Self-diagnosis: Your workouts can reveal what’s wrong with your health.

Self-diagnosis: Your workouts can reveal what’s wrong with your health.

You’re used to thinking that exercise can improve your health, reducing your risk of heart disease, simmering down your blood pressure, diminishing your chances of Type II diabetes, and cutting the likelihood of different cancers. However, you probably didn’t realize that if you are already sick, your workouts can also diagnose what’s wrong with you. In fact, sometimes exercise is the only way to tell that something has gone awry – that is, without subjecting yourself to a full array of doctor’s visits and laboratory tests.

If you’re surprised about the diagnostic potential of your training sessions, you shouldn’t be. After all, you’re no doubt aware that exercise can be a pretty reliable revealer of coronary heart disease: if your workout tends to produce chest pain, that’s a fairly dependable sign that all is not well with your ticker. And you probably know, too, that exercise can unveil respiratory problems: If you wheeze or experience unusual respiratory discomfort when you train, you should ask your doctor to check for asthma or other respiratory disorders. So why shouldn’t exercise be able to reveal pathologies in other parts of the body?

In fact, it can. Exercising places the whole body – not just the heart, lungs, and muscles – under stress and can accurately reveal dysfunctions in a variety of different organs and tissues. For example, running, cycling, or swimming can be very good at tipping you off that something is amiss with your blood. After all, your blood, or more specifically the haemoglobin in your red blood cells, carries oxygen to your leg muscles to help create the energy you need to keep exercising. Hurt that haemoglobin, and you will feel it when you work out or race.

Take anaemia – a condition in which haemo-globin levels in the blood are below par. If you were a sedentary person with a moderate case of anaemia, you would probably feel fairly good throughout the day and never suspect that anything was wrong. Because you were sedentary, your tissues’ demand for oxygen would be pretty modest, and so your blood’s reduced oxygen carrying capacity would tend to go unnoticed. You might feel a little breathless when you were climbing steps or carrying a heavy load, but you would probably attribute your gasping to being out of shape.

Do you want to chew ice?
Serious athletes, however, would realize right away that something was wrong. After all, intense workouts and races require heavy flows of oxygen to the muscles. Since oxygen delivery is reduced in anaemia, anaemic athletes usually feel fatigued and ‘lead-footed’ when they try to exercise at a high intensity. If you feel fairly normal when you’re not training or racing but have noticed that your race performances are falling, your interval workouts are becoming more difficult, and your breathing is more laboured when you train, you should think about the possibility of anaemia. Other indicators of low haemoglobin include excessively high heart rates, profuse sweating, dizziness during exercise, and (strangely enough) a strong desire to chew ice.

The exact reason for the ice addiction is unclear, although renowned University of Oklahoma haematologist E. Randy Eichner speculates that the cells lining the mouth run out of iron and send an alarm signal to the brain which is mollified only by chewing cold, crunchy things. This ice craving usually abates after one to two weeks of iron therapy – before the anaemia itself is fully resolved.

Although fatigue can suggest anaemia, there are of course lots of different conditions which produce fatigue. People who are depressed, for example, tend to feel fatigued when they wake up in the morning. Those who are suffering from a viral infection tend to be okay in the morning but become tired as the day goes along (this is particularly true for people who are recovering from hepatitis or infectious mononucleosis, many of whom experience a strong craving for a nap in the afternoon). Patients with chronic fatigue syndrome tend to be tired all the time. As mentioned, the fatigue of moderate anaemia usually reveals itself only during exertion, which is why exercise is such a good ‘anaemia barometer’.

What headaches can reveal
There are many other examples of the ability of exercise to detect disease, as Eichner and Warren Scott, M. D., recently pointed out in the March 1998 edition of The Physician and Sportsmedicine. For example, Eichner and Scott call attention to the fact that many athletes develop headaches during or after their workouts and races. What do such headaches reveal about the athletes’ states of health?

In some cases, the headaches are actually cervicogenic (ie, they result from arthritis in the cervical spine). Headaches may also result from exercising at altitude, and many head problems occur for no known reason and are totally harmless, aside from the annoyance of a throbbing noggin (these latter maladies are called ‘benign exertional headaches’).

