Do you feel tired, irritable and run-down even after a good night’s rest? Chances are you are suffering from chronic fatigue syndrome (CFS). This is a condition that urban Indians are increasingly becoming susceptible to, according to Sushum Sharma, senior consultant, internal medicine, and head of the preventive healthcare programme at Max Healthcare, New Delhi. “If the symptoms of fatigue persist for over two weeks, a person must immediately seek medical attention,” he says.
What are the symptoms?
Chronic tiredness or fatigue is described as a condition where people lack energy, feel unwell (doctors call it malaise), get drowsy or sleepy, have poor concentration, find it hard to make even simple or accustomed decisions, and perhaps feel depressed over a period of time. “Quite often, patients with CFS display asocial behaviour and say they do not like the company of friends and want to be alone,” says Sharma, pinpointing symptoms that are akin to depression.
Such symptoms can be a manifestation of underlying medical problems, or even psychological causes, which too can manifest themselves as physical tiredness. Besides medical issues, faulty lifestyles (either too little or too much physical activity, improper sleeping and eating habits or excessive travel) can lead to persistent tiredness. Mental tiredness can show up as headaches, fluctuating blood pressure and, in some cases, generalized pain or body aches. The absence of underlying fever can be a clue, helping to rule out a physical cause.
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Physical tiredness typically results from the overuse (or unaccustomed use) of muscles, which can be overcome simply with sufficient rest. “But when such muscle fatigue persists, it is important to understand the root causes of it,” says Prateek Gupta, consultant, orthopaedics and sports medicine, Sir Ganga Ram Hospital, New Delhi. CFS sufferers typically report pain in different body parts and muscle weakness.
Why is this happening to me?
In a fifth of all CFS sufferers, underlying conditions are the root cause of the tiredness. “As soon as a patient comes in, a routine blood pressure and body temperature test is essential,” says Dr Sharma.
“If a woman in her thirties complains of persistent tiredness, there could be thyroid malfunction; in the case of a woman in her forties, it could be menopausal syndrome,” he adds. For instance, he discovered that one patient with a history of chronic tiredness was running a low-grade fever (98.8-99.4 degrees Fahrenheit), and it emerged that she had a urinary tract infection. “In her case, a course of antibiotics solved what was an ongoing, long-running case of chronic fatigue,” he says.
Yet other patients receive a clean chit on medical tests yet exhibit symptoms such as generalized body ache or malaise. In this case, fatigue could have non-medical causes. “Often, these cases have to be treated with a combination of counselling, defined physical activity and modifications in lifestyle once the stress-causing aspect is identified,” says Dr Gupta.
8 reasons for fatigue
Thyroid malfunction: Women are more susceptible; symptoms include fatigue, difficulty in losing weight, extremely dry skin and hair, and sensitivity to cold.
Anaemia: A primary medical reason for fatigue in women, with those of childbearing age most affected.
Depression: An under-diagnosed condition. Dr Sharma says you should check for instances in your family history too.
Nutritional deficiency: In particular, lack of vitamins B2, B6 and B12, vitamin E, magnesium and zinc.
Food allergies/intolerance: For instance, allergy to gluten (in grains such as wheat, oats and barley) can lead to coeliac disease, one symptom of which is chronic tiredness.
Sedentary lifestyle: The typical reaction of a chronically tired person is that he is too tired to exercise, but in fact exercising is an effective energy-booster.
Sleep apnoea: Sufferers may wake hundreds of times at night without being aware of it.
Stress: Faulty work patterns are a major reason among urban professionals.
10 ways to fight it
Eat right: Increase intake of fresh fruits and vegetables, focusing on colourful vitamin-rich produce and varieties of it.
Drink up: By the time you’re thirsty, you’re already dehydrated. Try never to get to that point.
Pop a pill: Try a fortnight’s course of multivitamins with essential minerals (especially iron, calcium, magnesium, folic acid). If that helps, ask your doctor to check your diet.
Go to bed: Sleep six–eight hours every night for a week and see. Both sleep deprivation and disturbed sleep patterns can cause CFS.
Aim to moderate: “Urban professionals fall prey to CFS when they allow too much stress to accumulate,” says Dr Sharma. Assess your lifestyle for excessive travel, poor eating habits or even psychological aspects such as unrealistic goals. “Everyone is trying to be superman or superwoman. This itself can be a cause for chronic fatigue,” says Dr Gupta.
Take a health check: Jot down your family history; keep that yearly date with the doctor. Get a thyroid function test, check for diabetes or deficiencies of iron, calcium or vitamins.
Monitor all symptoms: Report irritability, slow reaction time, headaches, weakness, chest pain and generalized body ache.
Heavy or hungry: Look for changes in appetite and weight. If fatigue is coupled with low appetite, it may be a low-grade infection. If you have a good appetite, it may signal the onset of diabetes. If your appetite is unchanged but coupled with continuous weight loss, it could indicate a malignancy.
Check the calendar: Track the onset of your tiredness. Any major events in the months before? A change of environment or habits? Travel? These could be clues for your doctor.
Look inwards: “Mental stress and exhaustion need to be treated through relaxation techniques, and the patient needs to take the help of a counsellor to deal with causes for mental exhaustion,” says Dr Gupta.
“Dry lips and tongue, headache, nausea and muscle cramps and often, extreme fatigue are signs of dehydration,” says Nalin Nag, consultant, internal medicine, Apollo Hospital, New Delhi. “Even mild dehydration, 1-2% of body weight, can sap your energy. Excess sweat leads to loss of not just water but salts too.” As the muscles tire, the heart has to pump harder. To fight it, Ishi Khosla, consultant nutritionist, New Delhi, says: “Hydrate first thing in the morning with two glasses of water; sip water and non-caffeinated fluids (tender coconut water, ‘nimbu pani’, lassi, buttermilk, ‘aam panna’) through the day. Eat foods with high water content: cucumber, melon, bael fruit, orange, papaya. And give caffeinated drinks a miss.”
Identify night sweats that indicate a serious medical condition
Shari R. Midoneck, internist, Iris Cantor Women’s Health Center, New York, says night sweats that soak your pajamas repeatedly, if associated with symptoms such as fever, weight loss, swollen lymph nodes and extreme fatigue, should take you to the doctor. They are probably natural on a warm night in those who feel fine, in younger women around their periods or in older women around menopause, adds Dr Midoneck.
Itching, cough, sputum, shortness of breath, palpitations, chest pain and diarrhoea can indicate causes such as infections, lymphoma and other tumours, and low blood sugar in diabetics. Even those with no other symptoms should keep a record of temperature, medications and foods, says Carla Boutin-Foster, who teaches at New York-Presbyterian/Weill Cornell Medical Center.
©2009/The New York Times
Consult doctor for wax-free ears
Earwax shields the inner ear from dust and irritants. For swimmers, it also acts as a water repellent. Ideally, the ear canal is maintenance-free. But in reality, our polluted environments mean wax can thicken, becoming a hindrance. This is when the temptation to use cotton swabs or other pointy objects is great. Don’t! Most of us shove the wax up against our eardrums, which can result in hearing loss, infection and/or a perforated eardrum. The ear is a fragile organ, so keep anything smaller than your leg out of it. If you think wax has clogged your ear canals, it’s important to see a doctor, who has the tools to properly cleanse the canal.
©2009/the New York Times
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