Fatigue is one of the most common complaints presenting to doctor's offices today. It is one of the leading causes of disability and loss of function in society. It can vary in severity, duration and timing.
It can be caused by many things including Anemia, Adrenal dysfunction, Allergy, Autoimmune disorder, Cancer, Diabetes, Heart disease, Hormone deficiency, Hypoglycemia, Infection, Liver or Kidney disease, Metabolic abnormality, Nutritional deficiency, Prescription medication, Psychological disorder, Poisoning, Substance abuse, and Trauma. It is seen in all segments of the population, in all countries and in all ages. Fatigue may be very difficult to understand and treat because of its insidious nature.
Finding the cause of illness is crucial to understanding its entirety. There are many people who have combined causes of illness that are sometimes ignored or missed. The most accurate way of treating illness is therefore employing a comprehensive approach. Instead of the typical attempt of trying to place a person’s symptoms into a category to try to fit someone into a mold, we need to allow an understanding beyond the usual or ordinary.
Most people with symptoms do not fit into these neat, rigid categories. Categorization only advances limited thinking and understanding. We need to evaluate as many contributors to disease as possible and look at the entire picture.
At the time of the patient history and review of systems, a physician needs to listen closely to the patients’ experience. It has been said that the patient can tell the doctor all that he needs to know, but the doctor needs to listen and ask the right questions. Physical exam might be revealing, but in cases of fatigue many of the causes may be less than obvious, and on a much smaller scale. Typically appropriate blood testing tells the tale.
For example:
Anemia – CBC, Iron profile , Hemoglobin evaluation
Adrenal – DHEA, Cortisol levels
Allergy – Intradermal skin testing
Autoimmune – ANA, Anti DNA, Rheumatoid Factor
Diabetes – Blood sugar, Glucose tolerance test, Hg A1c, urine assay
Heart Disease – Cholesterol profile, Homocysteine, Apo a, Fibrinogen,C reactive protein, Vitamin levels, Hormone levels, EKG, Echocardiogram Vascular Sonography, Stress test, Ultrafast Cat Scan.
Hormone Deficiency – Female hormones, Cortisol, DHEA, Growth hormone, Testosterone, Thyroid profile including stimulation test,Pituitary evaluation.
Hypoglycemia – Glucose tolerance test (5 hr.)
Infection – Blood testing for Epstein Barr virus, CMV, Herpes virus,Coxsackie, Various bacteria, Lyme disease, Babesia, Erlichosis, Parasites, Fungal organisms.
Liver / Kidney Disease – Bun, Creatinine, Liver enzymes
Nutritional Deficiency – All Vitamin and Mineral levels, Heidelberg analysis, Protein and lipid levels Other techniques of testing may also include 24 hr urine testing for heavy metal exposure, Psychological evaluation, drug and prescription drug levels, X-rays or MRI.
As we understand all of the causes we are best able to begin a course of specific treatment. Changing diet, improving hormone and vitamin levels, adjusting allergy response, enhancing immune response, decreasing cardiovascular risk and actually having a realistic game plan can be the most rewarding combination for these patients.
Thanks,
Dr. Calapai