Yawner: Tired people have issues


I would never survive in jail. When I was a UVA fellow, I interviewed at the local jail for a moonlighting position. I suddenly related to my mother's experience as medical resident in NYC when she had to help at the local lock-up. Whooping, hollering (unlike Gwen Stefani, who ain't no Hollaback Girl), and name-calling– it was worse than the Jerry Springer show!

The worst thing about the jail, though, were the orange uniforms they had to wear. If I put one of those orange outfits on, it would be like the Wicked Witch of the West, "I'm melting, I'm melting!" It reminded me of Private Benjamin when Goldie Hawn says, "Do you have anything else besides green to wear?" But she looked very cute in her fatigues. Why do they call some military clothes "fatigues"? Does wearing them make you tired?

According to the literature, only seven percent of people at this very minute have a problem with fatigue. Only seven percent? Maybe the iPod is waking everyone up, but I think at least half the population suffers from fatigue. The proof is in the pudding– why else would there be a Starbucks on every corner? We work more than the Japanese now, and the 40-hour work-week has become a thing for slackers.

What is fatigue? The dictionary says, "a sensation of exhaustion during or after usual activities, or a feeling of inadequate energy to begin these activities." It basically means you poop out too fast, or you're just plain ole pooped. It's not being sleepy (somnolence), short of breath (out of shape), or physically weak (like a person who has Multiple Sclerosis). You can be fatigued with these three things, but fatigue means unusual lack of energy. (My personal mantra is, "Help, I'm in bed, and I can't get up!" I can easily sleep 14 hours.)

There are three periods of fatigue: 1) "recent" <1 month 2) "prolonged" 1-6 months and 3) "chronic" >6 months– not to be confused with Chronic Fatigue Syndrome, which has more criteria and is a whole other article.

When a patient comes to me with fatigue, I explore a wide range of potential causes: medications, infection, hypothyroidism, B12 deficiency, anemia, cancer, lung disease, heart disease, alcohol abuse, etc. But the number-one cause is... drum roll... psychiatric. Depression and anxiety occur in three quarters of people with fatigue. Sleep apnea is creeping up because two thirds of Americans are overweight or obese.

Psychiatric conditions are not necessarily the cause of fatigue, though– they just happen to exist in people with fatigue. In the '70s, my parents would complain how rude and demanding people were in Asia, unlike the U.S.

Today, my parents complain how rude and demanding Americans are, unlike in Asia. Yes, we Americans should congratulate ourselves for not only outworking the Japanese but also out-demanding them as well. And frankly, it is exhausting. I'm exhausted. Aren't you?

For those who have chronic fatigue, a good physical examination and labs are required. Exercise, yoga, meditation, and good sleep hygiene are all very useful. Antidepressants, psychotherapy, and good nutrition can be helpful. Avoidance of alcohol and drugs, having good interpersonal relationships, and taking good care of oneself is vital.

Should we go back to the '70s when things were slower? Fashion always goes back to the past. Movies keep doing remakes of classics. I think models should come back, too. It's nonsense that models fade away by the time they're 30 years old. Cheryl Tiegs should come back. Do you think her middle name would be Fa, as in Cheryl Fa Tiegs?