Athlete's Overtraining Syndrome vs. MG
 

I just wanted to write my experience here with you to share in the hope it may help others and as a way of thanks for all your kind support on this forum.

I just spent 3 days as an inpatient, the outcome of which has been a provisional diagnosis of Athlete's Overtraining Syndrome. I understand this to come under the heading of a 'functional' disorder. From what I have since read I understand that this may also be described as a neuro-endocrine condition leading to autonomic failure and hypoglycemia. This seems to resonate strongly with my situation and to a large extent, explain my symptoms. For those interested, this is a good link:

http://www.ausport.gov.au/sportscoac...ining_syndrome

The main point I want to make is that to all intents and purposes, about 85% of my symptoms closely resemble MG. However, I am convinced that that is not the case. Let me give you some examples.

Neuro exam:

slurred speech that worsens on activity, inability to smile due to muscular weakness
difficulty holding arms out in front, leading to tremor, very slurred speech and falling off of chair (this tremor has been called 'distractable')
complete inability to walk on heels or toes due to not being able to contract calf muscles
positive Trendleberg's sign (left leg collapsing at the knee), however, I was then able to stand up
convergence spasm on eye movements when looking hard left, right and upwards

Other general features:

weakness in neck muscles, leading to head dropping forward
difficult breathing, chewing and swallowing
rapidly weakening muscles on exertion
slowing of muscular activity on repetitive physical tasks
weakness exacerbated by heat
carpal spasm on blood pressure monitor inflation

I am told that my muscle weakness is 'inconsistent' and that this cannot be explained by muscle fatiguability. I was not given a scientific explanation for this so if anyone has had a similar experience I would really appreciate some help in understanding exactly what this means.

If you are somebody who is having trouble getting a diagnosis and have, as I have, historically been very disciplined and active, and perhaps at times not eaten quite enough to meet your calorific output, perhaps you should consider AOS as a possibility. I would add I don't consider myself to be an athlete.

Of course, as always, I am very interested for your thoughts and reactions.

Hi. Thanks a lot for sharing this with us! We are always looking for more clues.

I have a lot of questions, but I don't want to overwhelm you. Do you have any sort of light-headedness along with the symptoms you list below? I had the impression (but I don't really know) that feeling faint is the hallmark of hypoglycemia.

Is AOS expected to improve when the patient stops over-training?

Abby

I would suggest that you join the ranks of people like me that are too lazy to train and see if that helps. :)

Absolutely! I feel extremely faint, especially 10 minutes after eating anything containing even a remote amount of sugar, including fruit. I faint often, even when I'm sitting down!

When I asked what the prognosis is, the strange answer came:

1/3 of people stay the same.
1/3 of people get better.
1/3 of people get worse.

That's funny I thought, that sounds strangely familiar...:)

This is a little bit off the wall, but are you using any sugar free gum or other stuff with artificial sweetners in it?

Xylitol is a sugar substitute that is in a lot of gums and other stuff. It is supposed to be safe in humans; however, in dogs, it fools the pancreas into thinking that they actually ate a big bunch of sugar. As a result, the dog puts out a bunch of insulin. The dog's blood sugar drops so low that he dies.

I don't use artificial sweetners because if they can kill dogs, I don't think that they are safe for humans. I knew a person that had severe low blood sugar problems. She constantly chewed sugarless gum. She quit and it got better.

This is probably not your problem, but I thought it was worth mentioning.

"Signs of toxicity can be seen as quickly as 30 minutes after xylitol ingestion in dogs. The xylitol causes a rapid release of the hormone insulin, causing a sudden decrease in blood glucose. This in turn may cause the following symptoms:

Vomiting
Weakness
Ataxia (uncoordinated movements)
Depression
Hypokalemia (decreased potassium)
Seizures
Coma
Liver dysfunction and/or failure"

http://vetmedicine.about.com/od/toxi...ylitol_tox.htm

That's what my neuro-muscular Dr told me about Prednisone when I could barely walk. After a 40mg reduction (over a period of time) my legs returned to almost normal.
Mike

Good thought! Fortunately I've been steering clear of all processed food and sweeteners since I had the seizure in mid Dec.

However, I really am in quite a quandry over my diet. I'm going to arrange to see a nutritionist in the coming days, but my goodness I just don't know what I'm meant to eat.

I have been following the Paleo diet but having approx 25g carb every three days, which was working pretty good, except I felt very tired all the time (much more so than usual) and found I had even less muscle capacity.

However, I understand AOS is caused by low carb diet...so now I tried to reintroduce it and wallop! Nasty great agitated, slurry mess!

