I don't know about the medical side, but how old is she? You've ruled out nutritional problems, I presume?

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Swimming Workout of the Day:

Favourite Swim Sets:

2020 National Masters Champion - M50-54 - 50m Butterfly

What does she eat? How much?

I'd get a second opinion on the thyroid check. Depending on the lab and their readings, low end of normal could be on the wrong side of the bell curve with another check, i.e., if LabCorp did the first labwork, then retest at Quest Diagnostics. The numbers are based on sedentary, middle-aged females, not teenage athletes. Just a guess, but an experienced one ;-)

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DFL > DNF > DNS

I swam back in the day and I had 3 daughters who swam too. What you describe is pretty common!. It is a tough sport.

She may not be eating and sleeping enough. Just "eating well" often doesn't cut it for adolescent who is training hard. At some point it does come down to calories in vs calories out, and balanced nutrition takes a second chair. "Oh my God, she eats like a horse and the grocery bills are killing me" is more what you should be feeling. If you have not done so already, you should start counting calories for a bit against training output to make sure she is getting enough. If she is doing high levels of swim training, it can actually can take some focused work for some kids to get enough calories.

8 - 9 hours a night is not really enough sleep for an adolescent who is training hard. (that is about the minimum recommended for non athlete teenagers . . .). And, "8-9" is fuzzy enough that it could really be 6-7. Sleep needs to be worked, not just happen.

It is also possible she is just not physically capable of handling her current workload. There is a continuum of how much work different people (i.e. swimmers) can handle. (the capacity to handle high levels of work over time is actually one of the big differentiators between elites and lower level athletes). She may actually go faster if she backs it down a bit. It does her no good to train over her head. Have you talked to her coaches?

Does she also experience feeling sick a few hours or the day after a workout? This is the hallmark symptom of myalgic encephalomyelitis.

You may consider comparing her symptoms with the International Consensus Criteria for myalgic encephalomyelitis (ME): http://onlinelibrary.wiley.com/...96.2011.02428.x/full

Recent research indicates folks with ME are in a state of hypometabolism: http://www.pnas.org/...nt/113/37/E5472.full

Beware that because there is not a blood test yet for ME, and routine tests come back normal, there is a bias of some physicians to default diagnosis of depression (especially in a teen) and prescribe anti-depressants and stop pursuing the physiological symptoms. If a physician takes this approach, find a new physician.

25% of people with ME are house or bed bound.

Hopefully she has almost any thing else besides ME because there is virtually no research funding therefore little hope for treatment (unless you get cancer, because some cancer drugs help ME folks).

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Advocating for research & treatment for Myalgic Encephalomyelitis (ME).
http://www.meaction.net/about/what-is-me/

"Suck it up, Buttercup"
(me, to myself, every day)

What are the chances it isn't mono?

Not a medical expert

First thought is iron levels as it is pretty common, but the blood tests would show that. Even if iron was on the lower normal side I'd consider iron supplements or have her eat a steak every night. Better yet, teach her to hunt a deer and eat a ton of venison.

Best of luck!

x2 on the closer look at the thyroid - it's a no-brainer to rule that out with a young woman. if the bloods are generally normal (esp iron, etc), then yeah: maybe look to diet. lastly, consider checking where her head is at. is she burned out? overtrained? bummed out? no longer enjoying it?

talking to the coaches will also give you another data point. maybe she's been off in training? maybe the other girls have just lifted their games? at the risk of being indelicate, sometimes as adolescent girls 'develop,' they have big body changes fast that can have major impacts on their athletic performance.

good luck!

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____________________________________
https://lshtm.academia.edu/MikeCallaghan

http://howtobeswiss.blogspot.ch/

If you've already checked iron, a mono spot test may be a good idea. Both low iron and mono are quite common (I've had both) and may be causing the symptoms you're daughter is experiencing. Both really throw training for a loop...mono much more so.

Everything everybody else is saying here, and also maybe try skipping a practice or two a week. I never swam in college because I was too burned out by the end of high school. I'm pretty sure I could have eaten more, taken more days off, and slept more and that would have helped tons.

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----------------------------------------------------------
Zen and the Art of Triathlon. Strava Workout Log
Interviews with Chris McCormack, Helle Frederikson, Angela Naeth, and many more.
http://www.zentriathlon.com

This.

