February 22, 2023

Don’t Lose Hope

By Barry Otterholt, RLS Foundation Member

My search for understanding and help spanned 30 years, multiple primary care practitioners, many specialists, a wide array of prescription and over-the-counter drugs, and non- medical therapies – all while my RLS was taking an increasing toll on me and my ability to function. It got to the point where I would wake up each morning after only one or two hours of fitful sleep, wishing I just wouldn’t wake up at all. It was difficult to process even basic thoughts, making each day miserable. And I knew that the night would be a repeat of every night for the past seven-plus weeks, where time dragged on with repeated unsuccessful attempts to go to bed and fall asleep, until I was so mentally exhausted that I’d finally find sleep around 4 am, and only for an hour or two. I was at my wit’s end and turned my limited attention to finding a dignified way out – to end my suffering by ending my life.

The point of this article is self-advocacy – a concept that had eluded me all the years my RLS was progressing. I’d hoped to find a doctor to quickly diagnose my tightening toes and calf muscles at night and fix it. When I had a shattered shoulder, a doctor fixed it. When I had a heart attack, a doctor fixed it. When I had cancer, a doctor fixed it. I could always lean on a doctor to help me solve a problem and get on with life. Not so with RLS.

It’s a paradox. So many people have RLS or know someone who does, and many physicians have at least heard about RLS. The problem is that the body of knowledge at all levels is outdated and often leads to ineffective or even harmful advice.

After many primary care appointments and referrals to a variety of specialists, I was referred to a neurologist. In response to my query about his familiarity with RLS, he replied “Sure. We all have a chapter on RLS at university,” and prescribed a drug that is now known to worsen RLS symptoms, as it did with me. My mood was declining rapidly, and a variety of antidepressants were prescribed that are also now known to trigger RLS symptoms, as they did with me. I was in tough shape.

My primary care physician learned of a sleep doctor who had success with a drug called pramipexole. I was referred with a sense of urgency. She confirmed that I had RLS and that it wasn’t just a muscle cramp thing. Validation, at least! The pramipexole worked the first night. Relief! Hope! But after about eight months, I was needing more of it, earlier in the day. I learned of an obscure concept called augmentation, and I had to quit the drug. The next two weeks were miserable, weaning myself from it. My wife had read that opioids were effective and asked the sleep doctor about them, to which she replied, “That’s a red-flag drug.” Another dead end, quickly destroying what little hope I’d gained.

At this point, it became apparent that I had to advocate for myself. Most information led to the same dead-end advice of the past, since it was all based on the same outdated research findings the physicians “studied in the chapter at university.” I found the RLS Foundation and their discussion boards. Finally, a great resource with a bounty of information. Through it, I found a support group that I attended. It was nice not to be alone in my suffering. I learned of a doctor who had more advanced knowledge of RLS. I went to him, and after a thorough assessment, he asked me to try opioids. “I thought it was a red-flag drug,” I replied. “Yes, but your condition is more important than the scrutiny it brings.” I tried an opioid and it worked. Thank God!

I continued my research and learned of advanced studies by Christopher Earley and Richard Allen at Johns Hopkins, John Winkelman at Harvard, and others. The relationship with my RLS doctor turned into more of a partnership where we benefitted each other with our research. I learned of emerging thoughts about iron and the blood-brain barrier, and a particular type of iron infusion that might help. It did help. I learned of a different kind of opioid, called buprenorphine, that didn’t contribute to depression. It worked very well! I consider it a game changer for me.

I am now returning to the high-quality, active life that I had lost. I am forever indebted to the scarce few physicians who are blazing the trail on RLS, and the RLS Foundation for disseminating that information.

My message to you? Find the energy and courage to advocate for yourself. It can work.

Barry Otterholt is a (mostly) retired project management specialist, known for recovering troubled IT projects for a number of different state governmental agencies. He lives in the beautiful Pacific Northwest with his family. He and his wife are avid scuba divers who prefer to go where palm trees grow. He also loves exploring the backroads of the U.S. on his motorcycle.