If you suffer from restless legs (Willis-Ekbom Disease), and its a possibility that you’ll be having cataracts removed sometime in the future, or some other form of surgery, please read this.
For those of you who suffer from restless legs, I don’t need to tell you how tortuous the problem can be. If you don’t suffer from them, you’ve probably encountered someone who does as it’s estimated approximately 5% of the population suffer from the condition. Some have only mild symptoms that usually begin in the evening as tiredness sets in, and for these people sleep alleviates the problem. However, a large percentage experience a more debilitating condition known as Periodic Limb Movement Disorder (PLMD). PLMD is characterised by leg twitching or jerking movements during sleep that typically occurs every 10 – 60 seconds, and often all through the night. The movements can severely disrupt sleep and are involuntary with sufferer’s having no control over them.
My own symptoms of the condition worsened from mild to severe at around the age of 40, and for several years I rarely had a good nights sleep. Finally I was put onto Sifrol, (Pramipexole), a dopamine agonist drug used to treat Parkinson’s Disease symptoms. It helps, providing I take it around 5pm, with the main side effect being drowsiness. Most nights I’m usually dozing on the couch by not much after 8pm, but I do manage to get a relatively peaceful night’s sleep. Thankfully both Paul and I are morning people.
So what has all of this to do with cataract surgery. Read on – particularly if this could apply to you sometime in the future. Last December I needed a vitrectomy, which is a procedure done to remove the vitreous humour gel from the eye to prevent the possibility of retina detachment. The procedure causes a cataract to form some months later, so I was advised a second procedure for cataract removal would also be required.
The victrectomy is done under mild sedation administered by an Anaesthetist. I was conscious during the procedure, but not conscious enough to control my legs which took on a life of their own. The surgery was a tortuous nightmare for me, and I gather was somewhat of a nightmare for my surgeon and the rest of the medical team in the operating theatre as well.. My Anaesthetist seemingly tried to control the involuntary leg jerking by upping the sedative. The symptoms worsened! He then backed off to the minimal, and although the symptoms continued, I could at least try to help by using every bit of brainpower I had to fight the urge to perform kicks worthy of an Irish dance troop. I’m sure my surgeon was as scared as was, and I wonder if it wouldn’t have been sensible to have abandoned the surgery because of the obvious risks involved.
My surgeon assured me that things would be okay for the shorter cataract surgery, which I had earlier this week. How wrong he was. My memory of the surgery is cloudy so I gather I was given higher doses of sedation than during the vitrectomy, but I think I remember someone telling me if I didn’t keep my legs still restrains would have to be used. When I came around my usually normal blood pressure was over 200 and it was thought I’d have to remain in hospital over night. However, my blood pressure did go down, and I came home. The surgery was successful.
I’ve since done what Doctors and surgeons hate. I’ve used Dr Google to find out about anaesthesia and it’s possible relation to restless legs. Apparently there are some forms of sedation that are known to worsen the symptoms of restless legs, and these should not be used. These are:
Neuroleptic agents (butyrophenones, including droperidol: phenothiazines)
Tricyclic, tetracyclic or selective serotonin re-uptake inhibiting antidepressant (except as part of a current therapeutic regimen)
Opioid antagonists (naloxone, naltrexone)
Antiemetic agents with dopamine antagonist or histamine antagonist properties (metoclpramide HCI, prochlorperazine, promethazine HCI)
Sedating antihistamines that cross the blood-brain barrier (diphenhydramine in particular)
I don’t know which of these was used on me, but I do know I had a severe reaction on the operation table. My surgeon asked me on my follow up visit after my cataract removal what I remembered. Not much except my legs were doing a bit of a dance, I told him. His words were that I was jumping all over the operating table, he said, I was jumping, and he was jumping!
The operation was successful, and although I’m grateful for my surgeon’s obvious skill at dealing with a difficult situation, I wonder if good luck didn’t play as much a part as good management.
I intend to follow up with my Anaesthetist to find out which drugs were used, and to find out if the same drugs were used during both procedures. If the same drugs were used on the second occasion, I shall be asking why!
I will be keeping a list of these drugs, and will be having an in depth discussion prior to any future surgeries, and will want an assurance that my restless legs are given due consideration. I dread to think how disastrous the consequences of both of these surgeries could have been!
Fortunately, alls well that ends well. Clearly though Dr Google is more aware of the complications that can occur for a restless leg sufferer during sedation than was my own Anaesthetist. If you suffer from restless legs, and you are going to undergo any surgery, please make sure your medical team takes due notice of your special needs. Print off this list, or use Dr Google to get your own information. Present it in writing to your surgical team, and make sure notice is taken. I know I will be in future.