Fatigue

P 1:Bishop William C Latta J$1200

available video addressing Gods perspective on dealing with situations that lend to fatigue . Ater all God cares for you and desires that you place all your cares on Him for He cares for you .

"Doctor I just feel tired, my be I need some vitamins or something , I just don't know "

Heard any thing like this before or have you experienced it? -Some 20% of people experience fatigue significant enough as well as prolonged to interfere with normal functioning . I myself have experienced fatigue so severe that lying in one position so long ,because of lack of energy to move, led to significant pain on being moved because most likely ischaemia had set in to body points most dependent .

Usually the patient suspects some organic physical [20-60%] problem while ,the doctor initially considers psycholocic (emotional ) [40-80%] factors .The 1994 objective criteria for Chronic Fatigue Syndrome (CFS) established this entity as an objective syndrome ( dispelling common concepts of this being malingering or emotional instability. )

Fatigue lasting 3months or more merits serious evaluation and work up Thorough history and physical will narrow differentials and investigatory expenses

Some fatigue details you'd likely need to know:

About Your Fatigue
1)During the past two weeks, have you experienced persistent or frequent fatigue? Yes No
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2) How long have you experienced persistent or frequent fatigue?
Less than 1 month
1-3 months
4-5 months
6-12 months
More than 12 months
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3) If you have fatigue, on a scale 0-10, how severe has your fatigue been, on average, during the past two weeks?
Not at all 0
Mild fatigue 1 2 3
Moderate fatigue 5 6
Severe fatigue 7 8 9 10
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4) How much has your fatigue bothered or distressed you during the past two weeks? Not at all
A little bit
Somewhat
Quite a bit
Very much
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5) During the past two weeks, has your fatigue interfered with your ...?  
 

Sleep
0 1 2 3 4
Mood
0 1 2 3 4
Physical activities
(Keeping appointments, leisure/exercise routines, etc.)
0 1 2 3 4
Household activities
(Shopping, cooking, etc.)
0 1 2 3 4
Relationships
(Family, friends)
0 1 2 3 4
Employment
(Work, productivity)
0 1 2 3 4
Concentration
0 1 2 3 4
Motivation
0 1 2 3 4
About Your Health Treatment
   
6) Check these choices if you are currently seeing a doctor or nurse for any of the following medical conditions.
Anemia
Arthritis
Cancer- if yes, have you received any of the following treatment, in the past three months?
Chemotherapy
Interferon or Interleukin
Radiation
Surgery
Chronic pain
Depression
Heart disease
HIV/AIDS
Kidney disease
Liver disease
Lung disease
Multiple Sclerosis
Other Neurological problems
Parkinson's Disease
Sleep disorder
Thyroid problems
Other
Taking medication
For blood pressure
For angina
For pain (opioid or narcotic)
For pain (anti-inflammatory)
For pain (other)
For depression
For anxiety or insomnia
For epilepsy
For cancer (daily chemotherapy or hormone therapy)
For hepatitis
For multiple sclerosis
For Parkinson's disease
For another neurological condition
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7) Have you been treated by a physician for fatigue?
Yes
No
(If no, skip to Question 9)
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8) If yes, what type of treatment have you been offered?
(Check all that apply)
Treatment for sleep disorders
Exercise program
Nutritional program
Medication
Stress Management
Treatment for depression
Treatment for Anemia
Other
Skip to Question 11
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9) Would you be interested in obtaining treatment for your fatigue?
Yes
No
(If no, skip to Question 11)
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10) If you would be interested in obtaining treatment for your fatigue, what type(s) of treatment would you accept?
(Check all that apply.)
Treatment for sleep disorders
Exercise program
Nutritional program
Medication
Stress Management
Treatment for depression
Treatment for Anemia
Other
About You
   
11) Age
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12) Gender -Male -Female
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a thorough multi system history should be obtained as dysfunction in any of these could be the root cause of fatigue. Psychosocial questions on life events -death , divorce , job loss / unemployment , family work related problems . ? depression -is there changes in sleep , appetite , weight , , changes in memory or concentration , dejection , irritability , moodiness, anhedonia, hopelessness, helplessness, suicide ideation. Screen for panic attacks .

Many people don't realize how stressful their lives are !many get caught up in over indulgences- working prolonged hours often pursuing money , have very disturbed sleep activity cycles , eat indisriminately ie too much, too little , too insufficient of or too much of one component.

Some Condition presenting as Chronic Fatigue syndrome

1 Psychological
a. Depression
b.Anxiety	tension headaches
c Somatization Disorder
2 Pharmacological
a Hypnotics
b Anti-hypertensive	reserpine ,clonidine, propranolol
c Anti-depressants	amitrytilline
d Tranquilizers	benzodiapines
e Drug abuse and drug withdrawal	marijuana , cocaine
3 Endocrine -Metabolic
a. Hypothyroidism
b. Diabetes Mellitus
c. Apathetic Hyperthyroidism of the elderly
d.Pituitary Insufficiency
e.Hyperpathyroidism or hyper calcaemia
f. Addison disease
g. Chronic Renal failure
h.Hepatocellular failure
4 Neoplastic-Hematologic
a. Occult malignancy ie. pancreatic cancer
b. Severe anemia
5 Infectious	viral , bacterial, fungal , parasitic
a. Endocarditis
b Tuberculosis
c. Mononucleosis	epstein Barr virus ,Monospot test-fever lymphadenopathy symptoms may well prolong> 6 months *
d. Hepatitis
e. Parasitic Disease
f. HIV infection
g. Cytomegalovirus h. Influenza	symptoms can prolong> 6 months
6 Cardio-Pulmonary
a. Congestive Heart failure
b.Chronic Obstructive pulmonary disease
7 Connective Tissue Disease-ImmuneHyperreactivity
a. Rheumatoid disease
b.Chronic fatigue Syndrome	*Major criteria: must include both-a)New onset persistent , relapsing or debilitating fatigue that impairs daily activity to below50% of premorbid level for at least 6 months .-b) Exclusion of other physical or psychologic conditions that could produce similar symptoms *see minor criteras below.
8 Disturbed Sleep
a. Sleep apnea
b. Esophageal reflux
c. Allergic rhinitis
d. Psychological etiologies (above)

