special subjects
Fatigue
Evaluation of Fatigue
Fatigue can be highly subjective. People vary in what they consider to be fatigue and how they describe it. There are also few ways to objectively confirm fatigue or tell how severe it is. Doctors usually start an evaluation by trying to distinguish true fatigue from other symptoms that people may refer to as fatigue. Weakness : Weakness is lack of muscle strength that makes it difficult for people to move the affected muscles. Weakness is typically a symptom of a nervous system or muscle disorder. Disorders such as Shortness of Breath : People, such as those with certain heart and lung disorders, become short of breath with activity but do not feel fatigued at rest. Drowsiness: Insomnia and Excessive Daytime Sleepiness (EDS) is a symptom of sleep deprivation (for example, caused by lifestyle or by disorders such as allergic rhinitis, gastroesophageal reflux, painful musculoskeletal disorders, sleep apnea, and severe long-lasting disorders). Yawning and lapsing into sleep during daytime hours are common. However, many people with fatigue have disturbed sleep, so symptoms of sleep deprivation and fatigue can overlap. In people with fatigue, certain symptoms and characteristics are cause for concern. They include Persistent, Involuntary Weight Loss None Chronic fever or night sweats Swollen lymph nodes throughout the body Muscle weakness and/or pain Serious accompanying symptoms (for example, coughing up or vomiting blood, bloody or black stools, shortness of breath, swelling in the abdomen, confusion, or suicidal thoughts) Involvement of more than one organ system (for example, rash plus joint pain and stiffness) Headache or loss of vision, particularly with muscle pains, in an older adult All people feel fatigue occasionally, and not every case of fatigue requires evaluation by a doctor, particularly those that accompany an acute illness (such as an acute infection) or that go away after a week or so. However, fatigue that seems to last longer or has no obvious explanation should be evaluated. Older adults with a new or different headache or loss of vision and people who have serious accompanying symptoms should see a doctor immediately. Even if they have no other symptoms, older adults with fatigue should see their doctor as soon as possible. Other people who have other warning signs should see a doctor in a few days. People who have no warning signs should call their doctor. The doctor can decide how quickly they need to be seen. Typically a delay of a week or so is not harmful. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the fatigue and the tests that may need to be done (see table). Doctors ask the person To describe what is meant by fatigue as precisely as possible How long fatigue has lasted When fatigue occurs in relation to rest and activity What other symptoms occur (such as fever, night sweats, or shortness of breath) What measures relieve or worsen fatigue How fatigue affects the person's work and social activities Women are asked about their menstrual history. All people are asked about diet, anxiety, depression, and alcohol and drug use (including use of Overview of Over-the-Counter Drugs and Doctors then do a physical examination. Because many disorders can cause fatigue, the physical examination is very thorough, particularly in people with chronic fatigue. In particular, doctors also do a neurologic examination to evaluate the person's muscle strength and tone, reflexes, gait, mood, and mental status. The history and physical examination are more likely to reveal the cause of fatigue of more recent onset. A cause is also more likely to be found when fatigue is one of many symptoms than when fatigue is the only symptom. Fatigue that worsens with activity and lessens with rest suggests a physical disorder. The need for tests depends on what doctors find during the history and physical examination. For example, doctors test for (HIV) and If people do not have any other findings besides fatigue, many doctors do a few common blood tests. For example, they may do a complete blood count, blood tests to measure liver, thyroid gland, and kidney function, and a blood test called the erythrocyte sedimentation rate that suggests the presence of inflammation. However, such blood testing often does not reveal the cause. 