Preparing for doctor's visit about fatigue
December 20, 2018 3:55 PM Subscribe
I decided my fatigue is problematic enough to complain about it to a nurse practitioner. I've had some of the initial screening done, and I'm wondering what next steps would be like / symptoms to track to make this appointment useful.
Late 30s, F.
Symptoms:
- I'm not really sure when onset of symptoms is. Maybe summer?
- My focus at work is crap - I have a hard time motivating to do anything that isn't super time-dependent (this is unusual for me). I've been leaving early / taking long lunches.
- I have a hard time getting to the gym, when I previously enjoyed going, and have less stamina than usual when I get there
- I took a sick day yesterday because I didn't want to get up / still wanted to go back to bed post-breakfast and did 3+ hours of napping. I still slept pretty much fine all night last night.
- Sometimes I'm dizzy. I'm pretty sure I'm drinking enough water, and I'm planning to try taking an antihistamine for a few days to rule out allergies (I have gotten dizziness and fatigue as standalone allergy symptoms in the past, although not in winter.)
- I have been getting headaches lately. Hydration doesn't help, caffeine does. I don't get migraines.
- My stomach has been more uneasy than normal lately, I suspect because of anxiety. I started being more mindful about managing my (situational, sub-clinical) anxiety and that seems to have solved it.
Stuff I've ruled out:
- I had a vitamin D deficiency this summer, was retested and my levels are good, continuing to supplement. Associated depression and muscle weakness went away w/ treatment.
- I've been depressed in the past, but I don't feel depressed now, and a quick run-through of the Beck Depression Inventory supports that.
- I sleep about 8 hours a night, although I wake up around 3-4 am to use the bathroom and sometimes it takes a little while to get back to sleep after (this is normal for me)
- My iron was fine this summer and fine when I gave blood a few weeks ago.
- When I presented with fatigue this summer, they also ran a blood count, TSH, a metabolic panel, and B12, all were in normal ranges.
Other stuff:
- I've been traveling a lot, and I find it tiring and stressful, although the trips have been fun.
- I'm stressed about job-hunting
- I started using a SAD lamp about a month ago, and it noticeably improves my mood.
- I have a friend with Hashimoto's who's convinced it's thyroid, but I looked at a symptom list and none of it resonates (weight, hair, skin, digestion all normal).
- I can still hike and go for walks, but I feel extra-tired after.
- My alcohol tolerance seems lower than usual, but I typically only have a drink or two a week.
- I keep caffeine to 1-2 cups of coffee a day. Maybe a black tea on top of that.
- Despite the travel and holidays, my diet is pretty decent and close to my normal diet.
Late 30s, F.
Symptoms:
- I'm not really sure when onset of symptoms is. Maybe summer?
- My focus at work is crap - I have a hard time motivating to do anything that isn't super time-dependent (this is unusual for me). I've been leaving early / taking long lunches.
- I have a hard time getting to the gym, when I previously enjoyed going, and have less stamina than usual when I get there
- I took a sick day yesterday because I didn't want to get up / still wanted to go back to bed post-breakfast and did 3+ hours of napping. I still slept pretty much fine all night last night.
- Sometimes I'm dizzy. I'm pretty sure I'm drinking enough water, and I'm planning to try taking an antihistamine for a few days to rule out allergies (I have gotten dizziness and fatigue as standalone allergy symptoms in the past, although not in winter.)
- I have been getting headaches lately. Hydration doesn't help, caffeine does. I don't get migraines.
- My stomach has been more uneasy than normal lately, I suspect because of anxiety. I started being more mindful about managing my (situational, sub-clinical) anxiety and that seems to have solved it.
Stuff I've ruled out:
- I had a vitamin D deficiency this summer, was retested and my levels are good, continuing to supplement. Associated depression and muscle weakness went away w/ treatment.
- I've been depressed in the past, but I don't feel depressed now, and a quick run-through of the Beck Depression Inventory supports that.
- I sleep about 8 hours a night, although I wake up around 3-4 am to use the bathroom and sometimes it takes a little while to get back to sleep after (this is normal for me)
- My iron was fine this summer and fine when I gave blood a few weeks ago.
