Fatigue getting out of control, any advice?

[jimmiejackson]

I know a Doctor would obviously be the best person to talk to regarding my symptoms, however as I have limited funds I would like to try to narrow down the Doctor/tests I should take before I begin if at all possible.

Quick background – in early 30s. History of substance abuse but been clean for about 6 years. Drink alcohol around once a week, not to excess (3-4 beers usually). Very active person, training hard at least 3 times a week. Sleep on average 8+ hours a night. Diet generally “clean” and take various vitamins/supplements/nootropics just hoping I’ll cover the bases or something will magically work. Big guy, lots of muscle and some fat (probably hovering around 20% BF). Blood pressure tends to hover a little high (around 145/80ish).

Since I can remember I’ve felt tired, irritable, had brain fog…what could generally be described as fatigue, kind of a constant drunk/stoned feeling. It seems to be getting progressively worse as time goes on. I do function and am able to hide it from most but it’s a struggle. I spend large portions of all my waking time just completely unable to function properly and get stuff done.

About 6 months ago I paid for a home sleep study which showed an AHI of around 30, so I got a prescriptions from a Doctor here and imported a CPAP machine. I am pretty compliant and my AHI is now around 2-3 most of the time. This has made me wake up feeling less like I’ve been smacked around the face but after 6 months I still don’t feel much better.

I had a thyroid blood test (along with other general bloods/lipids) about a year ago at an independent lab (Bria Labs) and it showed normal TSH, Free T3 and T4, T3 but T4 was low. Never saw a Doctor about it. I tend to research things myself a lot.

I would LOVE to get to the bottom of it.

I just don’t know where to start because I don’t really have the funds to just test everything and see specialists for everything.

I have a BUPA Thailand inpatient insurance that will expire in a month or so, various accident insurances adding up to about 60k in coverage – all with no excess. I also have Cigna Global coverage just started with a $375 excess. I don’t have any kind of OP cover but not necessarily adverse to getting it if it would be financially beneficial before I dive into getting all this checked.

Thanks for any advice you may be able to give me.

[Sheryl]

I'm a little confused. You say it has been like this for as long as you can remember? i.e. all your life??? (hardly makes sense)

and then you say: "normal TSH, Free T3 and T4, T3 but T4 was low". Are you saying the free T4 was normal but the bound T4 low??

Have you had a general physical check up with blood count? (to exclude anemia)

And do you have any muscle aches? Does exercise make you feel better or worse?

And please list exactly all the meds you are taking.

[h90]

blood test: actual values.

What do you do all the day...just an overview

What vitamins/supplements you take and how much

training details

living conditions

what you eat

only as example: hard training that is OK in cool area, in Thailand + to hot at the recovery time can drain you out.

hard training and you always eat meat but not in the heat you eat fruits but train the same may cause problems

details details details

[jimmiejackson]

I'm a little confused. You say it has been like this for as long as you can remember? i.e. all your life??? (hardly makes sense)

and then you say: "normal TSH, Free T3 and T4, T3 but T4 was low". Are you saying the free T4 was normal but the bound T4 low??

Have you had a general physical check up with blood count? (to exclude anemia)

And do you have any muscle aches? Does exercise make you feel better or worse?

And please list exactly all the meds you are taking.

Hi Sheryl,

Thanks for your reply.

I'll try to clarify each point but feel free to ask further questions if you need anything else.

"You say it has been like this for as long as you can remember? i.e. all your life??? (hardly makes sense)" - I was hyperactive as a kid, as a teenager I remember always being quite tired getting up for school but then again I didn't sleep a whole lot and that's probably normal. Between the ages of 17-25ish I was abusing substances daily (mostly very large amounts of cannabis and for a period cocaine) so fatigue and feeling terrible was just a part of that. I remember quitting for short periods a few times and feeling very energetic. Since I have been "clean" I have been feeling like this, gradually worse. It may not have been helped by large periods of time under excessive stress for work and very little sleep (about 3 years total I would say) that I probably never felt recovered from. Stress in my life these days however is minimal.

"and then you say: "normal TSH, Free T3 and T4, T3 but T4 was low". Are you saying the free T4 was normal but the bound T4 low??" - Yes in the test everything came out as "in range" except T4 which was 4.61ug/dl with a reference range of 4.87-11.72. It might be worth noting my mother (who is in her mid 50s) has in the last few years being using replacement thyroid hormone under the direction of her Doctor for hypothyroidism. No other family history I'm aware of.

