Here it goes the classic - medical advice over the random internet request. Yeah, i understand there are some risks, but would appreciate any guidance.
My high school daughter is a pretty good swimmer. She swims AA and AAA times for distance events. March started a spiral where she runs out of gas in the pool sooner every day. We have had all the classic blood work done and they come back pretty normal, with exception of one thyroid hormone that runs at the low edge of normal. Our family MD has no idea and referred her to a neurologist. Of course we can’t get in there until the end of the month.
She eats well and sleeps 8-9 hours per night. She took three weeks off at the end of high school swim season and could not ramp back up to her previous work load. Now she is getting beat in distance swim by kids that are not free stylers. Lot of tears.
So, is a neurologist the right next step? Or does this seem more like a metabolism issue?
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
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?
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).
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.
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.
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.
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.
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…
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
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.
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.