- When I presented with fatigue this summer, they also ran a blood count, TSH, a metabolic panel, and B12, all were in normal ranges.
Other stuff:
- I've been traveling a lot, and I find it tiring and stressful, although the trips have been fun.
- I'm stressed about job-hunting
- I started using a SAD lamp about a month ago, and it noticeably improves my mood.
- I have a friend with Hashimoto's who's convinced it's thyroid, but I looked at a symptom list and none of it resonates (weight, hair, skin, digestion all normal).
- I can still hike and go for walks, but I feel extra-tired after.
- My alcohol tolerance seems lower than usual, but I typically only have a drink or two a week.
- I keep caffeine to 1-2 cups of coffee a day. Maybe a black tea on top of that.
- Despite the travel and holidays, my diet is pretty decent and close to my normal diet.
Yes, and to also observe how you feel when you wake up, etc. before I had my crap I woke with a bad headache every day.
Have you felt this way before? Think about what is similar or different.
posted by mermaidcafe at 4:25 PM on December 20, 2018
Have you felt this way before? Think about what is similar or different.
posted by mermaidcafe at 4:25 PM on December 20, 2018
Have you noticed if there any foods that have given you trouble in the past? I have food intolerances that make me feel tired, queasy, and affect my mood for a prolonged period of time, if I keep eating those foods. Food stuff (intolerances, allergies) can also change over time.
Also, could there be any chance you are pregnant?
Something else you might want to rule out with your doctor is a heart condition, if you haven't already done so.
Best of luck, this sounds frustrating and as though it's impacting your life so I hope you can figure it out with or without your doctor!
posted by DTMFA at 4:26 PM on December 20, 2018 [1 favorite]
Also, could there be any chance you are pregnant?
Something else you might want to rule out with your doctor is a heart condition, if you haven't already done so.
Best of luck, this sounds frustrating and as though it's impacting your life so I hope you can figure it out with or without your doctor!
posted by DTMFA at 4:26 PM on December 20, 2018 [1 favorite]
Sorry, couple more ideas.
Make sure what they are checking w iron. Often my hemoglobinwill be okay but not ferritin.
Fatigue can be really really hard to test and diagnose. Can you ask about your options if nothing turns up? If you need sleep meds or muscle relaxers, ask for them, and even bring up a stimulant if you might need sometimes. Vyvanse, Provigil, and Adderall are common ones.
posted by mermaidcafe at 4:28 PM on December 20, 2018 [3 favorites]
Make sure what they are checking w iron. Often my hemoglobinwill be okay but not ferritin.
Fatigue can be really really hard to test and diagnose. Can you ask about your options if nothing turns up? If you need sleep meds or muscle relaxers, ask for them, and even bring up a stimulant if you might need sometimes. Vyvanse, Provigil, and Adderall are common ones.
posted by mermaidcafe at 4:28 PM on December 20, 2018 [3 favorites]
Chronic fatigue syndrome 'could be triggered by overactive immune system'
Therefore it would probably a good idea to look at markers of inflammation.
posted by jamjam at 4:37 PM on December 20, 2018
Therefore it would probably a good idea to look at markers of inflammation.
posted by jamjam at 4:37 PM on December 20, 2018
I agree you should ask specifically for a ferritin test if it wasn’t done already. My hemoglobin is almost always fine, even when my ferritin is very low.
You also may want to keep a food diary until the appointment so the NP can take a look at that/refer you to a dietician if relevant.
posted by bananacabana at 4:52 PM on December 20, 2018 [1 favorite]
You also may want to keep a food diary until the appointment so the NP can take a look at that/refer you to a dietician if relevant.
posted by bananacabana at 4:52 PM on December 20, 2018 [1 favorite]
Do you usually sleep alone, or with a partner? If your significant other has started snoring or developed restless leg syndrome or ____, the quality of your usual eight hours of sleep would decline.
