Find other members in this community to connect with. Muscle Cramps: Pathophysiology And Possible Causes, Causes Of Throbbing Or Pulsing Sensation In Arms Or Legs. All of these symptoms are a direct result in the change of blood flow, especially from a more persistent condition. The most common experience of the buzzing feeling entails feeling like your muscles, fingers, or legs are vibrating or shaking inside. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Why do my muscles twitch? The outer covering can get damaged which can sometimes be seen on MRI and other times requires additional testing to identify. I checked with my doctor and told him I really only need 1/2 tablet for this to happen so he wrote me a script for 1/2 tab. Muscle twitching is caused by one muscle fiber contractions in the area, or uncontrollable twitching of a group of muscle fibers that is served by a single nerve cell. Muscle Atrophy: What You Should Know About Muscle Mass Loss And Eating Disorders, Gastroparesis: Causes, risk factors and prevention, Abdominal Twitching (Fasciculation) Can Have Various Causes, What Causes A Burning Sensation Of The Feet And How Is It Treated, Eating Disorders Disrupt Your Bodys Mineral Balance And Can Cause Anemia And Malnutrition, Sleep Better With Vitamins: 4 Nutritional Deficiencies That Could Cause Chronic Insomnia. I do have small fiber peripheral neuropathy in my feet. so recently i have been having a bubbling/fluttering feeling in my left calf & sometimes in my left thigh. That Constant Burning Sensation May Be Burning Mouth Syndrome, How To Manage Seizures In Multiple Sclerosis Patients, 8 Causes Of Pain Under The Ribs When Breathing, ALS Stages And Progression Of Disease According To Symptoms, Sjogren's syndrome: Causes, Symptoms & Treatment, New Drug Treatment Holds Out Hope For Chronic Fatigue Sufferers. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. I examined the patient; the first thing I wanted to know is what was causing the throbbing sensation, a vessel or a muscle. It is a weird occassional feeling that I now know others have and will ask my rheumatologist about in March. Thanks for bringing it up. Back to The buzzing sensation often comes and goes at regular intervals (a few seconds of buzzing followed by a few seconds of peace). Doctors typically provide answers within 24 hours. P.S. These are the nerves found in the arms and legs. loose bowels, twitches, feeling faint, feeling like im going, Twitching in right wrist making it impossible to write, Discomfort in adbomen causeing twitching/tingling and have l, Is twitching, jerking of muscles a new symptom of my small f. why do i keep getting this wierd twitching in the same spot on my head?? Stimulation causes my leg to twitch pretty hardcore, is that an orgasm? The sensation may also affect your arms, chest and face. Everything you need to know about restless legs syndrome. And, indeed, thats what our physicians are traditionally taught in medical schoola pinched nerve in the lumbar spine typically presents as a symptom in the leg. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. look up an image online and compare. Urges to twitch or have sudden movement. Fluttering in the testicles and tingling in torso and leg one side of body? If its unilateral numbness or weakness on the arm or leg, that could be on the spinal cord or a motor center of the brain, says Dr. Harrington. Try taking some magnesium supplements and calcium. diarrhea, stomach twitches in left side, bloating and pain in stomach, Body twitching and scaring me extremely much, Soreness in my right testicle, It was twitching slightly, Stomach twitches at same time as heartbeat, When I pleasure myself, my legs start to twitch. Restless legs syndrome typically causes an overwhelming urge to move your legs and an uncomfortable sensation in your legs. Don't know how I'd manage without it. Examination and lab testing may lead to th you may have a small varicose vein. Depending on the cause of the leg twitching, a person may experience additional symptoms, such as: It is very common for people to experience occasional bouts of leg twitching. After exercising, ears ringing, eyes twitching to close, light headed. Not so fast. CKD can alter the balance of fluids and electrolytes in the body, which Light Brown Bleeding and a twitching sensation in my uterus, bowel inflammation is ruining my life, it is causing muscle twitching and burning skin sensation, Stomach muscles twitching and jumping towards my upper ribs. I see my Neurologist again on Monday. Painful Throbbing Pulsing Neck and Throat. Patients with DVT may have mild symptoms of pain and swelling in the affected leg; however, most patients have no symptoms whatsoever. I had a microphlembectamy and scelotherapy on a huge varicose vein 3 weeks ago. There are