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I'd do all the right things if I only had the energy for it!
December 3, 2013 2:22 PM   Subscribe

This was me last year. Nothings's changed.

Fast forward a year. I had an absolutely challenge-free hysterectomy (fully recovered in four weeks).

-- My thyroid has been fully checked. Every test available. Reuptake scan, fine-needle biopsy (or something.) It's fine.

-- Recently switched from Pristiq to Effexor because the Pristiq seemed to have stopped working. I blamed the renewed depression on the change of seasons but honestly, the Pristiq never wowed me. I never got the extra energy push that I had gotten from SSRIs (which, too, also stopped working.) Also switched blood pressure med from HCTZ to spironolactone for the anti-hirsutism/acne boost.

-- I eat OK. I love my carbs. Not sweets but I could cuddle with a loaf of bread and be happy. I try to watch the food. I will work out in spurts and then the depression hits and boom, no workouts. I do cook for myself, my guy and his very picky daughter. I limit caffeine because I'm extremely sensitive to it.

Why do you need to know all of this? Because I CANNOT shake this fatigue. I can't get motivation to do much of anything. Vitamin D levels? Check? I know some of the fatigue might be residual depression. I have a desk job. I like it pretty OK most days. It pays me well and my health insurance is awesome enough that I can see any specialist I need.

I'd just like to have some actual energy and motivation. I am so incredibly, incredibly frustrated with this. I'm frustrated with all the medication (Four, including the ocassional Klonopin to get to sleep.)

I'm frustrated with not knowing where to start to get myself to more optimum health. I have carried around an extra 20 pounds or so most of my adult life (save for my time living in Miami where I regularly worked out pretty hard).

Where do I begin? Paleo seems so daunting for a person working full-time. I tried Weight Watchers for the weight loss (successful then tired of counting). I've tried meditation. Nothing seems to stick. I will take any ideas. I don't want this to continue. I don't mind taking it one step at a time so if anyone has a Step 1, Step 2 thing, I'll take it. Thank you.
posted by nubianinthedesert to Health & Fitness (16 answers total) 17 users marked this as a favorite
 
Pervasive, persistent fatigue? If the cause is not related to depression or other mental health challenges, I suggest you speak to a rheumatologist. About ten years ago I developed persistent fatigue and low-grade fevers, along with other oddball minor complaints. There's a whole spectrum of autoimmune disorders; it's not likely at this stage that you have undiagnosed Lupus or Sjogren's, but you could have a little subclinical thing going on that's easily treatable.
posted by workerant at 2:27 PM on December 3, 2013


You don't seem to want pharmaceutical suggestions but these are the things that have worked for me. Have you ever tried Wellbutrin (bupropion)? It's not for everyone but I think it's a bit of a wonder drug. Some who take it experience increased energy and weight loss. It's not for everyone but it's an option. I'm hesitant to suggest Nuvigil/Provigil/modafinil but again, for me, it's been the difference between night and day. Unfortunately, grouchiness is a side effect but I'll take being conscious and cranky over asleep most of the time.

Also, it's a cliche around these parts but therapy? If you have major depressive disorder, it might help and it might lessen the need for antidepressants. If you've tried it and it didn't work, I totally understand. Full disclosure - I also have major depressive disorder and haven't tried therapy in years. But maybe it would be helpful. Best wishes - being tired all the time sucks.
posted by kat518 at 2:59 PM on December 3, 2013 [2 favorites]


Done a sleep study to rule out apnea? I can pretty reliably generate a day of horrible fatigue if I can't be arsed wearing the CPAP mask the night before.
posted by flabdablet at 3:01 PM on December 3, 2013 [2 favorites]


Seconding a sleep test. Women who have sleep apnea often present with fatigue instead of sleepiness. Getting my apnea treated and faithfully wearing my CPAP has made such a difference in my health.

A sleep test can also diagnose other things that might be robbing you of a restful nights sleep, or pick up things like narcolepsy that can make you sleepy during the day.

Have you had your Vitamin D levels checked? Vitamin D deficiency can cause crushing fatigue. Try a high-quality D-3 supplement - I use SeekingHealth Vitamin D drops. I was deficient in Vitamin D and supplementing it made a difference in my energy level.
posted by Rosie M. Banks at 3:14 PM on December 3, 2013


My life got drastically better once I got a proper diagnosis, though I thereafter concluded that I also had some specific things going on not covered by my official diagnosis. Whether you do it through medical testing or through reading, I think you probably won't get a handle on this until you have some idea what is causing it.

