Are you tired? Yes, that sounds like the punchline to a bad joke: We’re all tired.
But how do you determine whether your fatigue is a normal part of your everyday life or whether it is a sign of a potential medical condition?
For this month’s Healthy Action’s topic, I spoke with Dr. Deborah Plate, a longtime family medicine physician, clinical associate director at the Center for Family Medicine, and Family Medicine department chair at Cleveland Clinic Akron General.
The Healthy Actions column is a monthly look at a different medical topic of interest with a local medical expert. To read previous columns, go to www.tinyurl.com/BettyHealthyActions
The following is an edited version of the interview. There is also a Now You Know Akron podcast and a video of the interview available.
What’s the difference between being normally tired versus needing to seek medical care?
This is such a broad topic that I think it’s great that we’re talking about it, because it really can be extremely significant for a lot of folks. Sometimes it’s someone in the family or a partner who says, “Wow, you look tired or you seem tired” before we even really appreciate that.
Most of us are tired with all that’s going on, particularly in the last 2½ years.
Short term, it may have been something that we may have been through — something in an evening and the next day we’re tired or for a week. We’re tired, and then it tends to dissipate. That tends to be short-lived. What does that feel like? It can be exhausted. If we’re celebrating or we’ve had an event go on that’s been emotional, that tends to have perhaps a beginning and an end.
Typically what we tend to see is the long-term fatigue. And sometimes we don’t even see it ourselves. It’s someone saying, “You doing OK? You feeling OK?” or we find that we’re really losing interest, we’re dragging or it’s hard to focus or we’re falling asleep.
Should you see a doctor if something is affecting your daily life?
Yes, some of my questions I ask a patient are: “How often do you miss work? How often are you napping, and how long are those naps?” It’s really important that there are some very significant things that could be going on if we get the right history and we do the right testing.
What are some medical reasons for fatigue?
There’s a huge list, and one of the first things I look at is the medication list. There are many meds out there that can cause fatigue. It’s really important to have an accurate list of what you’re taking to share with your care provider. Sometimes I’ll ask, “What’s new and how are you taking it? Or are you taking it?”
One of the other top things is a low thyroid. Is your thyroid underactive, which means the body machine is going slower than it should, and that is very significant. Another we see frequently is sugar. Sometimes folks are diabetic and they don’t even know it. Anemia or low blood certainly can creep up on us sometimes even due to cancer. Cancer can be extremely tiring. Is it something that hasn’t been caught that’s been there? That’s really important for us to be asking a lot of questions with regards to that. I have a lot of folks who come in and say, “I am exhausted.” They can tell you even when that occurred because once they go into this Afib (atrial fibrillation) rhythm, which is having to do with the upper portion of the heart, we can be very tired and there’s some symptoms that can go along with that.
High blood pressure also and certainly some of our bad habits such as alcohol and marijuana can cause fatigue. I look for vitamin deficiencies. I ask about diet. Oftentimes we’ll see extreme fatigue in folks that are perhaps dieting or not hungry and not taking in enough calories.
sleep apnea is a big question on my list with regards to family members who use a CPAP (which stands for continuous positive airway pressure) mask at night or if a patient hasn’t been diagnosed (and keeps the partner awake).
Depression can cause fatigue as well. Over the last two years, we have a heightened influx of patients coming in with concerns about depression.
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Who should I see first? My primary care physician?
Yes, your medical home or primary care doc is really a great place to start. Who knows you the best? Then we can help breakdown that fatigue. We also have their past medical history and to go to an urgent care or somewhere where you are not known doesn’t help for something like this.
What if you’re one of those people who has avoided the doctor and you don’t have a doctor?
Most hospitals have a physician finder line where you can call and say, hey, who is accepting patients, I need a doc.
What should I expect once at the doctor?
Be thinking about your family history: If there is heavy depression, if there is cancer, if there is anemia. Those are things we need to know about. Bring your meds as that is very important. You can expect most likely some bloodwork and that may be fasting or not fasting. We’re going to check a blood count and your thyroid and your sugar levels.
We’re going to check your blood pressure. High blood pressure undetected for a long time can make us feel exhausted. Maybe we will do a blood count and we’re not looking at anemia, but we’re looking at high blood count, and that can represent something like a sleep apnea because the body is struggling for oxygen during the night.
Would you like people to journal or write down patterns of when they are tired?