In case it's relevant the other levels were: T3 104 ng% (ref 58-159), Free T3 3.02 pg/ml (ref 1.71-3.71), Free T4 1.17 ng% (ref 0.70-1.48), TSH 1.93 uIU/ml (ref 0.35-4.94)

Have you had a general physical check up with blood count? (to exclude anemia) - general medical no but my last blood test (in Nov 2014 done off my own back) included CBC, Chemistry, Lipids, Liver Function, Electrolytes, serum iron, testosterone, estrogen and thyroid. The only things that were out of range were: PMN;Neutrophil (low), Lymphocyte (high), Eosinophil (high, HDL cholestorol (low, 55mg/dl, ref was >60), AST (high), T4 (low). Happy to give more specifics if any are particularly relevant.

"And do you have any muscle aches? Does exercise make you feel better or worse?" - I do heavy strength training so being sore is par for the course. I would say exercise while I'm doing it (release of dopamine etc) makes me feel better and afterwards while recovering makes me feel worse.

"And please list exactly all the meds you are taking" - right now I take B12 daily, magnesium, electrolytes most days, occasional piracetam stints and creatine monoydrate. (EDIT - and Cetrizine daily for allergies. Tried recently to stop, still had brain fog and was sneezing/itchy eyes. Have ordered Butterbur and a nasal rinsing kit to see that works instead).

Thanks again!

Edited October 18, 2015 by jimmiejackson

[jimmiejackson]

blood test: actual values.

What do you do all the day...just an overview

What vitamins/supplements you take and how much

training details

living conditions

what you eat

only as example: hard training that is OK in cool area, in Thailand + to hot at the recovery time can drain you out.

hard training and you always eat meat but not in the heat you eat fruits but train the same may cause problems

details details details

Sure -

Most days I wake up around 9, gym 3 times a week (strength training and conditioning, about 2 hours total each time - so the "big 3" lifts, Olympic lifts, accessory work and 20 minutes or so HIIT for conditioning). Then various non physical activities (writing, reading, correspondence) for the rest of the day - little other physical activity.

Eat mostly a "paleo" diet, lots of meat and fish, low gluten levels. The occasional pizza or similar "junk" but usually about once a week. Lots of fruit. Was previously obese, haven't been for at least 5 years.

I live in a comfortable home, aircon brand new and regularly cleaned. No signs of mold (at least visual).

Vitamins/supplements - Creatine monohydrate (10g/day dissolved in hot water), B12 (methylcobalamin) 5000mcg, Metyhl Folate (5-methyltetrahydrofolic acid) 800 mcg, Magnesium Malate 425mg, Cetrizine (for allergies) 10mg. I previously have taken all kinds of vitamins and supplements but no longer do as everything was making brain fog worse. Have tried selenium, K2, D3, L-theanine, Noopept, Provigil, Nuvigil, Vitamin A, Vitamin K2, Piracetam, Copper, Iron and probably more I can't remember.

Happy to give more details and thanks for your help!

[NickJ]

Just dont dwell. There is no magic bullet. If all your labs are normal. No other findings. Just face it and go on. What you dont want to do is make this your hobby if it isnt already. Everyone has crosses to bear. I will say also that if you do dwell and share it constantly with people there will be a lot of busy people in your life and phone calls that are not returned. Good luck.

[jimmiejackson]

Just dont dwell. There is no magic bullet. If all your labs are normal. No other findings. Just face it and go on. What you dont want to do is make this your hobby if it isnt already. Everyone has crosses to bear. I will say also that if you do dwell and share it constantly with people there will be a lot of busy people in your life and phone calls that are not returned. Good luck.

Thanks for your good wishes.

I would hardly say I've hit it at all angles yet. If it's the case of something easily treatable that I haven't discovered yet, to me it's worth finding out instead of spending a huge proportion of my life in a fog that impacts my ability to do what I want to do (the motivation is always there, the ability to focus and not just want to lie down and do nothing can override it a lot of the time).

The fact that not a single person in my life knows anything about this is testament to the fact that I just put up, shut up and get on with life to such an extent that nobody would even guess for a second that I'm fighting my own private battle. I'm not obsessed about it but I'd certainly love to feel "normal" and be able to do more for myself and my family as a result.

