Diagnose my tired fictional character

February 1, 2017 7:30 AM

What are some medical conditions where the main symptom is fatigue, other than CFS/ME? I'm in the process of researching a story and I want to give my character a realistic diagnosis and presentation. I have a few constraints, for reasons of a) plot and b) what I'm going to be vague and call 'metatextuality'.

For these reasons, this condition:
- Should be chronic and preferably not life-limiting
- Should plausibly have an age of onset, or at least age-when-it-became-too-serious-to-carry-on-ignoring, circa 16/17 years
- Should have my character able to work in a customer-facing role but only with great difficulty and a lot of accommodations* from an extremely sympathetic employer
- Should maybe have a relapsing/remitting or waxing/waning course

*(if you have ideas for what those accommodations might be please volunteer them, but I'll be researching this a lot so don't feel like you have to. This is just the 'okay what are my options storytellingwise' phase of things.)

posted by Acheman to Health & Fitness (35 answers total)

Depression often manifests as fatigue. Crohn’s disease might fit your required symptom set better though.
posted by pharm at 7:35 AM on February 1, 2017 [4 favorites]

Morbid obesity.

(I currently have the flu, and can barely walk across the room. It's going on much longer than it usually does, argh...)
posted by Melismata at 7:36 AM on February 1, 2017 [1 favorite]

Lyme disease could fit your criteria (it affects some people much more than others and fatigue is a leading symptom). Also, what about narcolepsy? I worked with a guy who had narcolepsy and was a great sysadmin. Among other things, he only worked at night.
posted by machinecraig at 7:37 AM on February 1, 2017 [4 favorites]

Pernicious anemia, from lack of intrinsic factor? Could require long-term Vitamin B12 supplementation, though I'm not sure if your character would need significant accommodations (i.e., anything beyond occasional fatigue-related breaks).

I've found anxiety to be extremely fatiguing. In fact, I misinterpreted the symptoms as tiredness/fatigue for years. I think it checks all of your boxes, especially if your character has social anxiety.
posted by schroedingersgirl at 7:38 AM on February 1, 2017 [2 favorites]

Leukemia (as well as other cancers) and the following treatment can lead to persistent fatigue, along with a few other long-term and late-term side effects. This fatigue can indeed wax and wane - for example, it can be triggered by a virus or overstress.
posted by muddgirl at 7:38 AM on February 1, 2017 [1 favorite]

To be clear I'm talking about fatigue that can last well after the cancer is treated and in remission/cured.
posted by muddgirl at 7:42 AM on February 1, 2017

Anything involving chronic pain is going to have a fatigue component - autoimmune arthritis, for example, often presents with fatigue and "brain fog".
posted by restless_nomad at 7:43 AM on February 1, 2017 [1 favorite]

There are some chronic leukemias which can last years with waxing & waning fatigue being pretty much the only symptom, for sure. My father in law was diagnosed 8 years ago and, while it does take him a longer than usual time to get over common colds and such, the main symptom he experiences is periodic fatigue. It's not bad enough to keep him from living a normal life - travel, golf, etc. - but he does get tired more easily than a non-leukemia person.
posted by something something at 7:59 AM on February 1, 2017 [1 favorite]

Pernicious anemia is fine when treated and life threatening within a small number of years when not, so not a good fit.

Maybe some kind of regular iron anemia caused by a chronic disease?

A sleep related disorder would fit too. There are various ones that are neurological.
posted by fshgrl at 8:07 AM on February 1, 2017

Narcolepsy, type 2 if you just want the fatigue, type 1 if you also want cataplexy. The timing works - in my case I really started noticing it around my senior year of high school and in college, because I couldn't stay awake in class no matter what I tried. I didn't get the official diagnosis until I was 21 and falling asleep at work every day.