I'm getting a fasting blood test on Monday to see what the score is but I really hope I can work something out soon. At the moment my option is:

- no carb and more weak and tired (preferable)
- or carb and majorly worsened symptoms with risk of another seizure, which, since trying to re-introduce carbs, has felt almost imminent.

I know which one I'm choosing :(

Have you tried eating some high protein stuff? I feel much better after eating a couple of eggs. I also eat some whole wheat toast with butter to go with the eggs. (I have my own chickens and they keep me in fresh eggs.)

Thank you for your suggestion. Yes, I have been on a high protein diet for the last month and it seems to help a lot. However, any kind of regular carb for me, even if wholegrain, seems to result in a big worsening of symptoms 10-15 minutes after eating. This is difficult when the last thing I'm supposedly meant to do with AOS is go on a low carb diet...ho hum.

wild_cat, Do you overtrain? Are you anorexic?

I'm a bit speechless. Were these doctors objective while evaluating you or had they already made up their minds that nothing was wrong?

Read this, particularly Type II and V.

http://emedicine.medscape.com/article/119777-overview

I hope you do get answers, ones that are logical and make sense. And then I hope you get whatever treatment is appropriate. Like a big hug.

Annie

I don't think that I have habitually over-trained for long periods of time, but there have been (relatively short) periods (notably before the first onset of my 'ME' symptoms) that could be considered severe calorific restriction + heavy endurance exercise + viral infection. I don't think I'm anorexic, I've certainly never been underweight before.

My second major relapse was preceded by a large bout of heavy exercise (dance performance in several places in Europe in quick succession) + viral infection + back injury.

In both situations I was left house-bound and without much food for 2-3 weeks as no-one was able to give me practical help at the time with shopping, so I was essentially slowly starving.

I have hill walked since aged 6 carrying a heavy pack and in my early twenties had a few occasions where I misjudged the distance and under-estimated the quantity of food required, meaning walking up to 36 miles in one day + 5,000ft of ascent and running out of food half way through.

So, though those things were infrequent they may have been the precipitating factors. I don't consider that my doing yoga for one hour in the morning is over-training, but perhaps it is the way I go about it. It's hard for me to tell when it has been suggested part of the problem is my approach to exercise. What I do know is that I am somebody who enjoys pushing my limitations and physical boundaries, and this has been a big feature of my work as well as my free time up until getting ill.

It's also something I find incredibly difficult to let go of and I still persist in trying to do high energy activity even when I can barely walk (!). But that is by in large a consequence of the graded exercise advice I'm continually given in which I am told to always do the same amount regardless of how I feel.

I know the neuro and assessing Dr had a preconception of what was wrong. I was actually quite strong with them and very challenging to their 'functional' diagnosis. I was feeling really put out by the whole situation until I spoke to (believe it or not), the psychiatrist. He is the only person who was speaking any sense and it was him that identified this might be the problem. He also explained to me why my arm is going into carpal spasm (blood flow restriction on already severely compromised muscles). I find it extremely weird that it was a psychiatrist that gave me this diagnosis.

I have come across the glycogen deficiencies and wonder whether it could be part of the story. But I have been refused any further testing or assessment and am not under any neuro. They may even refuse the fasting test on Monday, since it is me who will be instigating it, which is ridiculous as they have never done one.

I feel my hands are really tied in this situation. What I do know is that making changes to my exercise and diet pattern may have a very beneficial effect, and the only person who is making any sense whatsoever is the psychiatrist, because he is the only one giving me scientific explanations!

:grouphug:

Well call me crazy but your symptoms definitely sound like MG, and my weakness along with most people I know does not follow a predictable schedule. I can do well one day and not walk the next. I never know how it's going to go. It is not as predictably fatiguable as the textbook describes, though perhaps on a test it might look that way.

The whole thing is starting to sound fishy.

What the heck is going on when the psychiatrist appears to know more than the doctor, and doctors think they know more than the psychiatrists?!!!!!! :Doh:

This was the sentence that stuck out for me in Annie´s link:

The disorder has a unique "second-wind" phenomenon.[9] If a patient nearing fatigue slows exercise to a tolerable level, a point exists at which exercise may be increased again without previous symptoms.

Genetic predisposition, nutrition, enviromental exposure and the stress we put on our body all have a role in every disease.

In some disease we know (or think we know) the exact mechanism and in some we don't.

No doubt that life-style changes are essential when you become ill. If you become ill it means that the combination of your genetic predisposition and other factors caused it.

As you can't (yet) change your genetics, you have to change other factors.

medications interfere with certain biological processes, but this is not enough.
Sometimes it is not even required.

It is easier to take a pill that will take care of your high blood pressure or high cholestrol, but if that is all you do, it is not going to significantly alter your risk.

