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What causes extreme tiredness and fainting spells post workout ?

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Practicing since : 2002
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Hello. I get extremely tired and faint with loud ringing in both ears after exercising such as running. Have been to GP, cardiologists, neurologists, endocrinologists, ER. All fine. First episode was 20 years ago, recently getting much worse, presents with just a little exercise and feels flu-like for several days afterwards before totally recover. Please help.
Posted Fri, 27 Apr 2012 in General Health
Answered by Dr. Robert Galamaga 1 hour later

Thanks for the query.

Your question is a good one and I will try to provide you with some information and recommendations regarding what is going on.

When you report the symptoms which you have described after exercise a couple of things come to mind. One thing which immediately comes to mind is possibly a fluctuation in your blood pressure which occurs immediately during or right after exercise. We know from good research that blood pressure does go up during exercise but usually comes down very nicely after exercise is completed. I wonder if this fluctuation is perhaps a little bit more significant in your case.

The only really good way to measure this possibility would be to do a very closely monitored exercise stress test. It is possible that you may have had one of these done in the past and I wonder if the blood pressure did fluctuate significantly at that time.

Another consideration would possibly involve the sinuses. Sometimes with a stress on the body such as exercise the sinuses can swell and sometimes they may increase the amount of secretions which are generated. This would in turn create quite a bit of congestion and could also cause some degree of ringing in the ears due to a buildup of pressure behind the eardrums.

As far as the general fatigue and flulike symptoms which seem to persist this may have something to do with your overall conditioning and may also have some degree of influence of your immune system. Exercise can sometimes challenge the immune system because as I mentioned earlier it is a certain degree of stress on the body. I would suggest that you contact a good physical trainer to design a very slow and progressive regimen of exercise which you could partake in over a period of time. Perhaps the degree of exertion which you experience during exercise is too much for your body to recuperate from at this time.

Generally starting out at a very low intensity and paste with a slow increase over a period of time would provide a significant degree of benefit along the lines of tolerability as well as recovery.

Again I thank you for your query. I understand that you're dealing with something that has been quite frustrating and I hope my answer has served to be both informative and helpful. If you have any additional questions regarding this concern I would be happy to address them.


Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: What causes extreme tiredness and fainting spells post workout ? 4 hours later
Thank you for your response.

I mentioned I had an exercise stress test. It was closely monitored by my cardiologist. I have been examined by two cardiologists and pronounced perfectly healthy.

Regarding the swelling of the sinuses, I have never had this problem but will follow up. The ringing in the ears also occurs with very modest exercise, indoors or outdoors, and also I live in a dry climate, so I doubt this is the problem. I have been examined by my family doctor also. But will follow up.

Regarding overall conditioning this problem occurs with only slight exercise. I have discussed with my family doctor many times and have ruled out conditioning. The tiredness and weakness occurs mostly in my upper body. Also the faintness is not what one would expect from exertion. Tiredness, yes. Faintness, no.

Other thoughts? Again, thank you for your time and expertise. I was thinking more along the lines of a metabolic disease.
Answered by Dr. Robert Galamaga 7 hours later
Hello and thanks for the followup.

Yours is a challenging issue as your symptoms do not fit any obvious syndrome. Has your doctor done muscle enzyme testing? Sometimes inflammation of muscles can lead to elevation of enzymes such as CPK, or CK which might point us more to a direction of inflammatory muscle disease. I am really just thinking out loud here on your behalf.

I am sure the neurologist considered such things as myasthenia or Eaton-Lambert syndrome - these are disorders which can cause weakness. Again though your symptoms don't quite fit the XXXXXXX for either of these. A muscle biopsy might be another consideration again to assess of there is an inflammatory issue.

I assume also you have been tested for dysfunction of the thyroid, adrenal gland, anemia and testosterone production. All of these have a common thread where dysfunction can translate into fatigue. One additional thought would be an analysis of the chest with a CT scan to look for anything which might be contributing to more of an upper body dysfunction.

I thank you again for submitting your query and hope my answer has served to be both helpful and informative. Should you have additional concerns I would be happy to address them as we work to try and com up with a good plan for determining the cause of your symptoms.


Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: What causes extreme tiredness and fainting spells post workout ? 1 hour later
I had tests for thyroid, adrenal, anemia, and testosterone and all were normal. LEMS and Eaton-Lambert were considered and rejected and besides, they affect the legs and my legs are OK; plus, my symptoms don't fit...especially the faintness. Also I had chest and abdominal CTs with no abnormalities. Also I had a neurological work-up so no problems there. I met with the neuromuscular specialist at Stanford and got a clean XXXXXXX of health so I do not think the inflammatory muscle disease route is the right one, but I will certainly consider looking into it more.

