Fatigue: When to see your doctor

If I asked you, my blog readers, whether you are tired, I'm guessing that many of you would say yes. Sometimes the reason is obvious—maybe you stayed up too late watching the Red Sox game or didn't sleep well after a heavy meal. But sometimes fatigue persists, day in and day out, with no obvious cause. It's this latter case that should send a person to his or her doctor.

Below, Harvard Medical School's report, Boosting Your Energy, explains the questions you should anticipate from your doctor if you see him or her about your fatigue:

Because fatigue is a characteristic of many illnesses, you should describe your symptoms in detail to help your doctor narrow down the possible causes. How, exactly, does the fatigue feel to you? Do you have trouble concentrating? Are you mentally fuzzy, that is, do you take longer to think of words or compute simple math problems than you used to? Do you tire more quickly? Do certain activities take more effort than they used to? Answers to these questions indicate how severe your fatigue is and whether it mainly involves muscle fatigue, central fatigue, or both.

Be prepared to tell your doctor which activities you've had to limit. For example:

• You used to enjoy going out to dinner and the theater with friends, but now you can't stay awake during an evening performance.
• You no longer wake up feeling refreshed, even after you've slept all night.
• When you exercise, your muscles feel achy and weak in less time than they once did.
• You've done the newspaper crossword puzzle for years, but now your mind wanders, and you lose interest before finishing it.

This information yields further clues to the nature and severity of your fatigue. Timing is also important. Tell the doctor when you started noticing a decrease in your physical or mental energy level. Was the change gradual or sudden? When fatigue involves stress, overwork, or psychological problems, it usually comes on gradually. However, when the cause is chronic fatigue syndrome, fibromyalgia, or a side effect of medication, fatigue often starts suddenly. Did the onset of fatigue coincide with any other significant change in your life: Had you been ill? Did you have an injury? Did you start taking a new medication? Was there a death in the family or among your friends? Are you under an exceptional amount of stress? Your symptoms could be related to any of these factors.

Last but not least, make sure to tell your doctor about any other symptoms you might be experiencing. Give details about when the different symptoms began and whether they started together or at different times. Mention physical as well as emotional symptoms. Do you get out of breath easily? Do your muscles or joints ache? Do you have trouble sleeping? Are you feeling unusually sad or anxious? Different symptoms accompanying fatigue suggest different causes. For example, feeling blue and having trouble sleeping are two signs of depression. Shortness of breath can be a sign of heart disease.

Next week, we'll focus on what tests you may get to find out what's behind your fatigue. Have you ever seen your doctor about fatigue? What did he or she determine the cause to be?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Boosting Your Energy
Fatigue, like death and taxes, may indeed be an inescapable part of life. But that doesn't mean you have to take it lying down. Boosting Your Energy is a special health report from Harvard Medical School that provides you with the latest information about fatigue and offers strategies to help you regain the physical and mental energy you need to enjoy life to its fullest.

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