Carole has a debilitating health problem that she shares with countless others: she is always tired.
The 48-year-old lives a busy life. In addition to her job as a teacher, she has three children, of whom there has learning difficulties, and helps to take care of her elderly mother.
It may not be surprising that Carole would be lost somewhat. The tiredness that Carole experiences, however, explains me during my busy doctor in North London is comprehensive.
Carole struggles every morning to get out of bed. During the day she feels her eyelids hanging and trusting coffee and tea to keep her awake. Towards evening she hardly has the energy to play with her children, let alone do something for herself like practice.
Carole has felt like this for a while and it is only the last resort that she has made an appointment. “It doesn’t seem like something it’s worth disturbing a doctor,” she explains, when I ask why she didn’t come me before.
She is far from alone. Research shows that no fewer than seven in 100 patients complain to their doctor that they ‘are tired all the time’ – making it the most common symptom that we see.
Many patients, such as Carole, express help to seek help because they create the symptom to the hardships of daily life. However, what patients do not realize is that there is often an underlying medical condition that is to blame for their fatigue.
And in some cases something like a 40p supplement can help increase fatigue within a few weeks.
Seven in 100 patients complain to their doctor that they ‘always be tired’ – making it the most common GPS symptom.
Carole was one of these occasions. As soon as she has explained her symptoms, I start asking questions about her overall health. I quickly see what the cause of her fatigue could be.
She explains that her period has started more often in the past year – from every 28 days to around every 23.
And although Carole expected her period to become lighter as she got closer to the menopause, the opposite took place. They get longer and heavier.
I decide to offer her a blood test and the results that come back a week later reveal exactly what I expected: Carole has anemia. The condition is caused by a lack of iron in the blood, a crucial nutrient that helps the body to transport oxygen to the organs.
The most common symptoms are shortness of breath, heart palpitations, pale skin, headache and, yes, fatigue.
And although there are a number of causes of anemia, including infections, kidney disease and cancer, the two most common pregnancy and heavy periods are therefore anemia more common in women.
The good news for Carole is that anemia is usually treated easily. I started her on an iron supplement and advised that she took vitamin C tablets, available without a prescription, which help the body absorb more iron.
I have also recommended to treat her tough periods, and she chose to get a hormone coil – a contraceptive device that is inserted into the womb that stops ovulation.
Dr. Kaye: “What patients do not realize is that there is often an underlying medical state to blame their fatigue.”
In the beginning, Carole did not notice much difference. But a few months later she returned to say that her fatigue had begun to improve. She was no longer worried about nodding during the day. In the evening she had energy that was not there before.
And although the fatigue was not completely lifted (more about this later), it was still an amazing turn.
Of course anemia is not the only condition that causes fatigue.
Vitamin D deficiency – which affects one in six adults – is also a common trigger of fatigue, and it can also be diagnosed with the help of a simple blood test.
And, just like anemia, the treatment is fairly simple, usually with nothing more than a normal vitamin D tablet.
Hormone problems can also be behind the problem. Hypothyroidism, a condition in which the body does not produce enough of the hormone thyroxine. This is made in the thyroid gland in the neck.
Patients often also experience weight gain, constipation, cold, low mood and dry skin all the time. Fortunately, hypothyroidism can be effectively treated with the help of daily thyroxin tablets, which a doctor can prescribe.
Another hormonal problem that can lead to fatigue is the menopause. The menopause occurs when levels of the female sex hormone estrogen fall during middle age. Fatigue is one of the common symptoms, along with insomnia, hot flashes and night sweating.
The two most common causes of anemia are pregnancy and heavy periods – that is why the condition is more common in women.
Hormone replacement therapy (HST) tends to improve all these problems, including fatigue, and is usually taken through a skin plaster or tablets.
However, not all causes of fatigue are so easily diagnosed and treated.
Chronic fatigue syndrome (CFS), a debilitating problem that leads to fatigue and muscle weakness, usually occurs after a viral infection. There is no test for CFS and there are no effective medicines.
However, the fatigue that CFS patients experience is much more serious than those who complain that they are always tired. CFS patients are often limited to bed and cannot exercise.
People who always feel tired – regardless of the cause -, on the other hand, often benefit from physical activity and exercise.
It may sound contraindic, but research shows that regular exercise increases energy levels.
This does not mean that you have to start training for a marathon. Instead, concentrate on moving your body as much as possible, working to the recommended 150 minutes a week.
That amounts to 30 minutes five times a week of moderate intensity exercise – such as a powerful walk. Patients are often surprised how many exercises their energy levels can increase.
This was certainly the case for Carole. When her fatigue symptoms no longer improved, I suggested that she assumed a training routine. Exercise is also very effective in reducing stress – something that Carole desperately needed because of her family obligations.
Carole told me that she felt the most comfortable to take sturdy walks, usually in the evening. So I advised to do 30 minutes of running sessions five times a week.
And within a few weeks Carole reported that she had begun to notice a steady increase in her energy levels.
This, combined with the changes we had already made to combat her anemia, made a considerable difference for her quality of life.
It is also important that patients, regardless of the severity of their fatigue symptoms, view their sleep hygiene – use the term doctors to describe the environment in which patients sleep.
This is because the best way to combat fatigue is to have a good night’s sleep.
Studies show that patients sleep best in dark, quiet and cool rooms. For this reason, patients often find that buying blackout blinds, which prevent sunlight from coming in and a fan or air conditioning unit, to cool the room, to help them sleep better and reduce their fatigue.
Similarly, it is proven that you would sleep every night about the same time and wake up to stimulate the quality of sleep.
Although some patients, such as Carole, can benefit from a daily supplement, this almost always has to be combined with other measures, such as exercise and good sleep hygiene.
The good news is that although millions of patients suffer from fatigue, many also recover when they take the right steps.
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