Fatigue

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Fatigue
Fatigue Overview Fatigue is a common health complaint. It is, however, one of the hardest terms to define, and a symptom of many different conditions. Fatigue, also known as weariness, tiredness, exhaustion, or lethargy, is generally defined as a feeling of lack of energy. Fatigue is not the same as drowsiness, but the desire to sleep may accompany fatigue. Apathy is a feeling of indifference that may accompany fatigue or exist independently. Fatigue is common. Around 20% of Americans claim to have fatigue intense enough to interfere with their having a normal life. Physical causes are estimated at 20-60%, and emotional causes are the other 40-80%. The challenge is how to tell what is causing your fatigue and whether it is serious enough to see your doctor.

Types
Physical fatigue Physical fatigue or muscle weakness (or "lack of strength") is a direct term for the inability to exert force with one's muscles to the degree that would be expected given the individual's general physical fitness. A test of strength is often used during a diagnosis of a muscular disorder before the etiology can be identified. Such etiology depends on the type of muscle weakness, which can be true or perceived as well as central or peripheral. True weakness is substantial, while perceived rather is a sensation of having to put more effort to do the same task. On the other hand, central muscle weakness is an overall exhaustion of the whole body, while peripheral weakness is an exhaustion of individual muscles. Mental fatigue In addition to physical, fatigue also includes mental fatigue, not necessarily including any muscle fatigue. Such a mental fatigue, in turn, can manifest itself both as somnolence (decreased wakefulness) or just as a general decrease of attention, not necessarily including sleepiness. It may also be described as more or less decreased level of consciousness.[citation needed] In any case, this can be dangerous when performing tasks that require constant concentration, such as driving a vehicle. For instance, a person who is sufficiently somnolent may experience microsleeps. However, objective cognitive testing

should be done to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness.

Fatigue Causes 1. a. b.
c.

Sleep disturbances Not enough sleep Too much sleep Sleep apnea Shift work (changing shifts, night shifts) Alcohol Heart diseases Congestive heart failure (fluid in lungs) Cardiomyopathy (dysfunction of theheart muscle) Lung diseases Asthma Emphysema or chronic obstructive pulmonary disease (COPD) Pneumonia Nutritional disorders or marasmus,

d. e.
2. a. b.

3.
a. b. c.

4.
a.

Malnutrition (kwashiorkor, protein deficiency total caloriedeficiency)
b. c. 5. a. b. c. d.

Obesity Vitamin deficiency (thiamine, B12, B6, folate, vitamin C) Electrolyte disturbances Low potassium Low magnesium Low or high calcium Low sodium

6. a. b. c. d. 7. a. b. 8. a. b. c.

Endocrine disorders Low blood sugar or high blood sugar (diabetes) High or low thyroid Low cortisol (Addison disease) High cortisol (Cushing disease) Gastrointestinal disorders Gastroesophageal reflux disease (GERD) Peptic ulcer disease (PUD) Neurological disorders Multiple sclerosis Stroke Lou Gehrig disease Infectious causes Any chronic disease HIV/AIDS Tuberculosis Hepatitis Mononucleosis Chronic fatigue syndrome Urinary tract infections Connective tissue disorders Arthritis (osteoarthritis and rheumatoid arthritis) Lupus (SLE) Fibromyalgia Acromegaly

9.
a. b. c. d. e. f. g. 10. a. b. c. d.

11.
a. b.

General disorders Cancer Anemia (blood loss or not making enough blood) Gynecologic Pregnancy Menopause Exercise disturbances Lack of exercise Too much exercise (worn out) Excessive workload Psychological Depression (loss of interest, ambition) Anxiety Grief Stress

12.
a. b.

13. a. b. c. 14.
a. b. c. d. 15.

Blood pressure medications work by different mechanisms to decrease blood pressure. The ultimate decrease in blood pressure also means a decrease in the amount of work the heart is doing, which can lead to a feeling of fatigue. Sometimes, the drug works not only on the heart, but also on the central nervous system. a. b. c.
d.

Beta-blockers Calcium channel blockers Diuretics ACE inhibitors

16. Heart medications work in different ways to regulate the heartbeat. Fatigue can be related to the effects the medication has on the heart or to the effects that spill over to other areas of the body.
a. b.

Digoxin (Lanoxin) Amiodarone (Cordarone, Pacerone)

c. 17.

Procainamide (Promine, Rhythmin)

Psychological medications used to help depression and anxiety work by increasing neurotransmitters in the brain that have a calming effect on the body, thus stimulating fatigue. a. b.
c. 18.

Antidepressants Antipsychotics Antianxiety medications (such as diazepam [Valium] or zolpidem[Ambien])

Narcotics: Many pain medications are opiate derived. Drowsiness can be caused by opiates.
a.

Acetaminophen and codeine (Tylenol with Codeine) Hydrocodone and acetaminophen (Vicodin) Oxycodone and acetaminophen (Percocet) Propoxyphene and acetaminophen (Darvocet)

b.
c. d. 19.

