Hello All,
Many of the members of our PPN Support,
Education and Advocacy Group write about and ask questions about puzzling and debilitating
symptoms everyday. Most of these symptoms are actually related to exercise
intolerance. I have decided today to share a passage from our book, living
with Periodic Paralysis: The Mystery Unraveled about exercise
intolerance. I hope it will answer some of those questions.
(The photo I did not share from the visit to the lake last week)
Exercise Intolerance
“We know that there are two types of
involvement of muscles in individuals with Periodic Paralysis. There are
attacks of paralysis of the muscles, which are intermittent, and there is a
myopathy or a progressive, permanent muscle weakness, which can occur. Some
individuals experience one or the other and some experience both conditions,
though it is less common to have both, and it is very rare to have only the
progressive, permanent muscle weakness. If an individual develops the progressive,
permanent form of periodic paralysis, it begins as exercise intolerance,
usually in the legs and feet, which progressively spreads to the rest of the
muscles in the body.
In exercise intolerance the individual is
not able to do physical exercise or exertion that would be expected from
someone of his or her age and overall health level nor for the amount of time
expected. He or she lacks stamina. The individual may also experience extreme
pain and fatigue after exercising or exertion and other symptoms such as a
feeling of heaviness in the muscle groups. Exercise intolerance is a symptom
rather than a condition or disease. It is a common symptom found in several
diseases including metabolic disorders. Periodic Paralysis is a mineral
metabolic disorder.
Food and oxygen are normally converted
into energy and delivered to the muscles but this cycle is disrupted in
individuals with exercise intolerance. The muscles are unable to use the
nutrients and oxygen and therefore, enough energy may not be generated to the
muscles and he or she is left with little or no energy. The degrees of low
energy can be mild or extreme and the symptoms may occur during exercise or
exertion or they can occur later, even the next day.
Symptoms
Symptoms
of exercise intolerance include: fatigue, muscle cramps, insufficient heart
rate, depression, changes in blood pressure and cyanosis. Fatigue may show
within minutes of beginning to exercise with shortness of breath or dizziness.
This is a sign that sufficient oxygen is not being processed. For individuals
with severe exercise intolerance this can happen after doing simple tasks such
as eating, sitting up in a chair or writing.
Muscle cramping and stiffness also will appear within a few minutes of
beginning to exercise. This can linger for days after the exercising. There may
also be a delayed reaction of hours and the pain may begin while one is
sleeping causing one to awaken. The
heart rate does not increase enough to meet the needs of the muscles during the
activity. Depression is often seen in individuals with exercise intolerance.
Not being able to do the things a person wants to do or should be able to do
can create anxiety, irritability, bewilderment and hopelessness leading to
depression. Standing up or walking across a room may be all that is necessary
for an individual’s blood pressure to rise significantly. Cyanosis is a serious
condition that indicates there is not enough oxygen in the blood. The
individual may appear to look blue in the face and hands and needs immediate
medical attention.
Exercise intolerance can be seen in the small muscle
groups as well as the large muscle groups. Writing or other fine motor skills
can be affected causing cramping, fatigue and spasms. Tachycardia (fast heart
beats) can occur from increased breathing rate this during exercise or exertion
and rapid breathing increases from fatigue of the diaphragm and chest wall.
Vision may become blurry due to fatigue of the eye muscles. The oral muscles,
those involving the mouth, may be affected making speech difficult and making
chewing of harder or tougher foods a problem. 27, 28, 30, 31, 32
Diagnosing
Diagnosis would be based on the symptoms
above and the diagnosis of the root cause, which in this case is Periodic
Paralysis.
Treatment
For most individuals with Periodic
Paralysis who have exercise intolerance, it is best to avoid physical activity
and exertion because it can lead to muscle cell damage (muscle wasting),
exhaustion and a condition called lactic acidosis, a form of metabolic acidosis
(also discussed in this book). It also can be a trigger for attacks of
paralysis. 35, 36
My Experience with
Exercise Intolerance
My own symptoms of exercise intolerance
began as having a problem keeping up with others in exercise classes, walking
up inclines and stairs and later during and after physical therapy. I would get
fatigued, out of breath and dizzy after only a few short minutes. I would
develop terrible pain in my legs during the exercising or activity and would
have to stop. The pain and fatigue would be worse the following day. This
continued to gradually worsen until now it takes less and less activity to
create the symptoms.
Now, I cannot walk more than a few steps
at a time. I cannot sit up straight in a chair for very long to do a puzzle,
sew or talk with friends. I can no
longer wheel myself in a wheelchair. I cannot talk on the phone for very long.
Fine motor skills, like writing or sewing by hand, cause my hands and fingers
to cramp. Any exertion or exercise causes my blood pressure to rise; I get
short of breath, fatigued and will later go into an attack of paralysis.
A muscle biopsy revealed signs of muscle
cell change or damage and replacement with fat or lipids. I have been diagnosed
with metabolic acidosis and lactic acidosis, all related to the exercise
intolerance from the progressive and permanent muscle weakness I experience due
to the continued and unchecked (over the years before my diagnosis) shifting of
potassium from Periodic Paralysis, which is a mineral metabolic disorder. “
Until later…
