Just got bloodwork back from the doctor, low sodium..

bjlytle7

New member
So I'll give you the short version of the story.

I've been suffering from headaches and periodic migraines. They have increased over the last 1-2 years, but more specifically within the past year. I work an IT job and have for 15 years.

I'm 39, and have been working out since I was 31. I've been doing intermittent fasting for 8 years. I've had great progress during that time with some ups and downs due to injuries, but at the end of the day I've been happy with the results. However these headaches have really killed my motivation and the last 12 months have gone down hill because I've noticed they come on especially 1-2 hours after a lifting session. I've always had periodic headaches growing up, just not as often as I do now.

So recently I had a CT scan (results are still incoming) and bloodwork (which I received). The only things that were out of range in my bloodwork were low sodium (130L, range is 136-145 MMOL/L) and Billirubin (which was borderline high by 0.1). The sodium was apparently at 134L a few years ago as well. My Total testosterone was 468 (Desired Result: 241-827 ng/dL). In 2014 it was ~500 so that honestly isn't too bad, IMHO.

It's not like I don't eat sodium. I don't have the best diet in the world, but I don't eat a low sodium diet.....so I don't know if the IF has something to do with it, or if I am drinking SO much water I'm flushing it out, or there is something internally where I am not holding / processing the sodium (like some people do with particular B vitamins). But sounds like 130L is classified as Hyponatremia. 2 of the symptoms of this is headaches and nausea, and the nausea is one thing I've noticed as well. I never feel like throwing up, but it's that uneasy feeling that you can get with a headache, and I've been noticing it more and more when paired with these headache feelings.

As noted, I do computer work and have spent years constantly working on my posture and head position (constant battle) so I have the array of items (theracane, foam roller, pvc roller, lacrosse balls, peanuts, etc.) and have done some research to find some muscles in the back of the head that get quite tight called the Occipital muscles which can get aggravated and tight...and lead to headaches, tight neck, tight shoulders, etc... So I've been working on doing some release techniques on those. And I have found that seems to be helping a bit.

Has anyone else dealt with this before? Any theories on the low sodium? The recommended I see an endo? What would an endo even do? Do I just need to start consuming more sodium than I currently do?
 
@bjlytle7 There are many different causes of hyponatremia. I would definitely follow your doctor’s recommendations if they think it is best for you to see a specialist. In the mean time, it might be a good idea to track approximately how much sodium you take in every day for a few days with your normal diet.

The body usually keeps electrolyte concentrations pretty tightly regulated. If it was 1-2 units below normal I wouldn’t worry too much about it but 6 units definitely points to something worth investigating further. Could be simply that you aren’t getting enough sodium in your diet but it could also be due to something else so definitely worth getting it followed up.
 
@bjlytle7 This is not just from eating tonlittle salt. A young person should not have this problem. Definitely see an endocrinogist.

For reference, I am an emergency phydiscian
 
@bjlytle7 What country are you from?

3 months is probably a little too long to wait but it depends,i guess if you do not feel worse during the wait then its OK. Where i am from you would get an appointment in sep/oct depending on severity of symtoms and your age
 
@lifetime77 nothing...everything came back normal.

My headaches were mostly tied to tight muscles in my thoracic spine / upper back / neck region. I believe were pulling on my occipital muscle / region.

It took a while and it wasn't like an on/off switch..but gradually headaches slowed down. I still have them from time to time...a couple times a week minor but they aren't as severe as they were and I don't have this foggy head feeling anymore. Probably once every 2 weeks I get a really bad one that requires some extra advil or excedrin for it to go away.
 
@bjlytle7 I know this is old, but did you do anything to stop the tight muscles from causing headaches?

I think I have that issue too. Lots of tension in those areas that can cause really bad tension headaches and aches in the back of my neck
 
@danddolo This is 4 years old, but I am hyper fixated on my sodium levels. I just had blood work and they are 141 which is only 4 points from being too high and now I am nervous. Would decreasing salt help these numbers? I have been using drip drop since I have POTS.
 
@bjlytle7 Endocrinology referral for mild hyponatremia based on just a BMP? Is this really what your doctor told you to do? There's considerably more legwork that your PCP can do before subspecialist consult.

Things to consider:

-History of diabetes, myeloma, severe hypertriglyceridemia, recent infusions of certain IV fluids? These can falsely lower sodium counts.

-Is it possible you are drinking too much water? Maybe you are continuously exposed to MDMA and are rolling all the time? (one is more likely than the other)

-Kidney disease? If not, are there medications that could be leading to increased urinary sodium loss (like hydrochlorothiazide or chlorthalidone?)

-If not, are you afflicted with symptomatic heart failure or cirrhosis? (unlikely)

-If not to that, are you dehydrated? IE, have you not been drinking enough or excessive diarrhea/emesis?

-If not to that, check urine sodium and osmolality. I'm skipping steps here but if urine Na and osmolality are both high, then checking cortisol and ACTH stimulation tests might be worth doing.

-If those are awry, then an endocrinology referral is warranted.

These auto referrals really grind my gears. Maybe I'm just an irascible heme/onc fellow (board certified in internal medicine) who has yet to taste that sweet easy subspecialty pay for BS consults, but I personally would feel embarrassed to refer someone without doing the requisite legwork.

My apologies to you though, my ire is not directed toward you. Hopefully you end up feeling better.
 
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