Question:
One of the first lessons medical students learn in their first class in med school is the dichotomy of signs vs symptoms. Signs are what the doctor can see; symptoms ar what the patient reports. Quoting from Taber’s Cyclopedic Medical Dictionary: "Signs are more or less definitive and obvious, and apart from the patient’s impressions, in contrast to symptoms which are subjective." From day one of his/her medical education, prospective doctors are taught to differentiate between that which the doc can see for himself and that which the patient reports. The tone of the lesson is often that signs=truth and symptoms are not nearly as important; too many docs treat symptoms as whiny patients’ complaints that can be ignored. The first step in changing this attitude among so many doctors is to change the way they are taught. Let’s get this elementary dichotomy of signs vs symptoms thrown out of the classroom. Judy – Hide quoted text — Show quoted text -Ron Gould wrote: > I do understand your frustration. > I agree–it is easier to describe a terminal rash that they can see, than a > life threatening illness they cannot see and touch and feel. > It is such an obscure problem to them, that it is exactly that–obscure. > They tend to not believe what they are not informed about, and sometimes not > even after. > I don’t really understand that pschycology behind that type of outlook on > other people’s problems. > Anyone have any ideas? > Do we only get half-believed after we kick off? > Best— > Ron > "onetwothree" <n…@spam.com> wrote in message > news:Xns92359BF7628FFieldContainsNoData@207.217.77.25… > > You bet. Seems to be a minority of us. By "considers it" I take it to mean > > that people around you dont consider it a "real" sleep disorder? > > I went for years with PLMD and RLS and everyone gave me the conventional > > wisdom of the time. I’ve had both since birth but typically in my > > experience those of us with both are not diagnosed until we have to be > > places, be alert, have social engagements, etc. The symptoms aren’t taken > > seriously until people start noticing that you’ve slept 12 hours and wake > > up exhausted. Everyone had advice for me. It was because I didn’t get > > enough exercise and was overweight. I started working out like a madman, > > exercising, esp. lifting and running, and dropped 40 pounds. The problems > > persisted and this time it was because I exercised too much. It was > because > > I stayed up too late. If I went to bed early, it was because I was > > oversleeping. It was because I had too much stimulation before bed (I read > > at the library not in bed, had fun with girlfriend in the woods like a > > normal teenager and not in bed, exercised mid-day and not before bed, > NEVER > > drank caffeinated _anything_, never mind cola, coffee or tea…) It was > > because I read in poor light, because I drove barefoot, because I have a > > deviated septum, because because because because. > > When I finally explained it all to my doctor (I never did for most of my > > life because I was "always" sleepy, I thought it was just a quirk of who I > > am) and answered "no" to "do you snore," he diagnosed me as having > > "nocturnal myoclonus," now called PLMD. > > When I had my sleep study done, all of the staff at the hospital agreed: > > sleep apnea. There was a pervasive attitude of "Why are we even testing > > this guy?" Based on my appearance (I had gained some weight back at the > > time of the study) they figured: overweight=snores=easy diagnosis, why go > > to the expense to prove that he snores. Up down left right I got the > > Conventional Wisdom sixty ways from Sunday. I had "sleep apnea" being told > > to me left and right. > > The sleep study showed no respiratory impairments, to their shock. (Give > me > > a break, I was six foot and 230, I wasn’t exactly the Michelin Man). I had > > 180 limb movements with arousal. They termed this a mild to moderate case. > > I was on Klonopin at the time and occasionally used Librium when the > > Klonopin didnt seem to work (rare, but it happens a couple dozen > times/yr). > > I still encounter people who misunderstand, people whose reference frame > is > > so limited that they cannot understand that no, it’s not as simple as > going > > to bed earlier. And never mind my workplace. My tardiness is well > tolerated > > but coworkers think it’s just an excuse to come in late (it doesn’t occur > > to them that I don’t like having to work sometimes until 8pm when I should > > be out at 5; I’d murder for the normal sleep cycle they enjoy b/c RLS and > > PLMD can impact one’s life in huge ways). > > People simply will not lend credence to a disease that they cannot see. If > > you have a small rash, you could tell people you’ve got 3 days to live and > > they’ll believe you. But tell most people that your legs or limbs move and > > this causes awakenings and exhausts you at night, they’ll tell you to > drink > > warm milk and get over it. > > Having sleep apnea likely provokes the same reaction in people who don’t > > have it: exercise more, lose weight, exercise less, gain some weight, > isn’t > > it funny he/she takes his.her snoring so seriously like it’s a big deal, > > etc etc etc etc…. > > I’d love it if there were a Sleep Disorder Awareness Week… when people > > without sleep disorders would ideally have to suffer RLS, PLMD, or apnea > > for one entire week. Then, there would be some comprehension. > > — > > jag…@jaglairNG.com (=Jaguar=) wrote in > > news:3d14bddd.5838583@news.verizon.net: > > > I’ve been scanning this NG for a few weeks now, but haven’t seen any > > > posts related to RLS and PLMS. Is there anyone else here besides me > > > who has this and who considers it a sleep disorder? > > >=Jaguar=
Response:
I have OSA and PLM. Overt the years I have sen many postings on PLM. Do you have a question? For general information do a search with Google of WEB and Groups. The last one will bring a selection of postings of this and other NGs. Carlos ****** delete "nospam" for e-mail reply ***************************************
Response:
and I > was placed on Carbidopa 25/Levodopa (Sinemet) 100mg 3x/day. That was > about one month ago, and I have to admit that this drug really seems > to have helped. My RLS seems to be much abated and my wife says that > see has not seen any evidence of my PLMS either. > Sinemet CR (Carbidopa-Levodopa) is a sustained-release combination of > carbidopa and levodopa for the treatment of Parkinson’s disease and > syndrome — which you noted in your reply.
