My hypotheses & Carmex lip balm on the foot arch
Posted: Wed Sep 21, 2011 9:12 am
Please pause for a moment and try to get used to the idea that rubbing
a particular brand of lip balm into the arches of your feet may greatly
reduce or eliminate RLS/PLMS symptoms.
. . .
. . .
OK.
I know it sounds weird, but here are our observations and some of the
hypotheses which might explain it. A full account of my observations
and hypotheses regarding RLS/PLMS is in a 32 page document I sent
to about 25 RLS researchers at the start of September. This is not for
publication, because it is a work in progress and because health
matters need to be written about with more caution, and based on
more research.
It is probably not necessary to accept these hypotheses in order to try
using this particular lip balm (Carmex) on the foot arches, since
anything which is safe for lips is presumably safe for the arches of the
foot.
Here is a very brief summary of my hypotheses, without the references,
qualifications and further discussions which make up most of the 32
page version:
[1] - Humans have a recently evolved reflex response which lifts the
toes and the foot, in response to a light touch sensation in soft skin of
the foot arches - not the heel, ball of the foot or the toes. This response
is ordinarily enabled when walking on potentially spiky ground, or in
swamps, to avoid the soft skin of the arch from being punctured.
Today, only humans have foot arches. They are a necessary
consequence of a flexible foot which concentrates most weight on the
heel and the distant ball and toes, in order to gain the greatest
purchase on the ground, to facilitate forwards-backwards balance
which is so important for a bipedal species.
[2] - This reflex response is extremely sensitive, and is normally turned
off by a population of so-far unidentified dopamine-producing
(dopaminergic) neuron output terminals in the spinal cord. There must
be some dopamine receptors which inhibit the interneurons which give
rise to the reflex response. The brain or brainstem evidently activates
these descending dopaminergic neurons most of the time, including
when we are sitting still or sleeping, to prevent false triggering of the
foot withdrawal reflex response.
[3] - This is a modification of the standard foot withdrawal reflex which
is common to mammals in general and to primates and apes in
particular. The genetic instructions which create this soft-touch
sensitive system and its descending dopaminergic inhibitory system
also creates, as a probably non-functional side effect, similar
arrangements for the hands, the torso and perhaps the face. (This
system in the hands would help prevent the palm of the hand being
punctured if we grip a spiny tree-branch.)
[4] - RLS sensory symptoms and the PLM (Periodic Limb Movement)
sensations result primarily from some combination of:
(a) - Inadequate dopaminergic inhibition of these foot-withdrawal reflex
circuits in the spinal cord. This is likely to be due to lack of iron in the
dopaminergic output terminals and/or lack of tyrosine near these
output terminals and/or due to partial blockade of the dopamine
receptors due to dopamine receptor antagonists, such as the drug
Phenergan.
(b) - These and other nociceptive (pain sensing) circuits in the spinal
cord being more than usually sensitive due to inadequate activation of
their opioid receptors, such as due to ingestion of opioid antagonists
in coffee, or the use of drugs such as naltrexone.
(c) - A sufficiently high level of "noise-driven" - random - firing of the
soft-touch foot-arch sensory neurons, in the absence of any of the
point-contact very light touch sensations which normally stimulate them.
(This is "noise" in the electrical engineering sense - random events
caused by thermal motion of electrons, atoms and molecules. The
same process in an audio amplifier creates audible "hiss".) This low
level random firing is probably normal and would not result in a
conscious perception of touch, or in the foot withdrawal reflex, if the
reflex system was being properly inhibited by the descending
dopaminergic pathway and by sufficient activation of opioid receptors.
From this it follows that we can reduce or eliminate RLS/PLMS
symptoms by one or more of the following:
[A] - Increasing the activation of the dopaminergic receptors in these
spinal circuits. The best way would be by ensuring there is sufficient
iron and tyrosine in these parts of the spinal cord. Dopamine agonist
drugs will work too, but these affect the entire nervous system and can
lead to augmentation and side-effects including compulsive behavior
(punding) and pathological gambling.
[B] - Reducing the level of opioid receptor antagonists, such as by
reducing or eliminating the use of any kind of coffee. (Likewise
reducing or eliminating caffeine or any other drug which disrupts sleep
or in some other way contributes to RLS/PLMS.)
[C] - Increasing the level of opioid receptor agonists, such as by
increasing endorphins (such as through exercise) or by taking opioid
drugs such as morphine (which are addictive and have serious
ill-effects).
[D] - Reducing the level of "noise" firings of the sensory neurons which
can activate this foot-arch protective reflex system, to a lower level than
normal, even if this means these sensors are not able to properly
sense the lightest touch.
This final approach D is the subject of this message.
Anything which reduces the sensitivity of these cutaneous mechano-
receptor neurons would be expected to reduce the random "noise-like"
firing which I hypothesise is driving the RLS/PLMS symptoms.
