“I just feel so tired all the time.” I hear this usually once, if not two or three times a day from different patients. Depending on who I’m looking at, here are a few of the conditions I consider:
- Hypothyroidism–A blood test is used to determine if the thyroid is functioning the way it should. Besides fatigue, it can also cause constipation, cold intolerance, and dry skin.
- Iron Deficiency Anemia will cause fatigue in men and women. Women who have heavy periods are at risk for this. For men, a blood count, or hematocrit, of less than 40 is generally considered low, and should be seen by a Gastroenterologist (GI) for evaluation of possible bleeding in the gut. Women who have stopped menstruating , but are anemic, should also be considered for referral to a GI doctor.
- B12 Deficiency Anemia— Most B12 deficiencies are caused by not eating enough foods with B12 in them, such as meat, fish, poultry, shellfish, eggs and dairy products. A blood test is used to find out the B12 level in the blood; lower than 300 ng/ml means a deficiency. The quickest way to replace B12 is through an injection once a week for four weeks, then once monthly after that. Any person who has any kind of gastrointestinal disease, such as Crohn’s or Celiac Disease, or who has had any part of their gut removed such as with gastric bypass or colon resection, will need to replace their B12. Alcoholics also need B12 replacement.
- Diabetes— High blood sugars cause fatigue. Any person who is obese, has high blood pressure, high cholesterol or a family history of diabetes should be screened for this.
- Depression— There are two questions used to screen for depression:
- “In the past two weeks, have you felt down or sad on more days than not?”
- “In the past two weeks, have you lost interest or pleasure in doing things you used to enjoy?”
If the answer is “yes” to either of these two questions, than a more thorough evaluation for depression is done. If depression is diagnosed, treatment options would be counseling, medication, or a combination of these. A healthy lifestyle is also encouraged as mood can be affected by diet and exercise.
If you think that you are more tired than you should be, or than you used to be, please see your healthcare provider to see if you need to be screened for these common conditions. ¡Salud!
Keep in mind, this is not meant to be a comprehensive list, and each patient’s assessment is based on his/her health history and physical exam.
Have you ever wondered if you drink too much? The CAGE questionnaire is a screening tool that can be used by yourself or your healthcare provider to see if you have a problem that needs evaluation. It’s not used to diagnose alcoholism, only as a way to see if a person possibly needs help or support.
The questions are:
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves
or get rid of a hangover (eye-opener)?
If you answer “yes” to 2 or more questions, that’s an indication of an alcohol problem.
There are the different levels of misuse:
- Risky or hazardous use–having more than 4 drinks in one day for men or more than 3 drinks in one day for women
- Harmful use–drinking that causes physical or mental harm (i.e. falls, high blood pressure, unclear thinking)
- Alcohol abuse–drinking that causes a person to lose his job or have decreased work or school performance, neglect home responsibilities, driving while drunk, and/or have legal or social problems
- Alcohol dependence (alcoholism)–a craving for alcohol, physical dependence (get the shakes without a drink), loss of control over drinking, and a need to drink an increased amount to feel the effect.
For those with a positive screen that fall under the “Risky or hazardous use”or “Harmful use” categories, brief counseling with more than one session has been found to be effective. For those who fall in the “Alcohol abuse” or “Alcohol dependence” categories, brief counseling hasn’t been shown to work well; a treatment program with ongoing support would be more effective.
I’ve noticed that a lot of my patients are really not aware of what is considered “drinking in moderation.” For men, this would be no more than 2 drinks a day or no more than 14 drinks per week. For women, moderate drinking is no more than one drink a day or no more than 7 drinks per week. A drink is considered to be 12 oz of beer, 5 oz of wine, or 1.5 oz of liquor.
Please see your healthcare provider if you have questions or concerns about your alcohol use.