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Re: Soap for RLS
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Re: Soap for RLS - November 14, 2005 8:19:00 AM
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drbuddy
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There's a chance that the people who claim it works do not have true RLS. The patients that told me about it do not have RLS, but leg cramps.
Is there any rational explanation for soap to affect leg cramps?
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Re: Soap for RLS - November 14, 2005 8:39:00 AM
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Jon Newman
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They could try showering with soap. I'd suspect that the direct skin contact would be more beneficial than simple proximity.
jon
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Re: Soap for RLS - November 14, 2005 8:47:00 AM
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Barrett
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Nari,
Placebo, of course. Which means it's unlikely to last. Does anybody here think it's appropriate to bill a patient while offering advice you know to only, hopefully, have a placebo effect?
If soap had anything to do with legs cramps wouldn't somebody have discovered that prior to 2005?
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Soap for RLS - November 14, 2005 9:12:00 AM
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JLS_PT_OCS
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Barrett-
I absolutely think that it is inappropriate to use and bill for something that we know to operate only on the placebo level. Especially something that does not even have a shred of biologic plausibility to it.
I think inviting the editors here would be a great idea. I would be shocked if they showed up to defend their views, but it never hurts to ask. Perhaps the author and editor were acting in good faith and there was some sort of error in the printing or copyediting process?
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Soap for RLS - November 14, 2005 9:21:00 AM
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drbuddy
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Interesting explanation:
http://www.snopes.com/oldwives/legcramp.asp
Lots of anectdotal remarks on this page:
http://www.reallans.com/mmml.shtml?/002240.shtml
Ok, so stick by your guns. Next time a patient complains of leg cramps at night with no relief from anything, I am going to tell them about this remedy with the disclaimer that it is kinda crazy but others have said it works.
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Re: Soap for RLS - November 14, 2005 10:35:00 AM
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JLS_PT_OCS
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Buddy-
I think that's sensible. I think as long as we are merely passing along something we have heard but cannot explain nor recommend, then it's fine.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Soap for RLS - November 14, 2005 10:48:00 AM
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nari
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I was interested in the bit about peri-oral stimulation mentioned in the Scopes article.
We stop sneezes this way, and Rood (some PT from the dim past) had an entire catalogue of techniques to increase ventilation (pressure on mid thoracic spine); decrease spasms (peri-oral stim) and about a dozen others.
One day, with a TBI male who went into periodic spasms that nearly blew him out of the chair, I decided to try the peri-oral stimulation; the spasms ceased within seconds.
OK, pure chance..so I did it again another three or four times, and it 'worked'. Coincidence? Yeah..but his attacks usually lasted several minutes and were distressing to all. It seemed that the skin stimulation did something.
Diane...any suggestions on perioral stim??
Nari
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Re: Soap for RLS - November 14, 2005 11:11:00 AM
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Diane
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"Diane...any suggestions on perioral stim??"
Nope..not quite sure what you are asking.. My free association process yields up the following:
1. I think babies would exhibit whole body responses to it;
2. Creatures with rings through their noses (not too far away from the oral cavity, e.g., bulls) are easily led/controlled by them;
3. Oral cavity forms very early as a place where ectoderm and endoderm join;
4. Lots of nerve endings, primitive both embryologically and evolutionarily;
5. Distraction. Big time neuromod.
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Re: Soap for RLS - November 14, 2005 1:18:00 PM
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nari
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I was asking if you had some clues on why this technique 'seems' to work on spasms. I think your 4 and 5 statements fit the scene, particularly #5.
Just asking the big WHY, Barrett, I am not planning on using peri-oral stim as a nonEBM technique! ;)
Nari
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Re: Soap for RLS - November 14, 2005 5:25:00 PM
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Randy Dixon
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I agree with Jason that this letter may have been a DPT endorsement for the soap treatment or it may have been intended simply as a story, that wasn't written clearly. I think though that the editor had a responsibility to comment, at least lightheartedly, on the role of evidence and science on treatment.
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Re: Soap for RLS - November 15, 2005 1:51:00 AM
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Jon Newman
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At what point does passing along a story become endorsement? It's an interesting question I think.
I envision two scenarios.
1. Someone comes to the clinic asking about using soap in their bed for leg cramps.
2. Someone comes to the clinic complaining of leg cramps and they never mention soap as one of the things they've tried.
In scenario 1, I would hope most therapists would offer a reality to check for the patient, taking the time to look at the plausibility of cause and effect of such a thing. I think the implicit message, accurate or not, would be that the therapist doesn't think such a thing would work.
In scenario 2, if the therapist suggests the use of soap up out of the blue but states that they can't recommend it, there still is the possibility of an implicit endorsement because why would the therapist have even brought it up if they didn't actually think there was a reasonable chance of there being a beneficial cause/effect relationship? Where before there was no thought of sprinkling soap in the bed, there now is the idea being entertained by the patient.