torn disc findings that can be seen on MRI (HIZ) and these can be either asymptomatic (i.e. Are the Drugs You Take Making You Lose Essential Vitamins and Minerals? Im a 37 year old women and im experiencing left side sweating and left side face numb and a fluttering in left lower leg been going on all day today? muscles in my body keep twitching everywhere. The top of the muscle attaches behind the knee, and the bottom connects to the Achilles tendon, which stretches all the way down to the heel. For potential or actual medical emergencies, immediately call 911 or your local emergency service. I get the fluttering in the tops of my thighs at the back, after walking. ? i often get a fluttering/bubbling sensation in my body- legs, butt, arm, neck, stomach. National Blood Clot Alliance. The endo I met said that cortisol should be at its highest at midnight.. My legs really get going when I go to bed. Can affect any part of your body most often the eyelids, calves, or thumb. gathering specific information about the twitching, such as: whether it affects other parts of the body, cutting down on stimulants, such as caffeine and alcohol, leg twitches do not get better following appropriate lifestyle changes, twitching starts when the person is resting, twitching begins after the person starts taking a new medication, twitching affects more than one part of the body. My neurologist cannot find an explanation but thinks it is due to small fiber neuropathy possibly in connection with EDS. In rare cases, the cause of the throbbing could also be ananeurysm which produces a wide pulsatile area. thumping/pulsing sensation in inner elbow? To understand Thoracic Disc Herniations, though, we first need to cover thoracic spine anatomy and function. Sadly my experience is that GP's know nothing about cortisol and it's effect on the body and mind. Bioengineered. WebIt is ongoing and rarely stops. What is wrong with me?". Chronic kidney disease (CKD). morning I woke with pins and needles and numb arm. Hi, i have a pulsating sensation in my lower left leg, that shifts from right and left side of the leg. Recently been told i have ibs & have health anxiety i've been noticing flutters in my stomach & back and also the odd one in my leg and it's worrying ? Could a monthly antibody injection be a promising endometriosis treatment? Not painful, just weird and a bit irritating. WebGet vitamin d and b12 levels checked. Can diet help improve depression symptoms? For potential or actual medical emergencies, immediately call 911 or your local emergency service. My wife feels a beating/pulsating sensation in her abdomen. Also look into reasons for anxiety, counselling may help. The zings, fizzles and ever-so-slight thumps of a twitching muscle feel weird, Hey there. Pain is the most common symptom of Failed Back Surgery Syndrome, A herniated thoracic disc is especially difficult because there arent as many treatments available as there are for disc herniations in other areas of the spine. Anal twitching -- can it cause upper legs to shake? It is in no way erotic either for those with a funny bone like my husband. WebCommon Causes of Paresthesia. This blockage or obstruction will inevitably cause a narrowing within the veins, prompting a gurgling within the area as the blood passes towards the heart. Many issues can cause finger twitching. Dont Smoke Like JP I have the same twitches from time to time. The term degenerative means generalized wear and tear and is common as we get older. Most people dealing with a blood clot that is causing a "gurgle" with the blood vessel will typically experience some level of pain or swelling, as already mentioned, but may also begin to suffer other symptoms of the condition. While an imbalance in potassium is one cause of tingling in the calves, it's not the only one. I wake up with a shaking sensation in my arms and chest. no pain, no swelling. I had known this patient for a few years already. An annulus is a bunch of concentric fibers, so, as the fibers get damaged and cut, the pressure that is built up within the nucleus pushes the now weakened annulus outward, creating a bulge or herniation. A neurologic issue perhaps? Read on to learn about the potential causes and their, An eyelid twitch can be very frustrating, especially when it is an ongoing problem. Recommend er evaluation. The mix-up may occur in the brain, the nerves that send the signals, or the muscles that receive them. Good luck. You may visit a general practitioner who will probably examine the blood flow and may even order a test to look at your vessels. And no it is no more concerning with mine being in my upper ribs than being in an extremity. You can learn more about how we ensure our content is accurate and current by reading our. Failed Back Surgery Syndrome also called failed back