# Cramp - Primary Care Physician has given up - where do we go next? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [September 28, 2012, 10:19pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190 "2012-09-28T22:19:30Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![janeslogin](https://avatars.discourse-cdn.com/v4/letter/j/df788c/32.png) [@janeslogin](https://boards.straightdope.com/u/janeslogin)\ **Post date:** [September 28, 2012, 10:19pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/1 "2012-09-28T22:19:30Z")
Wife has serious cramp. She has run out of quinine which worked perfectly but can no long be aquired. The Primary Care Physician tried something else that didn’t work and now he has thrown up his hands, metaphorically, in an I don’t know what to do next gesture. [Small town rural doctor, overworked and perhaps not up to date on such things.] So, where do we go next? ---
**Author:** ![Szlater](https://avatars.discourse-cdn.com/v4/letter/s/90ced4/32.png) [@Szlater](https://boards.straightdope.com/u/Szlater)\ **Post date:** [September 28, 2012, 10:22pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/2 "2012-09-28T22:22:59Z")
My dad suffered from severe cramps in his calves and feet for ages, doctor prescribed quinine, but no good. Saw another doctor, at the same practice, she suggested increasing dairy intake (for calcium) and cramps went away. She said to avoid calcium tablets though, not sure why. YMMV IANAD ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [September 28, 2012, 11:05pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/3 "2012-09-28T23:05:45Z")
Tonic water. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [September 28, 2012, 11:09pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/4 "2012-09-28T23:09:37Z")
> [@Czarcasm](#): > > Tonic water. That’s what I was thinking as well. I have no medical background whatsoever. I only thought that because it contains quinine. ---
**Author:** ![Szlater](https://avatars.discourse-cdn.com/v4/letter/s/90ced4/32.png) [@Szlater](https://boards.straightdope.com/u/Szlater)\ **Post date:** [September 28, 2012, 11:14pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/5 "2012-09-28T23:14:59Z")
> [@Joey\_P](#): > > That’s what I was thinking as well. I have no medical background whatsoever. I only thought that because it contains quinine. As a tiny fraction of the effective dose. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [September 28, 2012, 11:19pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/6 "2012-09-28T23:19:43Z")
> [@Szlater](#): > > As a tiny fraction of the effective dose. Yeah, I have no idea about the dosage, just thought I’d put it out there. From Wiki “In the United States, the US Food and Drug Administration (FDA) limits the quinine content in tonic water to 83 ppm[3] (83 mg per litre if calculated by mass), while the daily therapeutic dose of quinine is in the range of 167–333 mg.[4] Still, it is often recommended as a relief for leg cramps, but medical research suggests some care is needed in monitoring doses.[5] Because of quinine’s risks, the FDA has declared nonprescription sources, such as tonic water, should not be used to prevent or treat leg cramps.[6]” Seems you’d have to drink 2-4 liters or about 2 six packs (or the small bottles) a day. ---
**Author:** ![needscoffee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/needscoffee/32/1076_2.png) [@needscoffee](https://boards.straightdope.com/u/needscoffee)\ **Post date:** [September 29, 2012, 12:06am UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/7 "2012-09-29T00:06:28Z")
Is it available in Canada? ---
**Author:** ![Sahirrnee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sahirrnee/32/13937_2.png) [@Sahirrnee](https://boards.straightdope.com/u/Sahirrnee)\ **Post date:** [September 29, 2012, 12:56am UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/8 "2012-09-29T00:56:53Z")
Vitamin B12 worked for me. ---
**Author:** ![Seanette](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/seanette/32/9139_2.png) [@Seanette](https://boards.straightdope.com/u/Seanette)\ **Post date:** [September 29, 2012, 2:04am UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/9 "2012-09-29T02:04:35Z")
I am not a medical professional, but I’ve heard potassium (bananas are a good source) could help with something like this. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 29, 2012, 2:05am UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/10 "2012-09-29T02:05:25Z")
