These symptoms not only warrant blood work-ups?to check for anemia or?low serum ferritin, but also to check thyroid function, adrenal fatigue, mono-nucleosis?etc. From my own experience, Doctors are a big problem in treating this, even Sports Medicine doctors.
Every Parent needs to become aware and have the knowledge to be able to Advocate?for their child.
My daughter has been suffering through this since May of this year.
Despite the low ferritin/iron reserves, she still ran a PR in the 400m each week,?leading up?to?going to the high school State Championships meet.
This is when it hit her hard.? The first day she ran in the 4 x 200m and felt?she had a lack of power.
The next day when she ran in the 400m pre-lims, she went flat… she said she tried?everything she could but her legs were?”mush”, she had no strength/power, and no matter how hard she tried, she just could not run?faster.
She said she felt lethargic, and had no energy.
This was the worst timing possible for her, as she had?trained so hard since last September for this moment only to not be able to?run.
We were both very confused at what was wrong.??Looking at all the variables I could think of, I could not see?anything that?could do this.
Yes, there were some issues, a long taper, a lingering hamstring strain, but nothing that would do this.
I continued her training into the next week and the following weekend, she went to a high quality meet that had some of the best athletes in the northwest.
My daughter ran even slower, and the symptoms were more pronounced.
Took her to her doctor 2nd week of June, and asked for blood work to be done.? ‘K’ had a similar experience in 2011 when she was?training for cross country during the summer.
When?the results came back, the ‘Tech’ at the lab called and told me that?everything was ‘normal’
From previous experience, I?went to her doctors office the next day and ordered a copy of the blood work-up.
After a couple days, I received the copy and?sure enough, her serum ferritin was low, down to a 17, far from ‘Normal’
Previously?in 2011, her serum ferritin level was?down to 21.? It took about 4 to 5 weeks of supplementing her diet with ‘ProFerrin ES’, which is the best iron supplement made and most readily absorbed (but $60+ per 30 day supply), almost daily she ate beef/chicken liver or oysters?and?washed down with lots of orange juice..?careful, don’t buy calcium enriched orange juice…?(vitamin C enhances the absorbency of iron).??Need to be careful 2 hours before/after to not consume?calcium rich foods, milk,?or caffeine, as these block?the bodies ability to absorb iron.
Since going to the doctor and getting the blood labs a month ago we have played ‘the doctor game’.
‘K’s doctor went on?vacation the next week, and we were not told.
I had asked for a referral to a local Sports Medicine doctor who had a good reputation to deal with this, as the current doctor admitted?her ‘training’ was that if a persons Hemoglobin was ‘normal’ and the serum ferritin fell between 12-160 (for a female) that a 17 (or 21 in 2011) was in the ‘normal’ range.
A search online will give a wealth of information on this subject, and recent studies that debunk what some doctors say.
I contacted a local Hematologist by email, in hopes that he might actually reply… to my happy amazement he replied the same day and we had many exchanges over the next week or so. I also emailed him ‘K’s blood work from 2011, 2012 and the most recent, 2014.? I did not have blood work done in 2013, as she no longer ran cross country then and at the time, I understood iron deficiency to mostly affect distance runners.
He told me that “NO”, ‘K’s serum ferritin level was NOT normal, and that it needed to be ABOVE 50, and that with her serious symptoms, there could be other issues.
Continuing with the ‘doctor game’ I finally was able to get ‘K’ in to see the Sports Med. Dr. 2 weeks ago…up to that time, I was continuing ‘K’s diet addition of liver, oysters, iron supplements and lots of orange juice.
At the Dr. visit, I explained the situation, that this was something ‘K’ went through in 2011 and was fixed with iron supplements and diet additions and that she had all the classic symptoms of anemia: fatigue, lethargic, nausea, feeling like not getting enough O2, dizziness, loss of coordination, etc.
I also explained that I had been exchanging emails with a local Hematologist and what he had said.
I also added that this could be a thyroid issue, mono-nucleosis, or other health issues that?I felt she needed other blood?labs ordered.
