Ask Dr. Berger: Feeling Sick While Exercising; “Quality of Life”

This column was originally published in Yiddish at the Yiddish Forward, and is published here in translation by arrangement with them.

Dear Dr. Berger,

Sometimes I’m nauseous after exercising — then my head hurts the whole day, and sometimes I get dizzy. Yesterday was awful. In the morning I did 50 minutes of cardio. I was fine while I was jumping, but right afterwards my head started hurting. I drank water, ate a healthy breakfast and waited till my headache went away. But it stayed, and after lunch I had to go home. I went to bed shaking and even threw up a couple of times, which helped.

What’s going on? Believe me, I’m not the type who likes to exert myself, I just want my heart to be healthy enough so I can get the bus. If I get sick when exercising, should I not do it?

Throwing Up in Baltimore

Dear Throwing Up,

I’m sorry to hear that you feel bad when you exercise! From your symptoms it is difficult to detect the exact reason, but it may be that your body’s reaction was more or less normal. When the body exerts itself, the heart often beats faster, with a concomitant increase in blood pressure to bring more oxygen to the organs. So the question is, why were you feeling so bad?

Several reasons come to mind. It may be that not all have a connection to your situation. (And with this I do not say that you are at fault — different people are differently affected by strenuous exercise.)

  1. Some people are easily dehydrated (dried out), and this can lead to nausea and dizziness, even fainting. It may be worthwhile drinking water or other liquid before you get into the gym.
  2. When the heart starts to beat faster, blood can be drawn away from the brain to provide oxygen to other organs, which can cause dizziness.
  3. Occasionally, drinking too much fluid without electrolytes (minerals), for example, plain water, can lead to significantly decreased levels of sodium, which might infrequently lead to serious consequences.

As is often the case, the correct approach is dependent on how much you are affected by the episodes. If they come to you every time you exercise, you ought to talk to a doctor.

Dear Dr. Berger,

How can doctors and patients understand what is meant by “quality of life”?

Amy Allara, Maryland

Dear Ms. Allara,

It depends on the context, of course. The term “quality of life” is naturally unclear, so one has to ask some serious questions even to find out what is being referred to. There are several possibilities. Is the situation that of a terminally ill person, who might not have long to live, when the question is: Are there any things that are so impossible to bear, that it is better not to live?

Perhaps “quality of life” refers to the outcome of a procedure or operation as reflected in the health of the person who underwent it? In this case, we can get help defining the “quality” by asking other patients who have also undergone the procedure in question.

Or maybe something else is being discussed: life with chronic illness, with a potential goal to increase such quality of life. How can one achieve a certain quality of life while dealing with a disease? Different people define definitely what makes life worthwhile and imbues it with “quality.” Some would emphasize meaningful activities and achievements; others, time spent with family and friends; a third group would classify symptom minimization as most important.

Numerically estimating quality of life is a complicated topic in itself, but such an approach often starts with asking the following question: “How much time out of your life would you give away so as *not* to live with such a disease?” Such figures can be used to calculate “quality adjustments” that affect life with a certain health problem. With such calculations, you can compare different illnesses and their effects on life, though such an approach has its detractors.