I am afraid that leaves us nowhere, except perhaps metabolic diseases, which I of course know nothing about. Can we consider those? I believe there are about 50-60 different kinds.
Answered by Dr. Robert Galamaga 20 hours later
Hello and thanks for the followup.

This is definitely a challenge - obviously as you have seen a number of experts already. Metabolic diseases really would manifest is abnormal lab results including electrolyte, liver, glucose or blood cell abnormalities.

I really would like to review any lab and imaging results you have had done. If you have the energy and time to collect these for my review I will do my best to think outside the box on your behalf to conceptualize what might be going on.

Thanks again for the query and followups. I hope you have found our exchange to be helpful. I am here if you have any additional concerns as well.


Dr. Galamaga

Above answer was peer-reviewed by
Follow-up: What causes extreme tiredness and fainting spells post workout ? 6 hours later
That's the spirit! I like a doctor who doesn't give up. All those specialists lose interest after they pronounce me healthy, so PLEASE don't give up. Also I am greatly relieved that any metabolic problems would show up in the regular blood tests. So, how do I get my records to you? Please advise.

BTW I forgot to answer your earlier query about my BP which is 110/80 consistently although it goes somewhat higher with exercise or when I have significant back pain. Also my glucose levels are fine...I bought a glucose meter and have checked.

Also I have seen 2 back doctors and 4 chiropractors for the back problem and 2 alternative medicine practitioners for the tiredness with no good insights.

Today, Tuesday, I am completely recovered from the tiredness episode that came on after doing my back exercises a bit strenuously on Saturday. Just have a little back pain. In fact, I feel great! It's baffling.

Again, how do I get those records to you?

Answered by Dr. Robert Galamaga 8 hours later
Hello and thanks for the followup.

You can scan and upload the photos on the right side of the query box. If you are unable to upload the photos then you can scan and email the records and send to my attention at YYYY@YYYY .

Please do confirm the uploading or mailing of the reports by writing here as to reply you back at the earliest.

Thank you again!

Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: What causes extreme tiredness and fainting spells post workout ? 4 days later
A lucky thing just happened that greatly helps our discussion about my mystery illness!

Last Saturday I did some strenuous back exercises since I felt quite well. I included one exercise (the "Superman") that in the past had irritated my back, thinking I was strong enough to handle it. However, I developed all the symptoms that I have been complaining about (faint, tired, ear ringing, flu-like feeling). It took about three days to recover completely. Then I did all the exercises again, but omitting the Superman exercise. I was fine. I repeated this twice over the past couple of days, exercising without the Superman, both times feeling great afterwards.

What this says is that when I exercise (running, biking, tennis) I irritate my back somehow like the Superman exercise does. Through some unknown mechanism I become tired and faint with loud ear ringing and long recovery times. The question now becomes, what is this mechanism, and how can I cure it, minimize it, or work around it?

I am quite excited about this discovery. As I had mentioned this "illness" has been a mystery for about 20 years and this is the first true breakthrough!

Again, what could the mechanism be? And, how to diagnose and cure? Thoughts?
Answered by Dr. Robert Galamaga 2 hours later
Hello again it is great to hear from you.

This is very interesting news what you have reported. As far as the Superman exercise which you have reported I did look online to evaluate the exact posture and exercise component of this position. Based on what you have told me I suspect two possible contributing factors.

The first factor which we must consider would be a vascular component. There is an extensive network of blood vessels which runs the length of the entire spinal cord. In addition there are key blood vessels in the neck which can be sometimes affected by the position of the next. For example if one extends the neck in a case where blood flow to some of the arteries and veins in the back of the neck are limited this may create a situation of limited blood flow to the brain. This is of limited duration but can certainly create symptoms such as dizziness which may persist.

As far as the blood vessel network in the spinal canal this is really only best visualized via a contrast enhanced magnetic resonance image of the entire spine. This would be an extensive study which would probably be expensive as well. Nonetheless it might serve as a possible point to start.

The blood vessel network in the neck is best studied via magnetic resonance angiography. This as well as the MRI is a study your doctor could request.

I suspect that the superman exercise maybe is triggering something in the spine or neck via the blood vessels or possibly the nerve roots in the spinal canal.

I thank you again for submitting your followup. I hope you have found my response to be both helpful and informative. If you have any additional concerns I would be happy to address them.


Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: What causes extreme tiredness and fainting spells post workout ? 9 hours later
Thanks for the response.

I suspect the problem is in the back, not the neck...

