The Mind-Body Connection

In my earlier posting on Adrenal Fatigue Syndrome I mentioned that I often wonder about a mind-body connection with regard to Conn's. I'm learning more each day as I investigate on the web. I happened to stumble across several interesting articles on the subject:

http://familydoctor.org/online/famdocen/home/healthy/mental/782.html

http://www.sciencedaily.com/releases/2008/07/080715152325.htm

http://www.bravewell.org/patient_empowerment/you_and_your_health/mind_and_body_connection/

I'd love to learn more, especially ways to improve an ill body with the help of the mind. As well, I am always on the look out for articles on diagnosing illnesses with both body and mind in mind. If only I could find them in the field of endocrinology. Thus far, none of the endo's I've been to have ever once asked about my emotional stress levels prior to prognosis. Nor have they seemed that concerned after, even when I complained of depression which I believe is common with Conn's. This isn't just a physical disease, things get convoluted and foggy. And even more stressful. I'm just trying to discover more clues as to why I got this thing called Conn's. Or have I just been conned by Conn's?

Becoming your Own Patient Advocate

Once I was diagnosed with primary hyperaldosteronism, I thought I was home free. I had a diagnosis after all, what more was there going to be besides a prescription or two and some follow up visits? Boy was I was wrong. There was so much more, including endless blood work, AVS tests, saline suppression testing and urine screening tests. And then there were the doctors, health insurance companies, prescription medications, family discussions and my job. I needed help trying to balance everything.

What you Need to Know

After having not one but two horrible experiences with endocrinologists being rude, insensitive, uninformative and generally unhelpful, I knew I was going to have another battle on my hands. Luckily I found the right one, but I had to do a lot of shopping. My advice is to start your research on-line. Yahoo groups has an hyperaldosteronism group where a lot of patients exchange doctor recommendations or those to avoid. The second way, which can often the the best, is to ask anybody and everybody you know that has or had an endocrine problem if they like their doctor. If that doctor only specializes in certain diseases, i.e. diabetes and not P.A., ask that doctor if he knows another endocrinologist who would. Personal referrals are the best--it's how I get most of my business and it's also how I found 2 very good doctors of my own. My third endo came to me by way of a well-known surgeon I had done translation work for. Distraught and desperate, I called him one day for some advice and not only did he give me the name of a good endocrinologist, he also said he knew my condition well and could operate on me if that was my option. It worked out perfectly.

Research~
After you get your endo, the next step is to go back on-line and research as much as you can on what this disease is about, including treatment options. This can get a little tricky since P.H. is rare. Some sites may have descriptions that don't include all the tests you'll need to take, while others don't list the many side-effects you may be experiencing. You just have to be vigilant and keep looking. Joining two support groups educated me about medication options and helped me realize I wasn't alone with all that I was feeling. (Support Groups listed on the front page of this blog). Having someone to complain to who understands can be so helpful. Sometimes it's easier to talk to strangers who are experiencing the same things as you. The more we communicate with each other, the more we can learn.

Health Insurance Coverage~
The next thing you need to do is find our what your health insurance provides for. If you've lost your plan (we all have done this, don't worry), contact their human resources department and they will send you out a copy. If reading all the medical terminology is too hard, contact this group, http://www.patientadvocate.org/
It's their job to help you understand your options and your health plan.

Get Copies of your Test Results~
Always ask for copies of all your test results, they are yours and by law you have a right to them. This can help also with the mountains of paperwork you'll receive from the insurance company. The more information you have the better equipped you'll be if there's a billing discrepancy. If you don't like the treatment you received from your doctor (he has to be very bad mind you), don't pay the bill, contact first a patient advocacy group (if he is in a hospital, they will have one). If he's not in a hospital, contact the patient advocacy group listed above, hopefully they can help. You may also call your insurance company and explain your story. You may not have to pay or at the very least may get a discount. Remember, you would complain if your service was bad at a restaurant, why stop at food when it's your body at stake?

Talk to Your Family and Close friends~
This can be hard for many of us to do. Originally I wasn't going to tell my family for a variety of reasons, one of which being I have an ailing, elder parent that requires constant attention. But when I kept missing family events because I was so exhausted or had muscle spasms, they had to know and I'm glad I was honest. You owe to yourself and your loved ones to let them know that your electrolytes and hormones will be off-balance and things can get scary. You will miss events, you will be very tired. If you don't tell them, your disease will come out sooner or later by you either passing out, or acting aloof or in a fog. So talk to them and hopefully they will support your journey to wellness. If they don't, join those support groups I mentioned or confide in one good friend. We all need a shoulder to cry on, no one is exempt.