I have type 2, which means my sleep is broken and I'm tired all the time. Mine is relatively mild and I take medication to help manage it. I can work at a normal job and mostly function like a normal human, just with the occasional nap. My doctor would prefer if I scheduled a 15 minute nap in the morning and afternoon, and has offered to write a note for my employer if I want it. Depending on the level of severity (which can change over time) you could easily write it so he needs more accommodations from his employer.

Feel free to memail me if you want more details about my experience.
posted by thejanna at 8:14 AM on February 1, 2017 [1 favorite]

Crohn's or ulcerative colitis seem a perfect match for what you want. Chronic, incurable, do not reduce life expectancy significantly but characterised by periods of remission interspersed by 'flare-ups' . Major symptoms are diarrhoea and fatigue. Often first diagnosed in the teenage years. Would not preclude working in a customer role but would require accommodation of sudden toilet trips and recurring fatigue.
posted by Segundus at 8:16 AM on February 1, 2017 [1 favorite]

Multiple sclerosis could also fit your criteria.
posted by mephisjo at 8:18 AM on February 1, 2017 [3 favorites]

Fatigue, especially cognitive fatigue, is a long-term effect of traumatic brain injury, even from milder injuries like a concussion. Your character could have post-concussion syndrome, which can last a long time after the original injury, and often requires accommodations at work. MeMail me for details, if you want.
posted by heurtebise at 8:19 AM on February 1, 2017 [1 favorite]

Hypothyroidism.
posted by kimdog at 8:21 AM on February 1, 2017 [1 favorite]

The TBI suggestion sparked this one-- how about epilepsy? There are tons of different presentations and etiologies, so you could almost pick and choose. Certainly could require some accommodations in a role like that. Fatigue could be either condition-linked or from antiepileptic meds.
posted by supercres at 8:31 AM on February 1, 2017

Pernicious anemia is fine when treated and life threatening within a small number of years when not, so not a good fit.

Often, but not always. OP, I encourage you to do some research of your own before ruling this out.
posted by schroedingersgirl at 8:50 AM on February 1, 2017

How about sleep disorders? Sleep apnea, Non-24-hour sleep-wake disorder, Delayed sleep-phase disorder, Morvan's syndrome, and plain old insomnia might meet your criteria.
posted by ourobouros at 9:02 AM on February 1, 2017

Epstein-Barr might work for this.
posted by Mchelly at 9:30 AM on February 1, 2017

Fibromyalgia?
posted by Rock Steady at 9:38 AM on February 1, 2017 [1 favorite]

If your character is female, then MS is entirely believable for this. It has the advantage of being so variable that you can pick exactly how disabling it is for the purposes of the story. Onset at 16/17 is early but not unusual, and the character could easily not need a wheelchair until their 50s. Relapses can be anything between a few months and decades, and vary in severity from slight tingling or numbness or vision problems to flat out coma in ER. Fatigue levels can vary between "get excessively tired whether or not I exercise" to "hysterical laughter at the suggestion of ever being able to work again".

If male, it's a lot less likely to be diagnosed this early and not be very much more serious and progressive.
posted by tillsbury at 10:01 AM on February 1, 2017 [2 favorites]

Epstein-Barr (chronic or with complications) is the only thing specific to the teenage years where fatigue is a major symptom. The other causes of fatigue are more general re: the age when they hit, I believe.

Few, if any, are likely to get an employer to provide accommodations, sadly! The conditions are seen as treatable and temporary, but for many they are anything but temporary.

Here's a good article that goes over the major medical causes of fatigue. Happy writing!
posted by Kalatraz at 10:59 AM on February 1, 2017

Congestive heart failure?
posted by cadge at 11:10 AM on February 1, 2017 [1 favorite]

Lupus? It is extremely life-threatening if not treated, but with treatment it would fit the bill.