Also I hope OP isn't pushing her too hard. There have been Olympic-quality swimmers that burn out before getting the chance to earn a spot at OT's or swim in college.

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"The person on top of the mountain didn't fall there." - unkown

also rule 5

I 2nd the mono/Epstein Barr test, it is what did me in a few times with the symptoms you presented..

Unfortunately you are in a rule it out phase with your daughter, so not a bad thing to get some advice here. Chronic fatigue can be so many things, you just have to go down the list until you hit the cause or causes, or take a break and hope it resolves itself in time..

Are there any other symptoms besides failing to complete swim practice?

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"Go yell at an M&M"

Ok, hitting a few high points here.

We already ruled out mono and Lyme disease. Should have put that in the original post. All standard blood work is good.

New round of blood work today, including complete thyroid panel and West Nile screen.

This a pretty driven kid. Her Mom and I hold her back from stuff. There is no pushing on our end.

Thanks, Alan

Apparently not a high note, but...

Are there any other symptoms besides failing to complete swim practice?

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"Go yell at an M&M"

Not to sound offensive or anything but also watch out for an eating disorder in the early stages (bulimia). Teen girl, driven, would not be uncommon.

She gets around fine during the day, though she wakes up tired.

No energy effects are seen in other activities, like a two mile bike ride or a mile walk-run.

Other than that, no other issues that her Mom and I can see.

How old is she/what year in HS? Whatever the diagnosis is, I hope its clear she needs a break.

No amount of sleep I got as a competitive HS swimmer was ever enough, especially paired with 5 am practice. I'd also echo the sentiments that "eating well" may not be enough. She needs to be eating A LOT. If some of it is healthy and nutritious great but supplement with cheeseburgers and fast food breakfast!

I second the recommendation to have another opinion on the thyroid number. I've dealt with hyper and hypothyroidism over the past few years, and even when my blood comes back in the defined normal range, its often not working for me.

As SallyShortyPnts said, these numbers are most commonly used to treat older women, not young athletic types (32 yr old male here). Low on the normal scale is way too low for me, and could be way too low for your daughter.

Only problem is that it can be hard to find a doctor that knows how to treat atypical thyroid patients. I've had my best luck seeing a naturalpath.

Did you get a ferritin test? This is not always part of the "standard blood work" and low ferritin levels might explain the symptoms you're describing. Not many family doctors or pediatricians have experience with teenagers who are training at high level, so this is something that's easy for them to miss. If this is the problem, iron supplements (and time) will fix it.

Here's a good article on the problem: http://www.runningwritings.com/...ficiency-anemia.html

True Story:
A bunch of International Olympic swimmers were in town for a swim camp. Several local swimmers were invited to compete with the Olympians in an exhibition meet. The meet was advertised in the papers. A crowd came out to watch the event.

I was one of local swimmers that was invited.
What a great opportunity!!!

Except ......that it was my first day with mono.
No - I didn't yet know it was mono.
(The knowledge would have made it better).

I told my coach that I didn't feel well.
He just thought I was being a baby!

So I got to swim 1500 LCM with a field of international Olympians.

Awesome.....

I would have finished last anyway.
But I was at least 1.5 minutes slower than normal.
And all in front of crowd of national and international, coaches and swimmers.


The good thing is that I spent the next month mostly asleep.

Been there, done that. Long journey for me (decades). Just sharing what helped me even though it may not help you. I had very similar thyroid labs. I take 10mg of Armor thyroid (straight from the animal, not synthetic) and this helped some but was not the whole story. If you read up on it, you will find out more about T3 and T4. You will find that it's a very tricky thing to get balanced. The rest of the story for me was diet. I had very nuanced but accumulative food sensitivities that were hindering me. I would get sleepy after eating. I lost strength. etc. Overall, I found it to be a long process of ruling-out different areas, forays away from traditional medicine, and lot's of patience. The most important thing to do is to start a detailed journal: diet, sleep, exercise. And get copies of her med records so she has them to reference as an adult.

Seems like you are ruling most things out , so here is my 2 cents. If she wakes up tired, maybe a sleep study is in order. Have her evaluated for UARS (upper airway resistance syndrome) which is a little more subtle to detect than sleep apnea. And no, sleep apnea isn't a disease of only the overweight.