This?Dr.?did not listen to anything I said.? He told me,?”yes, this could be?multiple things, maybe even 5, but I don’t think so”??he kept going on about how?even though the ‘evidence’ and ‘symptoms’?supported?my concerns and did not point to his, that he?still felt that?’K’ was suffering from?low Glycogen reserves…
I was in complete disbelief at this guy… he refused to do anything other than refer her to a Dietitian….. he then said?”I have had a couple girls come in that I recommended the same to, and?I have not seen them since, so it must have worked”…
I emailed the Hematologist and told him what happened.? He?replied that the Dr.?’doesn’t know the literature’ … a nice way to say he doesn’t know what he is doing!? He also said she needed?blood labs.
The same day I contacted the referred dietician, as I thought?at least it wouldn’t hurt… after?answering her questions and?also sending her the?copies of blood labs I had, she told me?that my daughter needed a bunch more.? She said?it was useless to even talk until the results of the labs?came back and?other issues looked at.
She said, first of all, the low ferritin levels need to be addressed, as that was a known given.
She?asked if I could go back to my daughters ‘normal’ doctor, and ask for more blood labs and to add some that she would like specifically.
She emailed me a copy of the labs she wanted done.
Last Thursday was able to see ‘K’s?Dr. and she ordered up a bunch of labs,?for thyroid, mono-nucleuses, adrenal?fatigue, etc.??including those from the dietitian.? She also has referred ‘K’ to the Hematologist.
Should hear back on all the labs by Tuesday.
During this time, I have reduced workouts in both number per week and work done in each.? One or sometimes even 2 days a week she just doesn’t feel good at all and we don’t do anything.
She has continuously gotten slower.? She is running now just for fun and being around her friends. She ran in the USATF Association meet a couple weeks ago and the USATF Regional meet last weekend, and it was a nice fun weekend for our family.
I have posted about this over at the charliefrancis.com forum:
https://www.charliefrancis.com/community/showthread.php?22651-First-outdoor-meet-of-the-year&p=250084#post250084
and in another thread here:
Still waiting for all the lab results, as she had 10 total tests done and a couple of them take longer.
As for the USATF meet times here are her results from all summer meets, including the end of season HS championships times:
May 24:??? District Championships – 400m – 57.70,??? 200m – 26.40? (also anchored the 4×200, ran down the 2nd place runner, finishing 2nd, qualifying for State)
May 31:???State Championships (felt flat, no power, lethargic, some?coordination loss, low O2) – ?400m Semi-finals?- 59.37???? Warm and very Humid
June 7:? Oregon Border Duel (felt flat, no power, lethargic, some?coordination loss, low O2)?- 100m – 13.37?(-2.3 headwind),? 400m – 1:00.54,? 200m – 27.32 (+3.4 tailwind)????????? Temp. Hot… upper 80’s
The next meet on June 21, I signed ‘K’ up for 4 events: 100/200/400/800m, so that at the meet I would decide what she should run and scratch the others, depending on how she was ‘feeling’ and how she looked.? ‘K’ was adamant after the last meet that she wanted to run the 800m, that since she didn’t have ‘power’ anymore, the 800m would be easier to run and at least she could compete in something.? At the meet, after running poorly in the 100 and 400m,? directly after running the 400m, she told me she wanted to run in the 800m, which was the next event after the 400m, that she knew she could just ‘jog’ and win… I told her no, that it would affect her upcoming 200m… she disagreed, told me she was just going to ‘jog’ and got upset.? I then told her to run it if she wanted.
June 21:? USATF JO Association meet (felt flat, no power, lethargic, some?coordination loss, low O2)?- 100m – 13.31 (flat, no power)?(4th),? 400m – 1:00.15 (same, no energy)(2nd),? 800m – 2:33.86 (1st),? 200m – 27.03 (flat,?lethargic)?(2nd)?? Temp. Hot, upper 80’s
June 25:? Shoreline ‘All Comers’ meet – 100m – 13.26 (felt flat, no power),? 800m – 2:24.55 (‘K’ said she just ‘jogged’ and could have ran much quicker)?? Twilight meet, nighttime, cool temp.? mid 70’s
The time leading up to her last meet on July 5/6, ‘K’s symptoms were getting worse.? She has days that she does nothing but sleep, as she feels weak, nausea. ‘K’ was qualified in 4 events for this meet, but I only let her run in 2 and chose the?events that were 1 day apart, as the temperature for the weekend was to be in the 90’s, and we found that on days of temperatures in the 80’s and up, that the heat sucks the energy out of her.
