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Tuesday, April 7, 2020  Spokane, Washington  Est. May 19, 1883
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With fatigue, watch for red flags

By Dr. Alisa Hideg

A friend was recently diagnosed with stage IV colon cancer. Her only symptom was fatigue for more than six months when she decided to see her doctor.

Another friend was chronically tired for years and she thought it was part of heading for the big Four-O. Turns out she had a tumor that was causing hormone problems and she began feeling less tired within two months of starting treatment.

This has started me thinking about fatigue – one of the most common concerns I hear from patients. It is usually not anything serious, so when and how do you decide that your fatigue might be something that needs a doctor’s attention?

First, let’s define fatigue. It is a general lack of energy and motivation, a feeling of weariness or tiredness.

Seriously? In this 24/7 world, everyone feels like that almost all the time, don’t they?

Feeling tired occasionally or even for a few weeks during an especially busy time is normal. Fatigue for months on end, for no discernable reason, is not normal.

So then the question is whether you feel tired daily, or once in a while.

Feeling tired sometimes is normal, but annoying. If you are only tired sometimes, then look at what is different about those days. Are you sleeping less? Skipping breakfast? Eating differently throughout the day? Stressing over something?

Look at your days and nights to see what might be the cause, then do what you can to improve it. It is a process of trial and error, but if the end result is fewer worn-out days, it will be worth it.

If you feel tired every day, it might still be related to those items mentioned above. Are you getting enough sleep every night? Eating breakfast? Eating nutritious and balanced meals? Moving or changing jobs? Grieving for a recently lost loved one? Caring for a new baby or an elderly family member?

Some of these things are actually good things, but even good stress can make you tired.

If you can identify things that could be contributing to your fatigue, do your best to improve the situations you can and see if you begin to feel less tired.

Some changes you just have to wait on as you will probably begin to feel less tired when you get used to your new situation. Other areas you can change.

Make getting enough sleep each night a priority. Eat a balanced breakfast that has protein in it every day. Eat healthy snacks and meals even when you are busy.

Do not depend on caffeine for energy. Talk to someone who is a good listener about your stress. Do not be shy about asking for help.

If you are still tired all the time after identifying potential causes and doing as much as you possibly can about them, it is time to make an appointment with your doctor. Make an appointment sooner if you have pain, abdominal symptoms, trouble breathing or anything else that concerns you.

Share with your doctor all symptoms you are having, the things you thought might be causing your fatigue and what you did to improve them.

After talking with you about your thoughts and what you have tried, your doctor will probably ask you questions to see if there are things going on in your life that simply did not occur to you or if there is any history of diseases that can cause chronic fatigue like anemia, thyroid problems, depression, allergies, diabetes, kidney or liver disease and cancer.

The next step may be a physical exam and drawing blood. If you are an appropriate age for any cancer screenings (e.g., mammogram, prostate exam or colonoscopy), get them done.

It may take multiple visits to the doctor to pin down the cause of your fatigue, but try to be patient. Once you and your doctor figure out the cause of your fatigue and you start the proper treatment, you may begin to feel like your old self.

As my friend told me after she got her hormones straightened out, “It’s more than not being tired anymore, I got my life back.”

Dr. Alisa Hideg is a family medicine physician at Group Health’s Veradale Medical Center in Spokane. Her column appears every other Tuesday in the Today section. Send your questions and comments to drhideg This week’s column is dedicated to Cinzia.

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