Adrenal Issues

[jeremyw]

Rip

May of last year I was having good success in the gym. I was able to manage 5 reps with 435 in the squat and 5 reps with 450 in the deadlift at a bodyweight of 250 height of 6', age 40. I began developing breathing issues, shortness of breath, light headedness, and PVC's. I was drinking alcohol regularly at the time. I stopped and within a couple of weeks I lost 8 lbs. The shortness of breath alleviated somewhat along with the light headedness. I had a clean echocardiogram and stress test. A pulmonoligist prescribed inhaled steriods for the breathing issue.

The steroids initially worked, but over a period of 4 months it worked less and less well. I tapered the steroids over a couple of weeks and stopped. Then I crashed: insomnia, GI problems, fatigue, etc. Primary care doctor did a metabolic panel. Thyroid was good, but LDL was high. He was concerned about the cholesterol not the fact that I was wreck. I met with an internal medicine specialist. They checked my testosterone. It was 450 ng/dl which I would think is pretty good after a month of not sleeping.

I worked out through this process squats, deads, bench, and press, but in the past month I have had to stop going to the gym. I have no stamina. A brisk hour walk will wipe me out.

I understand this is not your field, but you have some impressive contributors.

Any recommendations for pursuing further treatment?

I intend to start going back to the gym next week. Any recommendations on where to start or what to avoid.

If this is secondary adrenal insufficiency, I was on the steroid for 4 months, any ideas about when this might resolve its self.

[Mark Rippetoe]

Have your adrenal hormone values been measured?

[jeremyw]

I have an appointment with an endocrinologist next week. I was offered a test at the internal medicine specialist, it was a circulating cortisol test, but I was feeling good at the time. I thought I was pulling out of this mess. My understanding is adrenal testing is very time dependent. Would you know if there is some test protocol I should be looking for.

[coleossus]

Don't know if this is useful to the conversation, but I developed PVCs after a period of not lifting (unrelated to lifting I'm sure - just a statement in regards to timing), and also started taking Albuterol (as needed) and Dulera (morning/night) to remedy an asthma problem.

The PVCs bothered me at first - didn't know what they were. Then one night I was in bed on my stomach playing on my phone and I had a REAL BAD PVC - instead of the gentle, occasional flip-flop it was more like a *pause*-BANG. Cold sweat all over, muscle weakness, shaking. Had one other similar but less severe experience. In both cases I could feel the episode coming on, sensation of "something bad is about to happen", then I feel like I'm about to pass out for a second, then whamo. I've had a few other episodes similar to this, with the passing out sensation, but without the thunderous thump or muscle weakness.

Ended up going to the ER like 4 times (thought it was heart-attack stuff) but after 3 EKGs, a 24-hour holter monitor, two troponin blood tests, and two complete electrolyte/vitamin blood tests (sodium, calcium, potassium, etc), blood sugar tests, a chest x-ray, testosterone levels, thyroid levels, adrenal levels, the fucking works, they told me it's stress related because all my tests are coming back in healthy ranges - overall cholesterol is low (real low), but my HDL is lower than my LDL, so I'm getting the same run-around.

I dunno, but it sounds like a lot of bullshit and I'm basically waiting to drop dead or have an episode under a heavy squat and crush myself, but for me PVC frequency lessens the more active I am. Spoke to the cardiologist and a couple ER doctors/nurses. Conclusion is that PVCs are normal up to like 8 times a minute, and without other severe symptoms, they're not concerned.

General advice I've been given: cut out the caffeine and energy drinks, be careful with stimulants (carnitine, nicotine, other PWO shit) and depressants (alcohol), keep exercising.

I'm 372#, 28, drink alcohol very infrequently, caffeine usually no more than 200 mg as part of pre-workout (sometimes more via a couple cups of coffee on the weekend), I use carnitine daily, and I don't smoke. I'm lifting in the same neighborhood - 400-420 squat/deadlift when it started, down from PRs of 465. An hour walk winds me too, but that's cause I'm fat as hell. I don't have too much trouble doing the lifts, though.

