Cramp

Over the months and years (OK, year and nearly-two-thirds) that I’ve been blogging about my dance with breast cancer, I’ve spent a lot of time on side effects and collateral damage. I’ve written about hair loss, scarring, sleeplessness, aches and pains, and my seemingly endless adventures in PICC territory. I’ve blogged constipation, swelling, weight gain and nail disintegration.

Whenever I write about side effects I get a smattering of comments, a few supportive messages on Twitter, and a bunch of emails. They tell me about reader experiences and what might help.

Except when I write about cramp.

Cramp gets four times the emails of other side effects, if not more. And most of those extra emails are from people saying something along the lines of, “Whoa! I have cramp ALL THE TIME and no-one ever mentioned it could be cancer or cancer treatment related! I’m going to talk to my oncologist about it next time I see him/her!”

My heart sinks when I read that last part. Of course, the writer might have the kind of oncologist who is interested in every aspect of their side effects and wants to know everything that goes on in their body, because they are treating the whole person.

Or they might have an oncologist like mine.

When I mentioned cramp she did a very subtle body language thing. She moved her eyes, recrossed her arms, shifted slightly in her seat, did something with the corner of her mouth. What she communicated – most expertly – was, “I am a very busy and important and highly educated oncologist trying with every fibre of my being and soul to save your life (and, incidentally, the lives of people so much sicker than you that they would embrace cramp as a holiday) and yet you bother me with trivia so far below my notice that I would have to get a telescope out to be able to see it. If I could be bothered. Which I can’t.” What she said was, “Talk to your GP.”

But here’s the thing. Cramp is not trivial. OK, it’s not going to kill you, so it is on that level. But  it’s not pins-and-needles or a slight headache either. Cramp really, properly hurts. A cramp is an involuntary muscle contraction which may last for seconds or minutes. You may have had it in your hand if you’ve written for a long time, or in a muscle that’s been overused – tennis players often get cramps in their arms. I – and many other people dancing with cancer, judging from my inbox- got it in my hamstrings, calves, and feet. The foot cramp is sort of bearable, in that the muscles are not that large, so although it’s painful, it’s painful over a fairly small area. The calves, less so. The hamstrings…. agony. Seriously. Cramp attacks in my hamstrings in the middle of the night have been some of the most physically agonising episodes I’ve ever experienced (and I’ve had two babies, the traditional way). I have screamed and cried my way through them. And I have sought to understand and cure them. Here’s a digest of what I’ve found and what I’ve tried.

Cramp may be caused by:

- muscle fatigue

- sudden changes in temperature

- dehydration

- low blood salt

- electrolyte disturbance leading to low levels of magnesium, potassium, and/or calcium.

(There are other causes too but these are linked to specific conditions, such as kidney disease or multiple sclerosis.)

Treatments for cancer, as you probably don’t need me to tell you, cause big tiredness in the body as it struggles to do what it needs to do in the face of a huge assault from within. Any treatment that interferes with the hormones or brings on a medical menopause – such as many types of chemotherapy, and tamoxifen – is likely to have the body going through sudden night sweats, which bring on not only the temperature change but also dehydration and low blood sodium (from salt lost through sweating). Electrolyte disturbance is a known side effect of chemotherapy. So, many cancer patients will have all of the common causes of cramp going on at the same time. No wonder so many of us have woken up at 3am screaming.

So much for the causes. What about the treatment? Here’s what I did. I think some of it worked, but not all of the time.

- I took a walk during the afternoon. This is counter-intuitive as fatigue is a cause of cramp, but I think that getting my body moving did help, somehow. There certainly seemed to be a correlation between days when I didn’t take any exercise and more cramp as night. (Correlation is not causation, of course, but even so, I think it helped.)

- I drank a glass of water before bed, which kept me hydrated and also meant I got up at 2am to go to the loo. I don’t know whether getting my body moving that extra little bit helped too.

- I took magnesium, calcium and potassium tissue salts. (I tried to add more foods containing these elements to my diet, too.)

- I got quinine sulphate tablets on prescription from my doctor.

- If I had a cramp, I tried to get up and put some weight on it.

- In the unlikely event of Alan sleeping through the howling, I woke him up. (If there’s one thing guaranteed to make cramp worse, it’s someone else snoring peacefully through it beside you.)

- Once Alan was awake I got him to rub the cramp bit. I’m not sure it helped but it was a distraction.

- I also tried over-the-counter cramp meds, but found them less effective than the quinine sulphate.

- I wore pyjamas and socks in bed.

- Muscle pain can hang around after the cramp has gone, so I kept painkillers handy to take immediately after an attack.

Of course, the frustrating thing is that I don’t know what helped and what didn’t. It’s been a while now since I had a really bad attack, but I am still cautious: I drink tonic water (which contains quinine) every day and do Pilates exercises to strengthen my muscles and keep them moving.

What’s your experience of cramp, and dealing with it? What have I missed?

(Writing this post has reminded me that all things pass. If you were catapulted out of bed with hamstring origami in the early hours, take heart.)