I Get So Tired!
Can you be the detective? We shall see. In the next few months we will discuss four patients. Let me introduce them. Linda, David, Eliana, and Esperanza are patients who all present to the clinic complaining of fatigue. They all say says that they get every tired every day. What could be the cause of this? Over the next several articles we will investigate each one discuss Fatigue and its possible causes.
Fatigue is a symptom not a disease. Multiple Illnesses cause Fatigue. First what is fatigue? It is described as the lack of energy and motivation. It is very common complaint and there can be many different causes.
Linda, David, Eliana, and Esperanza all began to get tired between one month to six months ago. The history obtained will be very important to help decide what could be the causes. However, in about a third of all patients the cause is not found and the diagnosis is not known. Depression and other psychiatric issues may be the reason for fatigue, it is reasonable to make certain that there is not an underlying physical illness that is the actual cause. For these articles none will have depression.
Individuals with fatigue may have three primary complaints. There may be lack of motivation or the ability to begin an activity; the person tires easily once the activity has begun; and the person has mental fatigue or difficulty with concentration and memory to start or complete an activity.
How is the cause of fatigue diagnosed?
The key to finding the cause of fatigue in a patient is compiling a medical history. It is important to ask questions not only about the loss of energy but also about other potential problems that the patient may be experiencing such as shortness of breath, sleep patterns, hair loss, color of the stools, or any questions that might provide information as to what organ system may be involved.
A full physical examination is important to look for underlying signs of illness. History and physical findings will determine studies needed.
What is the treatment for fatigue? The underlying cause determines treatments. Sometimes treatment can improve some patients within a few days and sometimes it can take months.
Causes for fatigue
Some causes for fatigue include
Metabolic – endocrine: anemia, hypothyroidism, diabetes, electrolyte abnormalities, kidney or liver disease.
Infectious: Mononucleosis, hepatitis, tuberculosis, HIV, influenza, malaria, and other infectious diseases.
Cardiac: congestive heart failure, coronary artery disease, valvular heart disease, arrhythmias
Lungs: COPD, asthma, pneumonia
Medications: antidepressants, anti-anxiety medications, sedative, antihistamines, blood pressure medication.
Psychiatric: depression, anxiety, drug or alcohol abuse, grief, bereavement
Sleep problems: sleep apnea, reflux, insomnia, pregnancy
Vitamin Deficiencies: vitamin B12 deficiency, vitamin D deficiency, folic acid deficiency, iron deficiency, anemia
Other: cancer; rheumatology illnesses such as rheumatoid arthritis and systemic lupus; fibromyalgia; chronic fatigue syndrome; normal muscle exertion; obesity; chemotherapy and radiation therapy.
I will try to include all the above diseases in the future. I will discuss different labs and studies that may be ordered. These will be hyperlinked on the web to make your search easier. Next month will begin with the history of each of our patients.