Why the difference between the two scenarios?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Soap for RLS - November 15, 2005 2:18:00 AM
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dosrinc
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Tend to side with Dr. Buddy a bit on this debate, the problem, I think stems from the mis- or inappropriate diagnosis of RLS, in my area it seems that all an elderly person need do is tell their internal med doc "I am having trouble sleeping, I feel restless at night" and they are diagnosed with restless leg syndrome. My theory is that a majority of these individuals are depressed, suffering from anxiety or both and are therefore experiencing insomnia, if they come in and tell me they were having great trouble sleeping because of "Restless Leg Syndrome" but then a friend told them about the soap trick and it really helped (happens quite a bit down here) I am certainly not going to tell them, that is hogwash, stop that right now, I simply reply "great, sleep is really important in helping the healing process".
As an aside, it is amazing how many of the elderly population take what Dr. Gott says as gospel, when the soap article came out experiences as described above certainly increased exponentially, also when he mentioned the use of Vicks Vapor Rub as a cure for foot fungus I couldnt have one eldery male patient take off their shoes without sensing that familiar smell. Funny but true.
(PS, i think the vicks may work a bit like soaking your hair in olive oil for 10 mins helps to get rid of lice, maybe the vicks creates an environment, (No 02) that the fungus cant survive in?) As for the soap, I am going with strictly placebo until proven otherwise.
Rick
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Re: Soap for RLS - November 15, 2005 2:23:00 AM
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Jon Newman
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Yes sleeping with soap is a much better alternative than getting the help they need for their depression and/or anxiety. What would House say?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Soap for RLS - November 15, 2005 2:33:00 AM
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Barrett
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I'm in the middle of a book right now titled "Not in Kansas Anymore: A Curious Tale of How Magic is Transforming America" by Christine Wicker.
Reading this, it's no wonder we see a rise in these behaviors. I remain convinced that college educated healthcare workers shouldn't encourage it.
I'm not suggesting that people be told to stop doing anything that is obviously harmless, but I'm wondering when our suspicion that the patient has been misdiagnosed should trigger a suggestion that competent care be pursued. "I think this patient suffers from depression but the soap seemed to be helping so I didn't say anything" doesn't sound like something I'd like to admit.
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Soap for RLS - November 15, 2005 3:24:00 AM
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dosrinc
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From: Bonita Springs
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Barret and Jon,
dont misunderstand, in the population that I commonly work with depression and anxiety at mild levels are very common, many of these people are already treated with Ambien, Elavil and other alternatives to help them sleep, the point I was making is that these individuals do not actually have resltess leg syndrome but are having trouble sleeping for other reasons, maybe concern with their prostate gets them up 3 or 4 times per night, maybe they are drinking 2 or 3 glasses of wine per night and yet wonder why they cant sleep. I will certainly address these issues and do the appropriate education for sleep management but if they tell me "dont worry about it, I put soap in the bed and now I sleep like a baby" I chalk the sleep disorder up as a psychological issue "cured" by the placebo effect and continue on with my treatment plan. If, as you propose, the effects are only short lasting and the restless sleep becomes and issue again we can reintensify our efforts in that direction and make the appropriate referral if necessary. I professionally feel that the use of soap in the bed to treat a misdiagnosed case of "Restless Leg Syndrome" may be less harmful than having me refer this pt. out to a neurologist, have them put on another of a growing list of medications like neurontin or symbalta and have to deal with the side effects of those when they didnt really have a neurological issue in the first place. Reminds me of the scene in "Doc Hollywood" when Michael J. Fox is rushing the kid with the stomach ache to the hospital and the old doc comes in and gives the kid a Coke, knowing that he had swallowed his dads chewing tobacco.
Rick
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Re: Soap for RLS - November 15, 2005 3:28:00 AM
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Barrett
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From: Cuyahoga Falls, Ohio
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Rick,
Well put. You'll get no argument from me given the complexity of the situation you face. Makes you wonder how you or anyone else could begin to put together any sort of outcome study.
But, then again, is this situation all that unusual?
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Soap for RLS - November 15, 2005 5:08:00 AM
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drbuddy
Posts: 429
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From: Pennsylvania
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Getting off subject -
I am finding that 9/10 patients that walk in my office with complaints of muscle aches and pains have a terrible time either falling asleep or staying asleep. This is in spite of working 12 hour shifts and not sleeping well when they do get some time to rest.
Once we straighten out their sleep patterns, most start to improve above and beyond from any physical treatments they are receiving at my office.
Actually, there is quite a bit in the literature relating muscular pain to sleep deficiency. Addressing that problem has improved outcomes considerably.
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Re: Soap for RLS - November 15, 2005 7:36:00 AM
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OaksPT
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From: Va
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drbuddy,
I see alot of disruptions in sleep patterns, and agree that this can markedly contribute to a plethora of sx. How do you straighten out their sleep patterns?
Scott
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Scott Oaks PT,DPT
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Re: Soap for RLS - November 15, 2005 8:25:00 AM
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nari
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From: Australia
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Disruption in sleep patterns seems to go along with chronic pain, one intensifies the other.
drbuddy, I would be very interested in how you sort out their sleep patterns as well..
Nari
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