To think this is not just because I’m fat?

[exercisewoe]

I’m permanently exhausted . I weigh 21 stone, I’m aware I’m morbidly obese and I’m trying to fix it .

I take a beta blocker twice a day for anxiety . I take mirtazapine before bed .

I’m absolutely fucking exhausted . I’m wearing a sports watch and can see even if I’m out of breath and sweating (walking briskly) my HR rarely gets above 80, it’s hire often just 65 when walking quickly - it usually sits at 50 when relaxing . God knows what’s happening when I’m asleep .

I’ve started blacking out when standing for prolonged periods, so GP did an ECG, fine.

Severe postural hypotension though - BP drops by 45 on standing up . I know that’s happening as I can feel my heart pounding in my head when I stand up or move quickly . The nurse I saw on Friday said she thinks I need a GP review so asked me to organise .

GP did online review via email - said it’s definitely because I’m overweight and suggested I start running - said if my HR isn’t going above 90 I’m not exercising hard enough .

I cannot physically get my HR that high .

I’ve also been advised by cardiology specifically not to run - or do intensive exercise - as there’s a small chance of me having an inherited condition, get screened for it yearly .

I’m feeling very miserable with it all and so bewildered about being told it’s just because I’m fat, with no advice other than that !

Worth asking to come off the sodding beta blockers all together?

Could be the beta-blockers.

Could be your thyroid, you could be diabetic, low in iron, folic acid, B12.

It could be because you are carrying around a lot of extra weight.

I'd suggest blood tests, if I were your GP.

You could have obstructive sleep apnoea - exhausting

How long have you been on the mirtaz? It made me into a zombie, I kept falling asleep at my desk!

They’ve done bloods five times now, they were all a bit wonky (vitamins, iron, inflammation markers etc) but GP said happy to monitor monthly for a while - said not worth treating anything as all just borderline .

Said not concerned about T2DB as checked last year and year before (have PCOS so they check quite often)

I felt fine last year and able to exercise considerably more ie walk 3 miles - and I weighed 23 stone - this feels a whole world of different and it’s hell .

Mirtaz promotes weight gain too

I was going to suggest sleep apnea. It's fairly common. You'll need a sleep study.

They did think sleep aponea in hospital 2019 but said wouldn’t treat that either ... I often wake up with a pounding headache and coughing .

I’ve been on the mirtazapine two years now, it’s very sedating yes !

The GP should be offering you more support for losing weight. Just telling you to running when you are 21 stone with multiple developing health problems isn't good enough. Plus you are at risk of developing diabetes and your risk of complications from Covid is higher.

The NHS has specialist weight management programmes and dieticians that can help. I am currently on an NHS programme supported by a dietician and have lost 4 stone over the last year as a result.

I think you should go back to your GP and press for more support and a referral to specialist services.

In the meantime I would suggest trying to walk more and walk faster to get some mild exercise into your routine.

I'm permanently exhausted and I weigh 9 stone. First I think It was mainly low iron, so I am taking shit loads of that. Have they checked your bloods? I'm almost writing myself off now as exhausted forever and I'm in my 40s. Its a horrible feeling and it's not just about weight. (I'm trying to show there are medical reasons, not gloat that I'm not overweight).

Mirtazepine made me drowsy, I switched to Sertraline. Just as effective. Might be worth a try? Suggesting you start running at 21st is a bit optimistic. Brisk walking to start with, build up to running as you lose weight.

I can only speak to the b12 but loads and loads of people are deficient in the U.K. as the guidelines that are acceptable here are shockingly low compared to most of the rest of the world.

I happened to see a different GP to my usual one about 15 years ago who was appalled mine wasn’t being treated. I had a loading dose and have been on it ever since, injected by the practise nurse. It’s the cheapest thing they can give you and it’s life changing.

They referred me to a dietician a few years ago but it was a fertility clinic (apparently that’s what’s they do for PCOS) . Discharged as she said she couldn’t help . Told there’s no other services apart from a 4 week programme on healthy eating .

I’ve been told can get a review again in May/June (said they wouldn’t support a review again before then, they don’t feel it’s needed) so hopefully by then they’ll have a bit more advice .

Hopefully the walking starts to make a difference too, it’s so frustrating - four years ago I was walking 12 mile a day in hospital job, wish I could get back to that !

