Farewell to fatigue

By far the most common complaint doctors hear is fatigue. Whether patients are young and trendy, with a toddler on the hip and in the prime of life, or old and grey, most tell the same story: "Doctor, I’m tired, exhausted, worn out, finished.”

Fatigue certainly seems to be the disease of our time, a consequence of our hectic lifestyle.

But the phrase “l feel tired” is so subjective, vague and broad and could be a symptom of so many diseases that sometimes doctors are baffled. Where does one start looking for the cause?

Fatigue, however, should not be taken lightly.

Is the person who complains of fatigue trying to say he has no energy? Is he physically exhausted, dejected or perhaps depressed? Does he find it hard to concentrate or does he run out of breath easily? Does he feel sleepy? This is where a doctor also has to be a psychologist and detective. Is there an obvious reason for the patient’s fatigue or are the causes more profound?

Fatigue doesn't have to be a lifelong sentence. Take the first step in the right direction: find the reason for your fatigue and treat the cause. Identifying the problem is half the solution.

What are the most common causes of fatigue?
Although many questions remain unanswered, a persistent lack of energy is definitely not a figment of your imagination that will disappear if only you can manage to “pull yourself together”. Doctors now realise there are many underlying causes of fatigue:

• 2 - 5% of people who're tired suffer from chronic fatigue syndrome. Although the causes may differ, all patients with chronic fatigue have been tired for more than six months.
• In 20 - 30% of cases the cause of fatigue is either physical, such as infections, heart disease, diabetes, or thyroid problems, or the medication you take. Fatigue is one of the main symptoms of depression.
• In 75% of cases the cause is unhealthy eating habits, work stress, matrimonial stress, insufficient sleep or other forms of pressure. In many instances you're simply trying to do too much.

Do you have a disease that makes you tired?
In 20 to 30% of people who feel tired the cause is a disease of some sort. If a disease is causing your fatigue, you may suddenly or gradually feel more and more tired. If you feel too weak to go for a walk, go to work, take a bath or get dressed, it may be serious.

Is your fatigue the symptom of a disease?
1. Depression and melancholy. One in 10 people suffers from depression at some stage. Many depressed people complain of being tired. An imbalance in neurotransmitters such as serotonin may cause fatigue, apathy, a fuzzy feeling in the head and headache.

2. Anaemia. Low iron levels or insufficient red blood cells cause the blood to carry much less oxygen and if the brain, muscles and other tissues don’t get enough oxygen you’ll feel tired, especially if you walk or do anything that requires physical effort.

3. Rheumatoid arthritis and other connective tissue (auto-immune) diseases. In these diseases the body forms antibodies against healthy tissue and causes damage. The attack on the immune system drains the body of energy. Diseases include lupus erythematosus and keratodermia (hardening of the skin).

4. Thyroid problems. The thyroid secretes hormones that determine the pace of your metabolism. If your thyroid hormone level is too low your metabolism will be slow. You’ll feel tired, your skin and hair will be dry and dull; you may gain weight because your body is slow at burning kilojoules; your feet may swell and your heartbeat may be slower. You may be so exhausted that you become depressed. Up to 10% of women and a slightly lower proportion of men suffer from thyroid problems.

5. Diabetes and insulin resistance. Whether you suffer from type 1 diabetes (where the body produces not insulin and insulin injections are imperative) or type 2 diabetes (where the insulin becomes increasingly inefficient, as often happens when people are overweight) your cells don’t get enough energy to function. Even slight exertion may cause diabetics to feel exhausted.

6. Blood pressure problems. High as well as low blood pressure may cause fatigue. Some blood pressure tablets cause fatigue as a side-effect. Fatigue is also an important symptom of some kidney problems such as renal failure that lead to high blood pressure and anaemia, either of which can make you feel tired. Low blood pressure often causes dizziness and apathy.

7. Diseases with fever and infection. Most infections leave you feeling weak and tired, especially when they go hand in hand with fever. If the disease also affects vital organs such as the lungs, bone marrow or heart muscle, the fatigue may be even worse. Examples of such diseases are endocarditis, myocarditis, asymptomatic pneumonia (especially in older people), HIV (as a result of weight loss, diarrhoea, lung infections and anaemia), tuberculosis and hepatitis.

8. Sleep apnoea and other ear, nose and throat problems. A chronically blocked nose (as a result of allergies), sinusitis, enlarged tonsils and sleep apnoea may disrupt sleep and reduce the oxygen supply to the body. Eventually you’re perpetually sleepy, exhausted and irritable. Sleep apnoea is caused by a soft, flaccid palate that relaxes during sleep, thereby blocking the air passages. Although you wake up and change position as soon as the body’s carbon dioxide levels become too high, you are mostly unaware of this. Often the only symptom is loud snoring during deep sleep. Some people may wake up as often as 30 times a night.

Symptoms you shouldn’t ignore

Some symptoms combines with the sudden onset of fatigue may indicate serious disease. Alarm bells should start ringing when you experience:

• Chest pain, shortness of breath, dizziness, muscular weakness or suicidal thoughts. These may indicate a heart attack, stroke or an imminent suicide attempt respectively. See a doctor immediately. Shortness of breath, especially if you lie down or during exercise, may indicate cardiac disease such as cardiac failure, as well as lung diseases such as emphysema or asthma.
• Sudden unexplained weight loss may indicate cancer, thyroid problems, diabetes or chronic infection.
• Fever and night sweats may indicate serious infections such as tuberculosis, HIV, Malta fever or endocarditis.
• A pale or yellow skin or yellow eyes could be symptoms of anaemia or hepatitis.
• Excessive urinating may indicate diabetes, chronic renal failure or other problems.
• Other symptoms such as double or blurred vision, swollen glands in the neck, the armpits and the groin, severe persistent stomach ache, a rash on the cheeks, subcutaneous haemorrhage, lack of feeling in the skin, muscular weakness and balance problems also require medical attention.

What you can do to combat fatigue:

1. Get enough sleep. You need at least eight hours a night; any less and the brain doesn’t get enough rest.
2. Eat healthily. Enjoy balanced meals with enough kilojoules for your level of activity.
3. Live a healthy lifestyle. Achieve a balance of work, leisure and sleep.
4. Get help. Talk to your doctor if your fatigue persists or if you experience any of the symptoms mentioned above. There may very well be an underlying physical cause. If anxiety, stress or depression wears you down, it’s important to get in touch with a counsellor or psychologist.

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