Fatigue! Questions to Ask Your Primary Care Physician

By Carie Sherman

Carie ShermanWhen your adventures include autoimmune disease, fatigue is your constant companion. And by “fatigue,” I’m not just talking sleepy.

You know the commercial for COPD where the elephant sits on the woman’s chest? That’s what fatigue feels like for the lupus patient. Only the weight of the elephant isn’t just restricting movement and breathing–it’s also restricting your ability to think. Every step you take become scripted events: You literally must think through each action you take once your eyes open.

I must have sounded like Rain Man to my many docs, chirping “fatigue, fatigue!” at each appointment. My persistence paid off: Eventually, they helped me discover other issues impacting my health. And I’m thrilled to report it’s been months since I found milk in the pantry or woke up to honking at a stoplight. (I promise, I rarely drove after that incident!)

 Here are common conditions that impact my fatigue and could warrant a conversation with your physician.

1) Sleep apnea. I’m not the typical patient. But thankfully I work with a neurologist who looks beyond the typical patient profile. So off to a sleep study I went. The sleep techs got a kick out of me. They had to locate a smaller blood pressure cuff, making me feel tiny in a way I hadn’t felt since 1st grade. A week later, I cried with relief when my neuro called to say that I stopped breathing 60 times/hour, which woke up my brain and left me devoid of restful sleep. I’ve used a CPAP machine since last October. It’s changed my life. And, it’s lovely! (Okay, it’s awful, but being mistaken for the walking dead is so much worse.)
2) Iron-deficiency anemia. I was anemic post-baby. Iron pills are part of my routine and my red blood cell count returned to normal. Yet after watching an episode of Dr. Oz on fatigue, I learned that many women are iron deficient. But most routine screenings only test your red blood cell count and not your body’s iron storage. So while my RBC was normal, my stores–or ferritin levels–were extremely low. It’s not a routine screen, so ask your doctor specifically to test your ferritin levels.
3) Vitamin D. People with autoimmune disorders like lupus stay out of the sun to avoid flares. I didn’t consider that my vampire ways could lead to a deficiency. (I know, Michelle, my nutritional fumbling causes this as well…). I was tested last week and upon seeing the results, my doc wondered how I possibly get out of bed in the morning. After a week of taking 50,000 IU of Vitamin D, I’m downright chipper again. There are other vitamins that can be culprits, so ask your doc.
4) Thyroid disease. I daydream about being severely hypothyroid, just so I can be put on meds and lose 15 pounds. Yet my levels have always been normal. However, the American Association of Clinical Endocrinologists have revised the ranges of normal. Since my level was borderline, we gave treatment a shot. Today my levels are no longer borderline and fit quite well into the revised guidelines.

5) Depression. I’ve been treated for depression for years and understand it can cause fatigue. Recently I tried a different antidepressant, one that’s supposed to make depression not hurt. It didn’t work. I had nasty side effects, including more aches and pains. After a conversation with a new primary care doctor, I learned that my dosage level, in combination with another drug I was taking, was causing my blood pressure to skyrocket. So with her advice, I’m off of one drug and reduced my dosage on the other. I hurt less, I’m less tired, my blood pressure is normal and my depression hasn’t crept up.*

So there you have it. A few things to talk to you doc about. Of course, a good diet, frequent exercise, and good sleep hygiene are musts. But sometimes you need a little extra help from your body first. Then you’ll have the energy to get the rest of it right.

 Do you have co-current conditions that impact your fatigue? Any advice?

 *If you don’t have a primary care doctor coordinating and overseeing your treatments, go find someone. I’m only now getting my medications straightened out!