Why can't I exercise
 

I suffered a severe TBI about 3 years ago. Bleeding on the right side and SDH. Overall I am doing well but can't seem to get back physically. I didn't have any paralysis just some left side weakness that cleared within a couple of months.

I tried to get back to my running routine that I was doing before my accident 3-5 miles a day but I can barely run a half mile before I get hit with headaches and trouble catching my breath. Have seen many doctors and they don't have a clue. I just can't build up any stamina. Does anyone know why? Again we are 3 years out from my accident so I would think my brain has healed. I also read where others are running and almost back to "normal". I want to be that way too. I am only 23 years old but feel like I am 63 with all the body and headaches.

I do stay well hydrated and I know this is very important to help with the headaches. I had asked that the doctors do some blood work and the only thing was that my vitamin levels could be better. My vitamin D was marked low so I will supplement for that. But doctor said it really doesn't explain why physically I struggle to get back to the form I was.

Any suggestions would be appreciated.

Stuck in Boston

First I would guess that you are going to have to set a goal for yourself.
Not the 3 miles you used to do. But even say the 1/2 a mile you can
do before the headache comes on. I would also look into a exercise program
that does things that will help you get into shape without the running exactly.

It also might be that the sun is helping with part of the problem with the
headaches. So you might try different parts of the day. Do say the 1/2 mile
then stop till the evening.

I am trying very hard to get back to my exercising at a gym myself.:grouphug:

Donna

with an injury like that, people see headaches with returning to activity. i think it's due to vascular spasm in reaction to the increased pressure. in theory, taking a preemptive indomethacin or ibuprofen should help, but people have a limited response to that. a blood pressure medication that works on the calcium channel--namely, amlodipine or verapamil--should be effective as they prevent vessel caliber fluctuation. talk to your doc about these options.

Thanks
 

Just wanted to thank you for the replies.

I have tried setting goals. I gradually have tried to increase how far I run but can't get past the 1/2 mile. I do work out in a gym but even there I can have headaches after lifting.

I have told the doctors it feels like pressure headaches but their words of wisdom is to just stay hydrated and that medically there is no reason that I should be having these issues so far out from my injury. My response to them was, OK I understand that, but I am having these issues and I really want to stay active but it is getting harder to push myself, then be down for several days trying to recover.

The spasm thought is interesting. I think the last doctor is going along those lines. He stated that he feels that my brain's autonomic system is struggling to keep up when I run or workout but he wasn't 100% sure that is what was going on.

I am 6 months out from my head injury. Right after my injury, I was able to snowshoe, etc. For the past 3 months, I have been unable to work out very hard. I definitely cannot run. After just a few steps, my head is hurting. I have been trying to ride bike and do the elliptical, but I think weight bearing is important - just can't do it. I also try to lift 2-3 days a week, but find that the day after I work out I am exhausted and can't work out the following day. I don't know what it means to work out in moderation. Stationary biking does not do it for me. I even have a hard time while riding in a vehicle due to the bumps.

I have told my neurologist about this and she doesn't seem concerned at all. I never would have guessed that a mild injury could cause this kind of frustration.

That is what I am dealing with. I can work out but then the next day or two I feel like crap. I have a meeting with my doctor next week and I hope to try to get them to explain why. I have pretty much stopped running and my workouts are shorter with less weights.

If you ever come up with something please let me know...

Any injury to the CNS can take years to heal to an acceptable level. When I realized that I was losing my back muscles, I exercised by using a rowing machine. I eventually lost the use of all my paraspinal muscles but found that I had unwittingly increased the power of other muscles which took over the load.
One thing I used to do was to find out where the "top" was. I exercised until I thought I had "gone over the top", then remembered not to take my exercise that far in future. The CNS will repair at its own rate and cannot be forced by excessive exercising (despite what you see in movies).
Always bear in mind that Dr Kildares are figments of authors' imagination. In real life, Doctors know very little of the human nervous system and can only offer opinions.
Subtle cerebellar signs quickly disapppear due to central compensation, but that does not mean the problem has disappeared. Unless one has actually suffered from a neuro problem it is impossible to imagine what a neuro problem entails. Those very young, fit Doctors, can in reality have no idea at all what a neuro patient is suffering.

Well the doctor visit was just like the others...really no clue. He said that the MRI came back clear so they really don't understand why I am having this issue. He made the same suggestion that I should find my limitations then work from there. He did say that once the chemicals in the brain get messed up they might never be the same again.

