Why am I always tired, doctor? How (much) a visit to the doctor can clarify about fatigue

Monday morning.

A beep enters the placid dream.

You shake off your daze, you open your eyes and you can't believe it.

You'd swear you went to bed just an hour ago, but a glance at the clock clearly denies it: seven have passed.

And that you have spent the weekend in a horizontal position, from the bed to the sofa, and vice versa ... The worst thing is that it is not the first time this has happened to you.

It has almost become a habit.

Feeling like your strength has been stolen is your anomalous new normal.

But you find the strength to go to the doctor;

the first thing is

.

Well done.

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Because what the body asks of you is to find an easy excuse.

The change of season, for example.

It could be worth it.

After all,

with its gray days and nights that start earlier each time.

It is proven, it is a symptom of Seasonal Affective Disorder.

According to a study published in the

, it happens that the change of season favors slight alterations in the mood accompanied by the sensation of lack of energy.

An investigation published in the prestigious medical journal

explains that what happens is that the reduction in daylight hours is related to low levels of serotonin in the brain.

The body asks you to stop, rest and accept the diagnosis of autumnal asthenia without further ado.

Why move ...

But no.

"The change from summer to autumn can throw us off a bit because it causes alterations in the biorhythm and in the mood, but it happens as soon as it is regulated, it is not something pathological", explains Milagros González Béjar, primary care physician in the service Madrilenian of Health and member of the Spanish Society of Primary Care Physicians (SEMERGEN).

If you spend your day trying to remember when a steamroller ran over you, you can be sure that time is not to blame.

It is enough to sit in front of the doctor to realize that you are trapped by the fatigue pandemic: exhaustion is the seventh cause of consultation in primary care, and the most recent studies conclude that

, a situation that is twice as frequent among women, points out González Béjar.

And explain what you can expect from the query.

The "chair test", the best way to inquire into the context

There are things that are obvious when seen from the outside and go unnoticed by those who suffer.

What if that exaggerated tiredness showed up right after you've been made boss?

Or when you started the renovation of the house without suspecting that it would last longer than the work of El Escorial?

As stated by Dr. Jaime Merino, former president of the Spanish Society of Internal Medicine (SEMI), "the chair is the doctor's best instrument because talking with the patient is key to trying to find a diagnosis."

The method seems to be especially useful when we talk about a mysterious fatigue, since it is common that infinite exhaustion can be due to causes as diverse as

, lack of sleep, excess activity, the use of medications such as anxiolytics, antidepressants and antihistamines, that count fatigue among their side effects ... If this is the case, one can move with some relief to the next phase, that of treatment, but the origin of the problem does not always emerge so easily.

The doctor may have to dig a little deeper.

"You have to delve into the antecedents, if it has happened more times, how you are in your work environment, in your family environment ... The origin can be in organic or psychological causes, such as depression," says González Béjar.

So the talk continues until it is time to delve into something more tangible than words.

The physical examination begins.

As the primary care doctor explains, with her you can obtain other types of answers with measurable parameters: what temperature is the patient, what is his Body Mass Index (BMI) and if it has changed with respect to those previously registered, if the auscultation rules out heart failure, what does the blood pressure monitor indicate ... This information is important because

, from mild dehydration to endocrine or heart problems.

In the event that the examination reveals fever, that there has been weight loss or that there is an abnormality in the auscultation, the doctor will have new clues to follow, with the help of diagnostic techniques.

From blood test to CT

Possible tests range from urinalysis to examination of the thyroid gland (hypothyroidism may be behind fatigue), to liver and kidney activity, since a disease of these organs can also be the reason for excessive and unexplained exhaustion.

But the first thing will be a simple blood test.

Through it we can know if what happens to us is that we have horse anemia, one of the main causes of fatigue.

Or analyze a parameter that can provide quite a few clues: the sedimentation rate.

As the doctor Jaime Merino explains, this parameter “speaks of the tranquility of the body.

It increases in the face of any inflammatory process, so that if the results appear high in the results, it means that there is an inflammatory process ”that may be behind the fatigue.

The lower the red blood cells fall in a test tube over an hour, the greater the body's inflammatory response.

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Doctors have more complementary tests, including X-rays, CT scans, and MRIs, which will be requested if a specific disease is suspected from the analytics or the information collected through the questions.

For example,

, a condition whereby the patient does not wake up but does not sleep properly either;

is in a continuous sleep-awakening that results in a sleep that is not restorative.

It does not rest.

In the final picture, which can begin to be drawn in the first 5 minutes of consultation or require numerous - and advanced - diagnostic tests, there are many options, from stress to serious diseases such as cancer.

Also covid-19, which has among its most frequent symptoms, in addition to fever, great fatigue.

“The clearest expression of the coronavirus is that it

.

It is a secondary manifestation of this infectious process ”, recalls Merino, coordinator of the SEMI work group on health education for citizenship.

But it is also possible that, after all the tests performed, the doctor still does not find the cause.

When this happens and the fatigue lasts more than six months, and is not relieved with rest, the most likely diagnosis will be chronic asthenia.

“It is a process in which the real cause of this fatigue that lasts for several months is not quite clear.

, although it is not known with certainty ”, explains Merino.

It is not always a psychological illness.

Perhaps several causes combine to originate this syndrome.

In that case, the diagnosis may not be of great help, but naming the origin of fatigue in general is the way to get rid of it: once the reason is known, it only remains to follow the advice and treatments designed to combat what has caused it. caused.

But if the objective is to try to avoid in all possible ways the fact of finding ourselves in that situation, the experts consulted point out an almost infallible recipe: if we lead a healthy life, we have fewer ballots to belong to the 25% of the population that suffers from fatigue strenuous.

This implies eating well, doing discreet but permanent physical exercise, avoiding excessive physical activity, and avoiding toxins such as tobacco, alcohol or drugs.

Basically, sticking to the ABC's of the healthy lifestyle: a profitably happy routine.