Or chronic kidney disease - can stay stable for a long time, and patient could either be on dialysis if you wanted plenty of restrictions and impact on their job, or just have CKD4/5 if you wanted tiredness, dietary restrictions and lots of hospital appointments (transplant patients are generally pretty healthy so don't choose that).
posted by tinkletown at 11:28 AM on February 1, 2017

This constellation of symptoms is often un-diagnosed. People like mystery. I'd mention the afflictions and the mystery to build interest.
posted by srboisvert at 11:31 AM on February 1, 2017 [1 favorite]

Rheumatoid Arthritis or an autoimmune disorder of unknown etiology. Someone I know has the second, which is attacking their joints, and is on a couple of different chemo meds for it. When they take the meds, they're exhausted for a day and the meds contribute to their anemia/GI track issues. When they don't take the meds, the RA like symptoms reappear and growths start appearing on the joints. They were able to work as a sales person, but there was physical strain on the body.

If they have RA and are treated with methatrexate or some other chemo drug, you can hit a bunch of your markers. This is chronic, usually starts late in life, but can start earlier (a friend of mine started having symptoms at age 19 (not the person mentioned above)), accommodations for RA are those that are provided to anyone with arthritis while those on heavy duty chemo meds are exhaustion, anemia and GI track trouble. None of this is deadly, although liver status has to be monitored throughout. MeMail me if you want more details I fear that I'd unnanonimize the information if I give any more, which I'd rather not do in public.
posted by Hactar at 12:23 PM on February 1, 2017

It’s never Lupus.
posted by pharm at 12:24 PM on February 1, 2017 [2 favorites]

I have POTS.

Mine is pretty severe and life limiting but everyone is different. It can also go away or hang around in your life. I have good days and bad.

I'm constantly exhausted. If. You pick it I could tell you more about my experience.
posted by Crystalinne at 1:32 PM on February 1, 2017

Myositis. Polymyositis.
posted by ChristineSings at 6:34 PM on February 1, 2017

Depression, PTSD, Lyme disease, social anxiety disorder. . .
posted by mulcahy at 8:18 PM on February 1, 2017

Seconding kidney disease. My husband has this and has to take a weekly shot to maintain his hemoglobin levels. Low hemoglobin equals bad fatigue and when he doesn't do his shot, he suffers for it.
posted by ficbot at 8:09 AM on February 2, 2017

Hashimoto's disease/hypothyroidism. May take a while to be diagnosed, because many doctors seem to use outdated normal ranges for thyroid hormones, don't take patients (especially female one) seriously etc.
posted by LoonyLovegood at 9:22 AM on February 2, 2017

many patients with sleep apnea are chronically severely tired, and many cannot tolerate appliances or cpap devices designed to help, so they are perpetually sleepy

Rereading your criteria, relapsing/remitting MS is pretty much textbook for your criteria.
posted by docpops at 8:28 PM on February 2, 2017

A bit of a tangent, but many medications have drowsiness, sedation, etc. as a side effect. I think something like 9 of mine do. So your character could, in theory, have a condition for which the best practices treatment is Foo, and Foo has a strong sedation side effect. It's something Character's doctor would be interested in, but it's also something that Character's doctor would express that there's really nothing else to be done.
posted by The Almighty Mommy Goddess at 9:39 AM on February 3, 2017 [1 favorite]

Chronic pain. Speaking as someone who's suffered from debilitating spinal pain for 12 years, I can say that I tick off all the boxes on your list. I've been in customer-facing jobs. The pain waxes and wanes. The primary symptom (along with pain), surprisingly, is exhaustion. It came on at age 17 when I fractured my spine in four places. You can't tell I'm in pain if you look at me; I have to tell you about my problems.
posted by LawChick at 12:46 PM on February 3, 2017

Response by poster: I just want to thank everyone here for their suggestions - I'm not going to mark best answers because honestly they're basically all good and are helping me to get a sense of what I can do with this character. Especial thanks to everyone who offered to provide more advice over MeMail - depending on where my research takes me, I may take you up on that, and just in general I'm very grateful for the offer. I really want to get this right, and I really appreciate all of your help with that.
posted by Acheman at 4:53 AM on March 22, 2017