Saturday, August 12, 2017

ICYMI: Surviving Heat with Adrenal Insufficiency

In case you missed it, I released a video on how to best manage the heat while living with Adrenal Insufficiency. I cover three main things: water, salt, and fludrocortisone.

Surviving the Heat with Adrenal Insufficiency

Many people with Adrenal Insufficiency inaccurate believe that they cannot live in the heat. I have proven them wrong. I have survived summers in Arizona, Iowa, Florida, Georgia, Texas, and even Malaysia. Before I was diagnosed, summers in Georgia and Texas were especially brutal. I have many memories of playing outside as a young child and then suddenly needing to vomit. We did not understand what was happening.

I survived summers in Arizona as well. I had been diagnosed with Adrenal Insufficiency, however my first endocrinologist never put me on fludrocortisone. That was also miserable. I suffered the most painful muscle cramps imaginable. Through later medical testing, we discovered that I am an extreme salt waster and am slightly resistant to fludrocortisone. This means that I need to take a larger dose of fludrocortisone than most.

I point these out to highlight that without proper treatment, heat does not play nice with adrenal insufficiency. However, there are three simple tips to remember that will make the heat much kinder. You need not fear it.

1. Water

I carry a water bottle everywhere I go. I prefer my water either cold or room temperature, with no ice. By constantly carrying it with me, I am able to sip water throughout the day. If you do not have a water bottle, go out and purchase one that you like.

All of my water bottles must pass the drop test, which means I need to be able to drop it and have it not break. These water bottles have all passed my drop test:
Do you have a favorite water bottle brand? Let me know, and I'll add it to the list!

2. Salt

During the hotter months of the year, you will need to increase your salt intake. I accomplish this by overly salting my food. I carry with me a small Tupperware salt shaker in my purse constantly. But sometimes, merely salting my food is not enough. In the summer months, I supplement more heavily with salt tabs. SaltStick Caps, Electrolyte Replacement Capsules are by far my absolute favorite salt tabs. My body responds better to the buffered electrolytes over just pure salt tabs. I take one of these in the morning, one of them at night, and then I will take two of them at a time for every 30-60 minutes of activity in which I am sweating heavily. You can take up to ten tablets a day, and some days I do get close to that limit.

Salty snacks are also incredibly helpful. I'm a black olive girl, but I know many others who would rather go for pickles. I have found that a can of olive brine is one of the most effective energy drinks out there. If you ever find yourself getting extremely brain foggy during the summer months, reach for a super salty liquid. It is not uncommon for me in the hotter months to consume an entire can of black olives, and then drink the olive brine. That's about 2000 mg of sodium, and I find it very helpful for bringing me out of the dreaded brain fog. Find the salty snack that works for you, and keep it constantly stocked.

Recently, I have discovered cheese crisps. These magical, high protein, high salt, gluten free snacks are amazing! Most snack bars are so incredibly sweet and thus these are a welcomed alternative. I also enjoy Moon Cheese, with my favorite flavor being the Gouda.

Do you have a favorite go to salty snack? Let me know, and I'll add it to the list!

3. Fludrocortisone

I find it necessary to have two different doses of fludrocortisone throughout the year: a summer dose and a winter dose. This will vary depending on where you live. For example, when I lived in Nevada or Washington state, I just needed one dose of fludrocortisone year round. But in Texas, in Florida, in Malaysia, in Iowa, and especially in Arizona, I require two different doses of fludrocortisone with a higher dose in the summer and a lower dose in the winter. I know it is time to bump up my dose of fludrocortisone when I can no longer sleep through the night and must wake up ridiculously early to use the restroom.

My body salt wastes. Increasing the salt alone is not enough. Other symptoms (besides frequent nightly bathroom trips) that you might need an increased dose of fludrocortisone include an increased swelling of the hands or ankles, and an increase in your fatigue levels.

If you live in a location with more extreme summers, discuss an increased summer dose with your doctor. I personally need it. That extra half tab in the summer months allow my blood pressure to remain stable, it keeps my electrolytes in range on blood tests, and it lets me sleep through the night without having to wake up every three to four hours to pee.

Now it is possible to take too much fludrocortisone. Too much fludrocortisone will lead to easier bruising, a more prolonged swelling of the ankles, and potential weight gain due to fluid retention. It is also very important to realize that fludrocortisone does not work in isolation. It does absolutely no good to just increase the medicine without simultaneously increasing both your water intake and your salt intake. All three of these things work together. All fludrocortisone does is help your body retain salt, which helps you retain the fluids, which allows your body to remain hydrated.

Closing Remarks

Surviving summer with adrenal insufficiency can be broken down into three simple tips:
  1. Always make sure you carry water with you and drink it frequently.
  2. Increase your sodium intake through salty snacks, salt tabs, and extra salt on all of your food.
  3. Chat with your doctor if you live in a hotter area and see if you could benefit from an increased dose of fludrocortisone during the summer.
And in full disclosure, there is also a very important fourth tip that I should mention. After walking over a mile to a park, filming the video, and walking over a mile back in the peak of the Texas summer heat, I was extra brain foggy and not feeling particularly well. I corrected with an additional two salt tabs and a little bump dose of HC. Three hours later, I was feeling much better!
    4. Recognize the symptoms and pro-actively follow the advice!
In a future blog post, I'll share how I used these four tips and tricks to enjoy several theme parks in the heat of the summer!

Did we forget anything? Please comment below! 
Have a suggestion for a future topic? Suggest it here!

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  1. That was an excellent video. Thanks. I always struggle in the summertime, so I appreciate your advice and "being real."
    I have a question: how often do you check your blood pressure? I increased my fludrocortisone by 1/2 tab which makes me feel better, but now my BP is high.

    1. I check my blood pressure until I can discover a trend. So any time I'm feeling off, or weird, or just not right, I'll pull out my BP cuff.

      I also record every reading from every doctor visit.

      By doing this, I have a pretty good idea of "my normal."

      As of late, I've been decently stable, so I'm only checking it at doctor appointments. Back in 2013, I was checking it 5-10 times a day for a few months solid.

      ~ Amber


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