IF SYMPTOMS PERSIST By DR. JOSE PUJALTE, JR.

“O life! thou art a galling load,  Along a rough, a weary road,  To wretches such as I!”

— Robert Burns (1759-1796), Scottish poet, Despondency: An Ode (1786)

Dr. Jose Pujalte Jr. It took me a while to write this. I’ve been tired for many days. And no, it’s not COVID-19. After brisk walking (with proper social distancing  – thank you), sleeping a little longer than usual, I’m recharged. It made me wonder though about people who are always tired. And if we are not talking about the common cold, non-lethal flu virus, and the killer coronavirus, here’s the conundrum. What is causing your fatigue? Why Tired? According to MayoClinic.com, a reliable website for medical information, fatigue can have “a variety of lifestyle causes.” The most obvious factors are:

• Lack of sleep – the recommendation of 6 to 8 hours of sleep is just that – you have to find out how many hours of sleep you need to stay alert for the whole day; oversleeping, don’t forget, paradoxically leads to fatigue as well.
• Inactivity – A sedentary lifestyle is a spiral downwards because inactivity leads to more inactivity. But then when you try to exercise, you’re too tired to do it. The trick is to start slowly – maybe 10 minutes of walking – until you can walk continuously for 30 minutes a day.
• Stress – Need we say more.
• Eating habits – Some people too busy for breakfast take a glass of water with a multivitamin. It doesn’t work. Food is fuel and having not enough will lead to fatigue. Try not to skip breakfast because you may even end up eating more for lunch and even dinner.
• Medications – Some medications such as beta-blockers and antihistamines  can cause tiredness while some over-the-counter, “harmless” cold preparations have caffeine and other stimulants that can keep you up all night.

Do You Need to See a Doctor? There are some medical reasons for fatigue but these need to be uncovered by your doctor. If you believe that you’ve rested enough but there are no improvements, find out if you have:

• Diabetes – Fatigue is a warning sign that blood sugar levels are deranged.

Classic signs and symptoms of diabetes mellitus are excessive thirst, frequent urination, blurred vision, recurring infections or a non-healing wound.

• Cancer – Fatigue can be a symptom of a malignancy and your doctor will initiate the appropriate cancer screening tests.

• Depression – Some features of clinical depression are lack of appetite, and too much or too little sleep. These all contribute to extreme tiredness.

• Restless Leg Syndrome (RLS) – characterized by involuntary twitching of the legs with pain, especially at night. This will prevent a good night’s sleep and can lead of course to fatigue.

• Thyroid Disorders – There can be too much or too little usable thyroid hormones and both can present as fatigue. In hypothyroidism, fatigue is accompanied by sluggishness, cold hands and feet, constipation, and dry skin. In the hyperthyroid state, aside from tiredness, the person is irritable or nervous, has lost a lot of weight, and has an increased heart rate. There can be slurring of speech because of tongue tremors, and sometimes the eyes bulge out.

• Sleep Apnea – Related to chronic snoring, sleep apnea means that there are long pauses of no breathing during sleep. The person suddenly awakes, gasping for air. Obviously, this interferes with sound sleep and will cause chronic fatigue.
• Anemia – is a finding of low hemoglobin, the substance in red blood cells important in the transport of oxygen in the circulation. It is frequently confused with “low blood” which is low blood pressure.

Get Rid of Fatigue. The way out of fatigue begins with practicing good sleeping habits – getting a routine for bedtime. Some smartphone apps record sleep cycles and even actual snores (!). You will need a quiet room, subdued lighting, and no marital spats (!). This brings us to stress reduction which is about organizing and scheduling work and appointments. Eating well, in relation to fatigue, means avoiding too much sugar. An insulin spike is created and while this may mean a burst of energy, it is followed by an inevitable crash. The idea is to keep energy steady by consuming complex carbohydrates in fruits and vegetables and whole grains. There’s no point living tired. Vitality is natural but once lost, it can be reacquired. But that’s up to you. Dr Pujalte is an orthopedic surgeon. email [email protected]