Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Activity: Authorities recommend stretching before and after exercise or sports, along with an adequate warm-up and cooldown, to prevent
cramps that are caused by vigorous physical activity. Good hydration before, during, and after the activity is important, especially if the duration exceeds one hour, and replacement of lost electrolytes (especially sodium and potassium, which are major components of perspiration) can also be helpful. Excessive fatigue, especially in warm weather, should be avoided.
How much should I drink?
Hydration guidelines should be individualized for each person. The goal is to prevent excessive weight loss (>2% of body weight). You should weigh yourself before and after exercise to see how much fluid you lose through sweat. One liter of water weighs 2.25 pounds. Depending on the amount of exercise, temperature and humidity, body weight, and other factors, you can lose anywhere from approximately .4 to 1.8 liters per hour.
Pre-exercise hydration (if needed):
1. 0.5 liters per hour for a 180-pound person several hours (three to four hours) prior to exercise.
2. Consuming beverages with sodium and/or small amounts of salted snacks or sodium-containing foods at meals will help to stimulate thirst and retain the consumed fluids.
During exercise:
1. Suggested starting points for marathon runners are 0.4 to 0.8 liters per
hour, but again, this should be individualized based on body weight loss.
2. There should be no more than 10% carbohydrate in the beverage, and 7% has generally been considered close to optimal. Carbohydrate consumption is generally recommended only after one hour of exertion.
3. Electrolyte repletion (sodium and potassium) can help sustain electrolyte balance during exercise. Particularly when
there is inadequate access to meals or meals are not eaten,
physical activity exceeds four hours in duration,
or during the initial days of hot weather.
Under these conditions, adding modest amounts of salt (0.3 g/L to 0.7 g/L) can offset salt loss
in sweat and minimize medical events associated with electrolyte imbalances (for
example, muscle cramps, hyponatremia).
Post-exercise:
1. Drink approximately 0.5 liters of water for every pound of body weight lost.
2. Consuming beverages and snacks with sodium will help expedite rapid and complete
recovery by stimulating thirst and fluid retention.
Pregnancy: Supplemental calcium and magnesium have each been
shown to help prevent cramps associated with pregnancy. An adequate
intake of both of these minerals during pregnancy is important for
this and other reasons, but supervision by a qualified health-care
practitioner is essential.
Dystonic cramps: Cramps that are induced by repetitive non-vigorous activities can sometimes be prevented or minimized by
careful attention to ergonomic factors such as wrist supports,
avoiding high heels, adjusting chair position, activity breaks, and
using comfortable positions and equipment while performing the
activity. Learning to avoid excessive tension while executing
problem activities can help. However, cramps can remain very
troublesome for activities that are difficult to modify, such as
playing a musical instrument.
Rest cramps: Night cramps and other rest cramps can often be prevented by regular stretching exercises, particularly if done before going to bed. Even the simple calf-stretching maneuver (described in the first paragraph of the section on treatment), if held for 10 to 15 seconds and repeated two or three times just before going to bed, can be a great help in preventing
nocturnal cramps. The maneuver can be repeated each time you get up to go to the bathroom during the night and also once or twice during the day. If nocturnal leg cramps are severe and recurrent, a foot board can be used to simulate walking even while recumbent and may prevent awkward positioning of the feet during sleep. Ask your doctor about this remedy.
Another important aspect of prevention of night cramps is adequate calcium and magnesium. Blood levels may not be sensitive enough to accurately reflect what is happening at the tissue surfaces where the hyperexcitability of the nerve occurs. Calcium intake of at least 1 gram daily is reasonable, and 1.5 grams may be appropriate, particularly for women with
or at risk for osteoporosis. An extra dose of calcium at bedtime may help prevent cramps.
Supplemental magnesium may be very beneficial for some, particularly
if the person has a magnesium deficiency. However, added magnesium
can be very hazardous for people who have difficulty eliminating
magnesium, as happens with kidney insufficiency. The vigorous use of
diuretics usually increases magnesium loss, and high levels of
calcium intake (and therefore of calcium excretion) tend to increase
magnesium excretion. Magnesium is present in many foods (greens,
grains, meat and fish, bananas, apricots, nuts, and soybeans) and
some laxatives and antacids, but a supplemental dose of 50-100
milligrams of magnesium daily may be appropriate. Splitting the dose
and taking a portion several times during the day minimizes the
tendency to diarrhea that magnesium can cause.