As Eichner points out, the origin of benign exertional headaches is hotly debated. They are certainly not a new phenomenon, since they were described by Hippocrates, who said “One should be able to recognize those who have headaches from gymnastic exercises or running or hunting or any other unseasonable labour.” Benign exertional headaches are probably triggered by vascular events: hard exertion frequently causes blood pressure in the brain to shoot up, dilating pain-sensitive venous sinuses at the base of the brain (these sinuses are simply large vessels which collect blood which has already circulated through the brain and then return it to the heart). This dilation usually produces pain at the base of the skull or (strangely enough) the top of the head; as your fitness increases, the pain usually decreases.

Benign exertional headache can be differentiated from the pain associated with a brain tumour because the former usually occurs only during exercise, strikes ‘out of the blue’, and produces very strong throbbing sensations. Of course, the ache associated with a tumour tends to occur when one is not exercising, too.

However, few athletes are aware that an exercise-related headache may actually indicate heart trouble. In one case described by Eichner and Scott, a 57-year-old man began having headaches which developed about 10 minutes after either working out or engaging in sexual activity. Two neurologists examined this athlete and could find nothing wrong.

However, a third neurologist referred the athlete for an exercise stress test, which revealed underlying myocardial ischaemia (lack of adequate blood flow to the heart muscle). As it turned out, three of this individual’s four coronary arteries were significantly blocked; after coronary bypass surgery, he returned to his usual training and sexing – without the headaches. Had it not been for the sore brainpan which appeared only after exertion, he might have blithely continued on with his life and failed to get the necessary testing and surgery. As Eichner and Scott wisely point out, the lesson is that you shouldn’t assume that exercise-related headaches mean nothing. Although it’s true that they might tell you little about your head, they can indicate the presence of heart disease.

Some other cases
Let’s say that you have noticed blood in your urine after a strenuous workout. What’s causing red fluid to spill into your yellow fluid, and what should you do?

Eichner and Scott reveal that haematuria (blood in the urine) is not all that uncommon in runners. As you run, your bladder gets jostled around in your pelvic cavity, and the rather flaccid posterior wall of the bladder may strike repeatedly against the bladder base, irritating the interior lining of the bladder and producing some bleeding.

In most cases, however, the blood is not produced in torrents; usually, it must be detected microscopically. If you actually see blood in your pee (or if your doctor detects recurrent microscopic haematuria), there’s a strong possibility that the blood is the result of disease, not the mere flapping together of your bladder walls. Blood in your urine can be a sign of bladder cancer, so if you see red stuff make sure you are examined immediately by a specialist. If you detect bladder cancer early, you have a excellent chance of being cured.

What’s up your colon?
According to Eichner and Scott, your exercise can also provide information about the health of your colon. For example, if your large intestine usually behaves perfectly but you often develop diarrhoea when you work out, it’s possible that you might have giardiasis or amebiasis (parasitic infections of your gastrointestinal tract).

Somewhat more ominously, experiencing bad diarrhoea during exercise – but not at other times – might indicate that you have ‘athletic colitis’, which could also be termed ischaemic colitis (irritation of the colon associated with a lack of adequate blood flow). Athletic colitis can develop in the following manner: during prolonged, strenuous activity, blood is diverted away from the colon to satisfy the huge blood appetites of the muscles and skin. This diversion is worsened if an athlete becomes dehydrated, which reduces blood volume and therefore leaves even less red fluid available to the large intestine. The lack of blood flow can then damage the walls of the colon, sometimes severely. In recent cases, one elite female runner and two elite triathletes (one male and one female) had to have parts of their colons surgically removed because of the exercise-induced defoulment. That’s not a bad reason to take in copious quantities of sports drink whenever you exercise for prolonged periods of time!

