Why Am I So Tired: The Many Causes of Fatigue (cont.)

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The other types of questions are a bit harder for both the patient and the doctor to use as clues because if the patient responds positively, often the physician will be need some additional testing done (possibly by other doctors or tests with results that will not be immediately available to your physician) to uncover or clarify an answer. If you have a primary physician, that doctor should already have most of these questions partly or fully answered. However, the primary care doctor may not have these answers if you see multiple physicians, have not seen you doctor "...in quite a while..." or you are seeing a physician for the first appointment. Examples of such questions include:

  • Did the fatigue develop gradually or quickly?
  • Do you have a history of diabetes, thyroid or other medical problems in your family?
  • Have you had a recent illness (for example, the flu, mononucleosis, "viral" illness)?
  • Have you traveled outside of the U.S.?
  • What is your current medical history (asthma, chronic obstructive pulmonary disease [COPD], congestive heart failure [CHF] or coronary artery disease [CAD])?
  • What is your surgical history (neck, kidney, liver)?
  • What are the current medications you take, their dose and frequency?
  • Have you had any medical tests performed recently and what were the results?

Answers to these questions can lead to clues and further tests for underlying causes of fatigue that stem from:

  • metabolism or hormonal problems (diabetes, anemia, kidney),
  • infections (pneumonia, hepatitis, tuberculosis [TB], malaria), and
  • heart or lung problems (heart disease, heart failure, heart valve problems).

These diseases listed between parentheses are only a few examples of the major categories of diseases and other fatigue problems that can stem from underlying diseases such as cancer, autoimmune diseases, and even therapy such as chemotherapy and radiation therapy.

I find that most (unfortunately, not all) underlying causes of fatigue can be identified when the patient and I make a good effort to uncover the clues that lead to discovering the underlying cause of their fatigue. Treatment of fatigue is based on the treatment of the underlying cause; but that's another long story. Consequently, the answer to the person who asks "Why am I so tired?" is given when the underlying cause(s) is identified, usually done with you answering the tough questions accurately and the diligence in pursuing clues by your doctor.

The art and science is forever changing; in general diagnostic methods and how doctors use them often enhance patient care. However, many times our patients and we doctors don't think of the cumulative effects of lifestyle, minor changes in health, medication effects, and aging on one's overall health; we focus on a specific symptom and assume a single cause ant treatment. Functional medicine, a relatively new way to approach diagnosis and treatments may offer methods and treatments that are designed for each individual patient by identifying multiple causes that contribute to the problem and then trying multiple treatments to reduce or cure the problem. Chronic problems like fatigue, inflammation and others may be solved or maximally reduced by the approach.

Why Am I So Tired? The Many Causes of Fatigue Resources

Doctor written main article on Fatigue


The Institute for Functional Medicine. What is Functional Medicine?

UpToDate.com. Approach to the adult patient with fatigue.

Last Editorial Review: 11/26/2013