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"I keep hoping for you to use your superior intellect to be less insufferable. Sadly, you continue to disappoint." - gofigure

Ok, long slow path since June.

Recap:
Detailed iron panel - no sketchy results
Detailed thyroid panel - T4 a below normal low level
+ more to follow
+ MRI to investigate potential pituitary issue, no indication of trouble
Adrenal response test with no indication of troubles (she did not like the racing HR with that stuff in her system)
Negative for Lyme disease.
Negative for celiac.
She has picked up a dairy sensitivity in the last six months. She mostly avoids dairy now, occassionally taking Dairy Assist to allow pizza or ice cream. Roughly 2x per week.
Neurologist has no ideas and no recommendation for path forward.
Cleveland Clinic pediatric endocrinologist suggested that integrative medicine may be the next step.

She started on low dose of synthoid (levothyroxine 75 mg) seven weeks ago.
+ her Mom & I feel depression is reduced
+ her sleep pattern is better, she appears rested now in the morning
+ workout fatigue is not improved, last summer she wore us out biking and running in addition to the swim club
+ she describes it as "muscles feel tired all the time"
+ re-ran the thyroid panel last week, all markers within normal limits now, including T4.
+ I don't have the detailed results yet, conversationally, T4 is now above the low limit.
+ we asked for an increase in synthroid, the endocrinologist said no, it is too early

She keeps a food diary from time to time, but fights us on it tooth and nail. I see her with the herd of teenager swimmers a couple times a week. She is not the thinnest and not the heaviest.

I can't believe what a long road this has been with no real sign of an answer. I can't imagine how this must be for someone with a debilitating issue.

Any ideas out there?

Does anyone have any experience with this book? https://www.amazon.com/...lab+tests+are+normal

Thanks, Alan

Kind of random, but have you looked into lymes disease?

(Quote) "+ workout fatigue is not improved, last summer she wore us out biking and running in addition to the swim club
+ she describes it as "muscles feel tired all the time"(Quote)

I know that she is a very driven girl but have you broached the idea that perhaps, if she didn't bike and run at all, then she would have more energy for swimming???

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Has she seen a cardiologist? How is her resting heart rate?

I was a competitive swimmer all through college. Overtrained was my first thought. However, that's gone on too long now. I'd have a workup done with a cardiologist. Muscles feeling "tired" can often be attributed to an elevated heart rate.

Hows the protein in her diet? Lots of red meat, eggs?

Poor kiddo.

We have checked and she appears to be negative for Lyme disease.

No issues with joint swelling or stiffness.

Biking has ceased.

Her running has dropped off a lot. Last fall she could run a 23 minute CC 5k. This season her best has been 26:30. She likes the CC team a lot and has been reluctant to drop it entirely.

Her resting heart rate ranges from 60-70 bom. That would be high for a slowtwitcher, but for a 15 year old?

We started a morning evening log of heart rate. I don't have it with me at the moment.

Thanks, Alan

I'm in the cardiology consult camp. No history of heart problems as a child? ASD/vsd? Maybe needs a blood gas analysis...check her room air oxygen saturation...she may have a shunt causing her to have mixed arterial/venous blood...that would be very indicative of being tired all the time. Also does she snore? You're the one who knows her and her body habitus...OSA (sleep apnea) is not always directly related to being obese. Many skinny people snore, which leads to decreased oxygen levels at night and people wake up tires after a nights sleep...long term osa can lead to a multitude of other things such as afib...I'm guessing her rythem is normal?

Just some food for thought.

Hi Alan, I recently went through a version of this so maybe I can give you an idea or two. Boilerplate IANAD. In fact two separate doctors told me my thyroid was fine and I just needed an antidepressant. I don't remember my muscles being tired but I was depressed, overall fatigued, not sleeping well, experiencing mild gut issues, and couldn't lose weight.