Am I to understand that the doctor will no longer prescribe quinine? It’s a pretty risky medication; if it’s causing liver, kidney or CNS damage, then I wouldn’t go searching for it in unmonitored forms. If it’s not causing damage but her doctor is afraid of the FDA advisory suggesting (in pretty strong terms) that it no longer be used “off-label” for leg cramps, then you might have luck with a different doctor. If the doctor is okay with prescribing it but your pharmacy no longer carries it, you can still get it at compounding pharmacies in the US. ---
**Author:** ![Khadaji](https://avatars.discourse-cdn.com/v4/letter/k/9e8a1a/32.png) [@Khadaji](https://boards.straightdope.com/u/Khadaji)\ **Post date:** [September 29, 2012, 2:17am UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/11 "2012-09-29T02:17:43Z")
Due to internal plumbing issues, I don’t absorb many different things well and often suffer from muscle cramps. When I’m having cramping issues it is usually one of these three things: Potassium, Magnesium or Calcium. Of those three: too much Potassium can be deadly, but over-the-counter stuff is only 3% of your daily RDA, so it would be tough to over-dose. Still, it is never wrong to check with your doctor. (My doc prescribes big pills for Potassium) Magnesium will cause the runs if you take too much, so be careful of it as well. Of you take it and get the runs, cut back on it. (And it is never wrong to check with your doctor. ) ---
**Author:** ![ioioio](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ioioio/32/316_2.png) [@ioioio](https://boards.straightdope.com/u/ioioio)\ **Post date:** [September 29, 2012, 3:02am UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/12 "2012-09-29T03:02:57Z")
For leg cramps, I take a vitamin, eat a banana, and drink a glass of milk. This always helps me. YMMV. Where is your wife’s cramp? I had an excruciating cramp in the buttocks (literal PITA) which turned out to be something serious, but I won’t go into the details unless it’s relevant. P.S. I learned recently that it’s possible to overdose on Milk of Magnesia. Anyone who’s taking this, do not exceed the recommended dosage. It’s powerful stuff. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [September 29, 2012, 11:12am UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/13 "2012-09-29T11:12:55Z")
Is there a specialist his wife could see? What type would be appropriate? ---
**Author:** ![legalsnugs](https://avatars.discourse-cdn.com/v4/letter/l/45deac/32.png) [@legalsnugs](https://boards.straightdope.com/u/legalsnugs)\ **Post date:** [September 29, 2012, 11:52am UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/14 "2012-09-29T11:52:13Z")
I agree with the potassium suggestions. Bananas, orange juice and yoghurt are good sources and yoghurt contains the calcium, too. Bonus. Good luck. Cramps anywhere suck. ---
**Author:** ![lavenderviolet](https://avatars.discourse-cdn.com/v4/letter/l/cdc98d/32.png) [@lavenderviolet](https://boards.straightdope.com/u/lavenderviolet)\ **Post date:** [September 29, 2012, 1:30pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/15 "2012-09-29T13:30:49Z")
It’s really the primary care doctor’s job to make a referral to the appropriate specialist if he has nothing else to offer you himself. I’m surprised that he didn’t say what the next step was if you told him that his treatment didn’t do any good - it sounds very weird that a primary care would just “give up” on the problem. It’s very common for a primary care doc to see a problem that’s beyond the scope of what the PCP would treat himself, but then the normal thing to do is to refer to the right specialist who CAN fix the problem. However, if it really is true the PCP is offering absolutely nothing else as a next step, then you might want to try a physiatrist (AKA Physical Medicine and Rehab specialist). They often treat problems like muscle spasms. ---
**Author:** ![Patty\_O\_Furniture](https://avatars.discourse-cdn.com/v4/letter/p/96bed5/32.png) [@Patty\_O\_Furniture](https://boards.straightdope.com/u/Patty_O_Furniture)\ **Post date:** [September 29, 2012, 4:27pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/16 "2012-09-29T16:27:35Z")
Smooth or skeletal muscle? I’m wondering if it might just be a hydration problem. Getting enough water? Tried a muscle relaxant? I relocated to a tropical climate about a year ago and it has become very easy for me to become dehydrated without feeling a need to drink, and the result is often mild lower back spasms. If you’ve ever had a lower back spasm, you know that even a mild one can be excruciatingly painful. Rest and hydration is usually all I need to start feeling better again. I still have a bottle of muscle relaxants that my doc gave me a few years ago - named flexoral or flexeril or something - for times when I need faster relief. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 29, 2012, 4:47pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/17 "2012-09-29T16:47:56Z")
