Episode #284: When Going To The Gym Goes Wrong (#2)
Apr 2, 2024
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Dr. Baraki and Dr. Feigenbaum discuss cases of hospitalization post-gym. They explore exercise-induced medical cases, abnormal lab results, and diagnosing conditions like reversible posterior encephalopathy syndrome. The episode emphasizes the importance of patient checkups, interpreting lab tests accurately, and monitoring blood pressure for accurate diagnoses.
Gym-related injuries can lead to serious medical conditions like spontaneous pneumothorax requiring immediate intervention.
Anabolic substance use, such as SARMs, can result in adverse effects on physiological parameters necessitating monitoring and cessation of the substances.
Exercise-induced elevations in liver enzyme levels, like AST and ALT, may indicate underlying health issues requiring medical assessment for accurate interpretation.
Deep dives
Case Presentation and Initial Assessment
A 30-year-old male presented with chest pain and shortness of breath after bench pressing, leading to suspicion of a collapsed lung. Further examination revealed decreased breath sounds and an unremarkable EKG, prompting consideration for a pneumothorax. Initial imaging confirmed a left apical primary spontaneous pneumothorax necessitating a chest tube for management.
Diagnostic Evaluation and Differential Diagnosis
Laboratory tests showed abnormal lipid profiles, liver function tests indicating liver toxicity, and low testosterone levels, prompting considerations of anabolic substance use. Subsequent brain MRI was recommended, focusing on pituitary gland evaluation due to suggestive testosterone suppression and altered FSH and LH levels.
Management and Resolution
Following disclosure of selective androgen receptor modulator (SARM) use, cessation of these agents led to normalization of lipid profiles and liver function tests over a few weeks. Resolution of abnormalities emphasized the impact of SARMs on various physiological parameters and the importance of monitoring and addressing potential adverse effects.
Understanding Liver Enzyme Levels and Exercise
When individuals engage in strength training, their liver enzyme levels, specifically AST and ALT, can be impacted. AST generally increases chronically with resistance training, while ALT may initially rise but tends to return to normal levels. High AST and ALT levels after exercise may not solely be due to physical activity, and caution is advised to rule out underlying health issues. Consulting a healthcare professional for accurate lab interpretation is crucial in assessing liver enzyme levels to differentiate exercise-related elevations from potential health concerns.
A case of a 34-year-old male presented with impaired vision and speech difficulties after weightlifting revealed extensive gray and white matter edema in the brain. Further diagnostic imaging and consultation with neurology led to a diagnosis of Reversible Posterior Encephalopathy Syndrome. The condition, though named 'posterior,' can impact various brain regions and is linked to endothelial dysfunction and cerebral blood flow irregularities. Prompt identification and management of inciting factors, such as high blood pressure, can lead to resolution of symptoms within days to weeks, emphasizing the need for specialist evaluation and vigilance in addressing neurological presentations.
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