Do not take fatigue for granted

My two-cents Rx

Benj S. Bangahan, M.D., FPCP, FPCCP

Practicing physicians have the common observation that fatigue is one feeling that is frequently taken for granted by laymen, especially the busy ones. But this complaint, though ostensibly non-scaring during the initial manifestation, needs to be given importance, for it may after all warrant the help of a physician who is more attuned to the possibilities that the symptom, especially the bothering one, can translate into.

 The fatigue that we are referring to is not the one that a heavy worker or laborer complains of after having been assigned to a difficult and heavy work during the day, for more often this fatigue by itself disappears after a day or two. We are more concerned with the one that, for no apparent physiologic reason, just becomes a bothering feeling to be complained of, especially after it has unnecessarily continuously become a vague symptom for more than two weeks without the patient being able to make a sense of its cause. The vagueness perceived by the patient, not infrequently, makes him describe it to his physician in a way that is subjective clinically, perhaps even creating some confusion to the physician.

Sometimes fatigue is described as a sense of not being well, or a feeling of weakness, or even lethargy, which is a condition characterized by becoming easily  drowsy. At other times it may be described as lassitude, which points to weariness. So many subjective descriptions of the patient are apt to challenge the doctor in his diagnostic riddle. He therefore has to make a thorough physical examination.

With such confusing complaints subjectively narrated by a patient, a doctor must be astute enough to ask more questions that might make the patient remember and which can make diagnosing easier.  Episodes of fever and frequent perspiration at night time is a sign of a hard-to-detect infection, and if the subtle symptoms have been occurring for more than six months, the doctor might be led into considering “chronic fatigue syndrome”, usually attributable to a form of long-standing infection. History of drug use that the patient might have been into can be the cause of fatigue, as exemplified by some beta blockers used for hypertension and some drugs used for allergies. And presently doctors have accepted the fact there are non-organic causes of fatigue,  anxiety and depression being the most associated with it. Alcoholism is an accepted cause of fatigue.

 Weakness may point to a neurologic disease, which may manifest other signs recognized only by an inquisitive doctor during the process of physical examination. Fine trembling of the fingers means a disease of the thyroid, a finding of increased pressure of a venous blood vessel can spell congestive heart failure, and  noise from the lungs heard through the stethoscope can mean an obstructive lung disease. The doctor has to be meticulous with his process of physical examination.

  A thorough discovery of historical data and well-done physical examination may narrow down the suspected diseases, but that is not enough to pinpoint the actual  culprit — the doctor has to resort to the ancillary laboratory examinations, which may be able to indicate exactly the disease and its location, which can be any part of the human anatomy.

 It really pays to have a sense of caution and prevention, for it is way of helping the All-Merciful Allah in His taking care of our very own selves. Maasalāma.

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