Vitamin E has also been said to help minimize cramp occurrence.
Scientific studies documenting this effect are lacking, but anecdotal
reports are common. Since vitamin E
is thought to have other beneficial health effects and is not toxic
in usual doses, taking 400 units of vitamin E daily is approved,
recognizing that documentation on its effect on cramps is lacking.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Potassium is an essential electrolyte necessary for cell function. Low potassium (hypokalemia) may be caused by diarrhea, vomiting, ileostomy, colon polyps, laxative use, diuretics, elevated corticosteroid levels, renal artery stenosis, and renal tubular acidosis, or other medications. Symptoms of low potassium include weakness, aches, and cramps of the muscles. Treatment is dependant upon the cause of the low potassium (hypokalemia).
Shin splints result from inflammation from injury to the tendon and adjacent tissues in the front of the outer leg. Shin splints commonly occur in runners or aggressive walkers, causing pain and discomfort. An increase in workout intensity, weak ankles and pronation may be to blame for shin splints. Stretching, strengthening, and icing the affected area are effective treatments for shin splints. Rest and anti-inflammatory medications are also advised.
Myofascial pain syndrome is muscle pain in the body's soft tissues due to injury or strain. Symptoms include muscle pain with tender points and fatigue. Treatment usually involves physical therapy, massage therapy, or trigger point injection.
Hamstring injuries may range from minor strains to major ruptures. A hamstring injury causes spasm, tightness, and tenderness. More severe injuries may cause swelling and bruising. While most hamstring injuries heal without surgery, a complete rupture would require surgery.
The shoulder is the most often dislocated joint in the body due to its mobility. Dislocation occurs when the head of the humerus is dislocated from its socket. Symptoms and signs of a shoulder dislocation include nausea and vomiting, lightheadedness, weakness, and sweating. There are various methods of reducing a dislocation and returning the humeral head to its normal place. The method for reduction of a shoulder dislocation depends upon the type of dislocation, the patient, the situation, and the clinician's experience. Intravenous narcotics and muscle relaxants are often administered to relax the muscles and relieve pain.
Cholera is an infectious disease characterized by intense vomiting and profuse watery diarrhea and that rapidly lease to dehydration and often death. Cholera is caused by infection with the bacteria Vibrio cholerae, which may be transmitted via infected fecal matter, food, or water.
Patients with celiac disease are required to eat a gluten-free diet. Gluten is found in rye, barley, and wheat. Gluten damages the intestine in patients with celiac disease. Some mediations contain gluten, so careful monitoring of products consumed is imperative. Patients with celiac disease are also at risk for developing nutritional deficiencies. The information in this article contains both foods that contain gluten, and foods that do not contain gluten.
Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is described in three stages: perimenopause, menopause, and postmenopause.
However, not all women undergo natural menopause. Some women experience induced menopause as a result of surgery or medical treatments, such as chemotherapy and pelvic radiation therapy.
In hypoparathyroidism, the parathyroid gland does not produce enough parathyroid hormone. Causes of hypoparathyroidism include injury to the parathyroid glands, autoimmune disorder association, or may be present ab birth. Symptoms of hypoparathyroidism include: tingling fingers, toes, and lips, brittle nails, dry, coarse skin, dry hair; memory loss, headaches, severe muscle cramps, cataracts, malformed teeth, and convulsions. Treatment of hypoparathyroidism is to restore the calcium and phosphorus to normal levels in the body.
Stiff-Person syndrome is a neurological disorder associated with features of an autoimmune disease. Signs and symptoms of Stiff-Person syndrome include a heightened sensitivity to stimuli (noise, touch, emotional distress) and fluctuating muscle rigidity of the trunk and limbs. Conditions associated with Stiff-Person syndrome include thyroiditis, vitiligo, pernicious anemia, and diabetes. Treatment for Stiff-Person syndrome is generally medication to control symptoms.
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