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?

I was prescribed propranolol for panic attacks (they were so bad, I ended up in an ambulance). But I was told only to take one if I felt a panic attack starting. They work fast enough that they'll stop it in its tracks. Were you told to take them every day?

These days I manage fine with just Rescue Remedy, and the mindful technique of "list 5 things you can see, 4 you can hear, 3 you can feel, 2 you can smell, 1 you can taste", which takes me RIGHT out of the awful gathering terror.

How old are you? Mine started when I was mid/late 40s, and I was also very low in iron due to horrendous periods. I'm sure it was all connected.

Sorry you're suffering through this, it must be horrible.

Also dizziness and postural hypotension is a common/very common side effect of mitrazepine:

bnf.nice.org.uk/drug/mirtazapine.html

Sounds like the propranolol and the mirtazapine could both be having quite an impact.

Perhaps consider switching to a different anti depressant? Do you take the mirtazapine at night?

As for the panic attacks, have you tried any other approach aside from medication? You can request a referral for CBT from your GP which can be hugely effective for anxiety and panic. There are numerous breathing techniques to try online to combat the physical symptoms of anxiety and panic (best done at regular intervals throughout the day to prevent hyperventilation rather then just at the peak of panic). CCI Health have some great workbooks and information sheets on anxiety (specific and general) and panic disorder and are free.

How old are you @exercisewoe? Can I ask what you take anxiety meds for? By that I mean is your anxiety focussed in a particular way these days (worrying or phobias or OCD for example - anxiety often has a particular set of characteristics and/or a particular situation in which it’s activated). There are other ways to manage panic.

Metformin can help PCOS & promotes weight loss

I too am obese and have discovered that to doctors EVERYTHING is caused by obesity.
"Doctor, I have migraines." "You are obese. Lose weight."
"Doctor, I have arthritis in my elbow." "You are obese. Lose weight."
"Doctor, my tonsils are swollen." "You are obese. Lose weight. Then your tonsils won't be so fat."
"Doctor, the neighbor's cat bit a chunk out of my hand," "Well, I am glad you found a way to lose weight."

@lobster8 got there before me! If you decide to look at therapy for your anxiety you can get a GP referral for CBT or self refer to IAPT (NHS talking therapies). For a quicker and more flexible treatment you could go privately but be sure to choose a BABCP accredited CBT therapist from www.cbtregisteruk.com/

Panic feels horrendous but it has a very good recovery rate and CBT is definitely the indicated approach, but CBT can also help with other types of anxiety. Meds have their place of course but sometimes they aren’t the most effective way.

I think you might need to change GP.

@exercisewoe

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 !

Those are symptoms of sleep apnea, as is being overweight. I was diagnosed last year and since treatment has started I've lost 4.5 stone with no effort. You really need to push for an assessment for this.

Mirtazapine is known to make you feel utterly exhausted during the day. Perhaps you need to come off it now. You would perhaps have more energy, which would help you lose weight and to feel like taking exercise. Exercise itself can help you feel better.

I would guess thyroid, often GP's say it's normal when it really might not be based on your own ideal levels. If you haven't already, ask for a thyroid antibody blood test.

Who said they wouldn’t treat sleep apnoea? Bollocks to that get a second opinion and a sleep trial it’s too dangerous not to treat it.

As someone who was 21 Stone and no longer is...it is because of your weight.

I'd want some reassurance from my GP that there's no way the betablockers and mitrazepine are interacting to create the dizziness and postural hypotension. I had to stop taking betablockers as my BP was so low I was fainting. My understanding is that both those meds can potentially have that as a side effect so I'm wondering about them combined? My personal experience of GPs is that they often forget to check interactions with meds. Check with any other meds you're on as well.

I'd forget running for now, but what about walking at home? I got my weight down initially doing Lesley Sansone's Walk at Home. Now I do other walking videos (Keoni Tamayo is good - free on YouTube and also Rick Bhullar). I now do these along with short HIIT routines for strength (well, to stave off death and osteoporosis mainly). But diet is everything with weightloss. I often think the exercise only helps me because I'm not eating when I'm doing it! Well, not entirely that but it does help.

If everything medical is ruled out, then I'd suspect that your tiredness and lack of energy is a combination of things - meds, weight, sleep, lack of exercise. These things can have a cumulative effect.

I couldn’t stop eating in mirtrazipine. I slept like a baby and loved that bit, but oh the weight gain....

I was prescribed propananol beta blockers for a short while and they made me absolutely wiped out. I’m not the slimmest (BMI 30) but have always been fit and I just literally could not get up a hill on these.

I’d ask about tapering off them. Feeling the way you do can’t help your anxiety!

I felt exactly like that and had sleep apnoea, I have a cpap machine now and feel great.

I was going to say b12. I wouldn't be happy your GP didn't take that and the other vitamin problems seriously.

You can’t just forget your b12 levels if they are out of kilter. If you have a b12 deficiency you will need injections. Do not touch b12 tablets as they will give misleading results. Ring and ask your levels for b12 and iron and post them here. Go get a second opinion from a separate surgery or GP after talking the levels through here.

Then forget running. Do a combination of the following. ..

Walking 10000 steps minimum daily (5 miles)

Drink water

Do the 16/8 fast

@StopGuacAndRoll

As someone who was 21 Stone and no longer is...it is because of your weight.

Don't know how to say this tactfully but 21st is seriously overweight.

Because being overweight is becoming normal in the UK, you might not actually appreciate how overweight it actually is.

I would have thought it is the biggest contributor to the problems you are having. You really need to remove the biggest factor before you can really determine if there are other issues.

Your doctor sounds awful.
I weigh about the same as you and Beta Blockers did the same to me - I took them for hypertension during pregnancy though.

The change was near instant.

I would suggest that you need a different medication.

Also, why isn’t your sheep apnoea treated?

I would ask for a second opinion. My doctor certainly is concerned about my weight but sees a person and treats a person rather than put everything down to my weight.

You mentioned that you have had your blood checked but have they specifically done a Thyroid Panel (TSH, T4, T3, and Thyroid antibodies). The reason I ask is that before I was diagnosed my weight ballooned yet I had an unusually low resting heart rate and HR when exercising. It then turned out I had auto-immune Hypothyroidism. Once my medication stabilized my heart rate went up to a more normal rate when at rest and exercising.

@StopGuacAndRoll

As someone who was 21 Stone and no longer is...it is because of your weight.

I am 21 stone and don’t feel like that. So I’d suggest that your anecdotal opinion isn’t fact.

I had propanol for anxiety and I couldn’t do half the exercise I used to on it - felt like I was moving through treacle. I also fainted a couple of times if I stood up too quickly so I came off them and felt instantly better physically which helped my mental state too.

You say you’re very overweight but your suggestions of self help don’t mention a diet? Surely reducing food will be the fastest and most effective way of losing weight?