Treat Yourself Well~
You will have off days, this is a fact. But don't be hard on yourself, it will only make you more discouraged. Try to do nice things for yourself such as massage, manicures, spa days or a girls nite in with a movie or a martini. The better you treat yourself the more positive your attitude and the better you can fight those aldosterone blues.

Act as Normal as you Can~
Get back to your old routine as quickly as possible. This may sound weird but it helps. There was a time that I let this illness take over my life, it was hard stopping it. But I got so tired of being tired, I decided to do something about it. I started to work out again, it had been at least a month and I felt it. At first I really had to push myself, but now it's very normal. Even if I'm exhausted, I'll get on the treadmill for at least 25 minutes 3 times a week to give me some much needed endorphins. This helps with the high blood pressure part of the disease too. As well, I try and get together with friends/family when I have my good days. It may just be one day a week, but I still make the effort. Try to be positive, you will get better... the tests and results seems to take forever, but you will get there. I'm almost at surgery and I feel very hopeful finally.

Adrenal Fatigue is REAL

June 20, 2008 (original excerpt from journal)

Otherwise known as my adrenal rantings...

After all the blood work I've done, I'm starting to feel like a vampire victim. I have NO energy, I barely can make it up steps and I have the hardest time getting up in the morning....and I know it has to do with this thing growing inside me. I've been reading as much as I can about adrenal tumors. They are supposedly common, but not the kind I have. Endo # 2, after all was said and done, was pretty sure I have hyperaldosteronism (PH), one of the longest medical terms I've ever seen. He did say fatigue was not uncommon. I wish he told me more. He also called it Conn's syndrome. He did not however call it adrenal fatigue.

Now that I have become my own patient advocate, I am reading as much as I can on my condition. And I keep finding varying bits of information. But here is something interesting I ran across. I feel this best represents what I have been feeling for close to a year.

ADRENAL FATIGUE SYNDROME:
* excessive fatigue and exhaustion
* non-refreshing sleep (you get sufficient hours of sleep, but
wake fatigued)
* overwhelmed by or unable to cope with stressors
* feeling rundown or overwhelmed
* craving salty and sweet foods
* you feel most energetic in the evening
* a feeling of not being restored after a full night's sleep or
having sleep disturbances
* low stamina, slow to recover from exercise
* slow to recover from injury, illness or stress
* difficulty concentrating, brain fog
* poor digestion
* low immune function
* food or environmental allergies
* premenstrual syndrome or difficulties that develop during
menopause
* consistent low blood pressure
* extreme sensitivity to cold

When I read this, I had one of those serious "a ha" moments. Most of these were me, except the low blood pressure... hyperaldosterone raises the pressure instead. But at least I was getting closer to the culprit of my exhaustion and physical misery. Why endo #2 didn't assist me more when I called him pleading for help after individually mentioning these symptoms as well as others, I'll never know.

But after some more digging around on the web, I see that perhaps there was a reason why he didn't acknowledge my complaints. According to most board certified endocrinologists (including an explanation provided by the Mayo clinic), "adrenal fatigue" is a term that the alternative medical community has created. It's found in health books and web sites, but still isn't an accepted medical diagnosis. But how can this be I ask? I know what I am feeling. Are they disputing that? Well, maybe they are or maybe there still just isn't a lot known about hyperaldosteronism/Conn's. I haven't found any sites that list adrenal fatigue as a symptom of Conn's, only the word "fatigue" shows up.

All I know is what I am feeling and the above list hits it pretty much on the mark, even if it is coming from the 'alternative' community. In my opinion, it sounds a bit like medical east meets west. I have always identified with the eastern doctrine, which has a mind-body connection. But here in the west, we don't do that...we need endless research and testing, concrete evidence, factual data, and sometimes drug company involvement for a condition to become a legitimized condition. As a patient, I still want and need that, but I also need a wellness approach with holistic ways of healing. I heal better when my condition is listened to and so am I. I wonder if we can ever have it both ways in medicine.

