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Avoiding Burnout

andrewdumont.me

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Re: Avoiding Burnout

#91

Post by ahoyhere »

outworlder wrote: post #76
ahoyhere wrote: post #64

Earlier quoted context omitted.

The people in the know now understand that what we call "burnout" is not a psychological disorder at all, but sub-clinical[1] adrenal fatigue caused by stress, period. In other countries with superior medical system integration, like Austria/Germany, this is an accepted medical fact. If you stress out a rat long enough, its adrenal glands will actually bleed. If you stress out a human long enough, you cause first a h…

> Being unable to get out of bed. Being unable to make the simplest of decisions without feeling like you're having a panic attack. Being unable to read, because it's too much information at once. Being unable to watch TV shows that have too many "facts" in them. All of the above -- including simple questions of "What do you want for lunch, honey?" -- triggered panic-like attacks in me, who'd never had a panic attack…

Get the book _From Fatigued to Fantastic_. The "standard" tests your doctor would ordinarily order won't show jack. (See my comment below for more specific test information.) This book is the single best resource I have found. Even if you don't technically have full-blown CFS, it will probably be able to help you.

The five things that made the biggest difference in my life: Trazodone (Desyrel) to fix my constant waking at night, melatonin to work against the delayed sleep phase syndrome, magnesium/ATP/d-ribose to ease the excruciating muscle pain, B-vitamin complex for energy, and lots and lots of electrolyte supplementation to help with the POTS/low blood pressure.

Does your heart race when you just stand up? Doctors are famous for telling you that you just need exercise. I told mine that my heart rate doubled when I stood up (a classic symptom of POTS), and he said "You're just de-conditioned." I told him, "I wasn't de-conditioned three months ago before I got sick, and I was exercising every day. Tell me how I de-conditioned from being able to do aerobics, walk around and climb things to being unable to stand up in 60 days." and he just shrugged. Asshole. I discovered much later that electrolytes solved the worst of that particular symptom.

Re: Avoiding Burnout

#92

Post by ahoyhere »

_nxnx wrote: post #81
outworlder wrote: post #76

Earlier quoted context omitted.

> Being unable to get out of bed. Being unable to make the simplest of decisions without feeling like you're having a panic attack. Being unable to read, because it's too much information at once. Being unable to watch TV shows that have too many "facts" in them. All of the above -- including simple questions of "What do you want for lunch, honey?" -- triggered panic-like attacks in me, who'd never had a panic attack…

Unfortunately there is no standard blood test for CFS/burnout. I agree with Amy that cortisol might be useful, but the problem is that it isn't always a reliable indicator of illness. Anyway, just keep doing what you are doing and you will gradually recover. For more info, see: http://www.mind-body-health.net/recovery.html (a site I developed 10 years ago after recovering myself). Unfortunately this is a very misunde…

There are plenty of tests which can show what's wrong with you - but they're not "standard" in the sense of doctors using them.

If your morning cortisol is above a certain level or below a certain level; if your morning, before-you-get-out-bed axillary body temperature is above or below a certain temperature (under 97.8 or above 98.6); if your blood pressure deviates by a certain amount over a 16-hour day; if your average temps deviate by more than 0.2 F from day to day; if you have post-exertional malaise… you have an HPA malfunction of one kind or another.

I'd say "you should also get your thyroid checked" but the blood tests for that are atrociously useless. Check the symptoms. Low body temp, especially in the morning before you get out of bed (mine ranges from 96.5-97.4), slow heart rate if you're not an athlete (mine is 50-60 bpm and I am NOT an athlete!), puffy face/eyes, myxedema (non pitting) swelling/thickened rubbery skin on your upper outer arm or shin, changed ankle-tap reflexes, very cold extremities, Raynaud's phenomenon, etc., those are the signs that are actually diagnostic of a thyroid insufficiency.

These are how doctors have diagnosed and treated low thyroid successfully for a hundred years. The blood tests are a new thing but they aren't very indicative of actual dysfunction (or function).

All of the above is like a lot like low blood pressure. Low blood pressure is only defined by numbers when it becomes dangerous to life. Otherwise, you're diagnosed with low blood pressure if your blood pressure is "normal" or below and you have symptoms. E.g. I have low blood pressure at 100-110/60-70 even though that's considered just fine, because I feel faint when I stand up and other symptoms.

Generally, the best resource I've found is _From Fatigued to Fantastic_. It helped me get much, much, better.

Re: Avoiding Burnout

#93

Post by mdkess »

kamaal wrote: post #68
mdkess wrote: post #41

Earlier quoted context omitted.

If you AREN'T making large amounts of sacrifice toward high risk problems, I'd say you're doing something wrong. Startups are a perfect example of this. We see serial entrepreneurs fail spectacularly (see Color), we read about entrepreneurs who kill themselves after a string of failures, and we read all of the time about the new guys and girls who tried their hardest yet never managed to take off. People like to writ…

You need to strike a balance. I'm not saying you shouldn't make large amounts of sacrifice at something(Not just start ups), but you also need to do move on to something else if despite everything and many attempts things don't work out. Being stuck in the status quo will eventually make your problem much worse. You will continue much more sacrifices without achieving nothing in the end.