Having said that, I eliminated peanut oil from my diet after my son observed that I was always tired after eating at Chik-fil-a. It took months but I did gradually get better. I initially assumed "weird allergy" but later tripped across info that made me think something else was going on.

These days, I am very picky about what oils I consume. Here is some science I tripped across that fits with my experience: article about depression and omega 3. I find that the wrong oils can make me very tired and also depressed (as well as more symptomatic for my genetic disorder). While looking for a real explanation, you might try an elimination diet or keep a journal of what you eat and look for patterns. I tried things based on observation that x thing was associated with y issue. It was not just random. I eventually did see big improvements.

Best of luck.
posted by Michele in California at 3:31 PM on December 3, 2013


I would try to focus on your diet; I bet if you make some changes, you won't feel so fatigued. It seems daunting at first but once you make the changes, it can be surprisingly easy to keep them up.

Maybe you can start by eliminating white flour and refined sugar; if that makes you feel better, try eliminating flour of all kinds, etc. There are lots of things you can replace these with- rice, quinoa, different kinds of flours, etc. If you plan ahead and it becomes routine, it gets easier, and with the increased energy you are likely to have, it's easier to plan ahead with meals and such. And you may have more energy to then work out.

So, my simple advice is to first try to cut out white flour and sugar, and note how you feel.

There is a lot of research noting that these elements in foods cause fatigue, and many anecdotes to back it up.

Personally, I have cut out dairy from my diet, am in the process of cutting out wheat, and neither of these was particularly hard. (mostly because I just feel so much better!)
posted by bearette at 4:07 PM on December 3, 2013 [2 favorites]


Oh- besides the other deficiencies, you may want to look into iron deficiency, especially if you have a heavy period and don't eat many iron-rich foods.
posted by bearette at 4:08 PM on December 3, 2013


Keep going back to the doctor's and pressing them. If you don't tell them you're still sick, they generally won't follow up with you.

I second asking them to check D levels and iron levels, and sleep apnea and autoimmune issues. I would add B12 and celiac to that list.
posted by pie ninja at 4:22 PM on December 3, 2013 [1 favorite]


So it sounds like your problem is more the pervasive fatigue than anything else? Like, perhaps you wouldn't feel so depressed if you had more energy?

This shouts autoimmune disorder to me, and it can be hard to get that diagnosed. I would make sure your doctor checks or re-checks your bloodwork for:
-thyroid
-ferritin and any other anemia markers
-b vitamins
-vitamin d
-celiac sprue (digestive symptoms are not necessary for this to be a possibility)
-other autoimmune markers/candidates

See if they think a sleep study is in order. Be a thorn in their side. Fatigue is maddeningly general for a symptom, but dang it, something is wrong and you know it. I believe you. I'm sorry you're going through this.
posted by purple_bird at 4:23 PM on December 3, 2013 [2 favorites]


Congrats on still trying and still caring. I have been there, and it's really hard.

Changing to a gluten-free diet gave me back three hours/day. I felt so much better that I've never been formally diagnosed (you have to be eating wheat for the biopsy to see the damaged cells) and I don't care. I sometimes pine for kringle and ryebread but I can live without because I have so much more energy! Also lost around 20 pounds, because I quit eating bread and pasta for a year.

The Celiac.com Message Boards are a good place to chat with folks pre-and post-diagnosis, maybe see yourself reflected there.
posted by Jesse the K at 4:47 PM on December 3, 2013 [1 favorite]


In addition to the tests mentioned above, please also get tested for Lyme disease and other tick-borne illnesses. I'd suggest that you get tested by an infectious disease doctor or a rheumatologist.
posted by emilynoa at 7:21 PM on December 3, 2013


I sincerely appreciate all the suggestions, especially ones for specific tests. I have an excellent and responsive primary care physician and I plan to discuss each of these issues with her. I promise to update this thread with results.
posted by nubianinthedesert at 8:45 PM on December 3, 2013


I eat OK. I love my carbs. Not sweets but I could cuddle with a loaf of bread and be happy. I try to watch the food.

Reading between the lines.. do you have lots of carbs and feel that you're not doing your best at watching what you eat? I only ask because as someone who has suffered from depression and low energy, I had to cut out bread almost entirely and especially white flour. I will have an occasional couple slices of veggie pizza, as in once a month, and if someone brings in cookies to the office, I'll have a couple. But I usually don't buy bread or keep it around most of the time. Maybe once a month I'll get a loaf of sprouted grain bread and have a lot of peanut butter sandwiches and avocado on toast, but I don't eat it every day. I did this because once I got into my mid-20s, I loved bread but more than that, I hated the blood sugar rise/crash that would leave me almost too tired to stand up from my chair. I eat a lot of veggies and fruits and beans and rice and avoid processed foods.

