Constant tiredness      

Q . I am a 23 year old male. For as long as I can remember I have been suffering from what I assume to be fatigue. Firstly, it takes a long time for me to get off to sleep, sometimes 2-3 hours after retiring and I find it almost impossible to arise come morning. Although I feel much better for a short period after taking a morning shower this soon passes and once again I feel tired by mid-morning. By the early evening (roughly 6pm) I am ready to go to bed although I avoid taking a couple of hours as I just wouldn't sleep at night.

    My GP told me during my early teens that this should pass as I grew up but now I am 23 and I just always feel shattered. Last year at a visit I was advised to get some exercise and stick to my regular sleep pattern however this didn't really seem to help. I do not take much exercise but am of average health and quit smoking 3 months ago although this does not seem to have made a difference. Friends have suggested that I may have low iron, that I am a hypochondriac, that I may suffer from low blood sugar and various other ailments. What should be my best course of action to find out if it is just a lack of exercise or whether there may be a more serious reason for this tiredness?      

A. OK, forget the hypochondriac bit. It is actually very rare and most people do have something causing their problem if only us doctors were smart enough to find it. You describe a long standing problem. There are some basic test that I would ask for from your doctor these include:      

Iron... see if you are anaemic and why.      

Blood sugars: see if you are diabetic or have too low blood sugar.      

Thyroid function: Your thyroid governs your basic metabolism.      

Heart check: Some valve problems can cause tiredness.

After all these at least you will know that there is nothing serious going on. Best of luck.

Lethargy      

Q . I seem to suffer from lengthy periods (months) of lethargy and a lack of motivation for reasons which I cannot discern. At other times I am very energetic. It seriously affects work and study, and has affected me for several years, through university and possibly since high school.

    I am 23, sleep well, am in a good state of general fitness, do not smoke and do not drink excessively. I can't identify a source of stress which would be considered abnormally high and my diet is, I think, rather good. I avoid excessive coffee intake, and I have just been on holiday. Aerobic exercise seems to help, so I go jogging. I have had a blood test before and don't recall there being anything wrong with it, having low iron or anything.

    I'm rather at my wits' end. Do you have any ideas? Could it be related to low blood pressure or something?

    I would greatly appreciate any ideas. Thank you very much, and apologies for your time.      

A. You certainly do seem to have a cyclical process going on. Obviously any test performed would need to be done during both 'phases'. I can't give you definitive advice without access to your notes but it may reflect the levels of thyroxin you are producing from your thyroid gland which governs your metabolism. As an outside suggestion you may suffer from seasonal affective disorder (SAD). It lasts for months, and is related to seasonal changes. There is often conflicting advice on this possibility. Finally, you may be suffering from a protracted post viral syndrome.

    I find your response to exercise most interesting as this is both a treatment for SAD and depression. I can only recommend you see your GP and explain your frustration.

Candida or weak immune system?      

Q . I would like to know your opinion on whether you feel I might have candida or whether I just have a weak immune system. I was sceptical about candida and probably still am so your opinion would be interesting. I am 27 and for a long time now I have suffered with fatigue, insomnia, weak muscles, sore throats, swollen neck glands and a general depression that comes with it.

    I went on prozac for a year and this helped and I was able to return to the gym and carry on with my life. I did not want to stay on prozac forever though and last year came off it with the help of a nutrionist. The nutrionist suggested I may suffer with hypoglycaemia and possibly candida as I also have athletes foot.

    I cut out alcohol and all sugary foods although I am continuing to eat bread. For 2-3 months I felt good, but since Xmas I have one cold after another. With the colds come weak muscles swollen glands and overwhelming tiredness at times. I return to the gym for a couple of weeks and take it easy but quickly all my strength seems to be gone and the overwhelming tiredness returns and a great hunger for food to keep me going. I become particularly sensitive to cigarette smoke too, and my whole body feels lethargic, my eyes, skin and hair are dull.

    How can I pick up so many colds, as I eat well and exercise when possible! I try and get as much sleep as I can although I am not the best sleeper. They are not runny nose or fever type colds just a general run down feeling with sneezing etc. and tickly cough, and quite a bit of mucus.

    I did feel good last year after kicking the sugars, so is it yeast and candida that's my problem or do I not take in vitamins and nutrients as well as I should? I noticed that one of the main factors of Candida is the taking of anti-biotics but I can only remeber taking them once when I had tonsillitis at 21. Hope you can help.      

A. I can see the temptation of your doctor to diagnose depression. It is very badly under-diagnosed in men. It also mimics many other conditions such as cancer, anaemia, thyroid problems and blood disorders. The danger is assuming it is depression without checking first for any of the other possibilities.

