50-year-old, Galatia-resident, Linn Feazel felt, "terribly tired all the time."

"I just couldn't figure out why I felt so fatigued," she says. "In the beginning I blamed it on all kinds of things. I'd tell myself its winter, it's just the flu catching up with me, or maybe it's something I ate. I tried so hard to justify my exhaustion."

When she went to her family doctor, she was told it could be a symptom of menopause. She was approaching that "certain age" after all.

"I knew in my bones that wasn't it," Feazel says.

How about depression, her doctor wanted to know. Was she depressed?

"I told him, I was not depressed. I just had no energy. And I wanted to know why," Feazel says.

Her doctor prescribed a multivitamin. It didn't help her. Feazel would still wake up low on energy as if she had just spent the entire day in the hot sun. She would feel worn out in the morning, despite a good night's sleep.

She started keeping a journal, obsessively tracking her eating, sleeping and day-to-day habits. She would take it to her doctor time and again and ask him to help her feel less fatigued.

It took nine whole months for her doctor to reach a definite diagnosis.

Feazel had fibromyalgia.

"Without a diagnosis, your mind can run rampant with all kinds of thoughts," Feazel says. "At one point they almost had me convinced it was all in my mind. It was really quite frustrating."

It's been five years now since her diagnosis and Feazel is on medication that helps her day-to-day functioning somewhat. She also makes sure she gets a lot of physical activity, follows a healthy diet and tries to maintain a positive state of mind.

Experts say fatigue is a sure sign something is wrong. It affects every aspect of your life and prevents you from truly living.

While many things can cause fatigue, from the obvious, such as you stayed up way past your usual bedtime downing shots at the local bar, to the ridiculous, such as your cat jumping on you all night, the bottom line is you need to sit up and take notice when you feel tired and worn out.

"There are literally hundreds of diseases that can cause fatigue," says Jeff Ripperda, M.D., a family doctor at The Murphysboro Health Center.

"I do have many patients who come in complaining of fatigue. But the vast majority are overweight, not sleeping enough, not exercising regularly, following a poor diet, and generally leading stressful lives," Ripperda says. "The human body needs eight hours of sleep. A lot of people convince themselves they can get by with less and end up fatigued."

There is no magic pill in most cases, Ripperda admits. His advice? Give yourself 2-3 weeks to make some lifestyle changes, such as trimming your social calendar, getting more sleep, eating healthy meals, drinking more fluids, taking a multivitamin, and cutting back on alcohol and caffeine.

If you have made all these changes and still feel exhausted, you know you need professional help, for sometimes fatigue can be a sign of a serious or life threatening disease, Ripperda says.

Here's a checklist of some of the more common causes of fatigue that can be diagnosed at the doctor's office with a combination of tests and a thorough exam.

Remember diagnosis is the first and most important step to getting treated.

Anemia

According to the National Heart, Lung and Blood Institute, anemia is one of the more common blood disorders, which occurs when the number of healthy red blood cells decreases.

Symptoms: While the most common symptom of anemia is fatigue (feeling tired or weak), other signs and symptoms may include shortness of breath, dizziness, headache, coldness in the hands and feet, pale skin and chest pain.

Diagnosis: Since anemia may be the first sign of a serious illness, it's important to get a complete physical exam and blood tests, including a complete blood count (CBC), to check the levels of your red blood cells and hemoglobin. It's also standard to check the stool for blood loss.

Thyroid disease

Thyroid-stimulating hormone (TSH) is produced by the pituitary gland. This causes your thyroid gland, a butterfly-shaped gland in your neck, just above your collarbone, to secrete two hormones, thyroxine (T4) and triiodothyronine (T3) that control metabolism.

When there is too much thyroid hormone (hyperthyroidism), your metabolism speeds up; when there is too little thyroid hormone (hypothyroidism), your metabolism slows down.

