I am a zombie in a foreign country. How to cope? YANMD-filter
October 2, 2014 5:34 PM   Subscribe

I am a 21yr old student who experiences serious fatigue. On good days I can only describe myself as being like a toddler in how my energy levels are, as I appear to be normal until the early afternoon when my brain starts to cloud over and I need to take a two-hour nap. On bad days, such as today, I struggle to operate a keyboard and mouse because pushing the buttons is too hard. More details below the cut.

I take 40mg of fluoxetine for bulimia, although I have periods of low mood and depressive symptoms. Physically I have been in remission from my ED for two years now, although I occasionally binge-eat. I self-harm occasionally. My bloodwork is normal.

On bad days, such as today, I struggle to operate a keyboard and mouse because pushing the buttons is too hard. Moving my hand from the keyboard to the mouse is a monumental effort. I can summon my energy for a big push for about ten seconds of normal typing. Sitting up in a chair is difficult. I walk at the speed of an old woman. Walking and talking is not feasible. My girlfriend describes me as being like a zombie. It scares her because I lose all personality and sense of myself.

I feel no pain at any time. When I try to explain myself to a doctor she said I had low stamina, and that this is normal. On good days, maybe, but I don’t think my bad days are typical. I have a bad day once a week, with ‘medium’ days maybe three times a week. I would say I have been like this for three years now. I am unsure if I am more self-aware or if it has become harder to deal with since I have started university.

Over the summer holidays I worked in a charity shop for three and a half days a week, and I got noticeably worse as the week went on. To say the least, I am concerned as to how this will affect my desire to enter the legal profession.

I am currently on an exchange program in Belgium and will not return to the UK until mid-december.
1) How can I manage myself in such a way as to continue to work academically?
2) Failing this, how can I avoid frustration, isolation and the ever fun cycle of depression and self-harm?
3) My doctor says this is normal, is it?
posted by anonymous to Health & Fitness (12 answers total) 4 users marked this as a favorite
In addition to your other health professionals, I believe you should consider seeing a dietician to make sure your energy requirements are being met and kept steady. Obviously with your history, this needs to be done carefully and with someone experienced in the area.

But peaks and troughs from spikes in blood sugar rather than a long, slow release won't help. Low gi foods and excercise are the general recommendations to start with in this kind of scenario.
posted by taff at 5:40 PM on October 2, 2014 [1 favorite]

Is it normal not to be able to type for longer than 10 seconds straight without running out of energy, or not to be able to walk and talk 1 day out of each week? I don't think you need a doctor to answer that.

You can try to optimize your diet and exercise, and you can seek counseling via student health at your university, but I think that medically you need a second opinion.
posted by treehorn+bunny at 5:58 PM on October 2, 2014

If you can see another doctor, I would really recommend it. If not, bring your current doctor a copy of this post. I had a doctor (psychiatrist, actually) hear "extremely tired in the afternoons" but take me seriously when I started telling stories of the places I'd fallen asleep. Talk about what your girlfriend sees: her observations could be really valuable.

I was taking citalopram, which is apparently notorious in certain circles for that type of thing. I tapered off of it and started treating my thyroid more aggressively, and I'm sleeping much more normally.

Fluoxetine is the same class of drug. It could be making the exhaustion worse. (It could also be losing effectiveness, and you're getting depression-induced zombiehood. Psych drugs are weird.) Regardless, something is pretty clearly going on, and you have every right to push until you find someone that takes you seriously.
posted by catalytics at 7:13 PM on October 2, 2014 [1 favorite]

Please get your thyroid levels checked if you haven't recently.
posted by valeries at 7:18 PM on October 2, 2014 [1 favorite]

Please get your thyroid levels checked if you haven't recently.

This, and do not accept just a FT4 and TSH test. Here's a decent list of relevant tests, but don't do anything less than Free T3 and T4.
posted by vers at 7:24 PM on October 2, 2014 [3 favorites]

Get your vitamin D levels checked as well as the others mentioned - low D can lead to major fatigue and as winter comes that will get worse.
posted by leslies at 7:44 PM on October 2, 2014 [1 favorite]

Sleep apnea?
Hypoglycemia? You eat lunch, your pancreas overreacts and produces too much insulin, your blood sugar drops too low, and you feel great fatigue.
posted by H21 at 8:14 PM on October 2, 2014

