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“I am tired; every part of my body aches and I cannot manage my daily activities. I feel weak all the time.” This seems to be an international refrain, for which every system of medicine has tonics, supplements and treatment. As patients seek relief, it is important to distinguish whether it is muscle pain or fatigue they are complaining of.
Fatigue is a feeling of tiredness or exhaustion. It is not lack of strength but lack of energy. Weakness, on the other hand, means that muscles are performing below par and extra effort is required to move the body. If the muscles are also painful, the perceived weakness may actually be due to discomfort. Painful movements tend to be feeble.
A feeling of weakness can occur from sudden unaccustomed overexertion like walking a long distance or doing extra housework. This is normal. Spontaneous recovery occurs within a few days. If it persists, it needs evaluation. It may be due to a basic muscle or nerve problem, malfunctioning of the thyroid gland or, rarely, due to exotic illnesses such as myasthenia. A physical examination and blood tests can be done to detect these abnormalities.
Fatigue can occur because of constant overwork and inadequate sleep. Adults require 7-8 hours of sleep. Although you may feel that you can manage with less, fatigue eventually sets in. Also, the sleep, though theoretically of sufficient duration, may not be restful, with frequent wakening. To overcome this problem, sleep at a fixed time every day and remove electronic equipment from your bedroom. If this does not work, poor sleep may be due to obesity or sleep apnoea and need evaluation.
If too little food is eaten, the body is tired. If too much food, especially high calorie snacks, is eaten the blood sugar fluctuates and fatigue sets in. A diet with carbohydrates, fats and proteins in balanced amounts needs to be eaten. Caffeine boosts energy, but too much of it or a sudden withdrawal can produce fatigue.
Anaemia (haemoglobin less than 12gms /dL in women and 13gms/ dL in men) decreases the oxygen carrying capacity of blood, resulting in tiredness. The cause of anaemia needs to be investigated and treated and iron supplements given.
Worry or chronic stress produces a desire to “just lie down.” If it is due to an intolerable but unchangeable situation at home or work, professional help should be sought. It may require psychotherapy, medication or a combination of both.
Exercise is a double-edged sword. It helps relieve stress and depression but too little or too much can both cause fatigue. Muscles need to be conditioned constantly and stamina needs to be built up. As little as 20 minutes of aerobic exercise three times a week can tackle fatigue. For fitness, the recommendation is 40 minutes a day 7 days a week.
Any illness, especially viral infections such as a cold and flu, can cause a feeling of tiredness. This usually disappears a week or two after the illness clears up.
Diabetes, hormonal imbalances associated with perimenopause, vitamin deficiencies (particularly vitamin D3), electrolyte imbalances — particularly low potassium levels — can all produce long lasting tiredness. These can be detected by appropriate blood tests. Treatment makes the fatigue disappear.
Some prescribed medication such as anti hypertensives, statins and steroids can cause tiredness. If the symptoms started after a new medicine it is important to inform your doctor.
Sometimes the fatigue persists for six months or more. It is debilitating and worsened by rest. In addition there may be muscle or joint pain (but no tenderness to touch), impaired short-term memory, sleep which is unrefreshing, frequent sore throat and headache. This is typical of chronic fatigue syndrome (CFS). The exact reason is not known but it can follow a viral infection. It is a diagnosis of exclusion, when tests for other diseases are negative.
It is sometimes confused with fibromyalgia, which is also a long-standing illness with pain in the muscles and joints. Unlike CFS, there are certain points on the body pressing which elicits pain. Tests in fibromyalgia are usually normal.
Both CFS and fibromyalgia are treatable.
• Applying moist heat alternating with ice relieves pain temporarily.
• Painkillers such as paracetemol and ibuprofen can be used. It is better to avoid more powerful medication as they may be habit forming and have side effects. Also medication should not be taken for more than 10 days at a time.
• Some antidepressants help. This is because long standing stress associated with the illness depletes the chemical serotonin in the brain. The medication elevates serotonin levels. It also helps with sleep and that itself may produce an improvement.
• Exercise also elevates serotonin levels naturally. Gradual graded gentle exercise like walking and swimming tones and conditions the muscle and is beneficial. Too much rest aggravates the symptoms.
• Yoga and massage therapy are beneficial.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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