I apologize, I believe I misread your original post as being risk adverse. Absolutely agree with you here though - striving to fail fast is perhaps the one bit of startup advice that is nearly universally applicable.

Re: Avoiding Burnout

#94

Post by LowKarmaAccount »

ahoyhere wrote: post #92
_nxnx wrote: post #81

Earlier quoted context omitted.

Unfortunately there is no standard blood test for CFS/burnout. I agree with Amy that cortisol might be useful, but the problem is that it isn't always a reliable indicator of illness. Anyway, just keep doing what you are doing and you will gradually recover. For more info, see: http://www.mind-body-health.net/recovery.html (a site I developed 10 years ago after recovering myself). Unfortunately this is a very misunde…

There are plenty of tests which can show what's wrong with you - but they're not "standard" in the sense of doctors using them. If your morning cortisol is above a certain level or below a certain level; if your morning, before-you-get-out-bed axillary body temperature is above or below a certain temperature (under 97.8 or above 98.6); if your blood pressure deviates by a certain amount over a 16-hour day; if your av…

When you list ranges of temperatures you should indicate the body part that is being tested, because an oral temperature reading will be different than a rectal reading. Also, the temperature readings you gave are slightly inaccurate; this [1] says that the maximum oral healthy early morning temperature is 98.8°F, and 99.9°F overall.

[1] http://jama.jamanetwork.com/article.aspx?articleid=400116

Re: Avoiding Burnout

#95

Post by _nxnx »

ahoyhere wrote: post #92
_nxnx wrote: post #81

Earlier quoted context omitted.

Unfortunately there is no standard blood test for CFS/burnout. I agree with Amy that cortisol might be useful, but the problem is that it isn't always a reliable indicator of illness. Anyway, just keep doing what you are doing and you will gradually recover. For more info, see: http://www.mind-body-health.net/recovery.html (a site I developed 10 years ago after recovering myself). Unfortunately this is a very misunde…

There are plenty of tests which can show what's wrong with you - but they're not "standard" in the sense of doctors using them. If your morning cortisol is above a certain level or below a certain level; if your morning, before-you-get-out-bed axillary body temperature is above or below a certain temperature (under 97.8 or above 98.6); if your blood pressure deviates by a certain amount over a 16-hour day; if your av…

While I agree with most of what you say, the problem is that a lot of studies have been done on the HPA axis and cortisol in CFS/burnout, but there is no agreement. Some studies find low cortisol, others don't. There is definitely HPA axis dysfunction, but nobody can seem to pin it down. I suspect that if you measured cortisol throughout the day and correlated it to a symptom diary and/or a stress test, you might be able to come up with a diagnostic test.

The other issue is that there is no cheap and easy cortisol test like there is for blood glucose. As far as I can tell it would be possible to develop such a test, but nobody has done it yet for a number of reasons (lack of demand, cost, FDA approval, etc).

If someone were to [1] figure out a definitive test for burnout/CFS and [2] develop/patent a home testing kit they would be very rich and help a lot of people into the bargain.

As for Teitelbaum: while he does have some useful stuff to say, he also peddles a lot of quackery.

Re: Avoiding Burnout

#96

Post by _nxnx »

ahoyhere wrote: post #88
_nxnx wrote: post #80

Earlier quoted context omitted.

Having experienced burnout and resulting chronic fatigue syndrome (which is really just an extreme version of burnout that persists long after the stress has ended), I pretty much agree with everything you say. However it's incorrect to say that burnout is physical rather than psychological as psychological factors do play a large part in determining whether or not you experience burnout.

Yes, CFS has a psychological component… In the way that, if X happens the same to you and me, and you don't care, but I do, then my adrenals/thyroid go into overdrive, yours don't; I get sick, you don't. Some people get CFS because of minor stress, some people don't get it until their life is a living hell. That's the psychological aspect of it. But that doesn't make it a psychological disorder in any way, shape or f…

I'm more interested in understanding what is going on in the brain/body rather than arguing over terminology. Both psychological and other factors seem to cause burnout/CFS, although psychological factors do seem to be the most important. Depression is a resulting symptom, not a cause.

Stress and burnout affect different people in different ways: some people get depressed, others develop chronic pain (fibromyalgia, ME), others have chronic fatigue etc.

As for the psychological factors that seem to be important: motivation, goals and emotions all seem to play a large part.

While you're correct that CFS is not entirely psychological (functional would be a better term), it does appear to be mostly caused by psychological factors. If you look at the main triggers for CFS they are: job stress, relationship stress, and viral infection - and there is some doubt as to whether the viral infection is a cause or just a symptom of a weakened immune system.

Re: Avoiding Burnout

#97

Post by nostrademons »

mdkess wrote: post #41
kamaal wrote: post #33

Earlier quoted context omitted.