> [@WhyNot](#): > > Am I to understand that the doctor will no longer prescribe quinine? It’s a pretty risky medication; if it’s causing liver, kidney or CNS damage, then I wouldn’t go searching for it in unmonitored forms. If it’s not causing damage but her doctor is afraid of the FDA advisory suggesting (in pretty strong terms) that it no longer be used “off-label” for leg cramps, then you might have luck with a different doctor. > > If the doctor is okay with prescribing it but your pharmacy no longer carries it, you can still get it at compounding pharmacies in the US. With the FDA warning **[against](http://www.webmd.com/news/20100713/unapproved-qualaquin-use-is-risky)** prescribing quinine for leg cramps, one must be a rather bold (or perhaps reckless) physician to go ahead and order it for something that’s neither life nor health-threatening. And the only form of quinine available by prescription presently is Qualaquin, at a cost of about $7 per tab. No compounding pharmacist I know of would make this up these days. ---
**Author:** ![Szlater](https://avatars.discourse-cdn.com/v4/letter/s/90ced4/32.png) [@Szlater](https://boards.straightdope.com/u/Szlater)\ **Post date:** [September 29, 2012, 5:23pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/18 "2012-09-29T17:23:58Z")
> [@Qadgop\_the\_Mercotan](#): > > And the only form of quinine available by prescription presently is Qualaquin, at a cost of about $7 per tab. Is there no generic quinine sulphate available? > [@BNF.org.uk - British National Formulary (free subscription required)](#): > > Tablets, coated, quinine sulfate 200 mg, net price 28-tab pack = £1.93; 300 mg, 28-tab pack = £2.03 Seems like a massive mark-up for the US market. That cost, by the way, is the price to the NHS… the patient, if they don’t have a pre-pay card or an exemption (medical or other) would be around £7 per prescription item… so 400 tabs on one prescription would be £7, as would 28 tabs. ---
**Author:** ![April\_R](https://avatars.discourse-cdn.com/v4/letter/a/3da27b/32.png) [@April\_R](https://boards.straightdope.com/u/April_R)\ **Post date:** [September 29, 2012, 5:31pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/19 "2012-09-29T17:31:21Z")
in the States you cannot legally get it unless you have malaria > [@](#): > > On December 11, 2006, the FDA banned all over the counter products containing quinine sulfate, a drug used for centuries to treat malaria, but which has also been widely used to treat leg cramps and muscle spasms. The ban also applies to all higher strength, prescription-only generic formulations of the drug, but one manufacturer, Mutual Pharmaceutical Company, Inc., will still be allowed to market its name brand product, Qualaquin, which contains 324 mg of quinine sulfate. The sole approved use of the drug will be for the treatment of malaria. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 29, 2012, 6:05pm UTC](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190/20 "2012-09-29T18:05:30Z")
> [@Szlater](#): > > Is there no generic quinine sulphate available? Quinine is an old, old drug. For decades and decades, it was prescribed for a wide variety of things, many of which it wasn’t helpful for. Lots of folks were harmed by it, even though most who took it had no untoward effect. Finally the FDA decided that it couldn’t allow the widespread prescribing of it for any damn thing, and decided that modern standards needed to be applied to the drug. If someone was going to market it, they’d have to provide rigorous scientific studies showing that it was safe and effective for _something_. Just like it does for modern drugs. Now, most manufacturers were not interested in spending hundreds of millions of dollars on testing a drug that was unlikely to pay back that investment. So they stopped making it. The FDA left an exception for one company to produce the drug to use it in cases of Malaria where more standard treatments were ineffective or contraindicated. That’s a pretty niche market and I doubt that quinine gets used real often in the US for malaria, but at least it’s available, if pricey. The same thing happened to the drug colchicine, very handy for stopping an acute gout attack, used for centuries. Never had decent testing, of course. So out it goes, save for one manufacturer who makes it for use with Familial mediterranian fever, for dollars a pill instead of pennies like it used to cost. Fortunately for gout sufferers, most gout attacks can be broken quickly with NSAIDs or steroids. The above is guaranteed to be at least slightly true, as I’m writing it all based on memory alone. 😃 [Next page](https://boards.straightdope.com/t/cramp-primary-care-physician-has-given-up-where-do-we-go-next/636190.md?page=2)