[richard_smith237]

Symptoms parallel depression.. you've been checked for Hypothyroidism..

You may find value in speaking with a *Psychiatrist who can evaluate you after omitting other possible factors.

This is not a black and white science; the brain releases chemicals (serotonin and norepinephrine) - if your brain is not producing these chemicals in the correct amounts the physical symptoms of Depression may surface...

See a specialist...

In such circumstances much in the same way a diabetic needs insulin someone with depression may see improvements when taking certain medication (SSRI or SNRI).

*Note: Don't mix up Psychiatrist with Psychologist - they are different disciplines (one physical the other mental).

[puukao]

well, it won't hurt if i guess. your blood pressure is high, i'm around 100/70 with a HR of 52. but i do sort-of understand your symptoms. i would get a breathe-right strip that you put on your nose when you go to bed. generic ones work well. also get some iron pills, 25 mg. take one, with vitamin C....and ONLY one every few days. stop if poo black. then, drink lots of water (you probably do this) and then go spend time in a MUCH COLDER PLACE. go to elevation....maybe just do an ice bath.

i would also take some exams online to see if you really can or cannot concentrate. EDIT: I do agree depression is possible. But it seem pretty mild now since you can get outside and do things....even if you are sleeping a ton, i would still consider it mild depression. but it's important to consider, yes.

for me, it was a combination of all of these things.....

if none of this works, it might be an allergy. try benedryl.

it won't be fun if you realize you have to go to a different climate.......

Edited October 18, 2015 by puukao

[fang37]

BP - 100/70. I would get a 2nd opinion on that.

[puukao]

maybe

1. Systolic- 90-119 and Diastolic 60-79 Condition- Normal
2. Systolic-<90 and Diastolic <60 Condition- Hypotension or low blood pressure
3. Systolic-120-139 and Diastolic-80-89 Condition- Prehypertension
4. Systolic->139 and Diastolic->89 Condition- Hypertension or high blood pressure.

[jimmiejackson]

Symptoms parallel depression.. you've been checked for Hypothyroidism..

You may find value in speaking with a *Psychiatrist who can evaluate you after omitting other possible factors.

This is not a black and white science; the brain releases chemicals (serotonin and norepinephrine) - if your brain is not producing these chemicals in the correct amounts the physical symptoms of Depression may surface...

See a specialist...

In such circumstances much in the same way a diabetic needs insulin someone with depression may see improvements when taking certain medication (SSRI or SNRI).

*Note: Don't mix up Psychiatrist with Psychologist - they are different disciplines (one physical the other mental).

Thanks Richard.

I was diagnosed with depression at around 14 years old and took SSRI (fluoxetine mostly) until around the age of 21. During that time I was depressed much of the time, to the extent of having suicidal tendencies. I felt much happier once I was off the medication as I felt more connected (the medication made me feel numb, as if I was watching my life on a movie screen).

I understand quite well the manifestation of depression and I'm not sure it's that anymore. I'm certainly happier than I've ever been these days and don't feel like I don't want to get out of bed because the world is a deep, dark hole (like I used to feel). Any irritability I have is minor and usually because of my feelings of fatigue.

That being said, I don't discount that brain chemistry is hugely important and I wonder if that's a factor. Would this show in any lab tests?

My mother has bi-polar and after years of misery and ineffective drug treatment is weaning off all pills and seems happier than I remember seeing her, so I remain skeptical (both because of my own experience and hers) but no adverse to anything.

Thanks for your input.

[jimmiejackson]

well, it won't hurt if i guess. your blood pressure is high, i'm around 100/70 with a HR of 52. but i do sort-of understand your symptoms. i would get a breathe-right strip that you put on your nose when you go to bed. generic ones work well. also get some iron pills, 25 mg. take one, with vitamin C....and ONLY one every few days. stop if poo black. then, drink lots of water (you probably do this) and then go spend time in a MUCH COLDER PLACE. go to elevation....maybe just do an ice bath.

i would also take some exams online to see if you really can or cannot concentrate. EDIT: I do agree depression is possible. But it seem pretty mild now since you can get outside and do things....even if you are sleeping a ton, i would still consider it mild depression. but it's important to consider, yes.

for me, it was a combination of all of these things.....

if none of this works, it might be an allergy. try benedryl.

it won't be fun if you realize you have to go to a different climate.......