The man who didn’t sweat
If you have a seizure while you are exercising, it could signal epilepsy. However, if the seizure occurs after syncope (fainting), it may well be an indicator of very serious heart trouble. Seizures after prolonged workouts can also suggest the presence of hypoglycaemia. And of course, as Eichner and Scott point out, a seizure may also warn of the possible presence of a brain tumour, either benign or malignant..

Although we earlier linked unusual fatigue during running with anaemia, abnormal tiredness may also indicate other disorders. In particular, worrying fatigue may be the result of hypothyroidism (an underactive thyroid gland), which (fortunately) is usually easily remedied. One of the odd aspects of hypothyroidism is that its associated fatigue is often accompanied by tendinitis and an increased risk of ‘overuse’ injuries, probably because tired muscles do a poor job of protecting associated tissues.

Sometimes when something doesn’t happen when you exercise, you should begin to worry. Eichner and Scott cite the case of a man who noticed that when he ran in the heat, he did not sweat on the left side of his face, left arm, or left upper portion of his trunk. This man actually called Dr. Eichner on the phone for a consultation – and was told to look in the mirror!

When he did so, he noticed for the first time that his left eyelid drooped slightly. Of course, as you’ll no doubt recall from secondary-school health class, the man was suffering from Horner’s syndrome, an illness in which there is no sweating on one half of the face – or on the neck, arm, and trunk of the same side of the body. In addition, the same-side eyelid droops and the associated pupil is smaller than normal.

Horner’s syndrome is caused by damage to a tiny nerve in the neck which controls the sweat glands but also ascends to innervate the eye. This nerve is part of the sympathetic nervous system’s ‘fight-or-flight’ response; it fires signals to the sweat glands to commence sweating and widens the eye and pupil, presumably to promote more acute vision in a stressful situation.

As it turned out, the athlete who called Eichner had undergone chiropractic manipulation of his neck just before he stopped sweating – and started drooping. This manipulation had inadvertently injured the small nerve involved in eyelid-muscle control and sweating. Although the frequency of such chiropractic injuries is low, they do occur (one occasionally hears about an individual who has suffered a stroke after a chiropractic manipulation of the head and neck). Weightlifting injuries can also produce Horner’s syndrome, but an athlete may not know that anything is wrong unless he/she exercises intensely and produces ‘patchwork sweat’.

Diagnosing chest pain
Regular athletes tend to experience chest pain from time to time and often wonder whether the hurt is signalling heart disease – or some other less deadly disorder. As Eichner points out, it’s generally best to let your doctor decide what is wrong with you, but there are some general guidelines. True heart pain tends to develop in association with physical exertion or mental stress and is usually felt as a heavy, crushing, or pressing pain in the chest beneath the breastbone. It is usually dull, not sharp, and can radiate to the neck, jaw, stomach, or back – or even down either arm (although it is usually felt on the inside of the left arm).

In contrast, the chest pain associated with indigestion tends to occur at rest, after eating, or while lying down. Often, you will have a sour taste in your mouth, and antacids (or belching) will provide at least some relief. The chest pain associated with muscular strains or injury usually produces pain primarily when you move your arm, shoulder, or upper chest; you also tend to have a tender spot and stiff muscles at the spot where pain is maximal. Finally, the pain associated with lung problems tends to create a stabbing sensation whenever you cough or take a deep breath. If the discomfort is coming from pneumonia, you will usually have a high fever and coughing which produces sputum as well.

Don’t forget that although exercise can help prevent many illnesses, it’s not a foolproof protector against disease. Thus, you shouldn’t ignore symptoms of possible illness which pop up when you work out or race. In fact, the way you feel while exercising can often pinpoint exactly what’s wrong with you. Bear in mind that this is a very positive thing – not a negative. By revealing trouble early on, before it might otherwise be detected, exercise can significantly increase your chances of getting cured if you have a serious illness.

In fact, shortly after Eichner and Scott published their article, Scott received a call from a man who had suffered a seizure while working out. This exercise-related seizure led to the diagnosis and cure of an early, otherwise silent brain tumour. So, enjoy the health benefits of your exercise, but also pay attention to what your exertions are telling you about your current state of well being!

Owen Anderson


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