A local anesthetic should do the trick. We found that rubbing EMLA
into the foot arch worked well. Clove oil would probably work too - we
have some but have not tried it yet. (Please make your own decisions
on the safety of using these, Carmex or anything else - I am not a
doctor and even if I was, I haven't examined you.)
EMLA is two local anesthetics mixed so they are a liquid at room
temperature. Small droplets of the mixture are suspended as an
emulsion in water. We found this acts within seconds or minutes and
reduces or stops RLS/PLMS symptoms for some time - maybe an
hour or more. The instructions state that it should be rubbed into the
skin and covered. We find that EMLA needs to be covered by
something, such as clingwrap, to stop it evaporating. EMLA is widely
available in Australia without a prescription, on a "behind the counter,
ask the pharmacist" basis.
In a few tests, I got the impression that simply wetting the skin of the
foot arch with water, and then covering it with cling wrap to keep it
moist, was also effective at reducing or eliminating RLS/PLMS
symptoms, for as long as the skin remained wet.
The third technique we have tried is the most promising. Carmex is a
lip balm from Wisconsin with a long history. It is inexpensive, such as
USD$4 for three 10 gram tubes. We use the 0.35oz "Original Carmex
Tube":
http://www.mycarmex.com/our-products/or ... fault.aspx
with: "Camphor (alleviates pain), Menthol (kills germs and relieves
discomfort), Phenol (gently numbs your sore lips and removes old,
dead skin) and beeswax, cetyl esters, flavor, fragrance, lanolin,
mineral oil, petrolatum, salicylic acid and theobroma cacao(cocoa)
seed butter".
This is presumably the same as the "Original Carmex Jar":
http://www.mycarmex.com/our-products/or ... fault.aspx
"Available since 1937, with over 1 billion jars sold."
There's no need to rub it on the top of the foot, the heel, the ball of the
foot or on the toes. Just the arch of the foot, leading up to the inside
part which is higher.
For each foot I used about 25mm (an inch) of the ~2mm diameter
cylinder of balm which comes out of the tube. I rubbed it in for about
10 seconds, leaving an oily, waxy layer. This requires caution when
walking. If it were to be applied when not in bed, I suggest covering it
with clingwrap and then using a sock to keep the clingwrap in place.
There may be many other creams which work well too. I suspect that
almost any cream, or even just water, reduces the sensitivity of the
neurons sufficiently to reduce RLS/PLMS symptoms.
We have used Carmex several times, most recently last night when
it completely stopped Tina's RLS symptoms in both legs. This was
stopping her sleeping. She was rubbing her feet together and they
were at times moving of their own accord. This was the worst
symptoms she has had since stopping decaf coffee and all other
sources of caffeine ten weeks ago. These symptoms were less than
when she drank decaf. I suspect they were caused largely by some
thoroughly delicious dark Lindt Lindor chocolate we had not long before
bedtime . . . I gave her one 500mg capsule of tyrosine, which we find
generally effective for getting rid of minor RLS/PLMS symptoms.
(We used to use three in the past, when her RLS/PLMS was worse.)
She lay on her side, which usually reduces the symptoms as well.
The symptoms continued.
I tried rubbing a bar of dry soap on the arches of her feet - to explore
the pervasive idea that a bar of soap in the bed would reduce RLS.
Maybe soap would reduce the sensitivity of the foot-arch sensory
neurons. However, this only reduced symptoms for the one or two
minutes which would result from rubbing alone.
This was the first time Tina has had RLS/PLMS in both feet since she
stopped decaf. Within a minute of applying the Carmax, the
symptoms declined and disappeared. She had no more symptoms at
all for the rest of the night. Frequently, in the hours before we get up,
she has a few PLMs when sleeping. Lying on her side usually fixes
this. However, there were none this morning. Perhaps the effects of
Carmax last, to some extent, 8 to 10 hours.
Since Tina only has low level, occasional, RLS/PLMS since stopping
decaf, and since I only get occasional RLS sensations and PLMs in my
right foot when awake, it is now difficult for us to research the
effectiveness of creams such as Carmax. Last night was an exception.
Its my impression that Carmax works well because it has phenol as a
topical anesthetic, and because it is thick and unlikely to evaporate or
run off the skin, at least while sleeping. Maybe the menthol, camphor
and salycylic acid (aspirin) help as well.
If there are symptoms in the arms, then I suggest applying Carmex to
the palms of the hands. However, if RLS/PLMS is this bad, I suggest
ensuring there are no disturbing factors such as caffeine, alcohol,
other drugs or the opioid antagonists in coffee (as discussed in
another thread).
Tina and I are keen to hear of other people's experience with
Carmex, other creams or just plain water - on this forum or via email
to rw@firstpr.com.au .
