles, the feeling would subside, and I could then start my day. This feeling would appear intermittently from time to time, with increasing frequency until about 18 years ago. It became such a persistent and growing problem that I had to stop meditating. Then this issue began to interfere with my sleep. Just when I started to dream, I was suddenly awakened by an uncontrollable leg jerk. That’s when I decided it was time to ask my physician about this problem.

My doctor had the vague idea that I might be suffering from restless legs syndrome (RLS). She performed a blood test to check for iron deficiency, then wrote a prescription for quinine. For those who are unfamiliar with quinine*, it really did help with my RLS, though not consistently. However, I soon discovered that quinine has an insidious and horrifying consequence. Quinine kills bacteria. My intestinal flora was now a decimated wasteland (no pun intended). To say I was a difficult person to be around was a noxious understatement. I may not contract malaria, but I was destined to live my life as a hermit, alone and without human contact.

After about six months, my wife decided to schedule another appointment with my doctor. She said she was concerned for my health; I was not convinced that was her motive. My doctor prescribed ropinirole**, a drug many with RLS have been on. Fortunately for me (and my wife) the drug worked like a dream, literally. I could finally fall asleep provided I took the medication several hours before bedtime. My downfall was that in the evening, I would fall asleep on the couch if I sat still for 10 minutes or so. This was embarrassing when went to someone’s house for dinner and would sit for conversation after the meal, and within a short while I was snoring. Eventually, I let go of my embarrassment, as my wife would explain to our hosts the challenges of my medication. I also discovered that this was a great way to escape conversations that didn’t interest me. I would just close my eyes and willfully drift off.

My next pharmaceutical experience came when I changed physicians. My new doctor suggested I try pramipexole (Mirapex). He felt it could have less of a tranquilizing effect yet still provide the RLS relief I needed. He was right. For seven or eight years, this medication was consistent so long as I took it two hours before bedtime.

But it seems all good things must come to an end. For me, augmentation started subtly. I found I needed a little bit more medication to manage my RLS. I also had to adjust my schedule by taking it a half-hour earlier. Soon the augmentation dramatically changed. On bad nights, not only did my arms and legs violently jerk, but also I could feel it in the core of my body. Some nights while trying to fall asleep on the couch, I would be in tears at 2 or 3 o’clock in the morning. “Horrible” doesn’t begin to describe the problem.

Out of desperation, and following an article in NightWalkers about augmentation, I started to search for an RLS specialist. I called the Norman Fixel Institute for Neurological Diseases at Shands in Gainesville, Florida – a three-hour drive from my home. After a thorough review of my medical history, my newest doctor started me on a regimen of 600 mg of gabapentin, increasing it to 900 mg after six months. At the next appointment, we would discuss the reduction of Mirapex. Within three weeks, I decided I needed to be more aggressive with my therapy by reducing the Mirapex sooner. Through constant communication with my neurologist and my own assertive impatience, we were able to move me out of dopaminergic dependency, replacing Mirapex with 600 mg of gabapentin within eight months of my first exam. Needless to say, I am elated. I no longer need medication before boarding a plane or taking a long road trip. I can stay up late again if I want to. Chocolate, caffeine and alcohol no longer make me twitchy. I feel so much freer than I have in decades.

I understand that each of us is unique, and results will vary, but I stand before you as a positive example of what can be accomplished. You have a whole world of RLS sufferers who are behind you, cheerleading you on to success. Don’t give up! There is always hope for a better future.

Dan and his wife, Lara, keep pretty busy with their successful optical office in Port Saint Lucie, Florida. In his spare time, his hobbies include traveling, bookbinding, jewelry making, and numerous other activities (Attention Deficit Disorder is both a blessing and a curse)! They have a five-year- old granddaughter who lives too far away in Connecticut.

*Quinine has no proven effect on RLS except for a placebo effect. Quinine may kill bacteria but there is no real documentation of negative effects on the intestinal flora. The real concern with quinine (which is why it requires prescription and only approved for treating Malaria and not leg cramps) is its rare side effects of cardiac arrhythmia and blood dyscrasias.

**Ropinirole is no longer considered first-line treatment for RLS.