List of Possible Causes of Fatigue

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This has been at least a 6 year struggle for me, I am now 56. This forum fits my situation because I suffer from what I would call extreme fatigue for the last half of the day nearly every day. I get through most days with caffeine and modafinil once in a while, a couple times a week. I have seen many doctors and tried many different things. None have really moved the dial much. I thought maybe I would make a list of possibilities and post it here. I have considered, treated and experimented with everything on this list except cortisol levels, adrenal fatigue and actually stopping Liptor which I have taken for 10 years. Here is my list. Am I missing anything that I should consider?

Psychological factors
Exercise
Medications (statins and others)
Thyroid
Cortisol
Adrenal Fatigue
Testosterone
Diet
Sleep Duration
Sleep Apnea
Smoking
Alcohol
Drugs
Heart Disease
Caffeine
 
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This has been at least a 6 year struggle for me, I am now 56. This forum fits my situation because I suffer from what I would call extreme fatigue for the last half of the day nearly every day. I get through most days with caffeine and modafinil once in a while, a couple times a week. I have seen many doctors and tried many different things. None have really moved the dial much. I thought maybe I would make a list of possibilities and post it here. I have considered, treated and experimented with everything on this list except cortisol levels, adrenal fatigue and actually stopping Liptor which I have taken for 10 years. Here is my list. Am I missing anything that I should consider?

Psychological factors
Exercise
Medications (statins and others)
Thyroid
Cortisol
Adrenal Fatigue
Testosterone
Diet
Sleep Duration
Sleep Apnea
Smoking
Alcohol
Drugs
Heart Disease
Caffeine


Did you leave off on purpose :

1) Teenagers
2) Ex- Wives
3) Wives
4) GF's
5) AH Bosses
6) Money issues
7) Grown kids that move back home after college
 

Nelson Vergel

Founder, ExcelMale.com
Circadian rhythm issues ( you can get enough sleep but you do not follow a set sleep schedule or go to bed late)
Adrenal insufficiency ( tied to sleep issues and others)
Boredom with life, work and relationships. Lack of stimulation (this may have nothing to do with depression)
Sitting in front a computer most days.
Lyme disease (treated or lingering)
Allergies.
Chronic immune activation- Chronic Fatigue Syndrome.

Any others I am missing?
 
My challenge is to find a doctor that is well versed in fatigue issues and its such a diverse area with so many possibilities that ruling them all out one by one with a GP is nearly impossible. I did email my Kaiser SoCal doc a while back and this was her response after I requested additional specific thyroid and adrenal testing:

I am the covering physician for Dr. Narayan as she is out of the office.
Your TSH is within normal limits on thyroid medication. TSH is used to titrate levothyroxine dose. I do not recommend the other thyroid labs you have mentioned as TSH is the most sensitive test for hypothyroidism.
Also, I don't believe in adrenal fatigue. It is not recognized by the medical professionals as a disease. One may be adrenal insufficiency however. If you would like to discuss this, you can make an appointment for screening. However, reading your prior clinic notes, my suspicions are low for you having adrenal insufficiency.
 

Nelson Vergel

Founder, ExcelMale.com
Don

Is that all you take? Statins are known to cause fatigue in some patients. Blood pressure meds , antidepressants, etc can also cause it.
 

ERO

Member
My parents had Kaiser and let me just say that I was not terribly impressed. Just my opinion, I know...in your case, why not use http://www.discountedlabs.com and do your own 4-tube cortisol test? If it comes back showing that you have cortisol issues, even your Kaiser doc will have a hard time arguing with you
 

Vettester Chris

Super Moderator
Don, we've chatted before about the nuances at KP. Someone saying that the TSH Lab is the most "sensitive" lab to use for gauging Hypothyroidism is totally misguided. If I go digging, I will find at least 10 posts on this forum alone, where members TSH was < 2.0 , yet there free serum on T4 & T3 are respectfully anywhere from 0 to 30% of the reference range. If the TSH / Thyroid feedback loop was a fail-proof setup, then that would be great. However, it's not, and it should always be used in conjunction with all the other labs that are available to make an assessment.

In severe cases of adrenal imbalance, take for instance when it's a result of estrogen dominance, it's quite common to see thyroid serum levels at the very, very bottom of the chart (actually under the reference range), yet TSH will also be tanked; talking 0.5 and under. Dr. Uzzi Riess recognizes it, Dr. Bruce Rind recognizes it, Dr. Michael Lam recognizes it, as does a multitude of other specialists in the thyroid/adrenal medical field. I'm lucky my GP at KP doesn't take that approach, but way too many at KP want to think their limited study in this particular area is the gospel. It's not, and knowledge can debate ignorance any day of the week!!
 

Vettester Chris

Super Moderator
... And if any KP docs, or other PCP GP's read my post and take offense, it is not my intent to call anyone out or to initiate an adverse reaction. I mentioned three (3) well known physicians in that post, all who also have medical degrees, and their lives have been dedicated to these studies, and other studies that involve the endocrine system for men and women (Dr. Reiss more-so for women).

I've been in my profession/field for 28 years, I'd like to think I am amongst the best of the best, but everyday I take the approach that I can learn something new. I would think that in the field of medical research, you could study and recite this stuff for 100 years, and it would only be touching the surface. Just saying ...
 

ERO

Member
No personal experience, but this is a drug used for binge eating and ADHD. It is a stimulant and lists a ton of side effects. Personally, I would rather find the cause of the fatigue rather than just get a prescription for a stimulant as that only addresses the symptom, not the cause of your issue. Just my 2-cents :)
 
So would I and that's point of the list on this thread: to be sure I have left no stone unturned. Its been my mission for 5 years and 6 or 7 docs. We have not moved the dial with ANY of the above list so if you have additional possibilities that are not on the list, I am ready to try them. After 5 years of trying to figure this out you get to a point where almost anything is on the table that has the potential to salvage some quality of life.
 
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