Constant Fatigue, Annoying Nurse Comments

[Dentarthurdent]

To some degree, I've always been a bit low-energy. In the past six months or so, this has gone to an extreme, and most recently I've been finding it really difficult to get out of bed in time to get to work (which is a 15-minute walk, and I still can't drag myself out of bed half the time). My shifts generally start at 2 PM, and I find myself hitting snooze repeatedly until it's 1:30, and then I have to fly around the house getting ready and I don't have time to eat breakfast.

I have dry skin, I have unexplained aches and pains in my upper back and sciatica problems, and my periods are irregular. I have had half-eyebrows all my life.

I also frequently go hoarse at work, which could honestly be because there's no rope system or anything in front of our hotel desk, and people don't wait for us to finish putting stuff away or whatever from the last guest (I had someone get all huffy with me because I am *required* by company policy to put any cash I receive away before I help the next guest, and "Geez, ALL I WANT IS MATCHES!!"), so oftentimes I go an hour without a drink of water during busy periods.

All of this together sounds to me like I must have hypothyroidism, or at least, it's the most obvious explanation. I went to the doctor last week and told her the symptoms. She agreed that it sounded like thyroid problems, and drew blood. She said what I pay for a doctor's visit will cover three tests, so they tested my TSH and free T4, ran a metabolic panel (because my medication can affect blood counts), and tested me for diabetes (apparently for the sheer hell of it). I protested about the last one, because I was just tested for diabetes in 2011 AND 2012 and I don't have even the beginnings of it, but they insisted on doing it and I decided there wasn't any other test I could think of that would be a better idea (other than a more extensive test for thyroid, and you usually have to get one of those from an endocrinologist).

They took me into the blood-drawing room and I sat down and asked if they could please take it from my right arm. I always say this because I bruise horribly, and it's not any fun not having a full range of motion in my dominant arm for a week due to pain or soreness. They couldn't find my veins. Couldn't find them at all. Finally went for the back of my hand instead of the crook of my elbow, and the nurse (who I've already firmly established I do NOT like after she treated me like I was 2 years old when I came in to get a scrip for an inhaler a few years ago, and complained offhand that I had to have a doctor's visit at $125 to get a new scrip for it even though I'd been taking it for a good 11 years prior, and she looked at me like I was stupid and said "That's right, honey, you need to have a PRE-SCRIP-TION from a doc-tor for PRE-SCRIP-TION med-i-ca-tion!") looks at me and goes "I've done you before, they must have trouble finding your veins every time you come in here!" The subtext being "Because you're fat", of course. I wanted to say "No, just you," but I bit my tongue and they decided maybe they couldn't find my veins because I hadn't had enough fluids that morning. Finally I let them look in my left arm and they found one right away and got what they needed.

The doctor said they'd only call me if the results were abnormal. I called the clinic just to be sure on Tuesday (the appointment was last Thursday) and they said the results were normal, but the doctor wanted to talk to me about my symptoms some more, so I need another appointment. I've since done some more research on the symptoms and I really hope I don't have Chronic Fatigue Syndrome, because it's going to take months and months and a lot of money I don't have to rule everything else out.

Oh, and I got the doctor's letter in the mail today, which said all my results were normal and I don't have diabetes, but I *am* at an increased risk. Gee, thanks, I didn't notice I was fat when, I don't know, I was shopping for clothes or trying to shave or any of a hundred other activities. And also...I have a family history of diabetes, so...thanks, Captain Obvious.

The good news is, since I started taking a multivitamin over the weekend, I haven't felt so exhausted and dragged out all the time. The other symptoms are mostly still there, though. And I'm still barely on time for work.

[It's me]

I know you didn't ask for advice, and I have no suggestions as to how to deal with idiot medical staff, but if I may....

I can only speak to the diabetes part, as I have researched that extensively: If you have been diagnosed as "being at risk for diabetes".... I really suggest that you start living and eating as if you actually have it. Aches, pains, tiredness all show up long before blood glucose levels get enough out of whack to reach the rather arbitrary threshold doctors use to officially say you have diabetes.

There is gobs of new information coming out on diabetes (& cardio-vascular) management, and what it basically boils down to is that most of the standard advice given out over the last 40 years is completely wrong. DietDoctor.com is a good place to start.

[42_42_42]

Have you been checked to see if you are anemic?
Have you been checked to see if you have PCOS?

[BlaqueKatt]

also is your physician using the revised parameters, they just updated what's considered "normal" for thyroid, and a lot of medical professionals haven't kept up.

