Of all the patients I see every week, it seems at least half of them book an appointment because they are tired. Fatigue is one of the most common, yet unexplained complaints GP's are presented with. Part of the reason for its prevalence, is that almost any illness can have tiredness as a symptom.
As a good GP, the first thing we delve into, is what's going on in a patient's life.
I recently had a high-flying executive come looking for answers. She's a mum, works five days a week, over 12 hours a day and is going through a marriage breakup. She complained of feeling tired, all the time. She "chills out" by watching TV until around 11 every night, answering work emails right up till she goes to sleep. I asked if she started doing anything different in her life. "Not really," she replied. "Oh just training for a marathon, but that's fine." I was tired just listening to her! So we agreed, that she is probably just rundown and trying to cram too much into her days. That we would give it a month, ease up on the marathon level running, back off the bedside emails and see how she goes.
Everyone wants a blood test.
While there are no official guidelines for Australian doctors, waiting a month before ordering tests for a patient who presents only with fatigue and a few other vague symptoms, is becoming more and more the norm. This is already considered standard practice amongst the Dutch College of General Practitioners. And for good reason.
It is very unlikely that your lack of energy is something sinister. Less than 5% of patients who come in complaining of tiredness get a significant diagnosis from a pathology test.
The most likely cause of their fatigue is stress - our lives are just too busy. Or maybe there's some anxiety or depression bubbling away as well. To these patients, I offer some simple tips especially in this new technological age.
Drinking caffeine in the afternoon
Drinking too much alcohol
Using your phone in bed (yes we are all guilty of it!)
Eating good foods - lots of fresh food, fruits and veggies.
Exercising - it might seem like the last thing you should be doing, but even a twenty minute walk can kickstart your energy levels.
Overall - listen to your body.
Cutting back the coffee and hitting the sack when you are tired (instead of forging through so you can watch your favourite show while the kids are in bed) might make a world of difference.
For those who are really struggling with stress, where it has moved into more formal anxiety or low mood, I strongly recommend seeing a psychologist. Tiredness is one of the most common symptoms of these conditions, and won't alleviate until you get the help you need for your worrisome thoughts and feelings. Some people just need a little help navigating the pressures of life - and a trained psychologist who's not your sister or best friend is the perfect professional for the job.
So when should we test and what can we test for?
If fatigue continues for more than a month, or you have other symptoms that are rather telling (for example abnormal bleeding for female patients, or a sudden onset of the fatigue in an older patient who is a smoker to name just a couple) there is a range of blood tests we may do to start things off.
The most common tests done in Australia for patients who have ongoing fatigue, or fatigue and a solid list of other symptoms, are tests for your blood count (red and white cells); tests for your kidneys and liver; tests for blood glucose levels; and lastly checks on your thyroid and iron levels. Of course your doctor will check for other weird and wonderful stuff as needed.
If abnormalities within those results are found, the most likely causes will be anaemia, diabetes or hypo-thyroid conditions - management of which needs to be discussed with your doctor.
Physical conditions also need to be ruled out, especially those that are overweight. They could be suffering from sleep apnea - an obstructive airway disorder that affects about 4% of adults and means you aren't getting the "deep sleep" you need to rest each night. Your GP can refer you for a consultation and a sleep study.
If your fatigue has been going for more than six months, if sleep makes absolutely no difference at all, if your test results are normal and you are getting other symptoms like muscle pain or enlarged lymph nodes, you could have Chronic Fatigue Syndrome. It is super hard to diagnose, and it's also very rare - so not something most need to worry about.
The best (and probably only) way of knowing if your tiredness is something to be concerned about is to have an open and honest relationship with your GP. We're not going to judge how many hours sleep you are managing a night, or judge how you are coping with juggling work and home. Our lives are just as frantic and crazy! We just want to help, give you tools to cope, or for the 5% percent of tired patients, give you the medical reason why.