>>The best way to prevent burnout is to follow up a serious failure with doing small things that you know are going to work. If you are making large amounts of sacrifice towards high risk problems and failing. You are likely doing something wrong and merely backing them up with 'small wins' is not going to help and shouldn't help. The best thing in that case is to really burnout and quit, to do things that are better…

If you AREN'T making large amounts of sacrifice toward high risk problems, I'd say you're doing something wrong. Startups are a perfect example of this. We see serial entrepreneurs fail spectacularly (see Color), we read about entrepreneurs who kill themselves after a string of failures, and we read all of the time about the new guys and girls who tried their hardest yet never managed to take off. People like to writ…

(Side note: Google's probably the wrong example if you want risk adverse. Projects fail all the time at Google. I would've picked a big company like IBM or Cisco, where I've heard you tend not to try at all.)

Re: Avoiding Burnout

#98

Post by jennita »

ahoyhere wrote: post #90
jennita wrote: post #85

Earlier quoted context omitted.

I've been through something very similar to this as well and it was a severe depression for me. It was due to pushing myself too much while going through chemo, but it's possible that it can happen with any major life change (like leaving a job). I wrote about my story of depression http://jensablelopez.com/depression-what-summer-made-of/ - not sure if that helps at all. But I agree with others, go see a different do…

jennita, I'm glad you're feeling better now. I don't mean to belittle your experiences whatsoever, because depression is a terrible thing. I just want to explain: You wrote your husband was able to "force you" to get out of bed (good man) and brush your teeth and do sit-ups etc. When I say "I can't get out of bed," I mean if I stand, my heart rate doubles, it feels like the "bottom falls out" of my head, the world st…

Dang :( I'm really sorry you have to deal with this. I've definitely not been through anything like that. Thanks for explaining it better, I really had no idea what it was. (I also just googled it and am reading more about it) Don't worry, I hope it didn't bother you that I tried to relate to it. I do hope you can find a way to get better though!

Re: Avoiding Burnout

#99

Post by ahoyhere »

_nxnx wrote: post #95
ahoyhere wrote: post #92

Earlier quoted context omitted.

There are plenty of tests which can show what's wrong with you - but they're not "standard" in the sense of doctors using them. If your morning cortisol is above a certain level or below a certain level; if your morning, before-you-get-out-bed axillary body temperature is above or below a certain temperature (under 97.8 or above 98.6); if your blood pressure deviates by a certain amount over a 16-hour day; if your av…

While I agree with most of what you say, the problem is that a lot of studies have been done on the HPA axis and cortisol in CFS/burnout, but there is no agreement. Some studies find low cortisol, others don't. There is definitely HPA axis dysfunction, but nobody can seem to pin it down. I suspect that if you measured cortisol throughout the day and correlated it to a symptom diary and/or a stress test, you might be…

Re: the contradictory studies… if you go with the group of practitioners who argue that there are different stages to the disorder, they're not contradictory at all. The stages argument says a person starts off with very high cortisol output (because you're under stress) and this is what causes the damage and fall-off of production later:

http://www.ncbi.nlm.nih.gov/pubmed/10633533

The 24-hour saliva cortisol test costs about $100 and should tell you a lot:

http://labtestsonline.org/understanding/analytes/cortisol/ta...

There are definitive clinical (non-blood) tests for hypothyroid (I mentioned several of them), there are also ways to test for FM/CFS (muscle recovery among others). They just don't get used a lot.

As for quackery -- the only quackery I read in Teitelbaum's book was about the allergy treatment and it's not any more or less quacky than acupuncture (where the research was discredited) so I consider it harmless. Every "canonical" scientist has some kind of nutty side, from Isaac Newton on down the line. (Note: Not comparing Teitelbaum to Newton whatsoever. It's just an ideal, extreme, example.) Everything else in his book is supported with research citations. I've checked them, and others, because I followed his advice.

Re: Avoiding Burnout

#100

Post by ahoyhere »

LowKarmaAccount wrote: post #94
ahoyhere wrote: post #92

Earlier quoted context omitted.

There are plenty of tests which can show what's wrong with you - but they're not "standard" in the sense of doctors using them. If your morning cortisol is above a certain level or below a certain level; if your morning, before-you-get-out-bed axillary body temperature is above or below a certain temperature (under 97.8 or above 98.6); if your blood pressure deviates by a certain amount over a 16-hour day; if your av…

When you list ranges of temperatures you should indicate the body part that is being tested, because an oral temperature reading will be different than a rectal reading. Also, the temperature readings you gave are slightly inaccurate; this [1] says that the maximum oral healthy early morning temperature is 98.8°F, and 99.9°F overall. [1] http://jama.jamanetwork.com/article.aspx?articleid=400116

Sorry if I forgot to say: Axillary basal temperature. That is, under the arm, measured for 5-10 minutes, with a glass thermometer or electronic one that'll let you keep measuring that long. If that's higher than 98.6, you really should be evaluated for hyperthyroidism. Doesn't mean you DO have it. It CAN be a healthy temperature. But it's a possible symptom.
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