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Compulsive or automatic leg tapping may not be a big deal for those who do it but can be extremely irritating for those who live with or sit near tappers. One or both legs can tap, wiggle, vibrate, or shake. Nerves or anxiety can also cause our legs to shake and tremble.

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Why do people tap their legs? It could be due to boredom, to help concentration, a form of distraction, comfort, coping strategy or simply a habit. It can also be due to a medical condition known as restless legs, in which case it is advisable to speak to the GP.

Why does anxiety cause our legs to shake? The anxiety hormone adrenaline gears our body up for action (known as the “Fight or Flight” response) creating instant energy. This can be likened to a car being revved with the handbrake on and can be experienced as feeling jittery or trembling.

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What are the positive and negative effects of leg-tapping? Any physical movement can help to disperse nervous energy. Tapping or other repetitive limb movements can provide a meditative focus and feel soothing as well as distracting.

How can leg tapping be reduced? As most stress and anxiety driven leg tapping is automatic and unconscious, bringing it back to conscious awareness can be helpful. Mentally noting “I am aware I tapping my leg again” and checking in with feelings (“how am I feeling right now?' ... 'what is it I need?') and choosing to do something else can be useful. Regular relaxation practice can help to reduce the level of background stress which drives the tapping behaviour. Things like using a mindfulness APP such as Headspace, practicing deep breathing, taking regular meditative exercise (eg. walking, jogging, swimming) and the progressive muscle relaxation technique (where each muscle group is deliberately squeezed and released) can help. Expressing our negative feelings to a loved one or counsellor can help reduce built up emotions whilst enjoying a hug with someone we like releases Oxytocin which can act as an antidote to adrenaline.

If you find you are becoming annoyed because of someone else’s leg tapping what can you do? It is helpful to consider our own stress and tolerance levels if we are becoming annoyed with others tapping their legs. It can be useful to ask ourselves 'how am I feeling?' ...'Is it me who needs to sit still and relax?' If the other person who is tapping wishes to stop or reduce it, and has agreed, it can help to bring it to their attention back into conscious awareness by saying “I notice you are tapping your leg” so that they can choose to do something else. Alternatively, we can choose to distract our own attention away from their legs by looking elsewhere, moving away from them or going and doing something else.

A few months ago, Arav Gupta replied to an advertisement on our Facebook page – Sea Shepherd were looking for a Ships Medical Officer to support an offshore campaign against illegal and unreported fishing (IUU) in Gabon. He took some time out of his busy life onboard to tell us more about how he got involved, the lessons he’s taking from this incredible experience and how it’s changed his outlook on life…

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It was within touching distance. Four years since that first taste of expedition medicine on my elective and my FY3 was running as smoothly as I could ask for; I’d finished a fantastic ICU fellowship and in front of me stretched eighteen months to dive into expedition medicine before speciality training began. Countless emails had landed me four trips which had me beyond excited for all the adventures around the corner. Then, the Pandemic arrived. And just like that, a meticulously planned year was looking more unsure than Dominic Cummings’ eyesight. With my trips cancelled, it was back to the upsettingly empty drawing board.

I was on the verge of accepting a fellowship that in truth my heart wasn’t set on when in landed an email containing the most leftfield job offer I’d ever received: the chance to work as a Medical Officer (MO) with marine conservation charity Sea Shepherd Global. The mission? An offshore campaign against illegal and unreported fishing (IUU) in Gabon, an equator-straddling nation on the Atlantic coast of Africa. I’d applied in response to a Facebook post advertised through World Extreme Medicine (WEM), never considering I may actually get the gig. I had to do some reading…

Sea Shepherd has earned a reputation since their foundation in 1977 for their fearless and direct approach to defending marine wildlife from illegal whaling and fishing activity across the world, from the sweltering equatorial Atlantic to the unforgiving polar Southern Ocean. If you ever watched Whale Wars on Animal Planet you’ll be familiar with their historically confrontational methods. They’re not without controversy, but if recent societal issues are anything to go by, tangible progress is driven by radical change, and Sea Shepherd’s results are quite phenomenal: for example being the major player in the cessation of Japan’s whaling programme in the Southern Ocean. It was an offer I couldn’t refuse.