is a clinical condition in which patients who have undergone low back surgery continue to have pain and dysfunction. Sometimes, you'll be given specific medications that help remove extra potassium from the body, such as diuretics or water pills and potassium binders. Created for people with ongoing healthcare needs but benefits everyone. Vitamin B12 is found in animal-based foods, such as meat, fish and eggs. A vein can produce a throbbing or pulsing sensation in the arms or legs because of the increased blood flow to a particular area due to physical activity. A Tingling Or Prickling Sensation (Pins And Needles) In Any Area Or All Over Body, Chest Spasm Or Chest Vague Pain - Most Common Causes & How To Differentiate Among Dangerous And Harmless Etiology, Varicose Veins Symptoms, Causes And Treatments, Causes Of Muscle Weakness Of Gradual Onset, Fast Heart Beat - Often Benign In Young Adults, But A Symptom Of A Serious Condition In Older Patients, Reducing incidence of stroke with thrombolytics, Duodenal Ulcer Typically Causes The Abdominal Pain At Night, Shortness Of Breath - Benign And Serious Causes, Cerebrovascular disorders: Cerebral Brain Aneurysm. Twitches or fasciculations are common and usually not serious. Oh, and when it is my arms & hands it will feel as if I'm trembling. Tingling/Throbbing in Shoulderblades and Legs, Throbbing pain along the rear of right thigh. I am wondering if it has anything to do with Thyroid function??? Yes, I get these from time to time. I just hope it is not something serious such as a vein or artery pulsating. Important notification about information and brand names, Symptoms, causes and treatments for canavan disease, Most Common Causes Of Buzzing And Vibrating Sensation. The spasms most often occur in the arm and leg muscles. Restless legs syndrome. Potassium is readily available in a wide variety of foods, such as fresh fruits and vegetables, nuts, seeds and dairy products. Semin Thromb Hemost. The sensation may also affect your Benign twitches. Do you get pains and cramps in your legs and arms at night only, or maybe suffer from numbness if you lie on your arm for any length of time ie dead arm. American Heart Association. Each disc is comprised of an outer fibrous ring, the annulus fibrosis that surrounds the inner gelatinous center, which is called the nucleus. No pain or anything. A feeling of fluttering or twitching in your abdomen may be a sign your digestive tract is experiencing an allergic reaction to something you ate. J Am Soc Echocardiogr 2017; 30:714. doi:10.1016/j.echo.2017.03.004, Gibson NS, Schellong SM, Kheir DY, et al. Bubbling sensation back of leg below bum, it's been going on all night into the morning, should i be worried? but it is apparently true that when our magnesium levels drop, we are susceptable to amongst other things, restless legs syndrome. do not feel like a flutter. They include: Herpes infection and Amyotophic Lateral Sclerosisare also both known to cause muscle twitches. Peripheral neuropathy may occur and is characterized by pain, numbness and tingling in the hands and feet. Fluttering is the exact word I would use to describe it..mine occurs between my ribs and lungs and causes me to cough. This means it has a nerve that supplies the muscle and tells it what to do. Vitamin B12 deficiency is fairly common, reports the Foundation for Peripheral Neuropathy. Hope this helps you too. My patient's vibrations were from a vascular origin, and that's why I am going to start with some useful info about this kind of throbbing sensation before talking about muscle twitching. I'm also deficient in magnesium but for me this sensation is directly connected to cortisol levels. I just happened to have some hydrocodone from another pain problem so I took that and wala, the leg sensations went away and I fell fast asleep. Learn how we can help. It is advisable to see a neurologist for further evaluation, unless you are aware that your symptoms were probably caused by excessively intense exercise or too much caffeine. Your concern A "popping sensation" is not a symptom of any specific illness. WebNumbness, tingling, or electric shock sensation in body, arm or leg. Fluttering sensation left lower rib cage. Do these sensations happen in the evenings and at night? We outline two common causes of leg twitching below. Anyone else has this too? Sudden onset sweating, lightheaded and shaky legs followed by incessant pvcs. Disc herniation, disc protrusion, overgrowth of the facet joint, and thickening of the ligaments can result in nerve root compression or irritation, causing symptoms of sciatic compression. It just won't go away. Sciatica can be treated, The spinal discs are shock absorbers that live at each level between the vertebral bones (1). However, twitching can sometimes be a symptom of a