FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[READER'S FATIGUE MIGHT HAVE PHYSICAL OR EMOTIONAL CAUSE]

Question: I have been feeling very tired lately. My doctor has run a few tests without identifying the cause of my fatigue. Do you have ideas about what could be making me feel so tired all the time?

Answer: Fatigue is a common complaint among those going to their family doctor. Many of my patients - instead of choosing the word fatigue - say that they are weary, are constantly tired or have no energy. But, these terms all mean about the same thing.

An abnormality in practically any body system can produce fatigue. That's why the physician needs to treat each case of fatigue like a detective. His or her job is to find the clues necessary to solve the mystery. The first step is to interview the patient about the development of the symptoms and relevant medical history. Then, more evidence is gathered by conducting a physical examination and analyzing the results of a first battery of tests. At this stage, the physician-detective often has a good hunch what the culprit might be.

I assume your doctor has completed these stages and has failed to come up with a "suspect." You should consider that good news. Although normal test results may seem frustrating to you because they fail to identify the cause of your illness, they are actually a good sign because they suggest that you do not have one of the common but serious causes of fatigue. Diabetes, cancer, heart disease, kidney disease and many other life-threatening conditions cause fatigue. These are the sorts of illnesses that we doctors test for first if the history and physical examination fail to direct the search toward a specific illness.

Anemia, low thyroid hormone and a variety of other illnesses can have subtle symptoms that include fatigue. The most common of these illnesses is depression. Unfortunately, the term depression means different things to different people. I'm not talking about the severe episode where the individual is alternately sitting in the corner crying then trying to commit suicide. Most cases of depression are more subtle. The day may seem gray even when the sun shines; there appears to be no hope and no fun left in life.

There are no blood tests for depression, but there are paper-and-pencil tests that check for it. Some doctors choose to ask a series of targeted questions instead of using the written form of the test. Suprisingly, about one half of my patients who are depressed refute the test findings. They admit to being nervous, anxious, easily upset, unhappy at work or home, but they certainly are not depressed! This is the stigma associated with the label depression in our society. This is unfortunate because it often gets in the way of individuals receiving proper treatment for their condition.

I suggest that you return to your doctor for further evaluation of your fatigue. It is a clue to a complex mystery that often takes considerable time and effort to solve.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.