July 5 & 6:? USATF JO Regional meet (felt flat, no power, lethargic, some?coordination loss, low O2, compounded by hot temperatures) – 400m – 1:03.07,? 800m – 2:33.86?? Temp. very hot, mid 90’s
The hot temperatures created a lot of PR’s and fast races, but for ‘K’ it had the opposite effect.
And yes, Ryan, I will follow your advice and contact Dr. Colter.
Thanks for writing the article, I’m sure these issues effect many athletes who don’t even realize that it is a medical issue not just a performance issue.
An update to my post above.
Still waiting on results for blood labs, but received a call from the Dr. office that the mononucleosis test was positive and that her?antibody count was still?quite high (she started having symptoms almost 2 months ago), meaning it was a serious?infection.
Told to keep her out of the heat, take it easy and not to force anything.
She is ok to workout, as long as her body feels like it and ok to run as long as in cooler temperatures and not to push herself.
Ok to run at meets, as long as limiting the events and she does not push herself.
This is pretty much what we have been doing already.
Her symptoms have not changed, and still taking everything day to day.? Workouts are light, and only a couple days a week and in the morning or evening?when still cool.
Not only having iron deficiency, but mononucleosis too… hopefully the rest of the labs will come up negative.
Update, as this reinforces Coach Banta’s blog, these symptoms can be the result of iron deficiency and can include other medical issues, such that we are finding.
This has been extremely frustrating, as I’m dealing with inept Dr.’s.
Had all the blood work (second round of tests) done on July 11th, a phone call about a week later saying she recently had a serious mononucleosis infection, then a Dr. appointment on Tuesday of last week.
I made the mistake of assuming that the iron deficiency and mononucleosis were all that showed up on the 2 different blood labs done in the past month… I asked all the right questions and the Dr. talked about the need for rest and recovery from the mononucleosis infection and to continue diet/supplements for the iron until ‘K’s appointment with the Hematologist, which the hematologist already indicated that she would probably get iron IV’s.
At first, I trusted that the Dr. had been thorough, and even though I was going to get a copy of the blood labs, I was in no hurry.
Then, I thought I better check them out, as there were many labs taken and might as well check, something may have been missed.
Sure enough… looking at the cortisol test was High. In one of the thyroid tests, the ‘FREE T4’ test also came out Abnormal High.
Coincidently, the same day that I reviewed the labs I get an email from the dietitian, as the Dr. had sent her a copy of the labs, in her email she says:
“‘K’ does have an elevated T4 but her T3 is WNL. This is something I would keep an eye on especially if adrenals continue to be an issue. Still adrenal fatigue is an issue and definitely would be playing havoc with her performance.”
Again, very frustrating that the Dr. did not either understand or missed this and did not say a work.
In a little more than a week she has the appointment with the hematologist, for which, I have already written all my questions on paper. I am much more confident that with this Dr., issues will be dealt with properly and professionally.
Looking back…
First going to the Dr. in early June for these symptoms and getting the 1st blood test done… told everything normal, just rest…. then getting a copy of the blood labs and seeing she was iron deficient, and far from ‘normal’!
Then I pushed for a referral to a Sports Med. family physician, who supposedly is the best in our city… he refused to listen to me about the iron decency, the need for more testing for mononucleosis, possible thyroid issues, adrenal fatigue issues, etc.
He was adamant that even though all the symptoms and evidence pointed to the problems I mentioned and didn’t so much support his ‘diagnosis’ that he was standing by, that ‘K’ was suffering low Glycogen reserves from not eating properly and would refer he to a dietitian.
He said he based this on the fact that the last 2 or 3 female athletes that came in to see him over the year complaining of fatigue was given the same diagnosis, referred to a dietitian… and they never came back, so it must have been correct!.
Then, after doing some more research, I took ‘K’ back to her regular Dr. and pushed for more extensive blood tests, and the ones that the Sports Dr. refused.
From both of the blood tests:
Tested very low (17) Serum Ferritin (iron deficient)
Tested Positive for mononucleosis (recent, severe)
Tested Positive for Thyroid (elevated T4) issues
Tested Positive for Adrenal Fatigue
Considering that the symptoms started towards the end of May, continued to worsen… especially as the weather became hotter, she became very heat sensitive too.
I can only wonder how the blood labs would have looked had they done all of them at the beginning of June, especially the Cortisol test (adrenal fatigue) and the thyroid tests,?when first asked for?
