{"id":10478,"date":"2023-07-27T10:54:01","date_gmt":"2023-07-27T15:54:01","guid":{"rendered":"https:\/\/www.patheos.com\/blogs\/jenniferfitz\/?p=10478"},"modified":"2023-07-27T10:54:01","modified_gmt":"2023-07-27T15:54:01","slug":"why-your-doctor-needs-to-know-more-about-fatigue","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/jenniferfitz\/2023\/07\/why-your-doctor-needs-to-know-more-about-fatigue\/","title":{"rendered":"Why Your Doctor Needs to Know More About “Fatigue”"},"content":{"rendered":"\n<\/head>
Great piece this morning by Ed Yong at The Atlantic<\/em>\u00a0\u201cFatigue Can Shatter a Person\u201d<\/a> summarized here<\/a> if you don\u2019t have access to the whole thing. One of the points he makes is that \u201cfatigue\u201d is an all-encompassing term that covers a multitude of what are in fact very different symptom sub-types.<\/p>\n
Your doctors need to understand how different these types of fatigue are, and as Yong points out, there is a good chance they don\u2019t. This is exactly like other broadly-defined symptoms, such as headaches. You really, really need your doctor to be able to tell the difference between the type of headache that is due to migraine, versus sinus infection, versus brain aneurysm . . . and so forth.<\/p>\n
In my contribution to conversation, I\u2019m going to use myself as an example. Here are three possible differential diagnoses that various medical types asked me about over the past eight months (plus one bonus that I\u2019ve heard in the past). They were each good questions, and together provide a nice syllabus for Fatigue 101.<\/p>\n
<\/a>
Pretty sure this is what doctors see when faced with a middle-aged lady presenting with fatigue as a primary symptom. Also: At the moment things are good and I have the skates<\/a> to prove it.<\/figcaption><\/figure>\nOur Sample Case<\/h3>\n
This was me last fall (not the squishmallow photo above, but the description that follows):\u00a0 One week I was humming along enjoying a temporary miracle of normal energy levels (and openly discussing the resulting spiritual tension<\/a>) and next week I was down for the count. From mid-September to mid-November I was laid out flat. I could sustain 5,000 steps a day, otherwise was on my back, sleeping 10-12 hours a day. Had to plan 48 hours in advance and megadose on caffeine in order to make it (sitting) through Sunday Mass. I developed a quirky movement disorder and it\u00a0didn\u2019t matter<\/em> because I was tired enough to just drift off to sleep regardles.<\/p>\n
Those were weird times. And then, suddenly as it arrived it was gone again, and in the space of week I could reliably hit 7500 steps a day \u2014 doesn\u2019t sound like much but that is a 50% increase in activity level and <\/em>be upright and normal all the rest of the day. No more laying around. Normal eight-hour sleeps per day.<\/p>\n
This is a\u00a0very distinctive<\/em> pattern.<\/p>\n
So let\u2019s talk about some ways well-meaning medical people heard the word \u201cfatigue\u201d and grabbed for an easy diagnosis, going as far off the rails as if someone tried to treat your sinus infection with migraine meds.<\/p>\n
Is It Depression?<\/h3>\n***
**
When symptoms are accompanied by few or no clinical\u00a0signs<\/em> (things the doctor can test or measure, rather than having to rely on the patient\u2019s say-so), doctors and nurses are trained to consider depression as a possible cause for fatigue.<\/p>\n
**
It is certainly worth considering! You don\u2019t want your depression untreated, even if you also have some other disease that needs diagnosis and treatment as well. Depression is often a relapsing and remitting disorder, so it did need to be ruled out.<\/p>\n
**
However, one of the distinctive characteristics of depression is\u00a0being depressed<\/em>.<\/p>\n
**
***What if:<\/p>\n
\nYour spirits are buoyant?<\/li>\nYou work hard to plan and prepare in order to accomplish priority goals?<\/li>\nYou are able to think strategically and creatively, and to persevere in the face of obstacles?<\/li>\nYou enjoy time spent with family and friends, and look for ways to make that happen even when it\u2019s difficult?<\/li>\nYou relish the little pleasures in life?<\/li>\nYou would say overall that despite the unavoidable difficulties, your life is good and your are grateful for your many blessings?<\/li>\nYou do not feel depressed.<\/li>\nYou do not feel angry.<\/li>\nIn fact you feel quite happy, even though you are dealing with difficult circumstances.<\/li>\n<\/ul>\n***
**
Chances are if this is how you are thinking and feeling, you aren\u2019t depressed.\u00a0Many, many, many\u00a0<\/em>illnesses \u2014 I would hazard\u00a0most\u00a0<\/em>illnesses \u2014 cause fatigue. If your mood is happy and upbeat, you probably have one of those other things instead.<\/p>\n
**
***Lesson:<\/strong> Ask yourself whether the fatigue is accompanied by any other symptoms of the suspected illness.<\/p>\n
Is It a Sleep Disorder?<\/h3>\n*****
**
Hypersomnia (which I had during those two months) is often caused by sleep disorders. Your doctor\u00a0should<\/em> be on the alert for an undiagnosed sleep disorder, because they are common, they are pernicious, and they can lead to serious \u2014 even fatal \u2014 complications.\u00a0 If you happen to have a family history of, say, sleep apnea, your doctor should be double-aware.<\/p>\n
**
However. Your insurance company would\u00a0not be wrong<\/em> to deny coverage of an in-lab sleep study if your suspected sleep disorder\u00a0spontaneously disappeared\u00a0<\/em>after its two-month run on prime time, and for the past six months you have had\u00a0no hypersomnia.<\/em><\/p>\n
**
Obstructive sleep apnea doesn\u2019t just magically cure itself with no intervention and no change; central sleep apnea\u00a0could<\/em> be part of a relapsing and remitting brain disease, but in that case you aren\u2019t going to catch it in a sleep study during\u00a0remission.<\/em><\/p>\n