- Robin Whittle http://aminotheory.com/rlsd/
a particular brand of lip balm into the arches of your feet may greatly
reduce or eliminate RLS/PLMS symptoms.
. . .
. . .
OK.
I know it sounds weird, but here are our observations and some of the
hypotheses which might explain it. A full account of my observations
and hypotheses regarding RLS/PLMS is in a 32 page document I sent
to about 25 RLS researchers at the start of September. This is not for
publication, because it is a work in progress and because health
matters need to be written about with more caution, and based on
more research.
It is probably not necessary to accept these hypotheses in order to try
using this particular lip balm (Carmex) on the foot arches, since
anything which is safe for lips is presumably safe for the arches of the
foot.
Here is a very brief summary of my hypotheses, without the references,
qualifications and further discussions which make up most of the 32
page version:
[1] - Humans have a recently evolved reflex response which lifts the
toes and the foot, in response to a light touch sensation in soft skin of
the foot arches - not the heel, ball of the foot or the toes. This response
is ordinarily enabled when walking on potentially spiky ground, or in
swamps, to avoid the soft skin of the arch from being punctured.
Today, only humans have foot arches. They are a necessary
consequence of a flexible foot which concentrates most weight on the
heel and the distant ball and toes, in order to gain the greatest
purchase on the ground, to facilitate forwards-backwards balance
which is so important for a bipedal species.
[2] - This reflex response is extremely sensitive, and is normally turned
off by a population of so-far unidentified dopamine-producing
(dopaminergic) neuron output terminals in the spinal cord. There must
be some dopamine receptors which inhibit the interneurons which give
rise to the reflex response. The brain or brainstem evidently activates
these descending dopaminergic neurons most of the time, including
when we are sitting still or sleeping, to prevent false triggering of the
foot withdrawal reflex response.
[3] - This is a modification of the standard foot withdrawal reflex which
is common to mammals in general and to primates and apes in
particular. The genetic instructions which create this soft-touch
sensitive system and its descending dopaminergic inhibitory system
also creates, as a probably non-functional side effect, similar
arrangements for the hands, the torso and perhaps the face. (This
system in the hands would help prevent the palm of the hand being
punctured if we grip a spiny tree-branch.)
[4] - RLS sensory symptoms and the PLM (Periodic Limb Movement)
sensations result primarily from some combination of:
(a) - Inadequate dopaminergic inhibition of these foot-withdrawal reflex
circuits in the spinal cord. This is likely to be due to lack of iron in the
dopaminergic output terminals and/or lack of tyrosine near these
output terminals and/or due to partial blockade of the dopamine
receptors due to dopamine receptor antagonists, such as the drug
Phenergan.
(b) - These and other nociceptive (pain sensing) circuits in the spinal
cord being more than usually sensitive due to inadequate activation of
their opioid receptors, such as due to ingestion of opioid antagonists
in coffee, or the use of drugs such as naltrexone.
(c) - A sufficiently high level of "noise-driven" - random - firing of the
soft-touch foot-arch sensory neurons, in the absence of any of the
point-contact very light touch sensations which normally stimulate them.
(This is "noise" in the electrical engineering sense - random events
caused by thermal motion of electrons, atoms and molecules. The
same process in an audio amplifier creates audible "hiss".) This low
level random firing is probably normal and would not result in a
conscious perception of touch, or in the foot withdrawal reflex, if the
reflex system was being properly inhibited by the descending
dopaminergic pathway and by sufficient activation of opioid receptors.
From this it follows that we can reduce or eliminate RLS/PLMS
symptoms by one or more of the following:
[A] - Increasing the activation of the dopaminergic receptors in these
spinal circuits. The best way would be by ensuring there is sufficient
iron and tyrosine in these parts of the spinal cord. Dopamine agonist
drugs will work too, but these affect the entire nervous system and can
lead to augmentation and side-effects including compulsive behavior
(punding) and pathological gambling.
[B] - Reducing the level of opioid receptor antagonists, such as by
reducing or eliminating the use of any kind of coffee. (Likewise
reducing or eliminating caffeine or any other drug which disrupts sleep
or in some other way contributes to RLS/PLMS.)
[C] - Increasing the level of opioid receptor agonists, such as by
increasing endorphins (such as through exercise) or by taking opioid
drugs such as morphine (which are addictive and have serious
ill-effects).
[D] - Reducing the level of "noise" firings of the sensory neurons which
can activate this foot-arch protective reflex system, to a lower level than
normal, even if this means these sensors are not able to properly
sense the lightest touch.
This final approach D is the subject of this message.
Anything which reduces the sensitivity of these cutaneous mechano-
receptor neurons would be expected to reduce the random "noise-like"
firing which I hypothesise is driving the RLS/PLMS symptoms.
