Addison’s disease: Always the storm, never the calm
I remember Gravy Train dog food commercials. I guess you had to add water, but all I heard was “Makes its own gravy!” For some defective reason, I still say that a lot. I’m actually trying to explain something to people who wonder what Addison’s is like. “Makes its own stress!” I don’t have to add a thing.
Night sleep lasts an hour to maybe three hours at a time, but regardless of how much sleep I get or don’t get, I’m never rested. This is familiar to anyone with fibromyalgia or chronic fatigue; I have both. But the unrest of Addison’s depletes vitality in other ways.
With Addison’s, the crucial stress hormone cortisol is underproduced. I don’t make enough cortisol to calm the adrenal storms. Cortisol is one of few hormones that is essential to life.
Hormones have to work together. If you don’t make one in sufficient amounts, everything else is out of whack with it.
The hydrocortisone I’ll be taking is a replacement hormone for the cortisol I lack. It will replace the amount my system would normally produce. But the normal dosage will not boost the amount needed under stress. This is why people with Addison’s require extra hydrocortisone if they are in an accident, or undergoing surgery, or subjected to trauma or significant stress.
Under stress, people whose adrenals function normally produce extra cortisol to brace their system. With Addison’s, this doesn’t happen: the person goes into shock unless sufficient hydrocortisone is administered.
Shock can result in death within about an hour while ER docs are trying to figure out what’s wrong. Addison’s is rare: it occurs in 1 in 40,000 people (my doctor’s figure; others say 1 in 25,000). So low cortisol isn’t always at the top of an ER doctor’s mind the way, say, diabetic ketoacidosis would be.
For these reasons, some people with Addison’s wear Medic Alert bracelets so that proper information and instructions can be readily obtained. My endocrinologist has strongly recommended that I do this, and having learned the little I have so far, I agree that it is a sound thing to do.
Combat FatigueAddison’s brings about physiological combat fatigue. The Addisonian’s body is under constant stress because it never receives the all-clear memo from cortisol.
I thought I knew all about fatigue from more than 20 years with fibromyalgia. But the fatigue that sent me to the endocrinologist this time was different.
I never had to curtail very many physical activities because of fibromyalgia. Arthritis, not fatigue, grounded me from distance walking and bicycling. The Addisonian fatigue is like the end of life; I don’t want to be maudlin but there is no other way I can express it. Vitality is sapped.
Unlike other illnesses, like flu that makes you dead-tired, the adrenal stress of Addison’s keeps churning, unmitigated by cortisol, and anxiety overtakes the fatigue at intervals. Asleep and awake, I’m a little combat zone.
Some of my friends stamp their feet and demand to know why I have to wait so long to begin taking hydrocortisone. First the disclaimer. Careful monitoring and competent emergency care, should I ever require it, will keep the disease from being life-threatening. But the treatment may or may not alleviate the fatigue. I’ve read many cases of people who continue to rail about the debilitating fatigue even taking hydrocortisone. I can only pray that in my case it will mitigate my symptoms.
The reason for the wait is prosaic: my endocrinologist was scheduled to go on a two-week vacation right after he diagnosed me. The hydrocortisone I will be taking isn’t the stuff you put on your mosquito bites. I will be on a tightly managed protocol with regular blood monitoring. I am very grateful my doctor wants to be on hand when I begin this regimen. I think this is only responsible.
I feel very fortunate to have an outstanding doctor and medication available that will likely help my symptoms and restore me to my normal fatigue levels! The anxiety and hyperventilating should go away. I am blessed to have friends upholding me while I neglect them for want of energy. And I am blessed most of all to know the One who calmed the storm and lives to advocate for my help.