- I'm glad to hear she's getting complete thyroid panels. BUT, if she's still on the low end of normal, she might benefit from a dosage increase or switching from Synthroid to Naturethroid if her T3 is also borderline low. She is a teenage athlete and not a sedentary, middle-aged woman and her medication should be adjusted accordingly. Also, your doctor is right in that 7 weeks is too early to really detect a change in thyroid levels from supplementation. I usually go once every 3 months for blood testing when I need an adjustment.
- Have you checked her vitamin and electrolyte levels? My D was in the toilet. I also discovered my serotonin levels were in the toilet.
- Is she on an oral contraceptive? That could interact poorly with thyroid meds.
- Has she been tested for food allergies? If she's allergic to dairy or gluten, for example, that can inhibit absorption of nutrients, which could help explain why she's so tired. Gluten intolerance/celiac and hypothyroidism often go hand in hand as they're both autoimmune disorders (I have both).
- My new doc also wanted me to get rid of things like fluoride toothpaste, which supposedly can inhibit autoimmune function, but the jury is still out on that.
- Does she get enough protein and iron?

I haven't read that book, but I can definitely relate. Please keep us updated. Hoping you find an answer soon.

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http://mediocremultisport.blogspot.com

Did not know she was running CC, thought she was just running for cross-training. I can def see how she wouldn't want to give it up if she enjoys it. I run with my dogs every day at a park near my house and about 2 days/wk HS CC teams are running there, and they def seem to enjoy the camaraderie of their shared suffering.

Don't know what else to say except that the problem could still be overtraining. IIRC you mentioned she took 3 wks off back in the spring but, if she is really OT'd, she needs more like 3 months off. OT happened to me when I was 15/16 and it took me a good 6 months of rest to get over it; the "rest" should be qualified by saying i played a lot of tennis during those months, and my tennis did not seem to be affected at all. Came back to swimming and was doing my previous times in about 3 months.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

In medicine there is a saying that goes, common things are common. May sound stupid, but many seem to feel the need to look for a obscure diagnoses when the answer lies in the description of the problem. The most obvious issue is overtraining (reaching), fatigue. Many young swimmers work off a general training plan designed for an entire team or for parts of a team, that leaves little room for rest and recovery. As you know, once fatigue develops, but is ignored, it starts to snowball. The first thing that a MD should be doing is advising rest, and more rest. Trying to train through this is not advisable. Completing a work-up with a Neurologist may be indicated if the examining physician found signs that need further specialized work-up. I've had the opportunity to treat and a few swimmers with similar scenarios, that generally resolved with rest. Fatigue, leading burnout is not uncommon in young swimmers. Sounds like she rested, and expected to return to her regular performance levels too soon. Probably needs to shut it down for a while, and slowly return to activity in a monitored way. Not jumping back in and trying to compete. Comparing her current times to past times should be put on hold until she has a few months under her belt of training and feeling healthy.

I was pursuing my pro card in triathlon when I came down with Lyme Disease last year. I didn't develop chronic fatigue, but I did develop joint pain and swelling. Many people I know develop chronic fatigue caused by Lyme Disease. Chronic fatigue seems to present more in women than men.

You should look into it because the standard ELISA test that she took is falsely negative 50% of the time. It only tests one particular strain of borrelia burgdorferi and there are many strains. I tested negative with the standard blood tests as well - Standard ELISA and Standard Western Blot test. I even presented with the typical bullseye rash, which only occurs ~50% of the time in Lyme infections.

You should ask your GP to test her using a Western Blot test from Igenex. They are a lab specializing in tick borne infections in California. - I was positive on this test. If your GP isn't familiar or can't run the test for some reason, find a local "Lyme Literate" Doctor.

Now here is my story regarding fatigue that may help... For years I have dealt with fatigue issues and many years ago they found I had suffered from glandular fever so probably explains a period I felt fatigued but nothing as to why I was constantly dealing with it later in life. It varied sometimes worse than others and I learnt to adapt my Ironman training around it times of day I felt more energy or not but each year I was getting stronger I seemed to deal with it more and more until last year I did a massive few months leading into Kona and my numbers were looking amazing (for me) but during my big block of training mentally everything just felt harder due to a fatigue feeling and I had to go deeper just to get the numbers I was chasing and I started to constantly feel tired again. Kona it all just fell apart. I went and had everything tested thyroid, adrenals, hormones, you name it again and found I had adrenal fatigue. I started taking herbal adrenal support had some time off and started training again for Ironman New Zealand in March but never felt back to levels I had been. It all fell apart during the race again and I suffered my first DNF for an IM. I had some time off and tried to start training again but went through the worst cases of fatigue I have ever had including two weeks where to get off the couch was an effort. I found a doctors clinic that specialise in finding issues rather than a general practitioner and went with all the results I already had. They ran a few more tests and basically found nothing substantial. My nutritionist I saw after Kona who had all the original tests requested to find I was suffering adrenal fatigue suggested I send a faecal sample off to be analysed and found I have a parasite dientamoeba fragilis of which symptoms include fatigue, adrenal fatigue and the constant headaches I have been dealing with for years in the evening. They also ran a bioscreen on my gut and found I was low in e.coli collform should be 70-90% make up and I was 0.18% and on the inverse high in strepococcus should be less than 5% and I was 94%. High strep symptoms are also fatigue.