Minor criteria-Symptoms ( must have 6 +2 physical findings or 8 pf 11 symptoms)

1, Mild fever 2.Sore throat 3.Painful lymph nodes 4. Unexplained muscle weakness 5. Myalgias . 6.Arthralgias. 7 . Prolonged fatigue after exercise. 8. Headache .9. Neuropsychiatric complaints 10 Sleep disorder, 11.Rapid onset of symptom complex.

Minor criteria :Physical findings

1. Low grade fever 2. Non exudative pharyngitis 3 . Palpable or tender anterior or posterior cervical or axillary lymph nodes documented by a physician,

Lab work up CBC looking at peripheral smear, ESR~>75 mm/hr , electrolytes , lft's tsh , hetero-phile antibody test ( inf.mono.)? hiv ? Cxray. ?ppd testing . stool testing

- if nothing pans out on physical , labs and investigation reassure patients that your efforts will continue as things tend to pan out over time . For patient convinced that there is organic pathology but whom you feel reason is psychogenic don't rush to provide the viral condition crutch as this may make them resistant to psychiatric help . The ever Vitamin boost is to be weighed in the face that some "vitamins " can make patient worse esp, zinc components, and iron overload is a dangerous practice. Many patients will be taking supplements they rather not mention and the blend is likely to be causing more harm than good- after all the practice of medicine is a licensed profession ?

Symptomatic care is enhanced by supportive doctor-patient relationship ( one very good reason that women physicians have good practices is that they communicate with their patients more than their male counterparts.)Endogenous depression may be addressed with tri-cyclic antidepressants like imipramine that tends to less sedation than amitryptilline thats also used . Anxiety related fatigue may be addressed with short acting -short courses benzodiazepines. With chronic fatigue syndrome a gentle exercise programme , low dose anti-depressants , nsaid may well help. ENERGY CONSERVATION strategies include 1. Set priorities -doing more important things first 2. Pacing activities taking short rests in between activities 3. Planning efficiency 4 Maintaining proper posture and positions ie. sitting while chopping foods. Physical conditioning gently far out weighs no activity or too much activity, Anectedotal measures as biofeedback , acupuncture Omega3 / omega6 fatty acid ( fish oil /primrose oil ) though reported to have benefited patient has been often difficult to duplicate in other patients. Over all 9 out of ten patients tend to improve within a 6 month time frame-beyond this CFS is likely . Follow up- Patients will seldom experience fatigue without just reason and it must be appreciated as a major / significant problem , They shouldn't be made to feel as if they are wasting your time or just not trying hard enough . In unresolved cases schedule follow up in 1 month to re -evaluate if medical conditions are unveiling themselves or to rescreen for depression . Also encourage the patient to contact you if any other symptoms develop.

Things to experience and be rejuvenated

Falling in love.

Laughing so hard your face hurts.

A hot shower.

No lines at the supermarket.

A special glance.

Getting mail.

Taking a drive on a pretty road.

Hearing your favorite song on the radio.

Lying in bed listening to the rain outside.

Hot towels out of the dryer.

Finding the sweater you want is on sale for half price.

Chocolate milkshake. (or vanilla!)

A long distance phone call.

A bubble bath.

Giggling.

A good conversation.

The beach.

Finding a $20 bill in your coat from last winter.

Laughing at yourself.

Midnight phone calls that last for hours.

Running through sprinklers.

Laughing for absolutely no reason at all.

Having someone tell you that you're beautiful.

Laughing at an inside joke.

Friends.

Accidentally overhearing someone say something nice about you.

Waking up and realizing you still have a few hours left to sleep.

Your first kiss.

Making new friends or spending time with old ones.

Playing with a new puppy.

Having someone play with your hair.

Sweet dreams.

Hot chocolate.

Road trips with friends.

Swinging on swings.

Wrapping presents under the Christmas tree while eating cookies and drinking
eggnog.

Song lyrics printed inside your new CD so you can sing along without feeling
stupid.

Going to a really good concert.

Making eye contact with a cute stranger.

Winning a really competitive game.

Making chocolate chip cookies.

Having your friends send you homemade cookies.

Spending time with close friends.

Seeing smiles and hearing laughter from your friends.

Holding hands with someone you care about.

Running into an old friend and realizing that some things(good or bad) never
change.

Watching the expression on someone's face as they open a much desired
present from you.

Watching the sunrise.

Grreaaaat Sex

Getting out of bed every morning and thanking God for another
beautiful day.

Friends are quiet angels who lift us to our feet when our wings have
trouble remembering how to fly!