I had a contrast enhanced CT scan of the abdominal vascular structures earlier this year to check on my bypass by my vascular surgeon, and I asked him specifically about the possibility you mentioned. He said everything in the back looked fine. Also, I asked my back doctor about this several times and received assurances.

Thus I am somewhat less likely to suspect vascular involvement, but rather muscular or nerve issues. Might this alter your suggestion at all? If not, could you please provide a bit more detail on your vascular suggestion. Thank you.
Answered by Dr. Robert Galamaga 10 hours later
Hello again and thanks for the followup.

Regarding the vascular issue there are rare occurrences where there are vascular malformations around the spinal column which can sometime present as a constellation of symptoms which don't quite fit a particular diagnosis. I agree this seems less likely and patients with these such things such as spinal arteriovenous malformations typically have more severe issues such as inability to walk.

Everything at this point does seem to point more toward a musculoskeletal phenomenon in that the nerves, muscles and bones are somehow interacting such that in those certain situations as you described earlier it just seems to trigger this interaction and cascade of fatigue, ear ringing and overall flu-like symptoms ensue.

Now....what to do about it. The only imaging I know of which might focus us more would be an MRI with special attention to the cervical and thoracic spine. Another consideration would be a consultation with a physical medicine and rehabilitation physician - these are experts in the field of musculoskeletal medicine and they have a keen eye for helping us pinpoint triggering factors of musculoskeletal problems. Perhaps a consultation would be very helpful along those lines.

Again I thank you for the question and the privilege of discussing your health. I am here for you if you have any other concerns.


Dr. Galamaga

Above answer was peer-reviewed by
Follow-up: What causes extreme tiredness and fainting spells post workout ? 11 hours later
Thank you for the response. Some additional information follows with a further question.

I experienced a lower back pain flare-up this past March 2011, and during that period I would experience the following symptoms. When I would lie on my back, my ears would begin to ring and then my heart would begin pounding, my heart rate would increase substantially, and my blood pressure would spike to dangerously high levels. I would then get up and the BP would return to normal over the next 30 minutes or so. My back doctor, GP, and cardiologist all told me this ringing and BP spiking were normal reactions to the back pain.

As a follow-up I saw a physical therapist for this back pain flareup and BP spiking, and he told me that the muscles in my back were tensed up and pulling my spine out of position which could cause the BP problem. With his back massages and the exercises he recommended the muscles relaxed, and the blood pressure issue resolved substantially, proving that he was correct. However I still get the ear ringing and heart rate increases when I lie on my back but happily only with relatively modest blood pressure rises that decline quickly over about 5 to 10 minutes after I get up.

My question is this. Do you think that this back pain and subsequent ear ringing and blood pressure increases might be symptoms of the same underlying problem that is causing the exercise faintness? And, does this throw additional light on the cause, testing methods, and possible cure? Thanks as always.
Answered by Dr. Robert Galamaga 17 hours later
Thanks for the follow up.

It is certainly possible that you have some type of somatovisceral phenomenon going on where the musculoskeletal system has the effect in your blood pressure as well as the faint feelings you have had - particularly when the musculoskeletal system is maligned.

There is a test actually which may be able to demonstrate blood pressure changes in relation to position change in a dynamic setting. This is called a tilt table test. I encourage you to read about it and see what you think.

I don't know that this is something we can cure. We might instead focus on ways to manage and minimize the extent to which it affects your quality of life. I am happy to hear your thoughts on the subject as we work toward addressing this concern.

Wishing you good health.

Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: What causes extreme tiredness and fainting spells post workout ? 10 hours later
The tilt table test was done in 2011 and I reported it in my medical history above, no problems found.

Regarding management, I want to find an aerobic exercise that does not irritate the area and cause the problem. Running, biking, tennis, walking, and golf do not work. I doubt swimming would do any better. Your thoughts would be appreciated.

I also want to diagnose and cure the problem. This all hinges on finding the right specialist who has experience treating similar problems. I am willing to travel anywhere in the country at any time to resolve this. I have already done internet searches with no result. So:

1. Should we transfer this discussion to the back specialists at HealthCare Magic?
2. Can HealthCare Magic help recommend a knowledgeable back specialist?
Answered by Dr. Robert Galamaga 8 hours later
Hello again,

I think it is reasonable to seek the opinion of one of our specialists.

I shall consider referring your query to a Spine surgeon or a Back specialist.

I will write a special mail to the Customercare team at XXXXXXX

You can also write to them at YYYY@YYYY regarding your needs. You will be guided further.

It has been an absolute pleasure communicating with you and I wish you all the best in the future.

I also assure you best of my answers in future also when needed.


Dr. Galamaga
Above answer was peer-reviewed by
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