Health Awareness blog

Fatigue or lethargy is a very vague symptom. The feeling is extremely common and varies in normality. Only 1 in 400 episodes of fatigue will lead to the doctor consultation. Anyone can present to the clinic with this symptom and leave the doctor wondering why they are fatigue. Is that necessary? Well, if we have some ideas about cause of fatigue, maybe we have some ideas about the fundamental behind it.

Fatigue can be divided by organic fatigue and psychological fatigue. We need to rule out any organic fatigue before we can safely say that it is a psychological fatigue. Prompt diagnosis is important because the management varies largely.

Organic fatigue is characterized by true physical weakness. The exhaustion is aggravated by physical activity and improves to some extend after the patient take some rest. The history usually less than 2 months and there is unintentional weight loss about 10%. Most organic problems of lethargy have a tell tale that might give some ideas what the cause might be. Make sure you tell the doctor all the associated signs and symptoms.

Psychological fatigue is more towards lack of primary inertia to initiate a task or particular physical activity. However, if this task been proceeds, it can be performed. This type of fatigue does not exacerbate by exertion and most of the time does not improve by resting. The patients might describe it as “I feel tired all the time. I may take some rest, but it usually not helping.” Some patients can come out with multiple and non specific symptoms. Any life stressful events, anxious or depressed symptoms and appearance can give some clues.

In patients with history of fatigue for more than 1 month, about 60-70% has medical or psychiatric illness. Among psychiatric diagnosis, depression, panic disorder and somatization disorder are the most common.

A diagnostic approach involves careful history taking together with proper physical examination.  In some selected cases, some investigations like FBC (full blood count) and ESR (erythrocyte sedimentation rate), urea and electrolytes, plasma glucose, thyroid function test (TFT) and chest X-ray can be considered. Follow up patients to see how the progress and any emotional development.

Differential diagnosis of fatigue is very wide and management is depends on the right diagnosis. Identification of unusual organic cause takes one a great skill to detect. Even though it is clear that the patient is depressed, chronic causes need to be ruled out. Whatever the cause, avoid the early closure. Do not imply to the patients that “it is all in your head”. Give the patients time to talk. Most of the time, the right diagnosis is lies behind a good history taking.

Reference:

1. Murray Longmore et al. Oxford Handbook of Clinical Medicine. 7^th edition.
2. David S. Smith et al. Field Guide to Bedside diagnosis. 2^nd edition. 2007. Lippincott Williams and Wilkins.

All patients with diabetes mellitus should be educated to practice self-care. This allows the patient to take some responsibility and control of his/her own diabetes management. Below is some suggestions of self care management: 

• Blood glucose and blood pressure monitoring – today, more people can effort to buy blood pressure and blood glucose home monitoring. If you cannot effort to buy one, pay a visit to a nearby clinic or laboratory. Keep record of your blood sugar and blood pressure measurement. Show the record to your doctor during your follow up visit. This may help in the management of your diabetes.
• Body weight monitoring – Overweight people are increase risk to get cardiovascular disease. Record you body weight along with your measurement of blood sugar level and blood pressure.
• Foot care – Funny enough, people tend to forget about the foot which they use every day. Most probably because it is something that is very far away from the head so they tend to ignore it… The truth is, foot is very important. In diabetes patients, foot is prone for infection. Diabetic patients usually have decrease sensation at periphery (due to peripheral neuropathy). This is why the foot is susceptible for injury and expose to infection. Check your foot daily, use a mirror to look at difficult places. If you have poor eyesight, please ask someone to check it for you.
• Personal hygiene – Diabetic patients are prone to get infection, so, keep yourself clean.
• Diet and physical activity – the key is keeping a healthy lifestyle. Take diet with low calorie and less fat.
• Identify targets for control – each mission should have a target. Keep a diary and record your blood pressure and blood glucose level. Set a target level for your blood pressure and blood glucose level and give reasonable time to achieve it. Your doctor will help you to make this target.
• Stop smoking – everywhere you go, people will talk about smoking cessation. Even at the cigarette box has stated that smoking is not good for your health. So, why wait? Quit smoking now!

Other related article:

• Routine management of diabetes
• Complications of diabetes

Reference:

1. CPG Management of Type 2 Diabetes Mellitus. Ministry of Health Malaysia. 3^rd edition. 2004.
2. Tao Le et al. first Aid for the Family medicine Boards. Mc Graw Hill. 2008.