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?

@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 !

Are you coughing because you're waking up with a dry mouth (because you're mouth-breathing when asleep) or, do you think, because of the pressure on your chest/neck? I'm astounded that your GP suggested running as a first port of call when you need to lose weight. Think of the strain it would place on your joints AND your heart! The weight loss needs to come from diet, not exercise. Did your doctor mention getting support form a dietitian? a better exercise to help strengthen your heart without putting undue stress on your joints would be swimming. Would that be an option post-restrictions?

@AnneLovesGilbert

Do you mind me asking what was your b12 levels if you know? Mine was 212, as it was above the required level of 190, Gp said it was fine. I'm pretty sure the upper limit is 800.

I'm permanently exhausted and short of breath like Op, but am just over 8 stone. Fed up with doctors not listening.

FYI- I came off mitz in jan- and have lost 10lbs by doing... nothing!

But the weight is coming off naturally.

Mitz is pretty evil. It makes you hungry permanently and even when I was being "good" on it (I was on it for 8 months)- I couldn't shift any weight.

Three or four weeks coming off it was quite hard with insomnia and mild anxiety, but since then have felt good, taking different supplements and using cbt methods to manage my low level anxiety. And losing the weight I'd gained on it also feels good. I do feel for you. The tablet combo that you're on is not working in favour of losing weight. Good luck and wish you well 😊

@exercisewoe
DO get your Thyroid checked out.
I was falling asleep in pubs ( don’t drink alcohol)
And asleep at the table..
It was very low thyroid.
Periods became heavier and I did gain a stone!
(BMI 24)
It is so much better with daily Thyroxine !

I'm guessing its a combination of different things, but what concerns me immediately is your GP telling you to run. The best thing to do given you weight and various issues is something low impact like walking, biking (or swimming when we can), not high end cardio that will raise your heart rate. It isn't safe right now and would very likely also do your knees in.

That being the case, I would switch GPs - and when they ask why say she's giving you advice in direct contradiction to your cardiologists so you don't feel she is best place to advice someone which a complex range of health issues including obesity. Be firm about it, put it on paper - and do a google re changing your GP so you follow procedure.

When you have a phoner with your new GP start off by saying you've been exercising and lost 2 stone and suddenly you've been hit by this weird exhaustion. You want to keep loosing weight but right now it's very difficult to exercise because of said exhaustion so you want to explore what it could be so you can get back to helping yourself. It is intensely annoying when medics put everything down to weight, but they do - so play that game by pointing out you have been loosing weight and now you can't because of this.

It sounds like the GP isn't looking at the full picture. The fact you haven't been properly investigated for the sleep apnea astounds me, especially given your potential hereditary heart condition. The combination of drugs you are taking will explain a lot of your symptoms, and not help your ability to lose weight.
If your GP is unsympathetic, I would be tempted to discuss the issue regarding the medications with a pharmacist, ask them if there are other medications that would deal with your anxiety , but not cause the same side effects and then speak to your GP when armed with this information.
You deserve a fighting chance to be able to lose weight and live a healthier life.

@GeorgiaGirl52

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."

I am not obese, but do have anxiety and therefore EVERYTHING is caused by this. If the poster has anxiety and weight issues then it must be hard for the doctors to decide which of these 2 conditions is to blame for any ailment she has. Presumably there is a flow chart.

"B12, ..,
iron, folate and vitD"

All of these being sub optimal (not just out of range) can cause fatigue.

Get the results with ranges from your GP (you are entitled to them, don't be fobbed off) and post back on here.

Did GP check your thyroid? Post this result(s) with ranges also.

I don't understand why your GP is saying some of this . It is well known that beta blockers give you a "false reading " on your HR . I used to wear a monitor and it looked as if I was doing nothing due to beta blockers . You need a different GP . If you are on certain meds they will not even let you do the treadmill test . Why on earth is he saying start to run ?

Look you know you are greatly overweight and you DO need to lose ! What goes in your mouth is far more important than what exercise you do currently and when you control that you will be in a better position to start walking daily . Every medicine that you take has the potential to create there problems so concentrate on losing weight . Try low carbing . ( Not a doctor obvs , just speaking from my own experiences )

create other problems

As others have said could also be sleep apnoea. And its bollocks is they won't treat it. Yes they will because sleep apnoea is extremely bad for your health (and potentially others if you are driving!).

It's really difficult to lose weight when you are so tired. It makes you crave carbs.
It sounds as if you need to strip out the medication (with GP consent) and go back to basics and non-medication therapy.

Low carb and intermittent fasting for weight loss and energy. A good dose of vitamin D daily - assume that you are deficient. It's highly unlikely that you aren't.
Ask for the numbers for your latest blood tests and post them here, so that knowledgeable people can advise you on iron etc.
Follow up a sleep study test as a matter of urgency, even if you have to go private.
Get some good bacteria into your gut (read up on brain-gut connection).

Beta blockers definitely make you tired and sluggish, you need to talk about why you are taking them with the GP, if it is for heart reasons and to keep your BP down, there are other drugs for that, if it's for anxiety, then weaning off slowly over time, doing CBT or relaxation and at least getting the dose down would help. Beta blockers also cause poor sleep and vivid/unpleasant dreams including hallucinations/night terroris for some people. They are really effective drugs for some things, but surely you will not lose weight and feel peppy if you are on two different drugs that make you sluggish.

Even if is is because you're fat that's no reason for them to fob you off. ASleep apnoea, kills. Literally and a cpap can help.

[quote Okbussitout]@LunaHeather was it citalopram you gained weight on? I really feel its been a significant factor for me. But I don't want to stop my ssri in the middle of a pandemic![/quote]
Yes. Sorry, spelt it wrong.