Did this doctor do any actual blood tests??? You need to get your iron, thyroid, vitamin B12, and vitamin D levels checked.
posted by Jacqueline at 10:02 PM on October 2, 2014

I recently went on the whole30 paleo based system. The short translation would be that it is a way to manage what you eat for 30 days for low inflammation, allergies and excess sugars and carbs. I've had a lot of problems having a full day's worth of energy without crashing or napping. This helps a lot as you basically eat a packet of protein plus veggies or fruit at each meal. Simple, satiating and effective. Check it out.
posted by diode at 5:57 AM on October 3, 2014 [3 favorites]

Whoa, I came in here to suggest Whole30. It a actually did help with a lot of my energy/fatigue problems by cutting out high blood sugar and crashes, I presume. I just finished my 30 days and I definitely feel better than I have in the last 10 years.
posted by stoneandstar at 7:53 AM on October 3, 2014 [1 favorite]

What did the blood work cover?

Were you tested for magnesium and calcium deficiencies? Both, especially the former, are known to cause fatigue and are common in people who purge.

How about hyper/hypoglycemia? Not eating the right things can be just as fatiguing as not eating and there's some studies to suggest that people with eating disorders are especially sensitive to sugar levels in the body.

Are you staying well hydrated? Urine should be clear enough to read through all the time. I bonked a few years back, I was walking to work one morning and the muscles in my legs went on strike. I couldn't move. Since then I've become increasingly aware of how important staying hydrated is and noticed some of my tiredness is actually linked to dehydration. You might want to try drinking a Powerade, or something even better like Nuun, Refresh or other sports drink.

You didn't say whether you're a boy or girl. What about your iron levels?

I'd seek a second opinion and in the interim start taking a vitamin B complex with B6 and B12 and start keeping a log* because, no this isn't normal. I also limited caffeine because I've discovered there are days where it made me incredibly jumpy (I used to be a drink a pot right before bed and still slept like a baby kinda gal) since then I've got more energy and sleep even better.

*I'd include when I went to bed and how much I slept, when I ate and what I ate, any activity and when the fatigue happens. You may start noticing patterns and it might help when you get a second opinion.
posted by squeak at 9:36 AM on October 3, 2014

To hell with your doctor. It's not normal. Doctors are really crap at diagnosing fatigue, and many don't bother. I remember telling my doc one time about how insanely difficult it was to wake up in the morning, and she said something along the lines of "well, we all hate getting out of bed in the morning." That was before I was diagnosed with severe restless leg syndrome, which had me at a major sleep deficit. So much so that the same doctor that said that later thought the pain I later started experiencing was due to severe sleep deficiency (it didn't seem to be, but that's another story for another time.)

I think doctors don't do well with it because fatigue is such a vague symptom and can be a sign of so many issues from minor to major. This is something you'll likely need to be your own advocate for and do your own research. Many doctors will fight when you ask for specific tests (most docs will test TSH for thyroid function, but not Free T4 or Free T3. Some will even order total or reverse t4, which isn't very helpful.).

Came in to add iron levels - specifically serum ferritin. Most docs don't recognize what low iron stores can do to you. If it's under 50ng/mL, you may want to start taking iron supplements. The officially recognized low range is 12ng/ml, but most people report fatigue at low levels that are higher than that. I was 13ng/ml at one point, and it triggered restless leg syndrome. It can take a long time to restore iron stores, so if you had an ED, I can easily see it still affecting you.

D is another one where the level that is recognized as a deficiency is lower than the level people often need to feel well. Fortunately that is becoming more mainstream in the medical field.

You may also want a sleep study. Sleep apnea could be to blame. But so could a few other things, including restless leg syndrome, which was something I experienced and would literally fall asleep on my way to work, at the computer, etc...

Finally, is it a particular location that's the problem? I'm discovering I have high co2 in my home (My post is right next to yours, which is how I stumbled into this post), and I think it's to blame for some of my fatigue issues. I've had problems with fatigue for at least 10 years, and numerous things have been looked at and corrected or ruled out, but it still persists. So I stumbled upon the issue of high co2 by accident.

You might also consider something to help treat your fatigue in the short term. I was on provigil for a while. It didn't make me feel less tired, per say, but allowed me to function through the crushing fatigue. And before that, I used red bull, which was a crutch but it helped.

There are probably dozens more things you can investigate, but the suggestions in this thread area all really great places to start.
posted by [insert clever name here] at 10:58 AM on October 4, 2014

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