Symptoms: In addition to fatigue and muscle weakness, you may notice an intolerance to heat, sweating, weight loss, alterations in appetite, frequent bowel movements, changes in vision, menstrual disturbances, impaired fertility, mental and sleep disturbances, tremors and thyroid enlargement. These are all common symptoms of hyperthyroidism.

If you have hypothyroidism, you may suffer from fatigue, forgetfulness, depression, mood swings, weight gain, heavy menses, constipation, hoarse voice, and dry, coarse hair.

Diagnosis: "When a patient complains of fatigue and/or muscle weakness, one of the first things we do is a blood test to make sure the patient isn't anemic or have a thyroid problem," Ripperda says.

According to the American Association of Clinical Endocrinologists, thyroid disease can be detected with a blood test for TSH. Too much thyroid hormone, and TSH goes down; too little thyroid hormone, and TSH goes up.

Sleep apnea

"Sleep apnea is characterized by brief interruptions of breathing during sleep and is one of the more common causes of fatigue," says Terry Brown, D.O., medical director of the Sleep Disorders Center at St. Joseph Memorial Hospital.

The Mayo Clinic categorizes sleep apnea into two main types: obstructive sleep apnea, the more common form that occurs when your upper airway actually closes or collapses for a few seconds, which, in turn, alerts your brain to wake you up to begin breathing again; and central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing.

Symptoms: "You could have sleep apnea if you have been told that you snore, have unrefreshing sleep where you wake up feeling tired in the morning even though you had a full night of sleep, or are overweight," says Brown, who is a board certified specialist in sleep medicine and bariatric medicine.

Other common signs of sleep apnea include feeling excessively sleepy in the daytime, suffering from morning headaches, memory or learning problems and not being able to concentrate, feeling irritable, depressed, or having mood swings or personality changes, urination at night and/or a dry throat when you wake up. Up to 90 percent of people who have sleep apnea don't know that they have it.

Diagnosis: An overnight stay at a sleep clinic, where you'll undergo a polysomnogram, which is a painless test that will monitor your sleep patterns and breathing changes, can help diagnose sleep apnea.

Electrodes will be attached to your body to record your brain activity and detect episodes of abnormal breathing.

According to Brown, research indicates that a significant percentage of those with fibromyalgia have sleep apnea. "So my advice is to get a sleep study done first," he says.

Fibromyalgia

According to the National Fibromyalgia Association, fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle, and hands, but any body part can be affected.

Symptoms: Fibromyalgia patients experience a wide range of symptoms including headaches, irritable bowel syndrome, painful menstrual periods, numbness or tingling of the extremities, restless legs syndrome, temperature sensitivity, cognitive and memory problems, and/or a variety of other symptoms completely unrelated to the disease. The symptoms may be of varying intensities that wax and wane over time.

Diagnosis: "The criteria for a diagnosis of fibromyalgia to be made are that you have to pretty much rule out everything else," Brown says.

The Mayo Clinic notes that it is not uncommon to spend years going from doctor to doctor and undergoing tests for conditions as varied as arthritis, depression and multiple sclerosis before reaching a fibromyalgia diagnosis.

Unfortunately there are no objective markers or diagnostic laboratory tests for fibromyalgia. However The American College of Rheumatology (ACR) guidelines direct doctors making a fibromyalgia diagnosis to test 18 points on a person's body for tenderness. ACR criteria state that pain at 11 of the points may indicate fibromyalgia.

Even that guideline is controversial, since some specialists question its usefulness given that fibromyalgia symptoms may come and go.

How to cope with fatigue

Other common causes of fatigue can include obesity, diabetes, depression, rheumatoid arthritis, and in some extreme cases, chronic fatigue syndrome.

Experts note however that most people can transform from tired to energized by taking a few simple steps:

• Learn to manage stress levels and workplace tensions effectively

• Include at least 30 minutes of moderate physical activity into your daily routine

• Lose some weight

• Eat wholesome foods

• Avoid alcohol

• Practice good sleep habits

poornima.jayaraman@thesouthern.com / 351-5019