I have tried all the antidepressants, just about, and none of them did anything for me. The biggest thing by far, by FAR that helped me with depression is exercise. Cardio. I run a couple times a week, I do yoga (vinyasa, it's pretty challenging). When I started, it took me at least six weeks to reach a point where I wasn't fighting anxiety about leaving the house to run and frustration about not being good at it. But I kept at it, and now I don't get so stressed about going. I got one of those smartphone apps to track my progress, it helps, and cute/expensive workout gear because I care about how I look. So now I look forward to the running or yoga classes about 2/3 of the time which isn't too bad, and the remaining 1/3 isn't a battle like it used to be. I just tell myself I'm going to go, and I get up and go, and it's not so bad. I don't have that overwhelming feeling that I simply can't leave the house like I used to. The benefits of the exercise sort of snuck up on me, because I was so focused on how tough it was for a long time. I was actually extra tired for a while, not less tired. But one day, about two and a half months in, I realized I could fall asleep more easily and didn't wake up every morning feeling like absolute garbage and incapable of facing the day. Before starting the running and yoga classes, I typically walked (fast) about 3 miles a day on my commute and longer most weekends and it helped but did not make anything near the difference that the running did. Try it? (Your cardio activity of choice - running, swimming, cycling, whatever - and do be safe and consult your doctor before starting to be sure it's safe for you, of course.) Anyway, before this, I had no idea what it felt like to wake up in the morning and feel relatively normal, and I had no idea what it felt like to get up and do things instead of agonizing over everything and feeling terrible; even when I do agonize, it's not the insurmountable, overwhelming feeling it was when I was depressed.
posted by citron at 8:46 PM on December 3, 2013 [5 favorites]


Be sure that whatever antidepressant you're taking, it's the name brand and not the generic. I've never had problems with generic anything in all my years, but when my Lexapro went off patent a few months ago, I noticed a big difference in its effectiveness. I was surprised, but when I mentioned it to my doctor he told me the same thing happened with Singulair - a big drop in effectiveness with the generic.

And BTW, when I started Lexapro it didn't do much good at 10 mg; when it was increased to 20 mg it worked perfectly - and has for many years now. Celexa, Effexor, Paxil were useless to me and Wellbutrin gave me seizures (I have a history of epilepsy when I was young).

Really, what you're describing sounds like depression to me, only because I'm not seeing a description of anything specific or a particular problem getting much worse. Immune disorders, of course, don't show up in flashing neon as a rule, so that's a good possibility, but I'd be inclined to keep after the depression - medically - first. The thing is - when you find something that does lift the depression, you'll know it because you'll feel so different.

It's really good news that you have such excellent insurance. Use it - and insist that they find the answer.

posted by aryma at 9:35 PM on December 3, 2013


Disclaimer: I am absolutely not an expert, and issues of low-energy are totally alien to me. I have the opposite problem, in fact. But I've had friends ask me for health/fitness advice and I've been told I give good advice. Take that as you will.

Have you done really thorough allergy tests? Try to figure out if you feel more fatigued at certain times or places than others. Try switching around some of your food - one element at a time (start with gluten, but try ignoring breadlike things entirely instead of looking for all the "gluten-free" substitutes). Give yourself a couple of weeks without the food item you're testing, and see how you feel. Keep a diary and look for patterns of delayed reaction illness or fatigue.

Do you exercise? I know it might seem impossible to exercise while already being fatigued, but it may be that just existing is tiring for you because you're not accustomed to doing anything else. I always recommend weight lifting. At the beginner level it takes maybe 30 minutes for a complete workout (I'm talking fundamental free-weight movements here, especially the squat - if you do nothing else at all in terms of exercise, squat). It may be awful the first few times, but if you get yourself on a schedule and build it into a habit you may be surprised at how your energy levels increase.
posted by Urban Winter at 12:11 PM on December 4, 2013


Seconding what citron said. Cardio. Start running. A seven mile run puts me in another world. And you'd sleep like a baby. Make it a part of your lifestyle and you won't have to write us next year. And running gives you more energy to get through the rest of your day. Yes more.
posted by qsysopr at 6:23 PM on December 4, 2013


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