Some information on the change can be found here

[Ophbalance]

Something to consider... do you have many tics in your area? Some of the virus strains tics carry (lyme being one) can cause some of the symptoms you list, and sadly it's not easy to spot on first brush. There's two different tests for lyme and for some reason it can be a real pain in the ass to get a doctor to test for it.

[Aethian]

How about you vit D levels?

[Seshat]

Eating and exercising as if you have diabetes is actually healthy for most people. Obviously, check with medicos who know you whenever you are planning a significant change in your lifestyle!

My usual advice if you do end up choosing to make changes, is to make small changes at a time. Change one thing, take six to eight weeks to get it embedded into your life, change the next thing. Take longer if you need to; don't take less unless your doctor agrees.

[KatherineB]

No medical advice to offer, just hugs and an eye-roll at the idiot nurse for you.

[Dentarthurdent]

There is gobs of new information coming out on diabetes (& cardio-vascular) management, and what it basically boils down to is that most of the standard advice given out over the last 40 years is completely wrong. DietDoctor.com is a good place to start.

I will check it out, thanks.

Have you been checked to see if you are anemic?
Have you been checked to see if you have PCOS?

The metabolic panel would have shown if I were anemic, and that was normal. They haven't checked for PCOS, and from what I understand that shares a lot of symptoms with hypothyroidism, so I understand why they started by looking at thyroid hormones first.

also is your physician using the revised parameters, they just updated what's considered "normal" for thyroid, and a lot of medical professionals haven't kept up.

Some information on the change can be found here

I will ask my doctor when I go back.

Eating and exercising as if you have diabetes is actually healthy for most people. Obviously, check with medicos who know you whenever you are planning a significant change in your lifestyle!

I do intend to get back in the gym...when I either get a new job and have a regular 9-to-5 schedule and can work out after work, or figure out what's wrong with me and find a solution so I can get up before my shift. I live in a national park and they charge through the nose out here for fresh fruits and vegetables, and there's a bit of a logistics problem getting refrigerated fruit home from town. But I will do *something*. The multivitamin is definitely helping already, and that's just a small change.

How about you vit D levels?

Don't know. Will have to ask the doctor. I doubt they're fantastically high, since I get about 15 minutes of sun on my way to work 5 days a week.

Something to consider... do you have many tics in your area? Some of the virus strains tics carry (lyme being one) can cause some of the symptoms you list, and sadly it's not easy to spot on first brush. There's two different tests for lyme and for some reason it can be a real pain in the ass to get a doctor to test for it.

There is no tick population here, but good thought.

No medical advice to offer, just hugs and an eye-roll at the idiot nurse for you.

Thank you. And thanks for all the replies from everyone. I feel a bit silly posting in Sickbay because on the scale of things, this is a minor annoyance compared to what some people go through.

[Food Lady]

My mom is diabetic and says everyone should be following the diabetic way if eating. It's funny you mention the half-eyebrows. I have had that since my early 30s, as did my mom. When I was younger I had Brooke Shields eyebrows, and then they started thinning on the outsides. They ended up nearly bald at the ends. Mom says it has something to do with hormone shift. All I know is that castor oil has made them grow in fuller, but not to the lush fullness they were in my youth.

[Moirae]

Wow, no wonder health care costs are sky high and insurance is three times the amount in this country. They are charging for three tests when you only need one. Among other things. Disgusting.

So I have a question for you... how much sleep do you get and whats your natural sleep cycle?

See, my husband and I are naturally night owls. Meaning, our bodies become more alert and awake for hours around 8 pm or so. It's very very hard to get to sleep before midnight. The problem is that we have to get up at 5:20 am to get to work for 7 am. This means that, by the time the weekend rolls around, we are absolutely exhausted and sleep for 10-12 hours a day on Saturday and Sunday.

We really don't have a choice in this. We've tried to adjust our schedule with no luck at all. Even if we are tired around 10 pm, our bodies won't naturally let us go to sleep until later.

Something like 2% of the population are natural night owls and no amount of adjustments will change it. The problem is that most of the rest of the population are morning people so night owls are forced to live by daytime rules if they want anything more than minimum wage.

As well, have you considered depression? People suffering from depression have changes in sleep patterns and the like that they can't control.

[Sapphire Silk]

I will check it out, thanks.