Also, minor infections (inner ear, vaginal yeast, etc.) can cause fatigue and dizziness.
posted by Iris Gambol at 4:55 PM on December 20, 2018
Also, minor infections (inner ear, vaginal yeast, etc.) can cause fatigue and dizziness.
posted by Iris Gambol at 4:55 PM on December 20, 2018
In all likelihood one of the things they'll do is re-run bloodwork and compare. And yeah, if they're not checking inflammation markers ask for that.
Do ask them what you should be tracking/logging. If you don't wear a monitoring watch and it's in your budget, you might consider it for tracking sleep if nothing else.
posted by Lyn Never at 5:15 PM on December 20, 2018 [1 favorite]
Do ask them what you should be tracking/logging. If you don't wear a monitoring watch and it's in your budget, you might consider it for tracking sleep if nothing else.
posted by Lyn Never at 5:15 PM on December 20, 2018 [1 favorite]
You may want to visit a rheumatologist. After some very extensive bloodwork that didn't show anything out of the ordinary ordered by my family doctor, it was a rheumatologist who finally diagnosed me with fibromyalgia. It's pretty person-dependent so the symptoms may not all match, but mine include: muscle weakness when very tired, body pains, getting tired more easily and needing a LOT more sleep, occasional fatigue spells when I can barely move (much more rare now), and occasional sensitivity to bright light.
Rheumatologists can also diagnose other autoimmune/fatigue types of chronic illness.
posted by elsmith at 6:33 PM on December 20, 2018
Rheumatologists can also diagnose other autoimmune/fatigue types of chronic illness.
posted by elsmith at 6:33 PM on December 20, 2018
Can't believe nobody has mentioned sleep apnea. As the NP about a sleep study! Sleep apnea is super super common and you can have it for years and years and it can just ruin your sleep quality and most people never even know unless they get a sleep study done. It's usually treatable.
posted by Anticipation Of A New Lover's Arrival, The at 6:42 PM on December 20, 2018
posted by Anticipation Of A New Lover's Arrival, The at 6:42 PM on December 20, 2018
What exactly is your iron? The "normal" range for iron just states where 95% of the population falls (two standard deviations from the mean) and is an enormously huge range. Given how common iron deficiency is, especially in women, you can be "normal" and still deficient, sometimes severely so. Most doctors are terrible about understanding nutrient levels, and will write you off as healthy because you're in range even if you're still VERY low.
Know your levels--studies show that ferritin levels below 50 are associated with fatigue, and supplementing with iron helps reduce fatigue. The normal range for ferritin in the lab I went to started at 10 which is WAY too low.
posted by Amy93 at 7:02 PM on December 20, 2018 [1 favorite]
Know your levels--studies show that ferritin levels below 50 are associated with fatigue, and supplementing with iron helps reduce fatigue. The normal range for ferritin in the lab I went to started at 10 which is WAY too low.
posted by Amy93 at 7:02 PM on December 20, 2018 [1 favorite]
Has a neurologist told you that your headaches aren't migraines? Because I don't have some of the classic symptoms (auras or visual disturbances, pain and throbbing behind one eye), but others (muscle weakness, intense and sudden vertigo) led two neuros to diagnose me with vertiginous migraine.agnesium and Botox are starting to help.
posted by The Underpants Monster at 12:03 AM on December 21, 2018
posted by The Underpants Monster at 12:03 AM on December 21, 2018
Are you tired all the time? Do you wake up and feel rested, but then have fatigue worsening through the course of the day? Or do you wake up and immediately feel like you could go back to sleep for hours? Do you snore? Or stop breathing at night or wake up gasping for air?
Any changes to your bowel frquwncy; consistency; color? Changes to your diet?
Heat or cold intolerance? Mood? Are you more irritable?
Also, as an aside - lots of people have mentioned hemoglobin and ferritin - IANYD, but worth checking a whole iron panel that includes %iron saturation. I frequently start people on oral iron if theirs is less than 20% because ferritin is an Acute phase reactant and can be normal in patients with chronic disease (esp. inflammatory illness).
posted by honeybee413 at 4:36 AM on December 21, 2018 [3 favorites]
Any changes to your bowel frquwncy; consistency; color? Changes to your diet?