I had been eating my way through my depression as well, really shocking amounts of crap. After two weeks of citalopram, I felt much better, stopped the junk food, which was on top of meals btw!

After four weeks I went back to working out (gym regular before depression hit).

After two months, I'd gained a fucking stone!

It's hard to come off though, sorry. Every doctor will have a different plan but I was determined to switch so went to fluoxetine after three days of no citalopram. I was on 10mg which didn't come as a pill in those days, it was half a pill.

The first few days of fluoxetine, I had such bad restless legs, I wanted to cut them off. Doctor then gave me 7 days diazepam to get through that bit.

This is going back a very long time. That doctor is now retired. I don't know what switchover protocols are like now.

OP sorry to rant but I was actually thinking about you while I ate dinner. You have been let down very badly. The suggestion to run is wrong and quite dangerous given the POTS situation. I don't know anything about sleep apnea but unfortunately, my knowledge of depression and anxiety is reasonable, and you are not being properly treated.

Perhaps start with a complaint to the practice manager?

I am sorry that other posters are reporting that mitra doesn't cause weight gain.

If anyone has access to BMJ archives, I think there was a good article about 5 years ago explaining links between these meds and weight gain. It might help to send a link to your GP. There's loads of medical studies by now surely? I first went on these meds in my 20s, am now in 40s.

It is a well known fact that fat stereotypes pose a real danger in medicine and acknowledgement of true symptoms. There are tons of examples of people who have forced themselves to lose vast amounts of weight just so their doctors would take them seriously.
I think you'd had some great support from people who know a lot more about this than me, but I do hope you go and get further advice.
It sounds like your health has declined even though you've lost some weight and that should be ringing more alarm bells to your doctor than it is currently.
Also, please try to find out what the normal range is for blood results for your ethnicity is as this does differ a lot and in my experience the range of normal in the UK is much bigger than in other countries.
I have PCOS and for a while I kept getting bigger and bigger. Here, no one could tell me what was wrong as all my results were on the borderline. When I went to get advice from a polish doctor (my ethnicity) the results were completely off the scale according to their charts and I was given advice that has completely changed my health.
I'm sending you lots of hugs, it sounds like a really awful situation to be in.

*that should say - sorry other posters are reporting their GP saying mirtawotsit doesn't cause weight gain.

Propranolol will clearly slow down your heart rate and lower your blood pressure. However given that you have been reporting panic attacks, it's reasonable for your GP to question whether the black outs are panic attacks or blood pressure related. Sleep apnoea does not cause postural hypotension - if anything it is linked to hypertension. There is no evidence for giving B12 supplements if your levels are in the normal range. Low iron will only cause fatigue via anaemia - so if you're not anaemic, having a slightly low ferritin level won't cause symptoms. A lot of people in the UK are vitamin D deficient but this is unlikely to cause any actual symptoms (it's checked because of links to bone health via calcium metabolism). Sounds like you should review if a beta blocker is right for you, and lose weight - which realistically is only going to happen by calorie restriction.

For those saying it could be sleep apnea - I thought the solution for it was to lose weight and exercise more.

So OP could have it mildly which would be a vicious cycle as it would make other symptoms worse, increasing her weight, which increases sleep apnea.

@toocold54

For those saying it could be sleep apnea - I thought the solution for it was to lose weight and exercise more.

So OP could have it mildly which would be a vicious cycle as it would make other symptoms worse, increasing her weight, which increases sleep apnea.

the treatment for sleep apnoea is a cpap machine. That may, in turn, help her to lose wight and then feel human enough to lose weight but when you feel shit nothing happens.

Do you mind me asking what was your b12 levels if you know? Mine was 212, as it was above the required level of 190, Gp said it was fine. I'm pretty sure the upper limit is 800.

@Tootsey11 212 is very much at the bottom of the reference range and definitely not "fine". An NHS GP won't prescribe at that level but you should really supplement with OTC B12 and get it rechecked in 3 months in case you aren't absorbing it.

I really think you need to ask for a second opinion. It sounds like your gp is fobbing you off and being very discriminatory. PCOS can cause weight gain so you've got a lot to work against. I feel for you and am angry that your gp is being an impertinent twat.

How many calories do you eat a day?

Try dropping to 1,500 instead of going straight into running. Log everything because based on your size you’re consuming more calories than you realise/admit b

Mirtazapine made me absolutely exhausted permanently and also very hungry. Might be worth requesting a meds review x

Unfortunately, most doctors know very little about the causes and effects of obesity. I have just finished a book called Why We Eat (Too Much) by Dr. Andrew Jenkinson. He is a bariatric surgeon, who has truly listened to his patients and found that much conventional advice about weight loss is wrong. It is about far more than calories in/calories out. He always works with a psychologist when treating his patients too. Conventional wisdom for the last forty/fifty years has advocated a low fat diet. All this does is turn calories into carbohydrates in the form of sugar, which is far more dangerous than fat. Apparently, in the late sixties, scientists were looking into what was causing the shockingly high rates of heart attacks and sugar and fat were both in the frame. However, the real villain of the piece was sugar, but this was swept under the carpet by the sugar industry, who sponsored research into fat. Never mind the fact that heart attacks were beginning to reduce in numbers as people gradually gave up smoking. I would strongly advise reading this book. By the way, suggesting that an unfit lady, who weighs over twenty stones and has a host of medical conditions, should take up running, is ludicrous. This would be a one way ticket to a heart attack. Walking or swimming (when we are allowed) are far better forms of exercise for someone in your situation. Congratulations, too, on your weight loss to date.