A local anesthetic should do the trick. We found that rubbing EMLA
into the foot arch worked well. Clove oil would probably work too - we
have some but have not tried it yet. (Please make your own decisions
on the safety of using these, Carmex or anything else - I am not a
doctor and even if I was, I haven't examined you.)
EMLA is two local anesthetics mixed so they are a liquid at room
temperature. Small droplets of the mixture are suspended as an
emulsion in water. We found this acts within seconds or minutes and
reduces or stops RLS/PLMS symptoms for some time - maybe an
hour or more. The instructions state that it should be rubbed into the
skin and covered. We find that EMLA needs to be covered by
something, such as clingwrap, to stop it evaporating. EMLA is widely
available in Australia without a prescription, on a "behind the counter,
ask the pharmacist" basis.
In a few tests, I got the impression that simply wetting the skin of the
foot arch with water, and then covering it with cling wrap to keep it
moist, was also effective at reducing or eliminating RLS/PLMS
symptoms, for as long as the skin remained wet.
The third technique we have tried is the most promising. Carmex is a
lip balm from Wisconsin with a long history. It is inexpensive, such as
USD$4 for three 10 gram tubes. We use the 0.35oz "Original Carmex
Tube":
http://www.mycarmex.com/our-products/or ... fault.aspx
with: "Camphor (alleviates pain), Menthol (kills germs and relieves
discomfort), Phenol (gently numbs your sore lips and removes old,
dead skin) and beeswax, cetyl esters, flavor, fragrance, lanolin,
mineral oil, petrolatum, salicylic acid and theobroma cacao(cocoa)
seed butter".
This is presumably the same as the "Original Carmex Jar":
http://www.mycarmex.com/our-products/or ... fault.aspx
"Available since 1937, with over 1 billion jars sold."
There's no need to rub it on the top of the foot, the heel, the ball of the
foot or on the toes. Just the arch of the foot, leading up to the inside
part which is higher.
For each foot I used about 25mm (an inch) of the ~2mm diameter
cylinder of balm which comes out of the tube. I rubbed it in for about
10 seconds, leaving an oily, waxy layer. This requires caution when
walking. If it were to be applied when not in bed, I suggest covering it
with clingwrap and then using a sock to keep the clingwrap in place.
There may be many other creams which work well too. I suspect that
almost any cream, or even just water, reduces the sensitivity of the
neurons sufficiently to reduce RLS/PLMS symptoms.
We have used Carmex several times, most recently last night when
it completely stopped Tina's RLS symptoms in both legs. This was
stopping her sleeping. She was rubbing her feet together and they
were at times moving of their own accord. This was the worst
symptoms she has had since stopping decaf coffee and all other
sources of caffeine ten weeks ago. These symptoms were less than
when she drank decaf. I suspect they were caused largely by some
thoroughly delicious dark Lindt Lindor chocolate we had not long before
bedtime . . . I gave her one 500mg capsule of tyrosine, which we find
generally effective for getting rid of minor RLS/PLMS symptoms.
(We used to use three in the past, when her RLS/PLMS was worse.)
She lay on her side, which usually reduces the symptoms as well.
The symptoms continued.
I tried rubbing a bar of dry soap on the arches of her feet - to explore
the pervasive idea that a bar of soap in the bed would reduce RLS.
Maybe soap would reduce the sensitivity of the foot-arch sensory
neurons. However, this only reduced symptoms for the one or two
minutes which would result from rubbing alone.
This was the first time Tina has had RLS/PLMS in both feet since she
stopped decaf. Within a minute of applying the Carmax, the
symptoms declined and disappeared. She had no more symptoms at
all for the rest of the night. Frequently, in the hours before we get up,
she has a few PLMs when sleeping. Lying on her side usually fixes
this. However, there were none this morning. Perhaps the effects of
Carmax last, to some extent, 8 to 10 hours.
Since Tina only has low level, occasional, RLS/PLMS since stopping
decaf, and since I only get occasional RLS sensations and PLMs in my
right foot when awake, it is now difficult for us to research the
effectiveness of creams such as Carmax. Last night was an exception.
Its my impression that Carmax works well because it has phenol as a
topical anesthetic, and because it is thick and unlikely to evaporate or
run off the skin, at least while sleeping. Maybe the menthol, camphor
and salycylic acid (aspirin) help as well.
If there are symptoms in the arms, then I suggest applying Carmex to
the palms of the hands. However, if RLS/PLMS is this bad, I suggest
ensuring there are no disturbing factors such as caffeine, alcohol,
other drugs or the opioid antagonists in coffee (as discussed in
another thread).
Tina and I are keen to hear of other people's experience with
Carmex, other creams or just plain water - on this forum or via email
to rw@firstpr.com.au .
- Robin Whittle http://aminotheory.com/rlsd/