The psychiatrist helped because he was the only one who understood that although some people need to be encouraged to do more exercise, others need to be encouraged to do less. (a fact which was known from the time of Hippocrates). It seems as if he was the only one that did not have the "one size fits all" approach all the others had.

The combination of vigurous excercise with lack of nutrition can be deleterious. You don't need to have a rare myopathy for that.

Viral infections many times require a longer healing time. It's like a war that has been taking place in your body and it has to rebuild and correct the damage. This was also known from the time of Hippocrates (even before the discovery of bacteria and viruses) but this wisdom was gradually lost in our "instant fix" world.

No doubt that this was very bad advice in your case.

What I want to say is this:

It seems perfectly feasible that AOS may be the cause of my symptoms. What I do not get is why this is classified as a functional disorder.

As far as I (did) understand, the argument for having a 'functional' disorder was that the cause was emotional and/or behavioural. Now, IF I have AOS, the argument goes I have a dysfunctional relationship with exercise and eating that has caused me to have physical repercussions.

If a patient who over-eats and has high cholesterol ultimately has a heart attack, does that mean the illness is 'functional'? Over-eating is, arguably, a behavioural problem. This doesn't mean (as I would argue in my case) that the over-eating/over-exercising is deliberate, it just means it's lead to the consequent physical illness. So what's the difference?

I don't 'buy into' the use of the word 'functional' and never have. The fact that there are varied opinions on what this means between physicians makes me very confused. Let me give you an example:

The neurologist who arranged for my admission said my illness was caused by an 'emotional problem' (he included ME in this category).
The neurologist who assessed me on admission told me my illness was caused by a virus.
The doctor who assessed me after admission told me that my illness was caused by back injury.

All three explanations are classed as 'functional'. This means perhaps I have misunderstood the meaning of the term. If my illness is caused by a virus, it's not caused by an 'emotional problem', which seemed to me to be the justification for it being 'functional'. If AOS is a neuro-endocrine disorder, and I have been suffering the symptoms of untreated hypoglycemia for the last three years, why is that 'functional'? Because the cause of it was 'behavioural' in the sense I inadvertently, on a few occasions, took a lot of exercise, and due to circumstance, failed to meet calorific requirements?

Hi Wildcat,

Have a look at this website
http://forums.dinet.org/index.php?/f...ia-discussion/

This covers all sorts of autonomic nervous system issues and maybe of help to you.

Rach

I know it is terribly confusing...

Functional means that your ability to function is impaired.
It is a term used when TESTING does not show organic
disease. Blood work, MRI, Xrays, etc will reveal things, and then the functional term is not needed.

It is like with peripheral neuropathy... over 100 causes of this!
But many doctors can't or won't spend the effort to find the particular one for each patient. Instead they use Idiopathic, as a diagnosis, which means unknown. Some sensory neuropathies and the pain they cause totally elude testing, and hence doctors
are not interested for the most part with patients like this.
They just give palliative treatment, meaning symptom reduction.

I will suggest to you wild_cat, that dancers are well known for obsessive weight control. Three of them lived next to me at one time. What happens is that calorie restriction often includes lower fat intake, and the good fats, omega-3s get avoided.
These essential nutrients, form the blood brain barrier (BBB) of the brain and when that breaks down, nasty things in the blood can leak into the brain thru the microscopic openings that appear.

The BBB is often looked at for Parkinson's patients. There are many papers and some appear here on our PD forum discussing leakage of toxins, bacteria and viruses into the brain that the BBB would normally exclude. Your viral illness may have traveled this route and is inflaming your brain now. People really need to rest and have adequate nutrition when ill, because once these protective barriers are breached, fixing it is not going to be likely, when the brain is concerned. The most common sequel I've seen personally to viral patients who overdo...is cardiac emergencies.
The sac around the heart can be attacked by viruses and swell up compress the heart--- there is a fancy name for this-- cardiac tamponade from fluid building up in there--- which can be deadly. My son's physical education teacher had this from training when he was ill. It was a close call for him.

You can find many many papers posted on our PD forum about blood brain barrier research. Just use the search function at the top of every 1st page of each forum.

There are many things that doctors just can't grasp yet. Either it is too complex or all the data is not in yet. But with your viral,
link in there, it seems that it should be considered.

Thank you soOOOOooo much! That is unbelievably helpful and so valuable to feel understood!!!! I don't quite know how to express my gratitude!!!

Hello Wild Cat.I am so curious and would really like to know how that ended for you.Have you become fully functional?
Just for helping you;my friend had the similar condition but years ago,maybe arround 15y ago and he healed and it took him over a year to heal.
He was doing plemty of researches and was diagnosed with neuropathy due to viral infection along overtraining.
Please answer so we could know.