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Suggest Remedy For Nausea And Dizziness While Running
Question: My son, XXXX, is 26 years old and has had great success as a runner. He ran the 2013 XXXXXXX Marathon in 2:49 and ran the 2010 Rock & Roll Half Marathon in 1:15. A year later he ran the same time in the XXXXXXX Half Marathon. He has also run a 31:59 10K in college and walked on the varsity cross country team at the University of Illinois in 2007. After running the marathon in 2013 he took his normal time off and 6 weeks later started training again. 5 minutes into a run he became dizzy and nauseous and had to stop. This has been the situation ever since.
He has seen doctors, neurologists, and a chiropractor/nutritionist over the last 18 months. He has had every test imaginable, including EKG, Brain MRI, Vertigo testing, anything and everything related to the ears and no cause has been discovered and even after shutting down completely for months when he tries to run, anywhere from 5-15 minutes into the run the dizziness and nausea return. We have documented all the testing and doctor visits. He is very fit and has a true "runner's body". The chiropractor is exploring the possibility of adrenal malfunction and had him tested. His cortisol levels were low normal to below normal and he suspects that might be the problem. One neurologist insists this is vestibular migraine and the other neurologist doesn't know and has suggested going to Mayo. He had a partial splenectomy 20 years ago from a hemangioma on his spleen. The scar has bothered him.
I teach at a high school and a trainer at my school thinks he might have suffered an injury to his hypothalamus during the marathon. To be honest, we don't know what's wrong. Thank you for your consideration.
XXXX
He has seen doctors, neurologists, and a chiropractor/nutritionist over the last 18 months. He has had every test imaginable, including EKG, Brain MRI, Vertigo testing, anything and everything related to the ears and no cause has been discovered and even after shutting down completely for months when he tries to run, anywhere from 5-15 minutes into the run the dizziness and nausea return. We have documented all the testing and doctor visits. He is very fit and has a true "runner's body". The chiropractor is exploring the possibility of adrenal malfunction and had him tested. His cortisol levels were low normal to below normal and he suspects that might be the problem. One neurologist insists this is vestibular migraine and the other neurologist doesn't know and has suggested going to Mayo. He had a partial splenectomy 20 years ago from a hemangioma on his spleen. The scar has bothered him.
I teach at a high school and a trainer at my school thinks he might have suffered an injury to his hypothalamus during the marathon. To be honest, we don't know what's wrong. Thank you for your consideration.
XXXX
Brief Answer:
Adrenal
Detailed Answer:
I follow what you are saying.
Hypothalamus, pituitary and adrenal problems are a possibility.
I see you have mentioned a low or low normal cortisol test result. May I know the exact reading please.
Also was it done in the early morning before 8 am?
This timing is quite important and helps in the interpretation of the test.
Assuming for a moment that indeed the morning cortisol was low, I generally proceed to the 'ACTH stimulation test' for my patients who present with similar complaints.
It is a more definitive way to see if there is 'adrenal insufficiency'.
Such endocrine tests are challenging for the non-expert so it is best you consult an endocrinologist in-person who will perform a thorough physical examination and order appropriate tests if required.
Adrenal
Detailed Answer:
I follow what you are saying.
Hypothalamus, pituitary and adrenal problems are a possibility.
I see you have mentioned a low or low normal cortisol test result. May I know the exact reading please.
Also was it done in the early morning before 8 am?
This timing is quite important and helps in the interpretation of the test.
Assuming for a moment that indeed the morning cortisol was low, I generally proceed to the 'ACTH stimulation test' for my patients who present with similar complaints.
It is a more definitive way to see if there is 'adrenal insufficiency'.
Such endocrine tests are challenging for the non-expert so it is best you consult an endocrinologist in-person who will perform a thorough physical examination and order appropriate tests if required.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
He did a swab saliva test at 4 times in one day. His times and scores follow:
6 AM - 8 AM - 18 Ref Values 13-24
11 AM - 1PM - 4 Ref Values 5-10
4 PM - 5 PM - 5 Ref Values3-8
10 PM - 12 AM - 2 Ref Values1-4
Total Cortisol Out put 29 Ref Values 22-46
So morning wasn't low.
Thank you for your explanation and advice. In your experience when something like this happens, can it be successfully treated and cured? He desperately wants to get back to competitive running. He was aiming for a sub 2:30 marathon time when these symptoms literally stopped him. Thank you again.
There are other values in the test. His Dehydroepiandrosterone Free Pooled Value was 12 (DHEA + DHEA-S) - Ref Values 3-10
His fasting and non fasting insulin values were <3 - Ref Values 3-11
His P17-OH Progesterone Level was a normal 42 - Ref Values 22-100
His Tonal Salivary SigA value was borderline low <5 - Ref Values 5-9
His Gliadin Ab, SigA (Saliva) was <1 Ref Values 13-15 U/mi
I should also mention MS runs in our family. My mother and her aunt had it. However the neurologists both checked and cleared him of that. Having lived in a home with MS he doesn't show any of the symptoms except fatigue, but I thought you should be aware of the history and that it has been checked.
6 AM - 8 AM - 18 Ref Values 13-24
11 AM - 1PM - 4 Ref Values 5-10
4 PM - 5 PM - 5 Ref Values3-8
10 PM - 12 AM - 2 Ref Values1-4
Total Cortisol Out put 29 Ref Values 22-46
So morning wasn't low.
Thank you for your explanation and advice. In your experience when something like this happens, can it be successfully treated and cured? He desperately wants to get back to competitive running. He was aiming for a sub 2:30 marathon time when these symptoms literally stopped him. Thank you again.
There are other values in the test. His Dehydroepiandrosterone Free Pooled Value was 12 (DHEA + DHEA-S) - Ref Values 3-10
His fasting and non fasting insulin values were <3 - Ref Values 3-11
His P17-OH Progesterone Level was a normal 42 - Ref Values 22-100
His Tonal Salivary SigA value was borderline low <5 - Ref Values 5-9
His Gliadin Ab, SigA (Saliva) was <1 Ref Values 13-15 U/mi
I should also mention MS runs in our family. My mother and her aunt had it. However the neurologists both checked and cleared him of that. Having lived in a home with MS he doesn't show any of the symptoms except fatigue, but I thought you should be aware of the history and that it has been checked.
Brief Answer:
Follow up
Detailed Answer:
I have read your detailed comments and results of other laboratory tests.
I still suggest he consider undergoing the 8 am cortisol test and based on that proceed to the ACTH stimulation test if required.
Follow up
Detailed Answer:
I have read your detailed comments and results of other laboratory tests.
I still suggest he consider undergoing the 8 am cortisol test and based on that proceed to the ACTH stimulation test if required.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your guidance. We will follow up as you advised. The one question you didn't answer was:
In your experience when something like this happens, can it be successfully treated and cured? He desperately wants to get back to competitive running.
Thank you again.
In your experience when something like this happens, can it be successfully treated and cured? He desperately wants to get back to competitive running.
Thank you again.
Brief Answer:
Second follow up
Detailed Answer:
If he is found to be have adrenal insufficiency, it can be treated with medication. It cannot be cured in most cases, although this too depends on the cause. It should be possible then to get back to competitive running, provided he is diagnosed and treated accurately
Second follow up
Detailed Answer:
If he is found to be have adrenal insufficiency, it can be treated with medication. It cannot be cured in most cases, although this too depends on the cause. It should be possible then to get back to competitive running, provided he is diagnosed and treated accurately
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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