So from the stand point of the scan I have healed...why don't I feel that way. This has to be one of the most frustrating injury (actually most serious) that I had to deal with. I did have to laugh at one point, he said it is just all in my head and that I was fine. I said yeah I know it is all in my head.:winky:

He wants to see me in six months, at this point I don't see him helping so probably won't return.

I decided that I am going to see a friend of mine who is a doctor to see what he has to say. I figure he will be straight-forward with me about what is going on. We were on vacation last week and I suffered from a headache the whole week. One day I wanted to play tennis. That lasted about 1/2 hour before I had to quit because my head was just throbbing. I tried it again another day and experienced the same thing. One day I was getting on a tube to just lay out in the sun. While getting on the tube, my head hit and I could just feel my brain go from front to back. Our town has round-abouts and I can't even go through those without feeling like my brain is moving from side to side. I understand the frustration. I was taking between 6-9 ibuprofen a day. That's not right. I guess I don't really know what I am looking for. My headaches are what they are, but I really like to be active and this is putting a huge damper on that. My family doc thinks I am depressed, the psychiatrist says I'm not depressed. The neurologist says that symptoms could last up to 6 months. I am going on 8 and still have the symptoms and sometimes worse than they were a few months ago. I wish I could get back to "normal" but from what I read here that may never happen.

Those of you who complain of headaches when you do any exertion should go to the drug store and buy a blood pressure kit. They are very affordable and can be used to determine if your headaches are blood pressure related.

I believe every home should have a blood pressure kit. They are very easy to use. There are semi-automatic kits where you have to pump the squeeze bulb and full automatic kits that inflate automatically.

Walgreens has a semi-automatic model for $39.99.

Buy one and learn to take part in your own health care.

Mark,
I do have one of those machines and have been bringing up to my doctor that my blood pressures seem high after I run. They are in the 200's. I had a stress test and my highest pressure was 220/54. They said that was OK. They also said that my VO2 level was low and that I was just out of shape. When asked how I can build up any endurance with the headaches and shortness of breath they said that to just take it slow. 3 years later I am still taking it slow but still can't build up any endurance.

One of the suggestions was that the brain autonomic system is not responding to the increased in blood flow etc. when I am running or lifting weights. They said there is nothing they can do for that. I just had some blood work done and my CO2 level was marked high but doctor said it wasn't high enough to be causing me any problems.

Thanks for your reply and I will keep checking the blood pressures and heart rates - maybe something will show up.

A BP of 220/54 does not sound right. The 220 is extremely high. The 54 is extremely low. What was your starting BP? How was your head ache at that high BP?

What is your normal resting BP?

Mine is about 115/65 to 120/75, give or take.

When my BP spikes, it can hit 195/155.

I was asking what your BP is when you have a head ache as compared to resting. That will help you understand if your head ache is BP caused.

If the diastolic was accurate at 54, it says that your vessels stretch and dilate well. That is usually a sign of good vascular health. This vascular dilating can cause head aches.

MdotDdot's comment about a calcium channel blocker to stabilize vascular size may be worth a question to your Doctor.

Maybe you need to exercise more often so your fluid pressure in your brain normalizes to the BP effects.

I exercise and a lower heart rate and BP for 45 minutes or more. I don't know my pulse or BP but my respirations are probably around 25 to 30 per minute.

Since my accident my BP pressures have been running around 136/65 or higher. When I was in ICU my pressures were running very high. My heart rate NOW is always in the 50's.

Before my accident my pressures were in the 110/70 range and my heart rate was in the 60's, low 70's (All of these numbers are at rest). Until I am constantly in the 140's my doctor will not put me on medicine. I told him I would really like to see my systolic pressure <130.

On my stress test my starting blood pressure was 133/70 and I was told they expect the systolic number to go up and the diastolic to go down as mine did. So they said everything was fine. It took me a week to recover from the stress test. I felt like I got hit by a truck.

You wrote: "Maybe you need to exercise more often so your fluid pressure in your brain normalizes to the BP effects. "

I would if I didn't feel like someone was hitting me in the head with a hammer:)

I see a new neurologist in 3 weeks and I will bring up the calcium channel blocker. Maybe start out on a small dose to see if it helps.

Thanks again for your reply Mark - hope all is going good for you.

SIB

Look up adrenal cortical hyperfunction. You might find something to take to your doctor. Look at how epinephrine and norepinephrine are supposed to function. These important functions can be disrupted by a brain injury. Norepinephrine can cause an increase in blood pressure.