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Fast forward a fortnight and I was already in the port of Las Palmas, Gran Canaria, where the M/Y Bob Barker, a former Norwegian whaling vessel and my new home, had been moored throughout Spanish lockdown. After a short quarantine, it was already time to get on board. The twenty-something crew I would live with are a community of passionate volunteers from all walks of life who have perfected the constant process of maintaining their 55-metre queen of steel fit for purpose. Many fit into dual roles on board and I am no different, working also as a Quartermaster, which involves a nightly watch on the bridge of the ship (the equivalent to a plane’s cockpit but with binoculars instead of aviators).

And just like that, we were at sea. I had assumed (I thought quite reasonably) that I had turned my back on night shifts for some time to come. How wrong I was. Every night begins at quarter to midnight when my alarm goes off in the cabin following an hour’s kip. As I pull my shoes on, I imagine they’re Jon Snow’s and whisper “Night gathers, and now my watch begins” which hypes me. The stairwell to the bridge door is steep and eerily illuminated by a flashing red light reminiscent of a post-apocalyptic Call of Duty map. At the top, a heavy door opens into the wide bridge and my pitch-black watchpost for the next four hours. My time is spent studying the matrix-green radar, plotting our coordinates on the charts and keeping vigilant for errant fishing vessels crossing into the marine parks. It’s not difficult to imagine that we’re pushing new galactic frontiers when the windows are shut and the bridge is silent. There’s no time for caution. I’ve even learnt how to steer and hope to get signed off on some basic proficiencies before I go home. On my fourth night, muscle memory had me relieved that it was my last night. I then realised these aren’t ICU nights, and there are no zero days here. This is my routine now and will be every night while we’re at sea. The constant fine tuning and elements of risk management has me drawing parallels with anaesthetics and ICU, as does the regular data plotting. Perhaps that’s why the watch so far has been an oddly satisfying experience.

Of course, my main role is that of the ship’s medical officer and I’m lucky that there is a nurse-turned-deckhand on board too. On arrival, I was surprised to find out we’re stocked with full capabilities to intubate a casualty! Initially, this made me nervous, but I’ve since reflected that equipment present does not necessitate use, and if I’m not trained to perform certain procedures at home, I need to know my limits here as well. Furthermore, what would be the post-intubation plan without a ventilator?

Speaking of ventilators, let’s discuss a good old pandemic. Have you heard of Covid-19? It’s a virus that grows on 5G masts and dies if you drink bleach. My one reservation in working with Sea Shepherd presently was of course Covid-19, a virus I’d had the pleasure of befriending in ICU earlier this year. My short notice arrival was partly due to the NGO’s desire to have a doctor on board to enact Covid-19 precautions and in the worst case, manage an outbreak. I already had access to a comprehensive risk assessment of crew activities, a safety protocol for boarding fishing vessels and a large supply of PPE. For all the paperwork in the world however, reality has an uncanny way of playing against the rules.

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At the end of our two-week transit from the Canaries to Gabon via the pirate-infested Gulf of Guinea, we arrived thirty miles outside the port of Libreville. Under the cover of darkness, we dispatched our two RIBs (small powerful mercenary boats that we use to board vessels) to collect six marines and four government officials from shore. We were told they had self-isolated for two weeks and would have negative Covid-19 tests. As the ships medical officer I am on perpetual standby and was woken up at 2300, quite literally the 11th hour, to come to the bridge.

Our initial information was that one of the marines due to board had tested positive and had been sent home. They had all travelled to the clinic in the same vehicle. The RIBs were already in port, loading up the other nine. A myriad of questions was flying through my mind, trying to ascertain level of exposure, test details and RIB logistics. Should we allow boarding? Why had this information only just arrived? At some point during the meeting, a call came through with more intel: it was a serology test. A collective sigh of relief from the others in the room but my suspicions were still raised – why had he been sent home based on a serology test? I also realised we still didn’t have the PCR results for the rest of the marines. After a prolonged brainstorm with incoming drip-fed updates, we decided to radio the RIBs to leave the marines in port and delay collection by a day until the PCR results came through. We finally got through to them after several attempts when they were already one mile from shore with the marines already on board. To add to that, one of the RIBs then broke down and was finally recovered at 0430. Talk about Sod’s Law. Luckily, a full house of negative swab tests was received the following morning and a significant campaign delay was avoided.

Living offshore is the ultimate amnesic for Covid-19 and the night’s proceedings had served me a hefty slice of reality check pie. With our Gabonese colleagues now on board, patrols and therefore vessel inspections were soon underway. Illegal fishing vessels in the area are often crewed by multiple nationalities, both local and from afar. Language barriers and working conditions mean it’s virtually impossible to guarantee their Covid-19 status. With an ethos of “control the controllable”, we’ve taken doffing to a new level, converting the bow into a hot zone for decontamination upon return to our ship after boardings. It’s not perfect, but expedition medicine by nature isn’t.

