Monday, October 1, 2012

Adrenal Collapse

Well, here I am again! Dizzy, achy, dopy, tearful, nauseous, and I can barely walk across the room. I’ve been asking myself, “How did I get to this point?” “Were there any warnings?” and more importantly, “How can I avoid doing this again?”

In the three weeks since I collapsed (that what I call it when I reach this point), I’ve had a lot of time to think. Actually, I’m grateful to be able to think. For the first four days all I could do was sit and stare out the window in a dazed fog. My eyes wouldn’t even focus. Now that I am up to writing, I want to record what has happened while I can still remember it. I also hope that you might learn from my experiences and be wiser than I have been.

I have been sobered to realize that since my adrenal glands no longer produce any cortisone, I could have gone into an Addison’s Crisis. This is the point where your body can no longer cope with stress. You become extremely weak, confused, your blood pressure drops, and you can go into shock. All in all, not a place you want to go. There are warning signs right before this happens: headache, dizziness, nausea and vomiting.

I’m aware of these symptoms and just before I start vomiting, I start taking more hydrocortisone and resting. Consequently I don’t officially hit a “Crisis”, but I sure come close – too close!

I do this fairly regularly and am beginning to wonder how bright I really am. I am also becoming concerned because each time I collapse, I don’t seem to recover to the point I was before I collapsed. Besides it isn’t very fun and takes months to recover. Obviously, I need to make some permanent lifestyle changes.

I started by looking up the symptoms of exhaustion. They are rapid or high heart rate or pulse, dizzy (balance problems), confusion, sweating, fatigue, headaches, pains, no appetite, stomach pain, diarrhea, bloating, nausea, sore throat, sensitive to light and noise, depression, irritability, panic attacks, restless at night, swollen lymph nodes, poor memory, muscle and joint pain, bladder problems, heart palliations, and shortness of breath. I had every symptom! So I was exhausted, but this is how I always felt. I could even add a few symptoms to it: pinky skin, salt cravings, muscle and joint pains, muscle weakness, lethargic movement, dehydration (a 2.6% drop in hydration will double your fatigue), fever and chills, pain in my mid back (adrenal glands), and moments of low blood pressure and blood sugar.

I was shocked!  I was accepting exhaustion as “Normal”!  I’d always been ill, but that was no excuse. I think one problem I’ve had is that things change fairly slowly. When I collapse, I am forced to stay home and rest and relax.  After several weeks I  partly recover, become bored and tired of staying in, and resume trying to do all those things I want to do. At first I when I go out, I feel pretty good afterward. I think, “I can do it now! I’m better!” After a couple weeks, I become a little more tired after each thing I do or outing I take, and it takes me longer and longer to recover. Finally, I reach a point where I feel constantly tired, depressed, achy, nauseous, and can just barely drag myself around. My headaches increase and I have trouble sleeping, then I collapse again and rest!

How can I keep from doing this anymore?  First of all I have to accept that I have Addison’s Disease. I have been tested and my body does not produce any detectable level of cortisone. Cortisone keeps your blood pressure and blood pressure level so you can deal with stress and feel well. I try to take enough replacement natural hydrocortisone to cover the stresses in my life, but like a diabetic you can’t just keep taking insulin and stuff yourself with cake. I’m realizing that I have to live a life within the limits of a reasonable amount of medication. I haven’t been doing this. I’ve not had enough hydrocortisone to match my stress level. I wondered  if I could just increase my medication. No. There are effects of higher cortisone (weight gain, osteoporosis, diabetes, and depressed immune system ).  The only solution I can see is to cut the stress level in my life.

Ok. How do I do cut down on stress? Physically I think I do fairly well. I get to bed at a reasonable time and am now taking the time to rest during the day. I eat a good balanced diet of organic foods. As I recover, I will gently exercise. I avoid extremes in temperature (air conditioning is essential for me) and dress warmly when it is cold. I try and avoid foods and things to which I’m allergic. There is a lot physically that I can’t change, so I am trying to get more rest to help compensate for these stresses: injuries, allergies, chemical sensitivities, intestinal damage, malnutrition, and pain.

Physical stress can be rough, but it also seems that emotional stresses really wear me down. Feeling that I had plenty of time since I was retired, I had taken on several volunteer commitments in our community. I added them all up and was surprised to find that I was spending about thirty hours a week volunteering. With all the time I need to care for myself (rest and exercise), I just couldn’t do it all. I started to analyze each commitment. I loved doing each thing! I didn’t want to give up anything! I also knew that I wouldn’t live a very long or have a very enjoyable life the way I was going. Something had to go! It was very hard, but I chose just a couple of less stressful things that I really enjoy doing and let the rest go.

I’ve noticed a difference since I’ve made these changes. I’m feeling better and recovering faster. I’m finally relaxing, and it feels good! I didn’t realize how much I have been pushing myself. Life seems brighter, and I’m enjoying doing things that are meaningful to me.