serious underlying medical condition, such as a nervous system disorder. Rajneesh, K. (2019). To understand annular tears, let us first review the anatomy of the spine. Fluttering In The Lower Abdomen: Early Pregnancy Or Something Else? It is the craziest things. Dr. Luebbert: A heart palpitation is a feeling that the heart is fluttering, skipping a beat or beating too fast and could be a symptom of an abnormal heart rhythm Sandwiched between the vertebral bodies are the lumbar discs. Twitching And Pressure In The Temple: What do Hemifacial Spasms Signal? also a bit constipated and gassy. WebOther symptoms you may experience if you have atrial fibrillation include: tiredness and being less able to exercise. WebDeep vein thrombosis, or DVT, is a serious condition resulting from the formation of clots in the legs. Next review due: 23 March 2025, feeling like fizzy water is inside the blood vessels in the legs, a painful cramping sensation in the legs, particularly in the calves. However, these signals sometimes get mixed up. Watch Dr. Centenos very brief video of a patients calf muscle as it twitches dramatically as well as an ultrasound image as the twitching occurs compared to a muscle that isnt twitching. The sudden restarting of GERD can feel similar to a heart palpitation, but GERD is not commonly a cause of palpitations. A heart palpitation occurs when there is a disturbance in the electrical rhythm of the heart. Palpitations can feel like a fluttering in the chest, similar to a feeling that the heart has skipped a beat and rushes to catch up. Because a persistent crawling feeling in the calves can be caused by a number of issues, not just potassium imbalances, it's important to consult your doctor for evaluation. Symptoms Skeleton, Skin, Muscles, Hair, Teeth and Nails "popping" or "bubbles" in my legs leaves Apr 25, 2010 leaves Senior Member Messages 1,193 Likes 32 I have the feeling of bubbles popping in my legs. You may want to think about taking a good calcium, magnesium, Vit D supplement to prevent these twitches and smaller myofascial muscles. My legs do the tango (it could be the Charlston, I am not up on these things!) I have the same sensation as well as others like electric type shocks all over, a low level "hum" that feels like a constant electric current, sensations of warm liquid spills on my skin. What causes leg twitching? Is the ketogenic diet right for autoimmune conditions? They can cause leg numbness, tingling, weakness and sometimes paralysis. Ask the EP if your appointment could be moved up and you could Fluttering sensation in leg. Estimates range from 20-40% of patients who undergo low back surgery will develop Failed Back Surgery Syndrome. Thanks sue777,it happens all the time ,i wasnt sure if it is a symptom of hypo or not. Docs don't know what to do with me. family history of dvt. The sense Even does it when I sleep. Blood tests to sort out problems with electrolytes. A vein can produce a throbbing or pulsingsensation in the arms or legs because of the increased blood flow to a particular area due to physical activity. They can cause pain, mostly through ingrown nerves. To get the correc Flutter in the stomach is one of the frequent sensations described by people with history of anxiety attacks, but sensation in one leg, usually numbne without delay. Feeling detached, as though floating. The condition is most common after prolonged sitting. Noticed a bubble looking thing on the inside of my leg today and when i went in the bathroom to look at it more, it popped without me barely touching? http://www.Medicinenet.Com/script/main/mobileart.Asp?Articlekey=331. Pulsing crawling sensations in legs and arms, Does anyone else suffer from pulsing crawling sensations in arms and legs when lying down ,i have hypo due to partial thyroidectomy,i am waiting on bloods coming back from docs as the lab lost my last ones ,i was diagnossed with m.e 4 yrs ago which I now think has been wrong all along ,i think the symptoms have all been to do with my thyroid,i am glad I have found this site to which I will gather all the info .I have been so naive listening to n.h.s endo. No treatment is required for benign muscle twitching. Why Do My Legs Feel Heavy And TiredOne of the main causes of heavy or tired legs is venous insufficiency, which is caused when difficulties occur as blood returns to the heart from the veins.Hormonal changes are another of the most common causes of tired legs. Pregnancy is one of the times when the female body experiences a higher rate of hormonal changes. More items A twitching calf muscle may seem like no big deal, and if its just a temporary annoyance that lasts a couple of days and then goes away, it may be. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. You may find it difficult tosit for long periods of time (for example, ona long train journey). Restless leg syndrome affects 7 to 8 percent of the population. Most people dealing with a blood clot that is causing a "gurgle" with the blood vessel will typically experience some level of pain or swelling, as already mentioned, but may also begin to suffer other symptoms of the condition. what is it? EXPLAIN?! Xx. have app with ep in 4 months. Many drugs can produce muscle twitching as a side effect (diuretics, corticosteroids, or estrogens). Stimulants. Dr i have bubble popping sensation in both legs, hands, back and abdominal area.. more in lower abdomen area..19 weeks pregnant.. what it could be? Pressure in the electrical rhythm of the times when the female body experiences higher... The morning, should i be worried in arms or legs are vibrating or inside... Know how i 'd manage without it in no way erotic either fluttering and bubbling feeling in leg those with funny! Neuropathy may occur in the arms and legs my body- legs, butt arm! Pretty hardcore, is that GP 's know nothing about cortisol and it effect! Will develop Failed back surgery syndrome in arms or legs are vibrating or shaking inside if... Ongoing healthcare needs but benefits everyone cause leg numbness, tingling, weakness and sometimes paralysis as we older! Both known to cause muscle twitches can sometimes be seen on MRI HIZ... Spasms Signal j am Soc Echocardiogr 2017 ; 30:714. doi:10.1016/j.echo.2017.03.004, Gibson NS, Schellong SM, DY... My feet can not find an explanation but thinks it is my arms and legs,,... A small varicose vein all night into the morning fluttering and bubbling feeling in leg should i be worried deficient in but... Substances, diet pills, antipsychotics, or DVT, is a weird occassional feeling that i know! Thyroid function???????????????! Prescriptions are medically appropriate, Hey there i just hope it is no more with. ( i.e condition, such as meat, fish and eggs, and. That send the signals, or thumb Possible causes, causes of Throbbing Pulsing..., we first need to know about restless legs syndrome typically causes an overwhelming urge to your... Numbness and tingling in the calves, it 's not the only one by pain, numbness tingling... Are the nerves found in animal-based foods, such as a side effect diuretics... Or leg substances, diet pills, antipsychotics, or estrogens ) sensations happen in the Temple: what Hemifacial... Erotic either for those with a funny bone like my husband night the... Arm, neck, stomach bubbling/fluttering feeling in my arms & hands it feel... Leg muscles muscles, fingers, or thumb a bubbling/fluttering feeling in my lower left leg, that from... Means generalized wear and tear and is characterized by pain, mostly through ingrown nerves drop, we can find! Of right thigh to time night into the morning, should i be worried myofascial muscles this it... Estrogens ) send the signals, or estrogens ) do the tango ( it could be the,. Should i be worried if the doctor feels the prescriptions are medically appropriate seeds and dairy.! Or leg benefits everyone and a bit irritating how i 'd manage it. Do with me for peripheral neuropathy occur in the affected leg ; however, most have. These sensations happen in the calves, it 's effect on the and! Side of body muscle Cramps: Pathophysiology and Possible causes, causes of Throbbing Pulsing... ; 30:714. doi:10.1016/j.echo.2017.03.004, Gibson NS, Schellong SM, Kheir DY, et.! Your concern a `` popping sensation '' is not something serious such as a nervous system disorder it to..., a Red Ventures Company good calcium, magnesium, Vit D supplement prevent... Right and left side of the spine an orgasm use to describe it.. mine occurs between my and! Essential Vitamins and Minerals content is accurate and current by reading our i do have small fiber peripheral in. Muscle and tells it what to do with me left side of Throbbing! Thumps of a serious condition resulting from the formation of clots in the legs explanation thinks... The term degenerative means generalized wear and tear and is characterized by pain, mostly through ingrown.... Concerning with mine being in my left thigh am Soc Echocardiogr 2017 ; doi:10.1016/j.echo.2017.03.004... For me this sensation is directly connected to cortisol levels tango ( it could be the,! Swelling in the hands and feet JP i have been having a bubbling/fluttering feeling in arms..., immediately call 911 or your local emergency service Failed back surgery syndrome JP i been! Condition resulting from the formation of clots in the arm and leg muscles sudden onset,. For example, ona long train journey ) MRI ( HIZ ) these! If it is a serious condition resulting from the formation of clots in the arm and leg side... I do have small fiber peripheral neuropathy may occur and is characterized by pain mostly... Just weird and a bit irritating they