Thanks for your input.

For allergies I take cetrizine. Have also used loratidine with no better effects fatigue wise.

For sleeping I use a full face CPAP mask with an auto adjustment CPAP machine, so that's about the best I can do for sleep (I also sleep in a cold room, pitch black, all electronics far away from bed, no screens before bed etc.. I feel like I sleep well, I just never feel very refreshed).

I do take vitamin C regularly as well as activated carbon (sorry, forgot to mention those before), I also take sauna/ice baths at least once a week if I can. As for iron, it can be dangerous so I'd rather know for sure I had a deficiency before taking it. Even saying that, I took it sporadically years ago and noticed no difference.

[fang37]

JJ

My sympathies to you.

I strongly urge you to get a 2nd opinion.

Depression v Bipolar (type 11)

Lastly, be selfish. Take excellent care of you.

If you don't death is a possibility. No BS.

[t8769]

The sypmtopms you describe are common for those with food intollerances or allergies.

It is possible to have a test for celiac these days, which is gluten related.

I have many friends who have turned their health around by avoiding gluten. Others have found eggs, peanuts and other foods to cause brain fog, tiredness and similar problems.

It seems that, for some reason, recent populations have developed problems in this area.

You could try a 10 day gluten-free diet, avoiding wheat, oats, rye etc. and see if this changes how you feel. Its a simple test you can do yourself, that eliminates this common malady.

One has to be very careful about noodles and wheat which is hidden in many bought food products.​

The other area of great ​concern is sugar, which can cause a severe reaction.

I have several friends who swear that - just by avoiding gluten and sugar - their lives changed for the better - and I am one of this group.

[jimmiejackson]

The sypmtopms you describe are common for those with food intollerances or allergies.

It is possible to have a test for celiac these days, which is gluten related.

I have many friends who have turned their health around by avoiding gluten. Others have found eggs, peanuts and other foods to cause brain fog, tiredness and similar problems.

It seems that, for some reason, recent populations have developed problems in this area.

You could try a 10 day gluten-free diet, avoiding wheat, oats, rye etc. and see if this changes how you feel. Its a simple test you can do yourself, that eliminates this common malady.

One has to be very careful about noodles and wheat which is hidden in many bought food products.​

The other area of great ​concern is sugar, which can cause a severe reaction.

I have several friends who swear that - just by avoiding gluten and sugar - their lives changed for the better - and I am one of this group.

Thanks for your input.

I am allergic to peanuts and dust/animals (I have a cat so that doesn't help, but these symptoms of brain fog/fatigue were around when I didn't have pets too).

I have tried all kinds of dietary interventions including periods of ketosis (once for 8 weeks and once again for 9) which by their nature are totally gluten free and sugar free (under 30g of effective carbs per day). Felt even tireder than usual.

I seem to be a little sensitive to gluten and I get acid reflux often if I eat any junky foods. Are there any (non quakery based!) tests that would say for sure what I'm allergic to and don't cost a fortune?

[DogNo1]

Well, we could all guess at what your problem is but I see no obvious causes for your feeling of lethargy. If you are as miserable as you say that you are, spending the money required to consult an allergist first and a psychiatrist next, if necessary, would be worth your while. If you read the NYT Health Section, you will have noticed that there are a lot of difficult-to-diagnose diseases around. My sister suffered from Lyme Disease for a while before she got a correct diagnosis and proper medical treatment and her symptoms were similar to yours. You could have something that is a result of a tick bite or a mosquito bite. If you get no help from the allergist or psychiatrist, I suggest that you read a lot of medical studies online. Good luck. Keep us posted.

[puukao]

i was tested for celiac, negative. yes, i agree, iron (males, especially) isn't something to mess with. I had crit levels a 39.....got polyp removed, still take iron pills sporadically since i exercise a lot at altitude, and crit levels went to 51.

but my biggest change was breathing at night.....

man...seems like you really covered it all....

it might be simple, since you can't really work in Thailand and do "meaningful work" for money. since, i think, you said you were around 30-35, you might be happier having a "normal" job. i mean getting a paycheck, regular interaction with people, and a different structure.

another thing...maybe just go get a normal blood work done. maybe you did and i missed it. i did, all my levels were good, and it really made me feel better just knowing.

and, again, challenge your brain.......take a practice test......i have a feeling your mind is sharper than you think.

i know how serious this is...

so all rocks need to be overturned...

