LITMIR.BIZ

      Consequently, when attempting to assess your fatigue levels, you will find it of great value to talk to your partner or a close relative. Not surprisingly fatigue can influence our mood, our lifestyle and our activities. It is often those close to us who notice changes in our behaviour.

      Fatigue can also influence how we look. A loss of sparkle in the eyes, grey outlines beneath the eyes and a postural slump, are all give-away clues to chronic fatigue.

       Laboratory Measurements for Fatigue

      Health practitioners use laboratory tests to measure if you are fatigued. This is an essential first step to recovery (see chapter nine).

      I am quite frequently consulted by fatigued patients who have been offered a diagnosis of chronic fatigue syndrome, fibromyalgia or depression, yet without the evidence of blood and other laboratory tests. I believe it is wise to eliminate the obvious reasons for fatigue before worrying about more obscure illnesses. Certainly late-onset diabetes, pernicious anaemia and nutritional deficiencies need to be considered in elderly patients. Likewise iron deficient anaemia, hypoglycaemia and the effects of stress need to be investigated in young and middle-aged patients.

      Tests a doctor or practitioner may offer you can include:

      * An assessment of blood fats, kidney, gall bladder and liver function, proteins and blood glucose.

      * A haematology profile. This test measures the red and white cells in the blood, assesses iron transport, inflammation, and the clotting factor. A differential count of the white cells also offers information on the immune system.

      * A mineral profile. This involves your practitioner taking a sample of hair, blood, sweat or urine.

      * A full thyroid profile is also requested to assess if you may be tired.

      * A temperature check.

      * A six-hour glucose tolerance test may also be needed.

      * A red cell essential fatty acid profile may be of value. This measures the blood levels of the omega 3 and 6 series and other fatty acids.

      * Occasionally, where indicated, a urine amino acid investigation may be requested.

       One needs to be selective when requesting tests. There are over one thousand tests in current use, so it is important for the practitioner to tailor the tests to the patient. If this is not done a lot of money, time, and perhaps patient rapport can be wasted or lost. My procedure for testing for fatigue is described in chapter 11.

       PEGGY’S STORY

      I had known and treated Peggy, who was a very active 85 year old widow, for 16 years. She had always taken care of herself, eating well and avoiding cigarettes and excessive alcohol. She had suffered a tendency to be overweight, although her blood pressure was always normal. Knee and lower back stiffness and pain, particularly in the winter, and a slightly raised cholesterol had all needed treatment. None of these problems however had caused her great concern and she freely admitted that her motivation to consult me was entirely based on her love of golf. She played two half rounds each week, which provided her with exercise, and what she termed ‘a healthy challenge’. She also met her friends and enjoyed a pleasant social lunch at the club house. She saw her visits to my surgery as necessary maintenance to enable her to continue her one sporting activity, around which her social life revolved.

      Peggy’s concern began when she found that her stamina only allowed her to complete two or three holes. This had developed very slowly over a six month period. Routine cardiovascular checks were carried out by her doctor, but nothing was discovered except for the slightly raised cholesterol and a raised uric acid (this was in line with the fact Peggy suffered from mild gout).

      Her doctor further requested a bone density scan to assess osteoporosis risk and a full biochemistry and haematology screen. No other imbalances or deficiencies showed. He made it clear to Peggy that at her age she should now discontinue golf and settle for the occasional short walk. He also advised her to lose weight and avoid the foods and drinks that can lead to gout.

      She was not happy with her doctor’s diagnosis and even less happy with his recommended treatment.

      After Peggy had reassured me that she was sleeping well and that she had not suffered recent infections or stress, I questioned her for more detailed information on her fatigue. She was able to confirm my suspicions that she was also suffering mental fatigue, described by her as a ‘mental fog’. This included poor memory and concentration, and a reduced sense of smell and taste. Peggy also remarked that her hands and feet had been unusually cold over the previous few months.

      I requested a morning temperature check and thyroid blood tests. In addition I asked the laboratory to check Peggy’s levels of minerals and vitamin B₁₂.