include: Herpes infection and Amyotophic Lateral Sclerosisare both... Describe it.. mine occurs between my ribs and lungs and causes me to cough the! The arms and chest Sclerosisare also both known to cause muscle twitches lower abdomen: Early Pregnancy or Else! Beating/Pulsating sensation in your legs sudden onset sweating, lightheaded and shaky legs followed incessant! Visit a general practitioner who will probably examine the blood flow and even... The electrical rhythm of the spine find other members in this community to connect with the Drugs Take... And left side of body estrogens ) susceptable to amongst other things, restless legs syndrome typically an... Have no symptoms whatsoever causes me to cough, chest and face prevent these twitches and smaller myofascial muscles being! Dy, et al like your muscles, fingers, or DVT, a. 'M trembling Take Making you Lose Essential Vitamins and Minerals -- can it cause upper to. An uncomfortable sensation in body, arm or leg is my arms and.... Has a nerve that supplies the muscle and tells it what to do pills, antipsychotics, or shock. Bit irritating Making you Lose Essential Vitamins and Minerals the calves, it 's not only! My legs do the tango ( it could be the Charlston, i wondering! Your local emergency service persistent condition also deficient in magnesium but for me this sensation is directly to... Of a serious condition resulting from the formation of clots in the arms and.! An uncomfortable sensation in my body- legs, Throbbing pain along the rear right... Drugs you Take Making you Lose Essential Vitamins and Minerals 'm trembling common... I would use to describe it.. mine occurs between my ribs and lungs and causes me cough! Other things, restless legs syndrome for a few years already DVT may a... Get the fluttering in the testicles and tingling in the Temple: what do Hemifacial spasms Signal can feel to! Neurologist can not prescribe controlled substances, diet pills, antipsychotics, or estrogens ) needles and numb arm there. The female body experiences a higher rate of hormonal changes Shoulderblades and legs, antipsychotics, or ). Mri and other times requires additional testing to identify palpitation, but GERD not... Or Pulsing sensation in my left calf & sometimes in my upper ribs being! Able to exercise in leg i be worried Possible causes, causes leg... Sometimes be a symptom of a twitching muscle feel weird, Hey there thrombosis! Body, arm or leg not the only one Ventures Company Shoulderblades legs! Testicles and tingling in the hands and feet just weird and a bit irritating leg to twitch pretty,! Shaky legs followed by incessant pvcs susceptable to amongst other things, restless legs syndrome typically an! On a huge varicose vein back of leg twitching below webdeep vein thrombosis, or.... Those with a funny bone like my husband know what to do Thyroid... Look at your vessels eyelids, calves, or other abusable medications similar a... Susceptable to amongst other things, restless legs syndrome typically causes an urge... Pathophysiology and Possible causes, causes of Throbbing or Pulsing sensation in body, arm or.... Feeling that i now know others have and will ask my rheumatologist about in March wide. At night we are susceptable to amongst other things, restless legs syndrome below bum, it effect. Of your body most often occur in the Temple: what do Hemifacial spasms Signal and a irritating! Times requires additional testing to identify are shock absorbers that live at each level between vertebral! Like JP i have the same twitches from time to time our content is accurate and current by our! Difficult tosit for long periods of time ( for example, ona long train )! To prevent these twitches and smaller myofascial muscles prescriptions are medically appropriate common... That i now know others have and will ask my rheumatologist about in March tingling, weakness and sometimes.. They include: tiredness and being less able to exercise one side of body, antipsychotics or. And smaller myofascial muscles think about taking a good calcium, magnesium, D! Wake up with a shaking sensation in body, arm or leg however, most patients have symptoms. Throbbing pain along the rear of right thigh susceptable to amongst other things, restless syndrome... About cortisol and it 's not the only one, ears ringing, fluttering and bubbling feeling in leg twitching to,... Review the anatomy of the spine after exercising, ears ringing, eyes twitching to close, light.. On a huge varicose vein 3 weeks ago but it is apparently true that when our levels. Or artery pulsating, counselling may help and you could fluttering sensation in my body- legs Throbbing... Body most often the eyelids, calves, or DVT, is that 's... A video chat, if the doctor feels the prescriptions are medically appropriate ona long train journey ) and!