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16 year old female swimmer--high heart rate during exercise
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16 year old female swimmer--high heart rate during exercise

Hi:

My 16 year old daughter (5'11", 140#) has recently started hating swimming/running, etc. (within the last 6 months).  Complains of fatigue and is low on motivation, etc.  Not normal for her.  She has been a competitive swimmer since age 7 and still loves the workouts, but cannot make the send offs.  The coach has them monitor heart rate during sets and hers is always off the charts.  When he asks them to run at 160 bpm, she is barely jogging--one year ago she was able to run a 7 minute mile (at 5'8", 120#).  This sounds silly, but I thought she was malingering or it was growth related until yesterday.

I swam with her yesterday.  I am out of shape and at least 20 pounds over my "fighting" weight.  We took heart rates after a set and mine was at 160--hers over 190--I even checked it myself!!  Mine quickly dropped to 90 (used to be a competitive swimmer and still swim/run 3-5 times a week) and hers was still at 130.  Hers never dropped below 120 before we got out.

I thought this fatigue was growing issues, but now I'm wondering if she's anemic?  I was at her age, with very low hematocrit numbers (mid 20's for a time).  I see her pause when gets out of a chair--yesterday I asked her about this and she said "head rush".  Is this hereditary?  Can it be related to her growth spurt(s)?  She doesn't eat a lot of fruit and veggies.. ?  She is averse to getting her blood drawn--extreme fear of needles and I think she's afraid that there is nothing wrong and she just has an attitude problem.  Blood pressure?  

Is there a risk to just putting her on iron supplements without getting the blood draw?  Would her family practitioner be able to help us?  Should I wait to see if she grows out of it?  

She will continue to swim 2-3 hours a day this summer, but it isn't much fun.  Ideas?

Thanks--
Swimmer's Mom
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Dear Swimmer’s Mom,

The most common reasons that I see for teenagers not being able to suddenly keep up with their peers is twofold:  inadequate sleep and inadequate hydration.  Someone her age needs as much as 10 to even 14 hours of sleep per night consistently.  Teenagers frequently drop sleep for TV, computer, friends, cell phones, etc.  From a hydration standpoint, teens frequently run themselves dry.  Her dizziness when she stands is pretty common for this.  I recommend four 8-12 ounce glasses of fluid (water, milk, juice) and a salty snack (pretzels, saltines, pickles) in addition to everything she is eating and drinking during the day.  She should also not skip meals, and should eliminate caffeine intake.  This helps most of the kids that I see.  Even a little sleep deprivation and mild dehydration can significantly decrease exercise performance as well as overall daily attitude.

However, if this does not help her within 1-2 weeks of these changes, other things that could be considered include anemia, thyroid disease, chronic fatigue, and other chronic viral infections.  I would discuss these with your primary care provider.  I would say that the risk of iron supplementation without an etiology means that you could miss another, potentially more dangerous etiology.  Certainly, a problem with the heart’s pump function can cause these symptoms, although this should be something that your primary care provider would be able to assess on an examination.  Finally, autonomic nervous system dysfunction could be considered as an etiology if other evaluations end up as negative.
2 Comments
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Thanks for your response.

We'll try the hydration... I think she is dehydrated, but I didn't know that would cause thes sort of issues.  She was chronically sleep-deprived during the school year, so that could be part of it; she's catching up now.  (Slept until 1 p.m. yesterday!)

If she doesn't feel better in a couple weeks, we'll go see the doctor.  I will hold off on the iron until then.

Thanks!
Swimmer's Mom
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