In some respects, I feel > "different" in a number of ways since taking Sinemet CR, but it’s > been a long time since I’ve really felt physically well and mentally > alert and such.
I am on the 25/100 plus 4 Mg of Zanaflex. This finally did the trick. Mine was analyzed in a sleep study. I also feel "different" in the sense that I awaken with at least some feeling that I had some level of decent healing sleep. Best— Ron
Response:
I do understand your frustration. I agree–it is easier to describe a terminal rash that they can see, than a life threatening illness they cannot see and touch and feel. It is such an obscure problem to them, that it is exactly that–obscure. They tend to not believe what they are not informed about, and sometimes not even after. I don’t really understand that pschycology behind that type of outlook on other people’s problems. Anyone have any ideas? Do we only get half-believed after we kick off? Best— Ron "onetwothree" <n…@spam.com> wrote in message
news:Xns92359BF7628FFieldContainsNoData@207.217.77.25… – Hide quoted text — Show quoted text -> You bet. Seems to be a minority of us. By "considers it" I take it to mean > that people around you dont consider it a "real" sleep disorder? > I went for years with PLMD and RLS and everyone gave me the conventional > wisdom of the time. I’ve had both since birth but typically in my > experience those of us with both are not diagnosed until we have to be > places, be alert, have social engagements, etc. The symptoms aren’t taken > seriously until people start noticing that you’ve slept 12 hours and wake > up exhausted. Everyone had advice for me. It was because I didn’t get > enough exercise and was overweight. I started working out like a madman, > exercising, esp. lifting and running, and dropped 40 pounds. The problems > persisted and this time it was because I exercised too much. It was because > I stayed up too late. If I went to bed early, it was because I was > oversleeping. It was because I had too much stimulation before bed (I read > at the library not in bed, had fun with girlfriend in the woods like a > normal teenager and not in bed, exercised mid-day and not before bed, NEVER > drank caffeinated _anything_, never mind cola, coffee or tea…) It was > because I read in poor light, because I drove barefoot, because I have a > deviated septum, because because because because. > When I finally explained it all to my doctor (I never did for most of my > life because I was "always" sleepy, I thought it was just a quirk of who I > am) and answered "no" to "do you snore," he diagnosed me as having > "nocturnal myoclonus," now called PLMD. > When I had my sleep study done, all of the staff at the hospital agreed: > sleep apnea. There was a pervasive attitude of "Why are we even testing > this guy?" Based on my appearance (I had gained some weight back at the > time of the study) they figured: overweight=snores=easy diagnosis, why go > to the expense to prove that he snores. Up down left right I got the > Conventional Wisdom sixty ways from Sunday. I had "sleep apnea" being told > to me left and right. > The sleep study showed no respiratory impairments, to their shock. (Give me > a break, I was six foot and 230, I wasn’t exactly the Michelin Man). I had > 180 limb movements with arousal. They termed this a mild to moderate case. > I was on Klonopin at the time and occasionally used Librium when the > Klonopin didnt seem to work (rare, but it happens a couple dozen times/yr). > I still encounter people who misunderstand, people whose reference frame is > so limited that they cannot understand that no, it’s not as simple as going > to bed earlier. And never mind my workplace. My tardiness is well tolerated > but coworkers think it’s just an excuse to come in late (it doesn’t occur > to them that I don’t like having to work sometimes until 8pm when I should > be out at 5; I’d murder for the normal sleep cycle they enjoy b/c RLS and > PLMD can impact one’s life in huge ways). > People simply will not lend credence to a disease that they cannot see. If > you have a small rash, you could tell people you’ve got 3 days to live and > they’ll believe you. But tell most people that your legs or limbs move and > this causes awakenings and exhausts you at night, they’ll tell you to drink > warm milk and get over it. > Having sleep apnea likely provokes the same reaction in people who don’t > have it: exercise more, lose weight, exercise less, gain some weight, isn’t > it funny he/she takes his.her snoring so seriously like it’s a big deal, > etc etc etc etc…. > I’d love it if there were a Sleep Disorder Awareness Week… when people > without sleep disorders would ideally have to suffer RLS, PLMD, or apnea > for one entire week. Then, there would be some comprehension. > — > jag…@jaglairNG.com (=Jaguar=) wrote in > news:3d14bddd.5838583@news.verizon.net: > > I’ve been scanning this NG for a few weeks now, but haven’t seen any > > posts related to RLS and PLMS. Is there anyone else here besides me > > who has this and who considers it a sleep disorder? > >=Jaguar=
Response:
onetwothree <n…@spam.com> wrote: >I’d love it if there were a Sleep Disorder Awareness Week…
There is a National Sleep Awareness Week, this year’s was March 26th to April 1st. I don’t think anybody noticed. 