**
*****Lesson:<\/strong> The pattern of onset and remission is very important to diagnosis.<\/p>\n
Is it Deconditioning?<\/h3>\n*********
**
I don\u2019t think anyone said this out loud to me this round, but I will slip it in there because other patients have gotten this one at inappropriate times, and I\u2019ve gotten it in the past. Deconditioning will reduce your energy levels overall. It doesn\u2019t cause hypersomnia, certainly doesn\u2019t cause movement disorders (even weird ones), but the linchpin of our differential diagnosis: It doesn\u2019t just magically go away.<\/p>\n
**
It doesn\u2019t come on suddenly \u2014 you don\u2019t wake up one morning radically less fit than you were the day before \u2014 and it doesn\u2019t vanish suddenly either. If you are out of shape, you aren\u2019t going to magically \u201cget better\u201d one day and be able to increase your sustained daily activity level by over 50% just \u2019cause.<\/p>\n
**
Deconditioning is a long slow decline due to inactivity, and requires a slow, steady increase in activity level to see eventual recovery. It is not a quickly relapsing-and-remitting disorder.<\/p>\n
**
*********Lesson:<\/strong> The pattern of onset and remission is very important to diagnosis. Oh, did I say that twice? Interesting.<\/p>\n
Is it Chronic Fatigue Syndrome?<\/h3>\n***********
**
***********There\u2019s been a lot of research into what was once a very poorly-understood entity labled \u201cchronic fatigue syndrome.\u201d Unfortunately, there is very little continuing education bringing medical professionals up to date on the latest in that field.<\/p>\n
The hallmark characteristic of CFS\/ME is a form of exercise intolerance in which the body\u2019s ability to recover from exercise is impaired<\/a>.<\/p>\n
Whereas\u00a0most diseases<\/em> involve fatigue and require some level of pacing, CFS\/ME (and related disorders such as some forms of Post-Covid Syndrome) have an extremely\u00a0different<\/em> character.\u00a0 With \u201cnormal\u201d chronic diseases, if you over-exert yourself, you will need recovery time and then you will be back to baseline<\/em>.<\/p>\n
Your body may need a little more recovery time than other people, but it will still follow a normal recovery curve. If you have a progressively deteriorating illness, of course you are going to see a decline in your fitness over time. If you have a stable illness, you will be able to maintain or even increase your fitness level over time (even though your progress will probably be slower than it would be without the disease). What distinguishes CFS\/ME is that the challenge of physical exertion actually makes things worse<\/em> because it is the body\u2019s ability to respond to that challenge that is central to the disease.<\/p>\n
This is not something that was well understood in the past. However, I promise you, people with CFS\/ME do not suddenly get better overnight and then go on to have no difficulty ramping up to very intense exercise in short order.<\/p>\n
Lesson:<\/strong> Ask yourself whether the\u00a0type<\/em> of fatigue and\u00a0pattern\u00a0<\/em>of fatigue is characteristic of the illness.<\/p>\n
Where Does This Leave Tired People?<\/h3>\n*************
**
The reality is that differential diagnosis is a tough game. If you don\u2019t present with the classic symptoms of an easily-detected disease, it can be very difficult\u00a0<\/em>to uncover what\u2019s actually going on.<\/p>\n
**
Fatigue is the most-disabling, most-obvious, and often the earliest-presenting symptom of an overwhelming number of illnesses of many different kinds.<\/p>\n
**
So. I don\u2019t have a ton of good news, other than to say: Don\u2019t give up on yourself.<\/p>\n
**
If You Keep Having Problems, Keep Looking for Answers<\/h3>\n
**
I want to conclude with a final observation: You can have more than one disease.<\/p>\n
**
Let\u2019s say you\u00a0are<\/em> depressed, out-of-shape, and suffering from a sleep disorder. That\u2019s a pretty common combination!\u00a0 Once you begin to treat these three, you should feel better.<\/em> If you are still fighting debilitating fatigue despite your sleep apnea being under control, your mood having improved, and your exercise program coming along bit by bit . . . there is probably a fourth disease.<\/p>\n
**
If the standard treatments for these three\u00a0aren\u2019t working at all<\/em> to improve your fatigue? You almost certainly have a fourth disease.<\/p>\n
**
It could be anything. Don\u2019t ignore it. Find a doctor who will take your symptoms seriously and keep looking for answers.<\/p>\n
**
\u00a0<\/p>\n
**
\u00a0<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"
**
*************Great piece this morning by Ed Yong at The Atlantic\u00a0\u201cFatigue Can Shatter a Person\u201d summarized here if you don\u2019t have access to the whole thing. One of the points he makes is that \u201cfatigue\u201d is an all-encompassing term that covers a multitude of what are in fact very different symptom sub-types. Your doctors need to […]<\/p>\n","protected":false},"author":1209,"featured_media":10484,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[205,418,216,6,29,466],"tags":[851,854,342,857,863,860],"class_list":["post-10478","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-disability-chronic-illness","category-facepalm","category-its-all-catholic","category-stick-that-corner","category-suffering","category-thinking-topics","tag-cfs-me","tag-chronic-fatigue","tag-depression","tag-rare-diseases","tag-sleep-apnea","tag-undiagnosed-diseases"],"yoast_head":"\nWhy Your Doctor Needs to Know More About "Fatigue"<\/title>\n<meta name=\"description\" content=\""Fatigue" is not a generic symptom! 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