mtg fatiguue

Fatigue is defined variably as this is a non medical term. However it broadly encompasses the following.

1. Tiredness
2. Exhaustion
3. waking up and feeling you could go back to sleep again
4. Unable to push yourself through to your usual exercise levels
5. generalized myalgia ( muscle aches)
6. Feeling unwell

It may just be one or more than one of the above. However for most people, they realize when they are not their usual self.  It can be a difficulty or inability to start activity (a sense of weakness or reduced motivation). It may also manifest in not being able to do the usual level of activity. However there is also mental fatigue where concentraion, recall and moods change and even the act of trying to focus on a task is difficult. It is a fairly common symptom and is the main presentation in about 12- 15% and is a significant factor in up to a third of consultations.

Any fatigue that is less than a month in duration is acute ” and may come from an infection, inflammation or an emotional or mental challenge ( eg bereavement/ relationship breakdown.). Many viruses will leave a person with fatigue and reduced exercise and mental capacity even after physical symptoms have resolved.

Chronic fatigue is defined by persisting symptoms for more than 6 months. The intensity may vary, but it has been present for more than 6 months. A number of conditions need to be excluded prior to a diagnosis of chronic fatigue. Some of these can be excluded by history and physical examination. some investigations are required. Eg Disorders of the  hear ( Heart failure), lungs ( COPD), Psychological ( Depression, substance misuse including alcohol). Endocrine conditions including disorders of the thyroid, adrenal and pituitary need to be ruled out. Other organ failures including renal failure, hepatic failure can all contribute. Blood salt levels (sodium, potassium) and vitamin deficiencies are other conditions that need to be ruled out.

1. A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than six months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong),
2. This fatigue does not get better with rest
3. Post-exertional malaise (PEM)- Worsening of a patient’s symptoms and function after exposure to physical or cognitive stressors that were normally tolerated before disease onset.
4. Unrefreshing sleep.

Let us get the bad news out of the way first

The good news

When ever you get some bad news, you go through a series of emotions to get over it. This is a well established cycle initially described by Kubler Ross

Denial – Denial is the most frequent emotion to get stuck on. This will make you go from one doctor to another to another, different healers and practitioners. It is always important not to miss other diagnosies and so it is important to go to a person you trust. Once you get the investigations back and your doctor is confident that there is no underlying disease, then it is important to go to the next step.

Anger / Blame- WE might blame a person, the environment or an illness. Anger is good but only for a period of time.

Bargaining – We often tend to bargain. It is in our very nature. If I do this , will I get this? However we must accept the illness as it is only then can we move on

Depression – This is the deep dark tunnel , we have to go through when all the above emotions have exhausted themselves

Acceptance – WE come out of the tunnel and can then move on

We need to know where we are before we can move on

Why have I highlighted this? You probably knew this already.. It is important to recognize where you are on the roller coaster And only then can we move on. We often get stuck on a phase and that prevents recovery.

In addition to this we need to

check if there is any negative energy circulating

• Physical illnesses are often easier to deal with . and we don’t give fatigue the same importance
• Guilt – Because , I look physically well I should be able to perform well
• Failure – We can feel like failure because of the several times we have tried
• Secondary gain – Have we benefited from playing sick
• Expectations – Do we have unrealistic expectations?

Are there positive energies that we can tap on?

• Hope – you must be able to cling on to hope . The expectation that things will get better
• Faith – This can be religious or non religious faith – This is the ability to focus on a person or power that will carry us through. Just like a child trusts parents, sometimes that faith is important
• Trust – You must trust someone.. It is ok to have doubts once in a while but lack of trust will make recovery hard.