7/2/09
Ask the Doc: Tired all the time? Maybe it is fatigue
By Dr. Beryl Bachus-Keith

Are you tired of being tired? Do you feel exhausted just trying to get through your daily activities? Many of us suffer from fatigue at some time or another but is it more than it should be? When does fatigue become a problem?

Dr. Heather M. Shelton of Black River Healthcare-Olanta and Dr. Marilyn Connors of Manning Medicine have provided information to help answer some of your questions about fatigue.

According to Dr. Shelton, “fatigue” is a common complaint, particularly among women 20-55 years old.

In order to thoroughly evaluate fatigue, a physician will conduct a thorough history and physical exam. Laboratory work or other studies may also be done. Concerns may include heart or lung diseases, anemia or endocrine diseases such as diabetes or hypothyroidism.

“If there are no significant findings or risk factors for a specific medical problem, a physician will often recommend lifestyle changes including weight loss, regular exercise, stress management, healthy eating habits and a good sleep regimen,” Dr. Shelton added.

There are many other causes of fatigue that are more difficult to diagnose.

“Patients often ask me about conditions they have seen or read about in the news or magazines,” said Dr. Connors. “Fibromyalgia has received a significant amount of media attention in recent years.”

The most common presenting symptom of fibromyalgia according to Dr. Connors is diffuse, chronic musculoskeletal pain. It is six times more common in women and is often seen in patients with other rheumatologic conditions, such as rheumatoid arthritis, osteoarthritis and systemic lupus erythematosus.

Dr. Connors said that fibromyalgia affects the soft tissues such as muscles and ligaments, as opposed to bone disease such as arthritis.

The cause of fibromyalgia is unknown, but it often seems to develop after a significant amount of emotional or physical stress. It may develop after a viral illness. The criteria for diagnosing fibromyalgia include widespread musculoskeletal pain as well as tenderness at 11 out of 18 specific sites on the body. These sites are called trigger points.

Other symptoms such as headaches, mood changes, and changes in bowel habits may contribute to making the diagnosis. No specific blood or imaging tests are useful in confirming the diagnosis.

Living with fibromyalgia may be frustrating for patients and their families according to Dr. Connors.
“Treatment relies heavily on lifestyle changes and holistic treatments can also help with symptoms,” she noted. “These include acupuncture, massage, hypnosis, counseling, and whirlpool treatments. Antidepressant prescription medications are often prescribed and help a significant number of patients. Regular exercise and stress relief are important. Most patients continue to work full-time and learn to control their symptoms.”

Chronic fatigue syndrome is another condition often mentioned in the news.

According to Dr. Shelton, an estimated one million Americans are affected by the disease. It is a complicated illness that shares many features with fibromyalgia.

“The most common symptoms are severe fatigue that does not respond to rest,” Dr. Shelton said. “Other reported symptoms include insomnia, weakness, muscle pain, forgetfulness and poor concentration.”

There are two key criteria necessary to diagnose chronic fatigue syndrome. After other medical conditions have been ruled out, a patient must have severe chronic fatigue for at least six months. He or she must also concurrently have four or more of the following symptoms: significantly impaired short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, multi-joint pain, headaches, unrefreshing sleep, and post-exertional fatigue lasting at least 24 hours. These symptoms must be persistent or recurring during six or more consecutive months.

Dr. Shelton informs us that the risk factors for chronic fatigue syndrome are not well defined. It seems to appear more often in women around 40-50 years old. Some studies suggest involvement of the immune system and nervous system. Genetic and environmental factors also seem to play a role.

Other conditions that must be considered when diagnosing chronic fatigue syndrome include mononucleosis, Lyme disease, diabetes, thyroid disease, multiple sclerosis, depression, bipolar disorder and different types of cancer.

Research suggests that chronic fatigue syndrome is often misdiagnosed.

Treatment of chronic fatigue syndrome is aimed at controlling symptoms, much like fibromyalgia according to Dr. Shelton.

“Lifestyle changes including stress reduction, moderate activity, dietary changes, and good sleep hygiene are helpful,” she noted. “Nutritional supplements often help. Sometimes medications are used to treat pain or other specific symptoms.”

If you have concerns about excessive fatigue or pain, you should consult your physician for further advice. Many common causes of fatigue and pain can be easily diagnosed and treated, which will improve your quality of life. If there are concerns about other more serious conditions, further recommendations can be made. Support groups are available for both fibromyalgia and chronic fatigue syndrome, which can make understanding and treating these illnesses easier on patients and their caregivers.

I would like to thank Dr. Shelton and Dr. Connors for answering your questions on fatigue. To improve our energy levels, we all must work harder to decrease our stress, eat right, exercise and get more sleep.

This is Dr. Beryl Bachus-Keith reminding you that “an ounce of prevention is worth a pound of cure.”