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?

The fact is that weight could be and probably is a big factor, but there is no way any of us including your GP can be confident that it’s the sole or main cause in how you feel, and it might itself be a symptom of another underlying issue.

Definitely doing all you can to lose weight is an important priority, I need to myself so I totally sympathise with how hard it is, nevertheless it is unsafe and clinically unsound for a doctor to assume weight is just a cause rather than part of a more complex picture.

I would definitely insist on a change of GP and a complete reassessment including a printed copy of all your blood results, which you are entitled to have.

Hi Op, I might get slated for this but I think looking at your life holistically can be important for working out health issues. For example, are you happy in your life / job / relationship / home etc? I appreciate these things are all interlinked and impacted by the health issues, but are there any changes you're really keen to make in any of those areas that could be affecting your holistic health it might make a difference. For example, if you're deeply unhappy in your job it might be impacting on your overall health and ability to make changes for the better. (I don't mean that your current weight etc isn't affecting it but looking at our lives overall can make a huge difference in addressing things like weight, health and so on). Anyway just my tuppence from personal experience of similar!!

Also any GP who suggests someone of 21 stone start running is crazy. Seriously don’t see this person again, they are incompetent.

running? I can't get past that part.
What exactly were the words the GP said or wrote in online review?

They did think sleep aponea in hospital 2019 but said wouldn’t treat that either

Sleep apnoea is taken far more seriously now. You really need to ask for this to be followed up and be referred to a sleep clinic. Do you know if you snore?

Gp needs to take this seriously, proper review, diagnosis, referral on. Fatigue clinic

Running doesn't sound like great advice from your GP! At 21 stone that is going to put massive pressure on your joints. I have encountered some GPs who are very unsympathetic about obesity. It's a shame they advised running when they must know that is going to be really, really hard for you.

Do try whatever exercise you can do though.

It is likely that yes, a lot of what you are experiencing is weight related complications. That doesn't mean they shouldn't be looking into things for you. But the advice to lose weight is sound.

Your beta blockers are also likely to be making you tired. They slow down your heart rate! So if you think about it, you are doing that twice a day. Of course you'll be tired.

The only way to resolve being overweight is to eat less and exercise. Simply that really. When I was obese, i had so many health issues but was in denial that they were linked to my weight. Lost a lot of weight when I bit the bullet and started changing my lifestyle, and my health issues disappeared over time. It depends on your age too. When I was young and overweight, I didn’t have that many health issues, but as I got into my 40’s, it all came back to bite me in the bum.

Of course your health and energy levels are down to being overweight. You would not need to be on beta blockers if you weren't overweight.

Telling someone who is 21 stone to start running is a fast track to knee problems. By all means exercise, but you should be given information on how to start this more sensibly to avoid injury.

Your doctor sounds like a twat. As usual, a GP tries to blame obesity for a clearly proven and well known side effect of medication.

Insist on a second opinion from a different doctor. And if you're already under cardiology then contact them and request an urgent review so you can discuss it with people who are more qualified.

See a different doctor.

said if my HR isn’t going above 90 I’m not exercising hard enough

Given your other symptoms, this sounds very dodgy.

@anamazingfind

Of course your health and energy levels are down to being overweight. You would not need to be on beta blockers if you weren't overweight.

Read the fucking thread.

OP says she didn't have this problem when she was 2 stone heavier than she is now.

The effects of being overweight can accumulate over time

Beta blockers can be prescribed for anxiety, but their principle use is to reduce blood pressure in hypertension. They also slow the heart rate.

I cannot conceive how a GP who completed medical training is not linking postural hypotension & slow heart rate to the drug.

If you were prescribed beta blockers for anxiety with a normal BP it can reduce BP.

If I was you, I would lose weight so I was a healthy weight and see if the health issues have resolved themselves. The issues might not be linked to your weight but there's definitely no harm in becoming a healthy weight.

You need to request a review from a different doctor at the practice asap if you're blacking out.

You need to see what impact cutting the dose has. If you start to feel better it's obvious it was the drug.

I would be firm with them and say you think the drug may be responsible and to support you to reduce the dose to gauge the effect.

Mirtazapine excellent for anxiety and sleep but zap your energy and make you a zombie.

The combination of mirtazapine and propranolol can make you very sleepy.

My DH was put on beta blockers for his essential tremor. He coudn't stay awake and his HR (which was already 'marathon runner' slow, dropped to dangerously slow.. and he had to come off them pronto.

Combined with the Mirtazapine..which is well known for weight gain, it's an unpleasant combo. I think I'd look at seeing a different GP, get off the betablockers and see if there are other meds you can try. Sadly though your weight will be impacting your health in every way so you need kind support with that too .

A short trial with mirtazapine left me so knocked out, I was wetting the bed - I was incapable of waking up.

Mirtazapine and beta blockers would knock me right out.

No wonder you feel so zonked.

I would make another appointment with another GP, this one's setting you up to fail by asking you to do something that's not physically possible for you to do atm. What a cunt!

It sounds like the beta blockers are lowering your blood pressure. I agree that a medication review sounds like a good plan - your GP could prescribe a medication that treats the anxiety also, then the BB can be dropped. I'm prescribed mirtazipine too, which made feel a tad draggy. Venlafaxine has been introduced to excellent effect (there's a reason the combination's referred to as Californian rocket fuel! )

If you order prescriptions online, you may be able to also register to see your medical records and your blood results will be visible - mine are anyway, and there's a good couple of hours that I won't get back (all very normal, but didn't know what they were so took a while).

I was prescribed beta blockers for anxiety - they did exactly FA for anxiety but they lowered my BP to dangerous levels. Even breathing was an effort. I'd have thought beta blockers would be the obvious culprit in your situation.

Also you are blacking out when standing and your doctor recommended running? WTF?