What inhaled steroid are you on and what are the dosages/regimen? It's possible you have some newly developed asthma issues. I was fine with my lifting with no inhaler until I started getting heavier and it became more and more of a tax on my cardio - started having breathing problems and consistent non-productive coughing as I started the third set of my squats, made my benching/pressing stall. That's when I went in for a full asthma eval, solved those problems.

[Greg Ruhl]

Then I crashed: insomnia, GI problems, fatigue, etc. Primary care doctor did a metabolic panel. Thyroid was good, but LDL was high. He was concerned about the cholesterol not the fact that I was wreck. I met with an internal medicine specialist. They checked my testosterone. It was 450 ng/dl which I would think is pretty good after a month of not sleeping.

Have you been evaluated for sleep apnea? I have various endocrine issues resulting from a pituitary tumor surgery and my doc and I chased endocrine level issues for a year before realizing I was just not getting solid sleep. Strenuous exercise compounds the sleep quality issue. I had a lot of the same symptoms you describe... sweats, tiredness, PVCs followed by weakness, etc. that all went away once I was sleeping better.

I would expect the endocrinologist to perform a full set of tests on you (cortisol stress test, thyroid, testosterone, blood sugar, HGH, etc.) when you visit.

[jeremyw]

I spoke to the Endo this week. The strategy was to do a morning Cortisol test and if that came back low or questionable then they would do an adrenal stimulation test. Test came back 17.6 μg/dL. Upper and lower limit per the Wiki 5-25. I think that the issue with adrenals, if there was one has been resolved. Thyroid, Test, Glucose have all been normal. I do have apnea and use a c-pap. I resumed a prescription for Trazodone this week to help with the insomnia. I will probably keep taking it until I can get my sleep pattern normalized. Honestly I feel like I could lift today for the first time in a while.

My experience with PVC's first evidenced with the Apnea diagnosis. I cannot say I am done with them yet, my heart was banging against the inside of chest 2 hrs this morning until I could get out and take a walk and have lunch.

[Aryah]

Do you ever have pain in your chest?

Do you cough a lot?

Do you sometimes cough up foamy liquid?

Do you ever find swelling in your ankles or anywhere else in your body?

Do you sweat an abnormal amount during the night?

[Mark Rippetoe]

CHF? Even the doctors would have detected this.

[jeremyw]

I do have pain in my chest.
Define alot.
I cough up some goobers sometimes.
No ankle swelling.
I have been sweating abnormally at night.

I have been to the ER twice in the last 4 weeks for bigomny and irregular heartbeat. They did multiple EKG's. Tested my blood enzymes and took chest x-rays to asses the size of my ticker. I had a holter on through last weekend to observe the PVC's. I think I may have a problem with my LV ejection fraction based upon my current symptoms and my experience preceding my apnea diagnosis. Some of the breathing symptoms have improved in the past few weeks. If things don't look better by the end of the week I intend to request another echo cardiogram. The doc is referencing a test done in August of this past year which showed 65% LV ejection fraction. My concern in requesting the echo and getting an assessment that shows substantially lower heart function is that the suggested remedy may be worse than the problem. I am currently functional and being professionally monitored. Any suggestions?

[Aryah]

CHF? Even the doctors would have detected this.

You may be surprised.

I do have pain in my chest.
Define alot.
I cough up some goobers sometimes.
No ankle swelling.
I have been sweating abnormally at night.

Do you have any spinal structural abnormality you're aware of? Do you ever have pains in either floating rib area? Is one shoulder lower than the other? Does one leg seem longer than the other?

Did you pick up a lot of weight during your gains? What would you say your bodyfat percentage is at the moment? Roughly.

250lbs is a fair amount for someone who is 6'. Usually not a problem of course if you are strong, but in some individuals with other factors present it can be. If all else fails and you're desperate for a solution, I would suggest losing weight relatively quickly and see how it goes.