Diets for diabetics are controversial. I would seek the assistance of a dietician rather than get my information from the Internet. It certainly would not hurt you to avoid food high in processed carbs; especially foods containing high fructose corn syrup (which is added to a lot of processed carbs like pasta and breads).

The metabolic panel would have shown if I were anemic, and that was normal. They haven't checked for PCOS, and from what I understand that shares a lot of symptoms with hypothyroidism, so I understand why they started by looking at thyroid hormones first.

Actually, a metabolic panel would not show if you are anemic. The metabolic panel is the electrolytes (sodium, potassium, chloride, calcium, magnesium), renal functions (BUN, creatinine, GFR), and the liver function tests.

To check for anemia, you need a complete blood count. The red blood cell count and hemoglobin and hematocrit are indicative of some forms of anemia (others, such as pernicious, need special tests).

However, I would imagine they did one with your last visit; you should ask.

I will ask my doctor when I go back.

Ask your doctor if you can get more specific testing. There is another test that is more sensitive. I'm actually getting ready to talk to my doctor about the same thing; I've suspected hypothyroidism for years, but my TSH is always on the low end of normal.

I do intend to get back in the gym...when I either get a new job and have a regular 9-to-5 schedule and can work out after work, or figure out what's wrong with me and find a solution so I can get up before my shift. I live in a national park and they charge through the nose out here for fresh fruits and vegetables, and there's a bit of a logistics problem getting refrigerated fruit home from town. But I will do *something*. The multivitamin is definitely helping already, and that's just a small change.

Well, the quality of what you eat can make a big difference in your energy levels. I find I have more energy when I cook fresh foods at home rather than eating out. I understand it can be hard; I struggle to do it consistently myself.

My suggestion: see if you can join a 24 hour gym. Then you could still work out after work. I picked my TKD school specifically because class times accommodate both my day and evening teaching schedules, and I still have a membership in a 24 hour gym so I can supplement that with other physical activity (I can't wait until my foot gets well enough for me to start working out again).

Let me ask you something; you work a 2pm shift, right? So you get off work at what, 10pm? And you're having trouble getting up in time for work? Oversleeping will make you more tired, not less. Lack of exercise will make you more tired, too.

When I started working out regularly, I found I had more energy, slept better, and had an easier time getting up. I'm working evenings now myself, but I still try to get up at 8 because I know I'll have to go back to a day schedule in a few weeks.

Don't know. Will have to ask the doctor. I doubt they're fantastically high, since I get about 15 minutes of sun on my way to work 5 days a week.

The supplement you're taking probably will address that if it's an issue. If not, fortified milk will do. I drink protein shakes for breakfast, and as a restorative after working out: 30 gms of protein, and healthy doses of vitamins and minerals.

There is no tick population here, but good thought.

There is some evidence that people can harbor Lyme for years if it is untreated, so it might be worthwhile to look into if you lived somewhere previously. However, be wary of the "Lyme Literate" crowd. There are a lot of quacks out there selling antibiotics to people who don't need them.

Thank you. And thanks for all the replies from everyone. I feel a bit silly posting in Sickbay because on the scale of things, this is a minor annoyance compared to what some people go through.

Nonsense. You're dealing with a situation that is affecting your quality of life. You're going through your doctor and trying to figure out a solution.

I think it will be a combination of issues. Pre-diabetes can be a factor for you with your family history, but so can something that's not yet diagnosed.

Working on your diet, becoming more physically active, and developing a healthy sleep cycle are things you can control with a little trial and error to see what works for you.

[Seshat]

She lives in a national park, and doesn't own a car: getting to a gym is the big problem.

However, Dent? You live in a national park. Walking is excellent exercise. When you wake up, take an apple or a small packet of trail mix and go for a walk. (You can buy the trail mix as a big bag, or buy an assortment of nuts and seeds and dried fruits and make your own.)

Start with the short trails, and gradually work up. Eventually, you'll be able to do an hour-long trail just for the hell of it.

[Aethian]

I work outside for a living and until I started getting vit D in a huge supplement my numbers were horrible. After I've started taking a vit D and by suggestion biotin I've started regrouping in hair and nails better.

[MoonCat]

The American Diabetes Assn. has an excellent website. I, too, was warned that I am pre-diabetic, so I've been eating more veggies, some fruits (you don't want to overdo the fruit either), and less starchy stuff. I lost some weight through changing my eating habits and walking more. (I got a pedometer and am aiming for the doctor-recommended 10,000 steps a day. I can do it if I try).

So check them out for good advice about food. Doesn't cost anything to look.