So I tried the herbal route to get rid of the parasite but it was still there so I have just hit it with antibiotics and the herbal at the same time and have just finished. I feel mentally more alert, the headaches have gone and my energy levels feel on the up so I will see how goes. To get the gut balance correct lowering strep and increasing e.coli takes time so I will have another analysis in a few months time. If you have tried everything else then my suggestion to you is to see a natropath and organise to faecal sample sent off to check for parasites and a bioscreen. Of all the doctors I went to in the end they said we don't know and never even made that suggestion and most don't seem to even understand what a good make up is.

If you are still lost to the cause as I was then I suggest give this a try. I hope it helps...

seconding what others have said about sleep. Does she have early AM practices? Teenagers get their best sleep during the day.

If you don't get a response from desert dude, PM him and see if he has some ideas. He's coached HS swimmers before and is super smart.

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

What you say is wise. What is there to lose by taking a few solid months off of swimming vs endless visits to doctors and tests and feeling superfrustrated at not seeming to be any answers. IMHO vague symptoms like this more often than not eventually get better no matter what is done and whatever was "tried" at the time gets the credit. The Lyme tests from Imegex are not recognized by CDC (many false positives good business model for them) and many "lyme literate" docs will give a diagnosis of lyme disease for symptoms that could be from almost anything.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Thanks for adding this. Test ferritin for sure. Not just iron. Many docs won't do this unless you specifically ask. Full iron panel should be done.

I'll share my experience:

I was a year round swimmer and towards the end of HS, I began experiencing a host of odd auto-immune symptoms: incredible fatigue, random arthritic swelling of joints, pressure in my head, flu like symptoms, severe sinus congestion and severe allergies to chlorine only when I was fatigued, but no allergies when I was feeling relatively healthy. I left HS with a 4:13 400y IM time that made D2 possible, but I wanted to try for D1, so I took a year off after HS, worked on a farm and trained extensively for swimming. I had good spells during that period of time, but then my symptoms began becoming more constant and remained relatively constant for more than 3 years while I attended college, not swimming competitively or competing much at all. I saw different medical specialists about once a week during the time. I had periods where I could barely get out of bed for two months at a time, and my white blood cell count was incredibly low. But all tests came back negative. I was told I had chronic fatigue syndrome.Subsequently, my research at the time was in autoimmune diseases.

I did have one nurse practitioner suggest it was stress. This was in the late '90's, so stress as the culprit was near laughable in the medical community at that time, outside of Sheldon Cohen's work on stress in the mid '80's. The nurse practitioner was correct. But, it wasn't day to day stress, or academic pressure, or athletic pressure related stress, but stress as measured by the adverse childhood experienced survey tool. That research is readily available today, but it did not exist in the late '90's. The correlation between those stresses and autoimmune responses and mediating epigenetic methylation is compelling.

Without tossing out a bunch of research papers, here's a quick summary. I did a quick google search and found this accessible article on a site I'm not familiar with, but I fact checked the article and the content is legitimate and it provides links to the original research being referenced: https://alignlife.com/...lt-chronic-disease-3

With your daughter's situation and with so many tests coming back negative. I suggest looking into this. Have a medical professional administer the ACE survey tool with your daughter with your daughter having the opportunity to keep the answers of the survey kept between her and the medical professional so that she can answer the survey honestly. It's a start and easy enough of an avenue to explore.