Tom
Response:
>On Thu, 20 Jun 2002 21:45:35 +1000, "Tal" <beth…@hotmail.com> posted: >>"=Jaguar=" <jag…@jaglairNG.com> wrote: >> Restless Leg Syndrome (RLS) and Periodic Limb Movement During Sleep (PLMS) >> I’ve been scanning this NG for a few weeks now, but haven’t seen any posts >> related to RLS and PLMS. Is there anyone else here besides me who has >>>this and who considers it a sleep disorder? >Beth in Australia wrote: >There is a bit of discussion – mostly about RLS – (little about PLMS) from >time to time….there are definately others around here who have it so if >you have any questions, just ask away
Thanks, I will … :*) >It’s defiantely a sleep disorder…..were you diagnosed through a sleep >study?
No sleep study, but here is a (somewhat) brief history. I’ve had problems going to sleep for a number of years. Basically, I couldn’t fall asleep easily,, and usually only after an hour or so of tossing, turning and near continuous leg movements … or when I was pretty much exhausted from not getting enough sleep. I just couldn’t get "comfortable". I tried a number of things such as meditation, the tensing and relaxation of muscles, and so forth. Sometimes they helped a bit, but not very often. Many times, I would have to get up out of bed, walk around, change locations, eat something … anything to help me feel more relaxed. Not much helped. I also tried Melatonin, but again without any noticable effect. When I initially told my GP of my "problem" and what I had tried, he prescribed Temazepam (Restoril). From my prespective that worked pretty well for me, and I was usually able to fall asleep within 20 minutes or so. I tried to only take it "as needed for sleep" as presceibed, but I began to feel I needed it more and more frequently until I was taking it most every night. After about six months or so of that, my GP said that I couldn’t take the Temazepam any longer, that I could become dependent upon it. I said, so what? At least I’m getting to sleep. Well, that didn’t go over well, but he did prescribe something else — Hydroxyzine HCL (50mg) aka Atarax, which is described as a drug which is supposed to provide symptomatic relief of anxiety and tension associated with psychoneurosis in which anxiety is manifested. Well, I tried it — once. I had a bad (to me) reaction. Instead of it relaxing me, I went just the opposite way, i.e. getting all jittery and feeling an increase in my heart rate and respiration. Those disconcerting effects lasted more than 4 hours! Some time after that I came across information about RLS and PLMS and to my delight (dismay?) found the described symptoms to match mine pretty closely. I brought that information to my GP and he knew of it, but not much about it. So, he referred me to a sleep clinic. The sleep clinic doctor did not feel that a sleep study was necessary, and that, based upon my described symptoms (and a video my wife took showing my PLMS while asleep), diagnoed mr as having RLS and PLMS. He referred my to a neurology clinic to determine if there was some specifc or general neurological problem which could be treated. Well, the doctor at the neurological clinic did some basic testing — reflexes, blood work-up and such — but did not find any organic condition which might be related to my diagnosis. The initial drug they prescribed for me was Clonazepam (Klonopin) .5mg 3x/day. While that drug did seem to help me to sleep longer once asleep, it did not really help me "get to sleep". After about two months on that, and during a clinic follow-up visit the Klonopin was discontinued and I was placed on Carbidopa 25/Levodopa (Sinemet) 100mg 3x/day. That was about one month ago, and I have to admit that this drug really seems to have helped. My RLS seems to be much abated and my wife says that see has not seen any evidence of my PLMS either. Sinemet CR (Carbidopa-Levodopa) is a sustained-release combination of carbidopa and levodopa for the treatment of Parkinson’s disease and syndrome — which you noted in your reply. >there was a post about RLS just today! about a study that’s being done >in Australia – they’re looking for volunteers…i think they’re triailing >a medication used for parkinson’s disease… I have a contact number I >think, if anybody’s interested in signing up for it.
