When there are no answers…

I have an inquisitive mind. My husband will tell you that I ask lots of questions. I will keep asking questions until I find answers.

When there are no answers, I suffer silently. I scour the internet, hoping to get a concrete response.

Sometimes, I need to accept with grace and patience that I may not get answers, or they may not come for a hot sec.

A month ago I got in touch with my functional health doctor (who also happens to have a family medicine degree) who follows me for diet and lifestyle changes that help my Hashimoto’s. I was frustrated that my metabolism is not moving, in spite of my training for an Olympic triathlon. I have also been quite tired. I realized that could be the training, but also thought my new thyroid meds that I had started in September might need adjusting.

We talked and she decided we should run labs both for my thyroid and hormone levels to check adrenal function. It took 2 weeks to get the results as her office sends them to a lab at Northwestern, in Chicago. Their price is cheaper than my copay with insurance at our local hospital, which says a lot about our healthcare system.

I eventually got a call that there were abnormalities. But not with what I had expected; my thyroid levels were all well within the normal range apart from my TSH. My hormones were dangerously low–so much that she recommended me seeing an endocrinologist to get a work up for Addison’s Disease.

Even with a referral, I can’t get seen in endocrinology until June, a week before my Olympic distance triathlon in Grand Rapids, MI. I immediately started digging around to see if I could understand what might be going on. If I do have Addison’s, I would need to be on cortisone (prednisone, most likely) for life. I would need to adjust the amount if I were to continue to do triathlons or endurance sports (and people do.) With Addison’s disease, your adrenal glands stop producing hormones that you need to function. This can be due to an autoimmune disease where your own body destroys tissue like Hashimoto’s, or a malfunction of the pituitary gland.

If I don’t have Addison’s, what the fork is going on?

I have many of the symptoms–super low blood pressure, salt cravings, frequent dizziness and fatigue. But some of those are associated with Hashimoto’s disease, too.

I asked my family medicine doctor if we could run more diagnostics before I get in to see endocrinology. My functional medicine doctor told me to only exercise 30 minutes a day, so we dramatically reduced my training load last week. I am worried about whether my body can actually make it to my Olympic Triathlon on June 13.

She prescribed more labs, and low and behold, my ACTH and Cortisol were back to normal. Although that was a relief, I still have so many questions. A visit with family medicine confirmed that the results were a good sign that I don’t have Addison’s, but don’t explain my other results. Were my low levels caused by too much exercise? Is it duration or intensity that caused them? What are signs that I am getting in trouble and I need to stop immediately? They were puzzled as overtraining usually causes your cortisol to shoot up, not be depleted.

Working with my coach, we have been careful to design my workouts so that I always have 1 high intensity run and bike per week (think speed intervals or VO2 max intervals,) one medium intensity run and bike and one long easy workout on both (60 to 90 minutes run or bike at all day effort.) I am on a 3 week cycle–2 weeks building, one weeks recovery with very little intensity. I think this has been actually more manageable than the past when I might do 30 minutes high intensity per day. I always have a rest day in my week.

Family Medicine could not answer any of my questions. They are not sports specialists, or endocrinologists, but were sympathetic to all my questions, like, ” I wonder if most endurance athletes have spikes and lows in hormones, but they are not just tested? Was this a fluke?” I wonder if this could be related to menopause and exercise, or the fact that I got my second Pfizer shot several days before the blood draw. My doctor has referred me to a family medicine/sports medicine doctor who specializes in exercise that I will see next week, so a month before the endocrinologist. These questions are so physiological that I’m not sure anyone but an endocrinologist with knowledge of endurance sports can help, but I’m trying to remain hopeful that I will get some guidance.

We have taken off one run and one bike per week for now, and I have promised my coach to really listen to my body and stay on my electrolytes. I had started swimming last week after being fully vaccinated, but my physical therapist suggested waiting a week due to some residual left bicep tendon pain. Both shoulders have acted up in the last year or so, and things were feeling a lot better, but swimming triggered some pain on the left side.

My mind is active. It is not easy for me to rest and wait. I wonder if I should cancel my Olympic tri, but I tell myself to just proceed with caution and wait for more answers. The internet may not have answers, as we are all unique, with bodies that react to stressors differently.

In the meantime, I can practice patience and let my body rest and heal.