On a positive note, I've been healthy now for 15 years, train at a pretty high level and consider my swim fitness to be greater now that when I was in HS; I'm working towards a phd; I have allergies and some autoimmune symptoms still, but I just control my environment and diet enough to where it doesn't interfere with my athletics, school or personal life. I suggest not seeing things in the ACE outcomes like addiction, and more dire outcomes and ruling it out. The health outcomes, seeing your daughter's situation, are why I suggest exploring this direction, and because I personally did not and have not suffered from addiction or the more dire outcomes; I was/am a bit of an over achiever but it was my health that suffered as a result of the ACE's, not necessarily my behavior. I scored a 6 on the ACE survey.

http://citeseerx.ist.psu.edu/...ep=rep1&type=pdf

http://slideplayer.com/slide/3963592/

http://slideplayer.com/slide/4764873/

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wovebike.com | Wove on instagram

len wrote:

What you say is wise. What is there to lose by taking a few solid months off of swimming vs endless visits to doctors and tests and feeling superfrustrated at not seeming to be any answers. IMHO vague symptoms like this more often than not eventually get better no matter what is done and whatever was "tried" at the time gets the credit. The Lyme tests from Imegex are not recognized by CDC (many false positives good business model for them) and many "lyme literate" docs will give a diagnosis of lyme disease for symptoms that could be from almost anything.

Hi Len,

Do you have any evidence to substantiate your claim? I said in my previous post that the CDC recognized two tier tests (elisa + western blot) are notoriously inaccurate. In fact, they are so inaccurate that many states on the East Coast have laws in place that require your doctor to tell you that you still could have Lyme even if you test negative. Look up Dr. Neil Spector - A top Duke University Oncologist. He was negative so many times that by the time he eventually tested positive, he had irreversible heart damage and required a heart transplant.

I agree that doctors of all sorts, not just Lyme Literate physicians can make mis-diagnoses. It happens all the time. I was mis-diagnosed as having reactive arthritis by a rheumatologist with 40 years of experience.

I suggest you read this article with information from 6 studies, which shows how poor the standard elisa and western blot tests are. It also explains the qualifications of Igenex.... not "Imegex":

https://www.lymedisease.org/lymepolicywonk-the-cdc-the-fda-and-lyme-disease-lab-tests-two-tiered-tests-igenex-the-c6-and-the-new-culture-test-2/


Again. I was negative on BOTH standard tests when I had a bullseye rash. A bullseye rash is enough to make a clinical diagnosis of lyme disease without the two tiered test. This is N=1, but it paints a picture for sure.


Let me be clear: I didn't even know what Lyme Disease was before I got it. I live in the Seattle area and you never hear about it out here. I am simply stating the facts of the matter.

Please listen to tri Doc here. I am also a physician.
The law of parsimony says that the simplest explanation of phenomena is usually the best.
Most likely is that she is simply overtrained. . Her workload exceeded her ability to recover. Better nutrition, sleep, recovery (ie massage) can help but will not make up for the fact she probably needs a huge break from training.
That said it would still be worthwhile to simultaneously look for common medical problems like mono, subclinical hypohyperthyroid problems, anemia, depression, cardiac issues .... Deep overtraining can make her susceptible to some of these conditions as well.
If she still has symptoms after 3-4 months of rest, go ahead and look for the zebras.

'

I second this. Hb doesnt cut it. You need to test ferritin as well as free iron. A low ferritin causes workout fatigue and inability to work at any reasonable intensity.

Howevery, burnout is most likely. Swim teams build a scheduled that is supposed to make a maximum amount of people perform better, not make every athlete perform at their best.

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Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede

I had multiple normal results of routine blood work, yet had mutli-system dysfunction and could only walk up 1 flight of stairs at a time, or walk 10 minutes slowly on flat ground, so fairly disabled.

I had to send my blood to Germany (Armin Lab) to test for enteroviruses as my (Canadian) health care system stopped doing enteroviral testing in the early 90s.

Turns out I have coxsackie B, one of about 100 enteroviruses. Polio is probably the best known disease caused by enteroviruses.

Just as an FYI, Dr Hyde maintains that the difference between poliomyelitis and myalgic encephalomyelitis (ME) is the location of the enteroviral infection on the spinal cord. With polio the infection site is further down the spinal cord causing paralysis, with ME it is higher up, closer to the brainstem.

http://www.millionsmissingcanada.ca/.../Hyde-What-is-ME.pdf

From what I understand, Dr Chia in the US tests and treats enteroviral infections: http://www.enterovirusfoundation.org/directors.shtml

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Advocating for research & treatment for Myalgic Encephalomyelitis (ME).
http://www.meaction.net/about/what-is-me/

"Suck it up, Buttercup"
(me, to myself, every day)

One thing that I haven't seen covered here: asthma. Tired all the time and inability to recover could both be a result of reduced oxygen intake. And when it develops in fit athletes, it can be hard to catch, because you don't think "asthma" if the person isn't having an obvious attack.

