Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Medical Author:
Charles P. Davis, MD, PhD
Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
One of the most common complaints that I hear when taking a history
from a patient of a current illness is that the patient says, almost as
an afterthought "... and I don't know why I am so tired." In most
instances, this complaint is not the main reason that the patient is
seeing me. In some instances, "being tired" is mentioned to physicians
during a routine checkup after the patient said they have no current
health concerns. So, should I as a physician treat the comment like an
afterthought and concentrate on the "real reason" the patient is being
seen? I could focus on the "real reason" for the visit, but if I skip
asking questions about "being tired," I may miss finding out information
or clues about the patient's illness and completely overlook a potential
diagnosis and treatment for the patient.
Therefore, the first thing to understand about "tired" is what the
patient means by the word. Does the patient mean they feel sleepy or
fatigued -- they are not the same.
Fatigued (tired) describes a lack of
energy and motivation, not feeling sleepy (although both can occur
together). If the answer is fatigue, the next step is to determine if
the fatigue is mental, physical, or both. Now we are beginning to narrow
down some clues to the cause of the fatigue, but we (the patient and the
doctor) still have a long way to go together.
Fatigue is mainly a symptom and not a disease in itself. The key is
for the doctor, with the patient's help, to discover the underlying
cause of fatigue. The patient's input is important because accurate
answers to the doctor's questions may lead the doctor toward a diagnosis
or, at least, may suggest what medical tests may help provide a
diagnosis. For example:
If the patient says things like "Starting any
project is tiring...It is exhausting to get motivated... Concentration takes
all of my energy....or... it takes so much effort just to feel normal," the
fatigue may have a mental cause.
If the patient says things like "I'm
exhausted after walking up a flight of stairs...I lose muscle strength
after simple repetitive movements..., or I had a viral infection but now I
seem unable to get my normal strength back," the fatigue may have a
physical cause.
Fatigue (either physical, mental or both) is a symptom that may be
difficult for the patient to describe and words like lethargic, exhausted and
tired may be used.
Taking a careful and complete history is the key to help making the
underlying diagnosis of the cause for the symptom of fatigue, However, in about
a third of patients the cause is not found and the diagnosis is not known.
There are numerous causes of fatigue symptoms. Examples of some treatable causes of
fatigue include anemia, diabetes,
thyroid disease, heart disease, COPD and sleep
disorders (Table).
Long lasting complaints of fatigue does not equate to chronic fatigue
syndrome. Specific criteria as set by the CDC need to be met to make that
particular diagnosis.
Fatigue introduction
Fatigue can be described as the lack of energy and motivation (both physical
and mental). This is different than drowsiness, a term that describes the need
to sleep. Often a person complains of feeling tired and it is up to the
health care
professional to distinguish between fatigue and drowsiness, though both can occur at
the same time. Aside from drowsiness, other symptoms can be confused with
fatigue including shortness of breath with activity and muscle weakness. Again,
all these symptoms can occur at the same time. Also, fatigue can be a normal
response to physical and mental activity; in most normal individuals it is
quickly relieved (usually in hours to about a day, depending on the intensity of
the activity) by reducing the activity.
Fatigue is a very common complaint and it is important to remember that it is
a symptom and not a disease. Many illnesses can result in the complaint of
fatigue and they can be physical, psychological, or a combination of the two.
Often, the symptom of fatigue has a gradual onset and the person may not be
aware of how much energy they have lost until they try to compare their ability
to complete tasks from one time frame to another. They may presume that their
fatigue is due to aging and ignore the symptom. This may lead to a delay in
seeking care.
While it is true that depression and other psychiatric issues may be the
reason for fatigue, it is reasonable to make certain that there is not an
underlying physical illness that is the root cause.
Individuals with fatigue may have three primary complaints; however, it can vary in each person.
There may be lack of motivation or the ability to begin an activity;
the person tires
easily once the activity has begun; and
the person has mental fatigue or difficulty with
concentration and memory to start or complete an activity.
While fatigue can last for a prolonged period of time, the presence of
chronic fatigue is different than
chronic fatigue syndrome, which has specific
set of two criteria set for by the Centers for Disease Control and Prevention as
follows:
Have severe chronic fatigue for at least six months or longer with other
known medical conditions (whose manifestation includes fatigue) excluded by
clinical diagnosis; and
Concurrently have four or more of the following symptoms:
Infectious mononucleosis is a virus infection in which there is an increase of white blood cells
that are mononuclear (with a single nucleus) "Mono" and "kissing
disease" are popular terms for this very common illness caused by the
Epstein-Barr virus (EBV).
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
HIV (human immunodeficiency virus) is the cause of AIDS (acquired immunodeficiency syndrome). HIV is a type of virus called a retrovirus, which infects humans when it comes in contact with a break in the skin or tissues such as those that line the vagina, anal area, mouth, or eyes.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Anorexia is an eating disorder characterized by markedly reduced appetite or total aversion to food. Anorexia is a serious psychological disorder and is a condition that goes well beyond out-of-control dieting. With anorexia, the drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. There are psychological and behavioral symptoms as well as physical symptoms of anorexia including: depression, social withdrawal, fatigue, food obsession, heart and gastrointestinal complications, kidney function, flaky skin, brittle nails, and tooth loss (this list is not exhaustive).
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Non-Hodgkin's lymphoma is cancer of the lymphatic system, a vital part of the body's immune system. Symptoms include swollen lymph nodes, fever, night sweats, coughing, weakness, chest pain, unexplained weight loss, and abdominal pain. Treatment depends on which type of non-Hodgkin's lymphoma you have, the stage of the cancer, your age, how fast the cancer is growing, and whether you have other health problems.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Pregnancy symptoms vary from woman to woman. There are some symptoms that are more frequent in some women. These symptoms include a missed period, nausea, vomiting, bloating, weight gain, headaches, food cravings, and mood changes.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
In cancer treatment, chemotherapy refers to the use of drugs to kill or slow the growth of rapidly multiplying cells.
Chemotherapy usually includes a combination of drugs, since this is more effective than a single drug given alone. There are many drug combinations used to treat breast cancer. Ask your doctor for specific information and side effects you can expect from your chemotherapy medications.
How Is Chemotherapy Given?
Chemotherapy drugs are given intravenously (directly into a vein) or orally (by mouth). Once the drugs enter the bloodstream, they travel to all parts of the body in order to reach cancer cells that may have spread beyond the breast -- therefore chemotherapy is considered a "systemic" form of breast cancer treatment.
Chemotherapy is given in cycles of treatment followed by a recovery period. The entire chemotherapy treatment generally lasts three to six months, depending on the type of drugs g...