Heat or cold intolerance? Mood? Are you more irritable?
Also, as an aside - lots of people have mentioned hemoglobin and ferritin - IANYD, but worth checking a whole iron panel that includes %iron saturation. I frequently start people on oral iron if theirs is less than 20% because ferritin is an Acute phase reactant and can be normal in patients with chronic disease (esp. inflammatory illness).
posted by honeybee413 at 4:36 AM on December 21, 2018 [3 favorites]
Another vote for have your ferritin level checked. Your symptoms are very close to low iron stores...ie.ferritin.
posted by pearlybob at 5:42 AM on December 21, 2018
posted by pearlybob at 5:42 AM on December 21, 2018
My B12 gets out of whack, so I eat read meat once or twice a week. I make sure I eat nuts and dried fruits to get magnesium and potassium; in my case I make supermuffins. These are easy things to try for a weeks or 2 with no side effects.
posted by theora55 at 6:09 AM on December 21, 2018 [1 favorite]
posted by theora55 at 6:09 AM on December 21, 2018 [1 favorite]
I dealt with something similar over the last couple of years. My issue ultimately ended up being a medication reaction to otc allergy meds, which doesn't sound like your issue, and there are lots of ideas about causes upthread so I won't contribute on that front. I can speak a little to the process of going to the doctor when you have issues with fatigue.
- Be persistent. I dealt with a few extremely dismissive doctors/specialists, and it was infuriating, and slow, and discouraging. Keep going anyway, or try another doc! Emphasize that the way you are feeling is not. Normal. For. You. I got a lot of 'it's normal to be tired,' 'it's just allergies', or insisting that I just had a virus (despite symptoms going on for over a year). I had to repeatedly and bluntly insist that what I was feeling was really abnormal for me and was interfering with my daily functioning. Trust your gut, read up on your symptoms, ask for what you want and see what your doctor thinks. Most doctors were willing to run blood tests if I specifically asked, even when they thought nothing was wrong.
- Write down every way you can think of that this is preventing you from living a normal life. For me it helped to stress that I really wasn't able to do anything outside of work and sleep, and that I wasn't able to engage in any activities that I really enjoyed, because I was too exhausted - NOT because I was depressed/uninterested! Be clear about that, since it sounds like it applies. I periodically do deal with depression and I am proactive about dealing with my mental health, but I knew what I was feeling wasn't that.
- Track all your symptoms, you're already on the right track with this but be painfully specific - e.g. you say that when you go to the gym, you don't have stamina like you used to - what does that look like? Racing heart? Weak heartbeat? Dizzy? Weak? Sleepy? Nauseous? The more specific you get, the more doctors seem to pay attention, and the better you can research what's going on for yourself. Also emphasize that the issue has been long-term, and mention any tests that have already been done. If you go to a new doctor or specialist, don't assume they actually looked at any records your doctor sent over.
- For what it's worth, sometimes doctors don't catch everything - after months of testing and specialists, I figured out that it was a med reaction basically by accident/desperation, but I probably wouldn't have been able to tell if I hadn't been tracking my symptoms so closely for so long. None of my doctors ever flagged any of my meds as concerning.
- Stay positive! It took a long time but I did finally figure out what was wrong, and I feel so much better that it's still blowing my mind every day. I didn't even realize how much of a zombie I had become until I was fully recovered...it's 100% worth it to pursue this.
posted by MartialParts at 11:45 AM on December 21, 2018 [1 favorite]
- Be persistent. I dealt with a few extremely dismissive doctors/specialists, and it was infuriating, and slow, and discouraging. Keep going anyway, or try another doc! Emphasize that the way you are feeling is not. Normal. For. You. I got a lot of 'it's normal to be tired,' 'it's just allergies', or insisting that I just had a virus (despite symptoms going on for over a year). I had to repeatedly and bluntly insist that what I was feeling was really abnormal for me and was interfering with my daily functioning. Trust your gut, read up on your symptoms, ask for what you want and see what your doctor thinks. Most doctors were willing to run blood tests if I specifically asked, even when they thought nothing was wrong.