There is a class of drugs called SNRI's. Selective Norepinephrine Reuptake Inhibitors. I don't know if they help with this kind of problem but it shows that they can manipulate norepinephrine.

Adrenal Cortical Hyperfunction can cause emotional outbursts (lability) and other stress reactions. I believe it is the cause of my 195/155 BP during stress situations that overwhelm me. These are usually brought on by too much auditory and/or visual stimulation.

I have propanolol (a beta blocker) in the cabinet as a back-up in case I have a difficulty getting my body to relax and recover.

Mark,
Thanks for the information. I will head out to the WWW to see what I can find. Is there a blood test that they could do to test these levels? (epinephrine and norepinephrine)

I don't seem to be able to handle stress like I use to. It seems the littlest thing can set me off or I will have the reverse reaction. Something I should be upset about I have no emotions towards it. Weird. This really hasn't helped personal relationships either.

Thanks again and will let you know what the Doc has to say

Google search the neuroscience corporation (also known as neurorelief). They, by way of saliva and urine, test you neurotransmitters and adrenal function. Personally, I had mine tested and it showed that I had crashed my adrenal glands -from all of the stress of going through pcs- and that a number of neurotransmitters were out of balance. They are now putting me on natural adrenal support therapy and a couple of amino acids - precursors to the neurotransmitters - to try and get things back into balance. FYI: you don't go directly to them for this, they refer you to a practitioner in your area that has an account set up with them - you can search for one on the internet. If you can't find one in your area, you can print out information to deliver to your current doc and try and go through him/her. Also, if your adrenals have crashed, I would highly recommend not going on any conventional medication - such as pregnalone or prednisone - these drugs are the worst drugs on the market and cause more harm than good to your body. Definitely try the natural way first with this one.

Disclaimer: I haven't used the amino acid or the adrenal support stuff yet, so I'm not sure how its going to work out. I'll definitely let you know in a month how things are going though. This is all very new science right now, but does show some promise as a therapy.

Hi..haven't been to this board in months and doing well. Your question got my attention as working out was an important part of my recovery measurement - that is, can I work out the same way I did before?

After several failed attempts on my own to get back to working out, I finally signed on with an agency that helped me surrender to what I needed to do. And that was basically, start over and go slow. Like a stroke victim that needs to relearn certain things, I found my brain needed to relearn how to cope with workouts again (increased vascular activity and balance were the big issues for me). I started VERY slowly with cardio and weights, increased VERY slowly and always stopped at any sign of headache. It took several months, but I am now pretty much back to the level I was at before.

I can't stress enough that you have to surrender to healing and coming back slowly to things you did before. Every time you push to hard, you start over. That was a tough lesson for me. Even now, I have to watch it - just like most of the posters on this board. Good luck.

That is exactly where I am at...can I do the things now as before. Exercising is the last piece of the puzzle but seems to be the hardest piece to make fit. Like you said, if I push to far I can be set back days - if I don't push myself I feel that I am not getting any benefit from the exercise. Which then just triggers my frustration level.

Got a call earlier this week and the new neurologist can see me sooner. Really don't think he is going to have anymore insight but will try one more, then I am done with doctors.

Just wanted to let you know that doctor wanted to test cortisol levels and mine came back low. He said that could be why I was struggling to exercise. Anyway need to go back and have another test and then decide from there.

Have not really been feeling very well with fatigue, nausea, lightheaded that is why he wanted some more blood work. Also my vitamin d has dropped again so looking to add a higher dose.

Amazement
 

Just a note to say how very, very much I admire those of you trying to continue work out regimen following TBI's. My hat is off, and I salute you. I wish I had more to offer, but I gather that jiggling the brain about following tbi, even remotely, can cause pain. Running, therefore, sounds risky for H/A. Congratulations to all of you! billie

Thanks,

Its more that we need to show we are alive I think.

Donna:grouphug:

StuckinBoston,

Re: Vitamin D,

Has your doctor told you that you need to increase your Vit D for months before it starts to show a difference.

Just FYI

Mark they didn't really tell me what dose to go to - just increase. I didn't get the impression that they were overly concern about vit.d. More that this was an observation from the blood work being marked low.

I have gone up to 5000.

Mark or anyone else do you know anything about stim test results? It looks like my adrenal glands might be struggling but drs. seem to think they are OK. After the stim test there was basically no reaction from the adrenal glands to the stimulation. Dr. said that was OK because the cortisol level was high to begin with.

Doesn't sound right to me...