By John McElligott, MD
with Jeffrey Heinrich, Ed.D., PA-C
All of us deal with the age-old dilemma of running out of energy when we need a few more productive hours. The reasons are many. But it’s important to understand the basics of different types of “lack of get up and go” and the reasons behind them.
The basic difference in true fatigue and the doldrums can be answered by a few simple questions:
- Do you recoup and feel energetic when something exciting is about to happen?
- Do you perk up when you are about to embark on a vacation?
- Do you rally when it comes time to head home?
If the answer is yes, you are probably suffering from normal fatigue.
If the answer is no, you may need to see your doctor.
The most common cause of abnormal fatigue is depression. Depression affects most everyone several times in a lifetime. Situational depression is the most common form. This simply means that a situation in your life caused the depression, like the death of a family member, divorce or failure of one’s career goals. The most common symptom of depression is not being able to fall asleep at bedtime, or awaking and not being able to go back to sleep.
You can be fatigued because of bipolar depression, which is beyond the scope of this article. Suffice to say, bipolar disease is a major problem and needs expert advice. Most depressions come and go and need no treatment. However, a debilitating depression requires a thorough medical evaluation.
In addition to psychological depressions, anemia is at the top of the list for fatigue. Iron deficiency is most prominent in folks who have minute gastrointestinal bleeding or females who have heavy periods. It is diagnosed by checking one’s blood count and finding the source of bleeding – which is usually iron deficiency – and can be treated by replacing the iron stores.
Sleep disorders are high on the fatigue list but among the hardest to diagnose. This is a result of an atmosphere in the medical community where, on occasion, we must do a gazillion-dollar work up, rather than treat and then re-evaluate symptoms.
I don’t advise professional drivers to use sleep aids, either over-the-counter or prescribed. These aids frequently quit working, and it wouldn’t surprise me to see FMCSA consider a ban on them someday. Have a basic evaluation by your primary care provider if you need help.
Nutrition is another factor that is a major cause of fatigue. Primarily that’s because we eat unhealthy processed food all day long, and expect to be energetic. Well, guess what? Junk in, no energy out. Processed food that is high in calories and low in nutritional content has literally had the energizing properties processed away and only the fattening energy-sapping portion is left. Simple suggestion: Until you see a good dietitian, look for color in your food. White food should generally be avoided.
Obesity is an epidemic in the U.S. and is present in 30 to 40 percent or more of professional drivers. Think of it this way: If you have a BMI of 40, that’s the equivalent of carrying around a 100-pound bag of cement in your arms all day.
The above are a few examples that you can evaluate intuitively. Many other medical diseases need a medical workup.
Here are some medical diseases or conditions that run in families, in smokers or just plain happen.
- Emphysema from smoking;
- Thyroid disease, hypo- and hyperthyroidism;
- Heart disease – often the only sign of a heart attack is profound fatigue, heart failure.
Also be aware of adverse effects from antihistamines, blood pressure medications and prostate medications.
These are just a few of the more common problems we see, but there are literally thousands of medical problems that cause true fatigue. Most, if not all, are treatable.
If your truck was stuck doing a top speed of 40 mph, you would call someone to get it fixed. If you feel like you can’t get out of the slow lane, do something about it. LL
Editor’s note: John McElligott is an M.D. and Fellow of the American College of Physicians. Jeff Heinrich, who serves as the column’s medical editor, has a Doctor of Education degree and PA-C, which means Physician Assistant-Certified.