Perhaps I am getting way ahead of myself here... like I said these are my rantings and I'm writing this at 2:00 a.m....(just around the time I get the big cortisol energy burst, thanks to this stinking disease). For me personally, I'd love to know more about the mind-body connection with Conn's syndrome. I'd be interested in hearing from others to see if there was a stressful event that occurred before the tumor. I know I had one, a very long drawn out event. Five years ago, I experienced serious stress when I was became involved with a mentally ill person who lived in a revolving state of paranoia and anger, which ultimately came out on me. I was walking on eggshells and dodging landmines, all the while I was trying to run a business. It put me in chronic fight/flight mode, which is a horrible way to live. I also survived a near fatal car accident last year which I am still recovering from. I cannot think my stress glands weren't on major overload from these events. After my mind had had enough, my body gave out, I got sick and the adrenal fatigue symptoms followed. Hyperaldosteronism or not, I have adrenal fatigue.

All I really want is to feel better, like I did before 5 years ago, before all this weirdness started. And to have a good nights sleep, and not be so exhausted all the time. To not have to take horse pills 3x a day and to never have a migraine again or have hypertension at my age. That's what I really want. Well, that and a doctor who will listen seriously to all of my symptoms and maybe just for once, look me in the eye.

Tips for living with Conn's

The following tips may not be for everyone, but they have greatly enhanced my daily routine while living with primary hyperaldosteronism.

** Get a really good endocrinologist. This is crucial. Not all endocrinologists understand or have experience with Conn's. Some even dismiss it as a disease that simply requires meds and little else. You owe it to yourself to find an expert. It took me 3 times to find the right one.

*Get a second opinion if you feel your doctor isn't listening to the severity of your symptoms or helping you. Ask friends/family whomever you know that have been to endocrinologists who they recommend. Personal referrals are the best.

* Research as much as possible about Conn's on your own. I've learned a lot on the internet and through support groups.

* Join a support group, they really help. These are two good ones:
http://health.groups.yahoo.com/group/hyperaldosteronism/
http://www.inspire.com/groups/rare-disease/discussion/conns-syndrome-hyperaldosteronism/

* Get your blood pressure checked regularly. Your endo and other doctors should do this each time you go in.

* Insist on getting all your results from your endo. The more you inform yourself about this disease, the more you will be able to manage it or get proper treatment.

* Avoid as much as possible salt and sugary products. It's hard if you go out to dine as most restaurants use a high content of salt in the preparation of food. Start reading labels for sodium percentages, this goes for sugar, too. Foods to avoid (I know, this part hurts...) Pizza, some soups--they can have a lot of salt, Chinese/Thai food, sugar covered sweets- donuts, candy, cookies, bacon/ham or other cured meats, fried foods, salty peanuts or other nuts (try to get them unsalted if you can), some popcorn that has salt, all sodas.

* Eat more fruits and vegetables and stay as far a way from the above list as possible. You have a disease where you retain water, eating those foods will make you feel worse and swell more.

* Drink lots of water. Also, drinks with electrolytes are great. Drink at least twice a day-- Gatorade or Smartwater, both are good choices. There are others too, read labels!

* Avoid caffeine, or cut back on it as much as possible.

* Develop or maintain a daily routine and do your best to stick to it--even if you have to push yourself to get out of bed. Try and get up at the same time, try and go to bed at a reasonable time--although this can be very hard if you suffer from insomnia, which is a side-effect of Conn's. But having a routine really helps you to feel more in control of yourself when there's an insidious disease trying to control you.

* Avoid alcohol, or cut back if you drink. One drink can feel like three, seriously.

* Start a work out routine if you never have. You will be exhausted most of the time and really have to focus on doing this, but the more you work out, the better it is for your heart and high blood pressure. It also helps with the water retention. Do this at least 3 times a week. (I swear by it)

* Tell all of your other doctors that you have Conn's Syndrome. The more they know the better. Most other doctors may not even know what it is, so you'll be educating them. This also helps with the management of prescriptions-- your other doctors need to know that you are on spironolatone/aldactone/other potassium sparing diuretic, or taking potassium supplements and high blood pressure meds.

* Take your BP meds daily, don't ever skip.

* Make sure if your doctor is suggesting surgery, that he/she has you take an Adrenal Vein Sampling test, (A.V.S.). This is crucial to determine if the tumor is unilateral or on both adrenals. You wouldn't want to go through surgery only to find out later that your other adrenal is also producing too much aldosterone. If you have the A.V.S., make sure the interventional radiologist performing it has a background of doing these tests. This is important--you don't, I repeat, DON'T want to have to go through another A.V.S. test. They are painful and take a lot of time (as well, they are expensive).