    Your sleep pattern along with other symptoms does tend to suggest depression. Unfortunately diabetes can also present this way. I would suggest that you have your blood checked for diabetes, anaemia and thyroid problems. If you are suffering from constant infections such as thrush I would also check out your immune system. Basically you need to sit down with your own doctor and discuss the possibilities.

Tiredness, sweats, powerful heartbeat      

Q . I am an active 23 year old. 2 years ago I suffered a 2 hour period of a very high heart rate whilst on a skiing trip in France. The emergency doctor was called out and prescribed me some tablets to lower blood pressure and heart rate. He told me that it was possibly due to altitude/alcohol/heatstroke or a combination of all three -he wasn't sure.

      During the last 6 months I have been feeling quite tired and have occasionally had the following symptoms. Sweating palms/feet, lethargy, a very powerful feeling heartbeat/pulse at a reasonably high rate (100 bpm). Recently my hands have been feeling heavy if they are by my sides and it almost seems like the veins are protruding more from my hands and arms. I have been out drinking with friends quite often up to this time as I was travelling around Australasia. I'm sure that there is something wrong with my condition at the moment and wondered if you could shed any light for me.      

A. There are a few things which could be causing these problems for you and the good news is that none of them are particularly life threatening and can be treated. Yes, the initial period of tachycardia (fast heartbeat) could have been due to booze, tiredness, dehydration etc as suggested by your ski doctor. Generally this is not so much a very fast heartbeat than an irregular fast heartbeat called atrial fibrillation. Athletes can suffer from it during high stress.

      I suspect he was not quite right as you complain of other symptoms when you returned. This sounds very like an over active thyroid, the gland in the neck which controls your basic metabolic rate, not unlike a thermostat. This can be checked with a simple blood test at the doctors. Anaemia will also cause a high pulse rate and tiredness although it is rare in younger men. You should check for any lumps under your arms, groin, collar bone or neck as some blood disorders will show themselves this way. Either way you need a check up at the docs so miss a few pints and go to the surgery instead.

Getting tired easily      

Q . I am a 22 year old male and I exercise regularly. However, recently I have been feeling tired easily and I get puffy eyes easily especially by night. This is a bother because I used to be able to stay up late without having these problems. What could be the cause?      

A. There are a lot of things which will cause tiredness and baggy eyes may not be part of the problem. Alcohol abuse will produce a chronic tiredness despite apparently sleeping long hours. Diabetes is a classic cause so if you are losing weight, have an excessive thirst or there is diabetes in the family, you should check it out. Anaemia is rare in adults who eat normally, but there are some blood conditions which will cause a disturbance in the number of white and red blood cells leading to tiredness.

      Kidney disorders can produce a build up of fluid which is generally seen around the ankles or your back if you have been lying down. It may contribute to 'baggy eyes' as they are simply collections of fluid under the skin which is trapped against the cheek bone just beneath the eye socket. On the other hand, loose skin in this area will produce exactly the same effect. Gentle massage is the best bet, although they can be very useful for supporting matchsticks.

General malaise      

Q . I have been feeling unwell for quite some time - perhaps over a year. The symptoms are like a constant cold, I feel like the room is swaying and I can feel throbbing through my head in line with my heartbeat. I frequently get very hot and then cold, my hands and feet get cold and I am t ired a lot, especially in the afternoon, it feels like a fog. I also can't sleep properly and wake up every night at 2.30am and again at 5am. I also get night sweating every other night.

      I was recently diagnosed as having atrial fibrillation which was controlled by drugs.

A. You have given me a very mixed picture which will be difficult to bring together to suggest what might be wrong. Without a physical examination and access to your medical records it is frankly impossible to be precise.

      There are many conditions which will give the general feeling of malaise which you describe and they will depend on your age, lifestyle and present medication.

      Perhaps the most obvious would be an overactive thyroid which will cause poor sleep, fatigue later in the day, atrial fibrillation (a sort of heart flutter), changes in temperature and sweating. A simple blood test will make sure, so see your GP. Anaemia is also a contender as it makes you feel tired, causes heart problems and can make sleep difficult. Again, a simple blood test will tell.

      Depression will also mimic many of these conditions, even diabetes, by causing fatigue yet early waking. The constant feeling of apprehension which you would experience comes from the release of adrenaline which would also cause atrial fibrillation.

      Alcohol abuse is a major cause of all of the symptoms you describe.

      The biggest danger is saying 'it's all in your head' so make sure you have the tests done to eliminate the kind of conditions I describe.

      I'm sorry I cannot give you a clearer idea of what the problem might be.