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Dear Dr. Roach: For the past few months, I have been training for a 160-mile bike ride, scheduled for this July. After almost every long ride (longer than three hours) I suffer the most excruciatingly painful cramps in my vastus medialis quad muscle.

I am a 59-year-old male, a lifelong runner and have had quad, hamstring and calf cramps before, but I rate the pain from those cramps as 2-3 on a 1-10 pain scale. The inner-thigh cramps I get are 9-10!

I’ve almost passed out a couple of times. They always hit a few to several hours after the hard ride, sometimes in one leg, sometimes in the other, and once in both. They always occur when I’ve been sitting for a while and start to get up, or am bending over to put on shoes. I’ve tried “home” remedies such as eating Tums, eating mustard and drinking pickle juice. The pickle juice seems to help the most.

I suspect dehydration has a role in the cause, and I drink 16-20 ounces of liquids containing electrolytes every hour during the rides, but I still get the horrible cramps later in the day. They are so severe that I almost don’t want to ride anymore.

Any thoughts on cause and prevention?

B.R.

Dear B.R.: There are many causes of cramps. Losing fluid and electrolytes are two important ones, but it sounds like you are working hard to prevent that (although many sports drinks have too much sugar and not enough sodium or potassium). Those who are just beginning to exercise and overdo it are at risk, but that doesn’t seem like you.

My best guess in your case is inadequate stretching, which is a very common problem, especially among cyclists. Stretching well before your training rides may prevent the problem entirely, and stretching at onset of cramps can stop them quickly. A physical therapist or exercise trainer can help you learn the best stretches for your vastus medialis muscle, a muscle that extends the leg at the knee.

Pickle juice, amazingly enough, has been found in studies to quickly relieve cramps in athletes with electronically stimulated cramps, and this effect is thought to be neurologically mediated, rather than an effect of the salt and other compounds in pickle juice.

Dear Dr. Roach: Twice in the past six months, I read responses from you in regard to eye twitching. I noticed that you did not mention myasthenia gravis as one of the possible reasons. Twitching was the first thing I noticed. It took two and a half years, two GPs and two ophthalmologists to make the diagnosis. I am hoping to bring awareness to this disease. Maybe you can further the discussion on this. I had to put my finger on the twitch to quiet it.

V.B.

Dear V.B.: Myasthenia gravis is a neuromuscular disorder whose first symptom is weakness in the muscles of the eye and eyelid. I did not read anything about MG presenting with eye twitching, but I have looked it up and have found several case reports of people with undiagnosed MG being inappropriately treated with Botox for the diagnosis of blepharospasm (which my previous columns were about). Apparently eye twitching can occur in MG, but less than 10 percent of the time.

I appreciate your writing to tell me, as it is clear that many people do not know about this less-common presentation.

Email questions to ToYourGoodHealth@med.cornell.edu.

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