* Never take other diuretics, for example diet pills. You'll lose potassium.

*While this may be hard for some (or maybe unnecessary), I do suggest going on anti-depressants. Conn's is a disease that messes with your hormones, even if it's the hormone aldosterone. When there's an imbalance with your electrolytes, it can affect you over time. The exhaustion and brain fog is enough to affect anybody, as is insomnia.

* Confide in a really good friend or lover about your condition. Everybody varies in the severity of symptoms, but there will be times you will feel down, out of it, forgetful and just plain exhausted. Having a confidant really helps. It may even be someone you don't know very well, like an on-line friend. But reach out-- you really need to be supported right now.

* If you choose to manage your Conn's with a life-long commitment to medication, find out as much as possible about the long-term effects. Ask doctors or even better, other Conn's sufferes who have chosen this route. This goes for surgery as well. The more you ask, the more you'll know how to live with Conn's.

The Third and Final Endocrinologist

Out of frustration, with no where else to turn, I called Dr. Armando Sardi at Mercy Medical Center to ask for advice. I told him I had been diagnosed with an adrenal tumor and Conn's was highly suspected. He talked to me for at least 25 minutes, telling me he was very familiar with the condition, as well he had surgically removed quite a few adrenal glands/tumors in his career. Finally, I thought, someone who really knows this disease. I asked for endo recommendations and he pointed me in the direction of Dr. Pamela Quinlan at St Agnes Hospital. I called her office, made and appointment and she became my final endocrinologist. The lady knows her adrenal diseases and then some.

She spoke to me like an adult and didn't hold back on the technical jargon, which suited me fine. When I first was diagnosed, I promised myself I would learn as much about this disease as possible. Through Dr. Quinlan, I have learned more than I ever realized was possible-- some things I have a hard time articulating in this blog-- but at least I understand the bottom line. I often left her office with my head spinning but still felt she was on my team. And if I had to choose too much vs. too little when it comes to my health, I'll lean towards the hefty portion of things.

She explained the hormonal breakdown in the adrenal, and told me it was important to rule out other adrenal diseases such as Cushings. Thankfully, after all the tests I took, that disease was eliminated from suspicion. I'm just a Conn's girl.

Throughout it all I have asked her a lot of detailed questions, and she has always taken the time to sit down and answer all of them. If you have found an endo like this, take advantage of her time and research background. It will give you options you may not have thought about. Even if what she tells you scares you, you at least will know where you stand, and can be a gift when you are battling such an unfair disease that takes so much away, both body and mind.

If you live in the Baltimore/DC area:

Dr. Pamela Quinlan, D.O.
3421 Benson Ave.
Suite 210
Baltimore, MD 21227
410.368.1370
drquinlan@verizon.net

The Second Endocrinologist

Late May 2008.

New hospital, new endocrinologist, maybe a fresh start? Next visit with Endo #2 went somewhat better in the beginning. He was very quiet and soft-spoken but again, he made no eye contact like endo #1 (I swear I'm trying not to take this personally). Since I hadn't been formally diagnosed yet, I was still confused as hell- all I knew is I had an adrenal tumor and lots of weird symptoms. What made me uneasy was that he kept looking up information on the internet (Google) as opposed to being well-versed on adrenal tumors with my symptoms. This made me worry a bit. What if I had something really rare?

Turned out, I did. During the visit, he mentioned terms like Conn's syndrome, Cushings disease and hyperaldosteronism, but that was all. He didn't give me much of an explanation of them. I wasn't sure what they were, actually I had never heard of them. I barely knew my endocrine system, which embarrassed me a bit. But unless you study medicine, why would you? I suppose it's a bit like war. Go to war, learn your geography...get an adrenal tumor, learn your endocrine system.

This is what we knew so far:
1) I have low potassium levels in my blood
2) I have an adrenal tumor on my right gland
3) I have high blood pressure
4) That's about it... although I had a slew of other symptoms at that time he didn't seemed too concerned about.