Safe. I think journaling is always great. There was a study in one of my areas of interest, which is women and heart disease. These women who had heart attacks, they went back one month to see what occurred prior to the heart attack. They all had one thing in common: extreme fatigue, different than their baseline. In addition to your bloodwork, you may get an EKG, which is a heart tracing.
Could fatigue be a symptom of any potential cancer diagnosis?
Absolutely, and that’s scary for a lot of folks, but I think it’s important to think along those lines. Oftentimes, I’m asking them about their screenings, their mammograms, their pap smears. If they are of an appropriate age group, their colon screenings are really important. Through COVID, we really lost folks who didn’t get health screenings, and so now we’re catching up and finding some pretty advanced disease because they were scared to death to certainly come anywhere near any of the facilities that they felt were higher risk .
Several patients have recently been diagnosed with melanoma, which is the most dangerous skin cancer that we must follow very closely. So cancer can be very quiet, very subtle, but fatigue can be certainly something that can help define it.
What about long-haul COVID symptoms of fatigue?
COVID has been such a nebulous thing for us. The longer we go, the more we learn. Cleveland Clinic set up a long haul clinic that I have referred patients to if someone is four to six months out and still struggling with fatigue and function. Before I send the patient, I make sure we’ve done our due diligence to make sure that there’s no anemia, sugar or thyroid issues.
These folks are exhausted. They’re exhausted with any form of exertion. They really struggle to cope day to day, and they tell you they were absolutely fine before their COVID infection.
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Depending on the cause of the fatigue, what are the range of treatments that someone can expect?
One of the things we might order is a sleep study. You can do one at home and if that is positive or showing signs of concern, they would then go to a sleep lab for further testing.
If you have anemia, we might be going on an iron pill or we might look at a transfusion. I have a lot of folks who donate blood and I love it, but sometimes I have to slow that down a little bit because they’re struggling with their iron stores.
For depression, we might find a medication that helps with mood and fatigue. Maybe altering medications someone is on will make a difference. Beta blockers are very important medications for heart disease. Fatigue is a common side effect. Sometimes we’ll tweak that dose a little bit, and that can make a huge difference.
One of the most common things we’re seeing in the wonderful state of Ohio, particularly during our winters that are gray and dark, are vitamin D deficiencies. So if someone comes in with low vitamin D, putting them on the 50,000 IU once a week can be really enlightening. As we age, we struggle to absorb B12. When B12 is low, it can cause us to feel really tired. The good news is we used to do injections but research says oral pills for many folks can be effective.
When you go to the doctor with your list of medications, should you include over-the-counter vitamins and supplements?
Great point. When I ask about prescription meds and over-the-counter medications and supplements, oftentimes the patient will say, “No, this is all I take.” But then you ask, “What about a laxative?” and they say, “Oh yes, I take a laxative,” and so on. Advil, Motrin and Aleve are huge issues for us because the anti-inflammatories can bore a hole right through your stomach. So when you think about anemia, oftentimes it’s that over-the-counter medicine that we’re using for the joint pain or for the headache.
Are there things that people can do daily to prevent fatigue?
Absolutely. I certainly think a good calorie intake. We talk about color: greens, oranges, yellows, reds, the berries, the purples, the blues. When you think about vegetables and fruits, color makes a difference. It sounds silly, but it really does enhance how we feel day to day. When I talk about meat, I’m thinking chicken, fish, turkey, lean beef now and then, like one to two times a month because we need those foods.
I see a lot of folks who are tired and anemic because of their dietary intake. Twinkies every day as a mainstay is not going to get us where we need to be. Diet is certainly important.
Sleep hygiene and really being cautious to make sure that we are consistent and trying to get somewhere between that seven- to eight-hour range. Some folks will tell you that they need more or they can get away with less, but we find not always.
Hydration is also important. This time of year it is critical. We see a lot of patients on a daily basis who are dehydrated. So we talk about that water or sports drink intake on a daily basis to keep those electrolytes in balance.
Is there anything else you’d like to add?
I just think it’s important to have a patient prepare for that visit. Fatigue is a very broad topic, so be thinking about how you can help your care provider help find what’s going on and anticipate that there will be some testing and bring your meds. I love to have the patients bring every single pill bottle they have because sometimes there’s something there that we don’t know about, especially if they’ve been to an urgent care center or somewhere where we may not have that information.
Bring your meds, bring it journal and let’s have a conversation.
Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ To see her most recent articles and columns, go to www.tinyurl.com/bettylinfisher