A successful expedition medically is one where I have to treat very little. Minor illness is however inevitable and I’ve managed presentations that would be common in primary care such as pompholyx, sciatica and stubborn traumatic olecranon bursitis. Exciting as malaria prophylaxis and hand hygiene are, every medic relishes the idea of having a slightly hairy situation to manage (The chest rash doesn’t count). There have been flashes of so-called expedition medicine: Removal of a chigoe flea (Tunga penetrans, a local parasitic insect) from a beneath a toenail and a swim stop resulting in stings from a mop of wayward jellyfish filaments come to mind, not to mention plenty of seasickness. Awkwardly, the most acute injury was my own, crushing my finger under a rung of the rope ladder back onto our ship after a boarding, held down by the full weight of the RIB below me. Thirty seconds of increasingly loud calls for the RIB to move away left it numb and misshapen, but a buddy strap and time has done the job – it could have been much worse!

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The pace of life onboard has created more personal headspace to think analytically about processes around me, often using past NHS experience as a comparison. One of the most eye-opening experiences so far was less to do with human medicine, but rather human factors, the bane of junior doctor teaching that I never thought I’d admit an interest in. Human factors describe the infinite number of psychological and behavioural influences that allow a group to work efficiently and safely towards a goal. In healthcare, we often learn about it in the context of aviation and how recognition of human factors has made the industry many times safer in recent decades.

One muggy evening the call came down from the bridge: a live net had been spotted in the water. It was the end of a busy patrol day, several crew had been out in the RIBs for hours and were exhausted. It had just started to rain. It was one hour till dark. Insert pathetic fallacy here. Nevertheless, within minutes, most of the crew were out on deck peering over the bow at the fishing buoy. A snappy decision was made to snare the line and retrieve it. Fast forward ten minutes and I felt as if I’d been transported to a Sunday fish market. Our crew of passionate volunteers was hauling up the line, large eels hooked on at one-metre intervals – alive. Two crew members experienced in marine biology became impromptu surgeons, using pliers and tweezers in the fading light to remove hooks and toss the dazed fish back to the murk. It was noisy, dark and chaotic to say the least. I had a strong sense of too many cooks and decided to take a step back to process what was unfolding in front of me. We had a fishing line of unknown length (it turned out to be nearly 5km), innumerable fish waiting to be hauled up, a team of variable experience and no overriding plan.

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“Unsustainable” sprang to mind. The mammoth effort for me was summarised when instead of an eel, the next animal on the line was a hammerhead shark. It was devastating to see such an iconic and majestic creature, a species I’d spotted swimming freely earlier that day, dragged up on several hooks. It was immediately clear that the poor shark was dead, yet precious time was spent removing the hooks when it was futile. The crew were mucking in with admirable enthusiasm, but I couldn’t help but compare it to my experiences at in-hospital cardiac arrests. There, the team leader is trained to step back for perspective and allocate roles to staff. This helps team members avoid the trap of getting sucked into tasks that they may be comfortable with but are counter-productive. I headed to the bridge to relay my observations. If this were a terrorist attack, we were doing the equivalent of randomising all victims into a queue and treating the person at the front with all our resources, regardless of injury severity and blind to what was coming next. Mass casualty triage is a nightmare scenario for any expedition medic and one that requires a head-not-heart approach. With a crew of dedicated conservationists who care so much for ocean life, this was the real deal.

Eventually, the focus started to change and the approach became more systematic, perhaps in part due to the thoughts I relayed to the captain, but mainly due to the innate gravity humans have towards order and improvement. Our approach became more rational, prioritising faster line retrieval and humanely killing eels with hooks embedded too deep, ending their suffering and enabling us to remove the lethal snares rapidly. In this way, they could be returned to the sea to become safe food for predators. When the line finally became stuck under our hull four hours after it was spotted, it had to be cut and left to sink to the ocean floor, sadly condemning all the remaining anonymous animals to a slow demise.

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The whole experience was an exponential learning curve for us all. This was my first time at sea, I told some of the more experienced conservationists the next day. I don’t know how to retrieve nets or operate on fish (or for that matter people!) but I have had human factors drilled into me once a month for 3 years (a slight exaggeration). If this or any new challenge were to arise again, a step back and a deep breath before diving in would do wonders for our work. I’ve often said that my mantra is “there’s always time.” Normally, that refers to my chronic refractory FOMO and wanting to say yes to everything that comes my way. Now, however, it took on a more salient meaning. Even in the most headless of times, there is nearly always time to step off the gas, stick your head into neutral and apply a little handbrake to your situation. It may just be the headspace you need to save a fish.