It's worth checking it out.

Hi. I'm sorry to hear about your daughter. It's hard to watch such a decline and not be able to find a definitive answer.

A swimmer on my daughters' club team was diagnosed with Postural Orthostatic Tachechardia Syndrome (POTS). It falls under the Dysautonomia umbrella. Teenage girl with tons of energy and huge success in the pool went from barely able to make it though a day at school. It was disheartening to watch. Luckily, the diagnosis came quickly, but follow through at the Mayo clinic and the timeline for improvement was lengthy. She is now back to the pool and running cross country as well.

I wish her and your family the best in finding an answer.

I struggled with an "on the low side of normal" thyroid for about 15 years before someone finally diagnosed Hashimoto's. That's certainly one to watch, and to be reasonably aggressive with. Some people just don't feel good at the low end of normal values.

I only saw one mention of Vitamin D through the thread - if the endo hasn't checked that, it's well worth it. That seems so small (it's just a vitamin, right?!), but if she's low on that the difference will be night and day. I take 50,000 units of D a week just to get to the normal range, so it can be more than a gummy-vitamin-in-the-morning treatment for some people.

You also didn't talk about the quality of her sleep; do you notice her snoring at all, or stopping breathing while she's sleeping? She's not the typical candidate for sleep apnea, but if something is preventing her from getting solid, restful sleep it doesn't matter how many hours she is in bed. That would certainly cause chronic fatigue on top of her training load.

correct. Rest comes first, then look for zebras/quaggas.

not in HS but managed to overtrain myself aged early 20s, needed six months complete rest and a course of immunoglobulin to recover..
diagnosed with CFS in the early 30s but I believe that was related to the aftereffects of cerebral malaria, rather than training as such. haven't recovered yet from that..

+1.
my son lost 10lbs last swim season, on 5000 calories/day.. we are mailing him care packages this year, to provide extra calories..

mono is hard to diagnose so I'm not sure it can be ruled out. Both my sons had it for a year, with the tests coming back negative. Eventually the bloodwork detected the persistent antibodies so we knew they had in fact been sick, but none of the tests captured it in the first stages.

This describes my daughter to a T (well, not the huge success in the pool). Mayo Clinic gave her life back to her and to us.

I had considered this for the OP, but a lot of the symptoms aren't there. The test is pretty simple, though:

1. Lie down for five minutes, then take heart rate
2. Sit up quietly for five minutes, then take heart rate
3. Stand quietly for five minutes, then take heart rate

Someone with POTS will show a marked increase in heart rate from the first to the second to the third reading.

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"Go yell at an M&M"

Lyme was suggested several times in this thread and was tested for several times. As an engineer, I failed to understand the high incidence of false negatives for some of the simple tests.

We did not realize was that there are multiple test for Lyme and they all have issues. Eventually we had the Western Blot run and she showed some reaction to three of the bands. My wife found a Lyme doctor here in western PA that would treat a juvenile. She started treatment (mix of antibiotics and crazy amount of nutritional products) in February. From my perspective she has been on a slow recovery since then. She does not always agree.

I guess the biggest reason for sharing this info at this point in the game is to hopefully help anyone else in a similar problem.

In parallel, after about a year of trying, her Cleveland Clinic endocrinologist got her in to see their functional medicine group. After some detailed testing for heavy metals he agreed that Lyme was the best fit and recommended she stay "outside the system" with the Lyme doctor.

I just read an article about Angela Naeth's battle with Lyme and it reminded me I had not updated this thread.

https://triathlonmagazine.ca/...OOSb3ZOB9m3G67ycQgPk

Thank you for all the council.

Best Regards, Alan

Ask her if she got herself a boy - could be why she is tired (not all sexually) but it is another fairly large time consuming thing to add to a schedule.

Happened to me when I did HS sports. Life was dived into 2's. School - sports. Then I got a girl and then it was 3's.

As a lyme disease sufferer myself a few years back, an anti-inflammatory diet also really helped my recovery which is quite long and had its ups and downs. But there is light at the end of the tunnel and hope she fully recovers.