- Write down every way you can think of that this is preventing you from living a normal life. For me it helped to stress that I really wasn't able to do anything outside of work and sleep, and that I wasn't able to engage in any activities that I really enjoyed, because I was too exhausted - NOT because I was depressed/uninterested! Be clear about that, since it sounds like it applies. I periodically do deal with depression and I am proactive about dealing with my mental health, but I knew what I was feeling wasn't that.
- Track all your symptoms, you're already on the right track with this but be painfully specific - e.g. you say that when you go to the gym, you don't have stamina like you used to - what does that look like? Racing heart? Weak heartbeat? Dizzy? Weak? Sleepy? Nauseous? The more specific you get, the more doctors seem to pay attention, and the better you can research what's going on for yourself. Also emphasize that the issue has been long-term, and mention any tests that have already been done. If you go to a new doctor or specialist, don't assume they actually looked at any records your doctor sent over.
- For what it's worth, sometimes doctors don't catch everything - after months of testing and specialists, I figured out that it was a med reaction basically by accident/desperation, but I probably wouldn't have been able to tell if I hadn't been tracking my symptoms so closely for so long. None of my doctors ever flagged any of my meds as concerning.
- Stay positive! It took a long time but I did finally figure out what was wrong, and I feel so much better that it's still blowing my mind every day. I didn't even realize how much of a zombie I had become until I was fully recovered...it's 100% worth it to pursue this.
posted by MartialParts at 11:45 AM on December 21, 2018 [1 favorite]
I had a similar issue at about that age. The biggest thing that helped me was asking around and getting a recommendation for a really good doctor. Having someone who will really listen to you and work with you to diagnose and treat is really important.
The first thing she did was a full panel blood test. Metabolic panel, vitamin D (very low), iron (low), full thyroid panel (low), and I’m sure other things I’m not remembering. Getting my bloodwork in shape with supplements made a big difference. The other big difference was looking at meds I was already on for side effects. For me, cutting out Zyrtec and Trazodone made a HUGE difference. If you’re on any antihistamines or psychotropic drugs (especially SSRIs I think), those might be contributing to fatigue symptoms.
Good luck! For me, it felt like I was perpetually in the first trimester of pregnancy— lying on the sofa took too much energy. But once I got a good doctor to help me work through it, I improved fairly rapidly.
posted by instamatic at 6:51 AM on December 27, 2018
The first thing she did was a full panel blood test. Metabolic panel, vitamin D (very low), iron (low), full thyroid panel (low), and I’m sure other things I’m not remembering. Getting my bloodwork in shape with supplements made a big difference. The other big difference was looking at meds I was already on for side effects. For me, cutting out Zyrtec and Trazodone made a HUGE difference. If you’re on any antihistamines or psychotropic drugs (especially SSRIs I think), those might be contributing to fatigue symptoms.
Good luck! For me, it felt like I was perpetually in the first trimester of pregnancy— lying on the sofa took too much energy. But once I got a good doctor to help me work through it, I improved fairly rapidly.
posted by instamatic at 6:51 AM on December 27, 2018
Response by poster: Thanks, all.
This wound up being simpler than I imagined: NP wanted to check my vitamin D levels again before doing anything else and they are back down to insufficient again since the good reading in August. (August-September is also when my job involved a lot of physical labor and being exhausted was normal.) I'm increasing my maintenance supplementation and retesting in a few months.
posted by momus_window at 3:44 PM on December 31, 2018 [1 favorite]
This wound up being simpler than I imagined: NP wanted to check my vitamin D levels again before doing anything else and they are back down to insufficient again since the good reading in August. (August-September is also when my job involved a lot of physical labor and being exhausted was normal.) I'm increasing my maintenance supplementation and retesting in a few months.
posted by momus_window at 3:44 PM on December 31, 2018 [1 favorite]
« Older Cooking project ideas for completionists | What do you think about group interviews? Newer »
This thread is closed to new comments.
posted by brainmouse at 4:07 PM on December 20, 2018 [1 favorite]