I don’t know how long I can or will need to take this med, but I’m not scheduled for another clinic appointment until the end of July. It seems to be working, so I will stick with it at least until then when I can disuss it with the doctor. In some respects, I feel "different" in a number of ways since taking Sinemet CR, but it’s been a long time since I’ve really felt physically well and mentally alert and such. So, I can’t really tell what, if any, side-effects I am feeling — mild nausea, impaired concentration, dizziness, fatigue, etc. — although usually "mild", may be related to the Sinemet. Time will tell, I guess. =Jaguar=
Response:
On Thu, 20 Jun 2002 15:26:14 -0400, Tom Devlin <tomdev…@ameritech.net> typed: >jag…@jaglairNG.com (=Jaguar=) wrote: >>Restless Leg Syndrome (RLS) and Periodic Limb Movement During Sleep (PLMS) >>I’ve been scanning this NG for a few weeks now, but haven’t seen any posts >>related to RLS and PLMS. Is there anyone else here besides me who has this >>and who considers it a sleep disorder? >It’s certainly a sleep disorder, and there have been many posts about >it in the past. Check the archives, I got lots of hits for both RLS >and PLMS. >http://groups.google.com/groups?hl=en&lr=&safe=off&group=alt.support…. >Tom
Start Here: http://www.btinternet.com/~kemp.paul/mongo_d.html Lots of RLS links. Rgs, SSS — SSS Steve / Strathclyde / Scotland ——————————
Response:
Restless Leg Syndrome (RLS) and Periodic Limb Movement During Sleep (PLMS) I’ve been scanning this NG for a few weeks now, but haven’t seen any posts related to RLS and PLMS. Is there anyone else here besides me who has this and who considers it a sleep disorder? =Jaguar=
Response:
jag…@jaglairNG.com (=Jaguar=) wrote: >Restless Leg Syndrome (RLS) and Periodic Limb Movement During Sleep (PLMS) >I’ve been scanning this NG for a few weeks now, but haven’t seen any posts >related to RLS and PLMS. Is there anyone else here besides me who has this >and who considers it a sleep disorder?
It’s certainly a sleep disorder, and there have been many posts about it in the past. Check the archives, I got lots of hits for both RLS and PLMS. http://groups.google.com/groups?hl=en&lr=&safe=off&group=alt.support…. Tom
Response:
Yep. I have RLS. Also PLMD (Periodic Limb Movement Disorder). They are frequently related and found together RLS’ers frequently have PLMD, but the reverse is not usually true. There are infrequent posts here on the subject, but it’s useful to see them. Current treatment seems to be medication, exercise of the offending limbs during the day (or if you can’t sleep, getting up to exercise them), the application of soothing heat if it works for you (a warm bath is my favorite) and learning to fall asleep quickly, even if you are medicated for the problem. Please see the below for more information (these sites may be helpful for those with other sleep disorders as well). Lis, a librarian 
Sleep Disorders and Psychiatry has an article on restless leg http://www.psychiatrymatters.md/index.asp?sec=sres&criteria=sleep%20A… sorder American Sleep Disorders Association http://www.asda.org/ The Sleep Well http://www.stanford.edu/~dement/ The Sleep Homepages (for advanced knowledge seekers) http://www.sleephomepages.org/ Sleep Medicine Homepage http://www.users.cloud9.net/~thorpy/ Restless Leg Syndrome Foundation http://www.rls.org/ National Center on Sleep Disorders Research http://rover2.nhlbi.nih.gov/about/ncsdr/ Sleepnet.com http://www.sleepnet.com/, especially http://www.sleepnet.com/rls2000.html Sleep Disorder Channel http://www.sleepdisorderchannel.com/ National Sleep Foundation http://www.sleepfoundation.org/ International Sleep Products Association http://www.sleepproducts.org/ Sleep/Wake Disorders Canada http://swdca.org/ Links to Sleep Sites has listings of sites in various countries and states of the US as well as to volunteer, professional or governmental organizations dedicated to sleep study or support. http://www.stanford.edu/~dement/sleeplinks.html — "Throw your dreams into space like a kite, and you do not know what it will bring back, a new life, a new friend, a new love, a new country." -Anais Nin, The Diaries of Ana