My other symptoms included:
1) Dehydration, especially at night
2) Polyuria- I pee like, well a racing horse, at least 10 times a day, 4-5 a night-no lie.
3) The fiercest migraines, they started about 2 years ago
4) Heart arrythmia at night thus making sleep almost impossible
5) Chronic fatigue
6) Tingling in hands and feet
7) Depression, which may be due to the above

By the end of the appointment, he told me I had to have a lot more blood work, but no more spironolactone for at least 6 weeks, at which point I was to take a saline suppression test. So what about my high blood pressure, what about a diuretic? None, he said, but I had to take potassium supplements 3 times a day. I already was having a horrible time retaining fluid. This was starting to really suck. One thing he was stern about was that each test HAD to be done in order, it was a process and it can take a long time. What he forgot to tell me was how bad I'd still feel throughout the testing period. Major depression was right around the corner, I could feel it.

The following weeks, I did the blood work as he ordered, but within 3 weeks, I had sunk so low and my energy was completely zapped. My migraines were back and I didn't know what to do other than call him and tell him what was going on and how bad I felt. When I called him it got very strange-- he yelled at me and said I had to follow the order of these tests, there was NOTHING more he could do. But that wasn't the worst part, he then told me, "Well... at least you don't have cancer, this we know." And then there was the longest silence I have ever experienced with a health care professional-- it seemed like 2 minutes passed without him saying a word. I knew something was very off about the experience and I got off the phone quickly. I thought his phone behavior was really rude and especially odd, he was such a soft spoken man in his office. He really freaked me out with his loss of composure. Later that day, I found out through a friend who works at the same hospital that Endo #2's wife was just diagnosed with breast cancer. Evidently he had taken his pain out through losing his temper on others as well, including staff and patients, I assume, which is never a good sign. So, I'll pray for his wife while I go look for Endo #3.

The First Endocrinologist

May 2008.

The reason for sharing this visit is to alert other Conn's sufferers that your symptoms may not be taken seriously at first. Unless you are rushed to a hospital for high blood pressure/heart palpitations or your blood work shows really low potassium levels, many doctors will dismiss your symptoms as common effects of age and stress. Even endocrinologists.

I was recommended to one of the best endocrinologists in town by my cardiologist. I got an appointment within a few days of her referral, which was pretty impressive. When I arrived I was seated in a small but nicely decorated waiting room. The doctor was middle eastern and had the prettiest hand-carved chairs I've ever seen. He (whose name shall not be revealed as I am fighting with the insurance company to not have to pay for his severely awful services), called me into his office and asked me why I came. I told him about the CT scan, the adrenal tumor they found and all about how lousy I was feeling. I also told him I was scared about my potassium levels being off and how alarmed my cardiologist was about that. He barely looked up at me. He asked me a few questions and then very rudely went on to answer no less than 7 phone calls on his blackberry and another cell. At one point I think he had the 2 phones going during my visit. He said he gives out his cell number to all his patients, that I could have it too. But I didn't want his cell number, I just wanted his diagnosis and help. He was making lunch plans with another Dr.and kept saying he'd see him in 10 minutes. Not a great first impression for a new patient.

After a rather speedy exam, I got dressed and met him back in his office where he continued to answer his ringing phones. I found it very hard to believe this was the same doctor my cardiologist praised. He was an unprofessional jerk. I felt judged when he asked if I was married, he kind of glared at me. I am divorced and fine with it but you know, some men just aren't. Towards the end of our appointment, I asked him how he felt about hormone replacement therapy. He said, and this is a quote, "That's the most intelligent question you have asked me today." My God. I got a slip for 3 weeks worth of intensive blood work and was told to stop taking spironolactone, a potassium sparing diuretic for hypertension.

That was my first visit with an endocrinologist and probably my worst visit with a doctor ever. I was left to wonder, is it always going to be like this?

After taking each test precisely the way he told me to, I waited for the results. And I waited, and waited...for two and half weeks. I finally called his office and his assistant said he was out of the country, plus she couldn't find the results but was sure he would call me Monday first thing. He never did. His assistant called me back sometime that week, seems she found my results and she said that my potassium levels were normal. The receptionist is now a doctor. My potassium levels were 3.4, normal is 3.5-5.5. That didn't seem normal to me. Confused once again, I told her I wanted to talk to the doctor to see if I was just borderline affected or did I really have a problem due to the tumor. I waited an entire week to hear from him. I called again, knowing he was back in the country. His assistant told me again he'd call me to discuss my results before the weekend. And again he did not call. At this point I called my cardiologist and explained to her assistant what I had been through. Her assistant is one of those people you want on your side, she is take-charge and is fiercely loyal to the Doctor's patients. She marched down the hall to get some answers and came back on the phone saying he would call me immediately. He finally called and said the levels were low-ish and more testing would be required. He never once apologized for keeping me waiting for two weeks. All that and he charged me $437.00 for one visit. I never went back to him, I called my cardiologist and told her she should NOT recommend him. She actually agreed with me. A small victory for the battered and abused patients of America.