Muscle relaxants work to decrease the contraction of muscles. This relaxation can lead to total body relaxation, which may cause you to feel fatigued.
a. b. c.

Cyclobenzaprine (Flexeril) Carisoprodol (Soma) Orphenadrine (Norflex)

Fatigue Symptoms Symptoms of fatigue include the following: 1. 2.
3. 4. 5.

Weakness, lack of energy, tiredness, exhaustion Passing out or feeling as if you are going to pass out Palpitations (feeling your heart beating) Dizziness Vertigo Shortness of breath

6.

When to Seek Medical Care Generally, you need to see your doctor if you experience any of the following:
1. 2.

Fatigue that comes on suddenly

Fatigue that is not relieved by adequate rest, adequate sleep, or removal of stressful factors
3. 4. 5. 6. 7. 8. 9.

Fatigue that is accompanied by unexplained symptoms Feeling as if you are going to pass out Unexplained weight changes Menstrual irregularities Any new masses, lumps, or bumps Mild to moderate pain in your head, chest, or abdomen If you experience any of the following, you should go to a hospital’s Emergency Department: Pass out Chest pain Shortness of breath Bleeding - Rectal bleeding, vomiting blood Severe abdominal, pelvic, or back pain Severe headache Irregular or fast heartbeat

10. 11. 12. 13. 14. 15. 16. 17.

Other people or pets in same household have same symptoms (possiblecarbon monoxide poisoning)

Exams and Tests If you go to your doctor for evaluation of fatigue, the first thing the doctor will do is take a complete history of your fatigue along with asking about associated symptoms.

The doctor may inquire about these activities and symptoms to determine the probable cause of your fatigue:


a.

Quality

i. Does the level of fatigue remain constant throughout the day? Does the fatigue get worse as the day goes on, or are you fatigued at the start of the day? ii. Is there a pattern to your fatigue? Time of day or year? Does your fatigue occur at regular cycles? b. c. i. ii. iii. iv.
d. e.

Emotional state: Are you feeling unhappiness or disappointment in your life? Sleep pattern How much do you sleep? What hours to you sleep? Do you awake rested or fatigued? How many times do you awake and are you able to fall back asleep? Exercise: Do you get regular exercise? Any exercise?

Stress: Have you had any new stressors in your life? Change in relationships, jobs, school, or living rearrangements?
f.

Diet: What is your diet like? Associated symptoms Fever Pain Nausea Vomiting Diarrhea Blood in urine or stool Shortness of breath Chest pain Constipation

g.
i.

ii.
iii.

iv.
v. vi.

vii. viii.
ix.

x. xi.
xii.

Muscle cramps or aches Easy bruising Cough Changes in thirst or urination Inability to sleep lying flat Inability to walk up more than one flight of stairs Changes in appetite Loss or gain of weight Menstrual irregularities Swollen legs Mass in breast Then, a physical exam will be performed, focusing on your vital signs (weight, blood pressure, heart rate, temperature, breathing rate). Your doctor will look at your general appearance, listen to your heart, lungs, and abdomen, and perform a pelvic and rectal exam.
• • 1.

xiii. xiv. xv. xvi. xvii. xviii. xix. xx.

Your doctor may order some of the following tests:

Blood tests - Gives clues to if you have an infection, if you are anemic, or if you have other problems with your blood or nutrition
2. 3.

Urinalysis - Gives clues that point to diabetes, liver disease, or infection

Chem-7 - Looks at 7 common substances circulating in your blood. It consists of 4 electrolytes (sodium, potassium, chloride, and bicarbonate), 2 waste products of metabolism cleared by normally functioning kidneys (BUN and creatinine) and the source of energy for your body's cells (glucose).
4.

Thyroid function tests - Looks at function of thyroid gland, too high or too Pregnancy test Sed rate - Looks for chronic diseases or inflammatory conditions HIV test Chest x-ray - Looks for infection or tumor

low
5. 6. 7. 8.

9. 10.

ECG - An electrical recording that looks at the function of your heart

CT scan of head - A 3-dimensional x-ray of the brain to look for strokes, tumors, or other abnormalities

Fatigue Treatment Medical Treatment Many causes of fatigue may be treated with medications.
1.

Iron supplements for anemia Medications and machines to help sleep apnea Medications to control your blood sugar Medications to support your thyroid Antibiotics to treat infection Vitamins Recommendations for dietary changes and a sensible exercise program

2.
3.

4.
5. 6.

7.

Prevention 1. Manage your stress: Practice relaxation. Take time out for yourself. 2. Get exercise: Start slowly. Do something you like. Find a good time to exercise. Find a partner. 3. Check out your medications. 4. Improve your diet: Eat a good breakfast (whole grain cereal, fruit, milk). Add more fruits and vegetables.
5. Stop the caffeine habit.

6. Give up smoking. 7. Have sex with your spouse or partner. 8. Get enough sleep: Have a routine. Go to bed at the same time every night. 9. Avoid coffee, tea, or caffeinated drinks after 6 pm.

10.Drink no alcohol after dinner and decrease the total amount of alcohol (alcohol interferes with sleep patterns).

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