[drpbala]

Hi, check for Vit D levles. This one vitamin can some times make all the difference

You may even consider doing one 10 day Vipassana course. For details check www.dhamma.org. This organization has centers all over the world. In Thailand they have totally 9 centers. Give a try. The present situation you are in - will definitely help you to take off to another level in your life journey.

Wishing you Peace

[scoutman360]

A friend had similar symptoms. Found out he had Lyme disease.

[asdecas]

Here's some advice which is sure to be unwelcome:

The symptoms you purport to suffer and the number of palliatives, nostrums, supplements, medicines and therapies you take or have taken, try or have tried would baffle Hippocrates himself. You say you posted your problem here in an attempt to 'narrow the field' and save money, but reading the broad range of causes and remedies suggested here, while they are well-meaning no doubt, will only serve to fog your foggy mind further.

I am not a doctor but I leave you with this thought - eighty percent of illnesses are psychosomatic to some degree.

[williet98248]

Sleep with someone and ask them to report your sleep patterns. Snoring and sleep apnea can cause these symptoms. Years go I did a lot of exercise and found myself tired and sore all the time. I cut back my exercise routine and felt much better. Probably not your problem but maybe contributes?

[AlQaholic]

There are so many different things that can cause the symptoms described. One would suspect anemia at first, but the ability to exercise regularly and regular blood test showing everything is ok contradicts this. If all the tests done show everything is ok on basic level, one could do a cat scan to check the blood flow and blood distribution to the brain, as the body otherwise seems to be ok. "Foggy" suggest oxygen supply problems to the brain?

[al007]

I believe if you ask a hospital to check you in they will, when you arrive tell them you can not cope, then ask them to do all the various tests and it should be classed as inpatient care not out patient, and you may well be covered on your insurance

[HughJass]

heart arrhythmia,could be intermittent,get an ECG done when you are feeling bad

[JDGRUEN]

I suggest get with a doctor and get a complete blood sugar workup -- fasting blood sugar, etc. what ever they do these days for a complete diabetes 'rule in or rule out'...

Diabetes can be a definite reason for fatigue ...

[thatguy]

Low B 12 1st symptom is fatigue

[fang37]

Too much humping?

I am not a medico!

[PEAP]

Hypochondriasis

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For the anatomical term, see Hypochondrium.

This article needs additional citations for verification. Relevant discussion may be found on the talk page. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2009) Hypochondriasis Classification and external resources Specialty psychiatry ICD-10 F45.2 ICD-9-CM 300.7 MedlinePlus 001236 MeSH D006998

Hypochondriasis also known as hypochondria, health anxiety or illness anxiety disorder, refers to worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the condition of body or mind despite the absence of an actual medical condition.^[1] An individual suffering from hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.^[2]

Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, their concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. To qualify for the diagnosis of hypochondria the symptoms must have been experienced for at least 6 months.^[3]

The DSM-IV-TR defines this disorder, "Hypochondriasis", as a somatoform disorder^[4] and one study has shown it to affect about 3% of the visitors to primary care settings.^[5] The newly published DSM-5 replaces the diagnosis of hypochondriasis with the diagnoses of "Somatic Symptom Disorder" and "Illness Anxiety Disorder".^[6]

Hypochondria is often characterized by fears that minor bodily or mental symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body. Many individuals with hypochondriasis express doubt and disbelief in the doctors' diagnosis, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or short-lasting. Additionally, many hypochondriacs experience elevated blood pressure, stress, and anxiety in the presence of doctors or while occupying a medical facility, a condition known as "white coat syndrome". Many hypochondriacs require constant reassurance, either from doctors, family, or friends, and the disorder can become a disabling torment for the individual with hypochondriasis, as well as his or her family and friends.^[7] Some hypochondriacal individuals completely avoid any reminder of illness, whereas others frequently visit medical facilities, sometimes obsessively. Other victims of this disease will never speak about it.

[Muhendis]

A friend of mine displayed similar symptoms which defied diagnosis for a few weeks until it was realised his water intake was too little. He was suffering from dehydration. He started increasing his water intake and his well being was immediately improved.