Oh and by the way, he never gave me his cell number. That might have helped.

Aldosterone: the hormone we never knew we had

Aldosterone is being over produced in my left adrenal. I had no idea what it was until I was diagnosed with this disease back in July. Wanting to learn as much as I could about this weirdly named hormone, I did some research to find out what its role was in my adrenals and what happens when too much of it is being produced.

The definition:
Aldosterone is a hormone released by the adrenal glands. It regulates the levels of sodium and potassium in the body, which in turn helps control blood pressure, the distribution of fluids, and the balance of electrolytes in the blood. Aldosterone is the main sodium retaining hormone from the adrenal gland. It increases the re-absorption of sodium and water along with the excretion of potassium in the distal tubules of the kidneys. Pathologically elevated aldosterone secretion with excessive retention of salt and water often results in the raising of blood pressure. High levels of aldosterone can cause a condition called aldosteronism or hyperaldosteronism, also known as Conn's Syndrome.

If a tumor is present, a test will show that aldosterone levels are high, while a renin level will be low. Usually a renin activity test is done when the aldosterone level is measured.
Aldosterone levels may vary between males and females, and can be dependent on the amount of salt in a person's diet. In pregnant women, normal aldosterone values may be 2 to 3 times higher than in women who are not pregnant. Normal aldosterone levels in infants and children may be significantly higher than those of adults.

Typical Symptoms of hyperaldosteronism or Conn's

These are my personal symptoms. While they can vary, many of my fellow Conn's sufferers have complained of these.

1) Fog: I'm in a constant state of fog. That's the best way I can describe my current state of being. It's been like this for a long time now...can't really remember when it started. I feel like I'm just going through the motions but am not really there. Like I'm stoned or something. I also forget stuff a lot which can range from the really stupid to the important.

2) Exhaustion: I never seem to have enough energy I am chronically exhausted. If I don't take a nap I am utterly useless. When I wake up I don't want to get out of bed, even in the morning. All I want to do is sleep. But I could sleep forever it seems and still be tired.

3) Fatigue: It's endless and debilitating. It relates to the above.

4) Rapid Heart Beat: Heart palpitations at night especially, will make you think you are having a heart attack sometimes. I feel this mostly at when I am lying down trying to fall asleep.

5) High Blood Pressure: Was oddly diagnosed with this 6 years ago and have been suspicious as to why at my age (I was considered young for it).

6) Weight gain/Bloatedness: While I'm in my forties, weight gain is to be expected. I didn't gain a lot, but the problem I'm finding is the bloatedness that I can never seem to get rid of. I find it in my hands, ankles and face.

7) The Salt/Sugar: This connection is undeniable. Both are craved, but the sodium does damage, you will puff when you eat anything salty. As well, the next day you will feel awful after eating these foods.

8) Migraines: I been having migraines now for 3 years. Never had them like this before. The first really bad bout that I can remember was in the Canary Islands in June of '06. I thought maybe the island's altitude fluctuations may be the culprit, I had clusters of them for a week. But when I came home, I still got them off and on for long periods of time. It's been years now.

9) Dehydration: I am always dehydrated. I drink water constantly and I'm still thirsty after wards.

10) Frequent Urination: Maybe due to the above, I get up to pee at night at least 4 times. I've told doctors this and I know they think I am exaggerating, but I am not. It has been this way for at least 4 years. I was told to stop drinking water a few hours before I go to bed, but this hasn't helped. I continue to do so.

10) Nerves Shot/Defensive: I have felt like this for a long while. It's like I fear an attack is coming and I can't win-- it's the worst. I used to think it was from lack of sleep, maybe due to getting up so often at night, but now I think it makes sense; the adrenals are your fight/flight responders, and mine are shot.

These symptoms were given to both my endocrinologist and surgeon in June-July. I was told by each that they are most likely directly related to the hormones in my adrenal. When your electrolytes are off, you are off.