The illegal line retrieval has so far been a one-off occurrence, although for some Sea Shepherd campaigns ghost-net recovery is the focus of the mission. The crux of our work in Gabon is the international issue of illegal, unreported and unregulated (IUU) fishing. This umbrella term refers to activities that contravene fishing and conservation laws, including unlicensed vessels, improper management of bycatch (unwanted species such as sharks, cetaceans and turtles) and falsifying records to maximise revenue. These processes destroy ecosystems and have brought hundreds of species to the brink of extinction. Incredibly, some sources suggest that 25-40% of global seafood catch could be traced to the IUU industry. In recent years, Sea Shepherd has been working collaboratively with several West African governments in Gabon, Benin, The Gambia and Liberia to assist them in enforcing their fishing regulations. Gabon’s laws are strict compared to its neighbours but enforcing them in the open ocean is a tall order. By providing our ship, crew and experience, we help to facilitate law enforcement through fishing vessel inspections and making arrests when appropriate. At our campaign’s half-way point, we’ve made two arrests, detaining a pair of trawlers caught with nearly one tonne of illegally finned rays and keeping endangered species for commercial use. I recently read a BBC article that this year’s closure of Southern African safari tourism has led to increased poaching activity. I can’t extrapolate to West Africa’s coastal waters, but what is clear is that the pandemic has not stopped marine poachers from recklessly damaging this fragile ecosystem. That said, our overriding approach seems to be working; this is our fifth year in Gabon and the number of illegal vessels caught annually is showing signs of decline.

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Without a doubt, this year has been a force for reflection for the majority of us. In a year where no one’s plans have come to fruition, we’ve had a rare opportunity to stop and reevaluate what’s important to us in our lives and how we interact with the world around us. Back in January, I was off skiing when that flurry of offers for expedition medicine jobs came through. I arrived in France with one and left with four – I couldn’t believe my luck! In the last months, four became three, two, one and then finally none. I’m extremely lucky to have replaced them with this incredible conservation campaign in Gabon, a trip I could have neither predicted nor committed to if Covid-19 hadn’t reared its ugly head.

The silver lining has got me thinking about what I’ve lost and gained: I’ve missed out on adventure tourism trips to Kilimanjaro, the Amazon and the Himalayas but found an eye-opening replacement. As well as the very nature of the campaign, living with others who care so much about our impact on the environment has got me thinking about the direction I want to head in with future expedition endeavours. Adventure tourism can be one of the most exhilarating ways to experience a country’s natural landscapes, but also bears the risk of damaging them and their inhabitants.

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All companies recognise this and go some way to mitigating these risks, promoting the idea of eco-tourism, sustainable development and fair treatment of local staff. Some do this better than others, and in the future, I will be doing more to sound these attitudes out before committing to a trip. Life at sea and long discussions with my officer have also prompted some thoughts about pushing out into the world of humanitarian medicine. Her long-standing work with Sea Watch is inspirational. It’s an NGO committed to rescuing stranded migrants in the Mediterranean and will certainly be getting my look-in. Pushing my own career is possible while minimising the negative impact on the world around me. Not saying I’ll be going vegan, but it’s food for thought.

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Last week I persuaded Spotify to work and had the pleasure of listening to a WEMcast interview with adventurer Anna McNuff. I related to her story immensely: Her rowing career took her painfully close to Olympic selection, reigniting memories of my experience with the Oxford vs Cambridge Boat Race whilst at medical school. After this ‘failure’, she stepped back and reassessed what was fulfilling her in life, finding a new direction through her legendary human-powered journeys. She had some very thought-provoking ideas about how so much of what we do nowadays is goal-directed while focusing little on the journey – the idea that the end rather than the means will bring us happiness. She ventures that if you surround yourself with experiences and people that make you happy, your end-game may be unknown but it will inevitably be a good one. It has to be a balance of course, especially in medicine where so much of what we do is goal-focussed and there are so many boxes to tick. But it’s hard to shake Anna’s reflections, which is why after this two month whirlwind of new adventure, I’ve decided to extend my time here by a month.

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Who knows where it’ll take me, but I have no doubt it’ll be a whale of a time.

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