I am starting to want to do more, but am firmly trying to resist the impulse to push myself to the max. I know I need to live a low key life so there is something left for all the expected things that happen. I am trying to live within a reasonable about of medication cover so that I avoid collapsing. I am going to do it this time!


  1. Hi Cheryl Anne,
    I'm glad you are blogging again. I have had a few ups and downs but mostly am doing better. I get stomach upsets a lot. I thought it might be Celiac, but my blood test was negative. I know that only a biopsy can give the 100% accurate diagnosis regarding Celiac, but I honestly don't think I have it because I eat wheat products and don't get sick. So, hmm, why do I get diarrhea, often lasting for days. I'm thinking it may be due to not enough cortisone replacement, stress in other words. I've been stress dosing more lately, and am feeling much better.

    I also have intense leg and shoulder pain, well, all over body ache really, if my body is stressed and not getting enough cortisone. When I do a lot of garden work, or over do it in other ways, I have to stress dose, otherwise I can't move the next day. It's my understanding that replacing the cortisone that the body would normally produce (whether in times of stress or not) generally carries no risk of the side effects that go with cortisone therapy to treat inflammatory conditions, like arthritis.

    If you're experiencing weight gain, it could be due to not taking adequate medication for hypothyroidism. When I start to notice weight gain, I get a Free T3 blood test done and so far this has been the reason for any weight gain---my body doesn't have enough Free T3. I recently had to double by dose of Cytomel and my Free T3 is still not quite where it should be, but I'm feeling more energetic and have lost the weight I had gained. If you're feeling quite lousy, it's possible it could have lower than normal levels of Free T3.

    If you feel lousy too too often, then maybe you're just not taking enough hydrocortisone. We are all different. Even though some people get by just fine on 20 mg of hydro per day, others need 40 mg.

    We went to a wedding this weekend and I danced until midnight at the reception, and then stayed up talking until 2:00AM. Halfway through the evening I stress dosed, and I stress dosed the following day. For the most part I was okay the next day, just a normal feeling of tired.

    Maybe you should try taking more hydro, and get a Free T3 check done. It all sounds like it could be low Free T3 and not enough hydrocortisone. If my Free T3 isn't high enough, I end up feeling emotionally depressed.

  2. I think you are right. I get diarrhea when my dose gets too low.Yes, a small higher dose for stress (usually 5mg of hydrocortisone) will help your body be less stressed and achy and tired and will not harm you.
    My T3 is always a little low but ok so they don't want to give me any. I am taking a couple of naps a day and exercising gently and am feeling much better. I have even been able to cut from 60mg to 50mg of hydrocortisone. I can get very depressed if my hydocortisone is too low, but it goes away when I take more.

  3. I am both surprised and sorry to read you come so close to crisis so often. I'm on 50mg per day and I don't ever get like that. I have twice since 2002. The second time was because my doctor (no longer my doctor) cut my dosage. (first time was before I was diagnosed. very scary, I almost died. But i digress...)

    Stress is a big factor. I have worked in a high stress job since 1993 - Mutual Funds. Over the last couple of years people were being laid off. Normally that would be stressful, and it was. But I have a way of dealing with stressful events: If something is outside of my control, then I have no responsibility over it. Believing you have no responsibility is a great stress reducer. :) If I do have control, then I do whatever I can to resolve the issue or get others involved to share the responsibility.

  4. I was diagnosed with addisons disease two and a half years ago. My consultant will not allow me to go beyond 25mg hydrocortisone per day (unless on sick days). He says this is to prevent side effects like osteoporosis. The trouble is that many, many days i feel unwell. Energy just flows from me and i need to keep moving or would immediately fall asleep. All of this despite feeling my joints are so painful and sniff, and my legs feel like lumps of concrete. Eating is difficult as i have trouble with hiatus heroin also. I smiled finding it increasingly difficult to hold down my job and look after my two teenage daughters. I am 49 years old and work as part of a clergy team covering three parishes. Anyone have any advice??

  5. James you are right. I push myself too much and come too close to crisis. I am now living a retired life and resting when I need to. I am feeling much better. You have a great attitude!

  6. Seabreeze
    You only have problems with osteoporosis and diabetes if you overdose on hydrocortisone. If you take the right amount, you can come out ahead since you will be up on your feet and moving.
    Have you been tested to see what your level of cortisone is and hydrocortisone should be? If you are not feeling well, it probably isn't enough.

  7. Cheryl,
    I have been recently diagnosed by my FP but I am looking for a doctor in Utah that will treat me. SLC or Utah county. My Addision's is due to medication - predisone that I have been on for sinus infections and back/shoulder pain. The one doctor I went to in SLC would only prescribe the 10 mg for the initial visit because I had a back pain/cortisone epidural earlier in the month, so he thinks that it is a false reading even though I was diagnosed prior to the treatment. I also have had symptoms of hypoglycemia as well as crisis since the appointment. I have to now convince my endocrinologist that I need help because he thinks it is temporary due to the back treatment. I am looking for help it you can provide information. Thank you for the blog. This is a great source of understanding what is going on with me.