Have you tried low carbing? I don’t have PCOS but several friends have found that makes a huge difference.

Sorry you’re struggling so much, it sucks

Excuse me if I'm stating the obvious here, but your GP did tell you that beta blockers will lower your heart rate and can cause postural hypotension?!

Is it proponaol?

It's not necessarily about weight (have you had bloods done?) but a lot of it - including things like sleep apnea- are made worse by excess weight. I'm also obese and trying to lose and I have to say it has absolutely helped. I doubt running is the answer though, I'd start with diet (calories). And yes the gp should be able to offer support with that it refer you onwards to support.

*propranolol sorry, my friend takes it when she feels she needs to for her anxiety, and can barely stand when she does!

Contact the practice manager and ask for a different GP in the practice to review your recent records and test results and provide a second opinion.

If you are unhappy with what one GP has said you should have a review. It may be that the answer is the same and that the answer is that it's weight related and losing weight is the fix but you need the assurance that nothing has been missed.

@AlrightTreacle

Excuse me if I'm stating the obvious here, but your GP did tell you that beta blockers will lower your heart rate and can cause postural hypotension?!

Is it proponaol?

She did - but then said on phone last week (after blacking out)

‘I highly doubt it’s the propranolol and probably anxiety and your weight isn’t helping’

DM had heart block with propranolol - HR of 33 - so I’m quite wary of it .

I was having horrendous panic attacks at the time it was prescribed though and it was sort of presented as the only/best option . Would love to come off it but suppose they’ll want to check with cardiology first . I’m due another echo this year so can maybe ask then .

Sorry I'd missed a bit of the thread. When they said your bloods were only a bit off, have you seen the figures? My gp was completely blase about my low vitamin d and anaemia for years, then luckily a dietician friend gave me some advice about supplements- again, made a huge difference which in turn gave me the energy to work on weight loss. So difficult when you are feeling exhausted.

Low Iron, thyroid or low vitamin D could all make you exhausted.

@Porcupineintherough

Sorry I'd missed a bit of the thread. When they said your bloods were only a bit off, have you seen the figures? My gp was completely blase about my low vitamin d and anaemia for years, then luckily a dietician friend gave me some advice about supplements- again, made a huge difference which in turn gave me the energy to work on weight loss. So difficult when you are feeling exhausted.

No, not seen the results - just told B12, CRP, iron, folate and vitD were all funny, but not worth worrying over apparently (counteracted by the fact I had 4 phone calls in one day to ask me to book another blood test) . I’ve had 4 further blood tests done since and just keep being told to book another.

I’m taking a vitD now, seemed the easiest one to supplement !

Common or very common side effects of propranolol:

Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; peripheral vascular disease; rash (reversible on discontinuation); sleep disorders; syncope; visual impairment; vomiting

bnf.nice.org.uk/drug/propranolol-hydrochloride.html

Your GP sounds a bit stupid to not consider it could be the propranolol. How long have you been on it and how much do you take?

My dh put on 4 stone in about 6 months on the drug with an M. He came off it for that reason alone even though it did help with his bipolar and now takes a high dose of citalopram which he is happier on and the weight has just dropped off.

Get checked for Addison’s disease. You’d need an early morning cortisol test. It won’t be done as standard. Cortisol issues can cause the heart rate issues and pots.

Also - are you possibly menopausal or near there (40 onwards). Low oestrogen can also cause similar issues. HRT can help and will protect your heart long term too - many people think they can’t take HRT when they can. Lots of fact based free resources at the Newson Health clinic website, have a Google.

Fitbits are useful for tracking heart rate, Oxygen sats, resting heart rate and the like. I know my consultant has said 'can you print out your monthly reports (I subscribed to FitBit Premium) for appointments?'. And it can help you being mindful of calorific intake. Is your watch a more advanced one than that? Or is it just a HRM?

I know that doesn't help straight away, and they are no replacement for proper monitoring, but when I can look at mine and say 'yeah, we need to vacuum under the bed as I'm snoring/my nose is stuffed up again' or 'my heart rate/sleep/temperature/whatever does this when I...' it's better than the situation you're in right now.

www.mdcalc.com/stop-bang-score-obstructive-sleep-apnea Worth a look? I’d say you are prime candidate for OSA