Medical Diagnosis for Your Fatigue: What Patients Can Expect at the Doctor’s Office
A thorough medical check can help you identify the cause of your tiredness. Learn what happens during the diagnostic process and what kind of tests and exams are typically used.
If you’re suffering from fatigue, it’s important to know what you can expect when you enter the doctor’s office for your diagnosis. That way, there are no surprises, and you can prepare yourself for the diagnostic process.
To identify the cause of your fatigue, the doctor will go through three main areas of concern:
- a review of your medical history
- an actual physical examination
- laboratory tests to either confirm or rule out potential explanations for persistent tiredness.
Stage 1: A Review of Your Medical History
Doctors typically begin the diagnostic process by trying to develop a comprehensive medical history so that they can gain a broader perspective of your fatigue. This is the stage of the process at which he or she attempts to gather as much detailed information as possible so that possible causes can be identified. This information covers a number of important areas that include the existence of any known medical conditions, the medications you take, your sleep patterns, the amount of stress in your life, and any psychological concerns that may be causing a psychosomatic reaction.
In this part of the diagnostic process, the doctor will evaluate your current state of health by observing your gait and demeanor, and asking specific questions. This is done in an attempt to better define your fatigue complaint, since it tends to manifest differently in each individual patient. At this stage, he or she may ask you questions about when you first noticed the lack of energy, when and for how long it occurs, and how it impacts your daily activities. Finally, your physician will also ask you to identify whether other specific symptoms are being experienced.
For many patients, this questioning can be a frustrating process. Obviously, you just want the doctor to run some tests, obtain a diagnosis, and then work up a plan to “fix” you. Recognize, however, that fatigue is generally not a condition that can be diagnosed with a simple blood test or an x-ray. It is more a collection of symptoms. Because of that, it is not something that can be treated directly, but is rather something that must be dealt with by treating the underlying condition or conditions that are creating the symptoms. Your doctor needs to be able to identify those conditions if he or she is to have any chance of successfully addressing your fatigue.
One of the best things you can do while preparing for your appointment is to put together a comprehensive list of all of the medications that you currently take. Include both prescription and over-the-counter products, since all of them have the potential to be contributing to your ailment. That includes seemingly benign medications such as allergy pills, headache remedies, and even any natural, herbal products you may be using.
When making your list, note the name of each product, the dose, the frequency with which you use it, and the reason for its use. If you’re taking vitamin or mineral supplements, include those as well. The more information you provide to your physician, the easier it will be for him or her to either identify certain drug interactions as possibly contributing to your fatigue or rule out that possibility and turn the focus to other potential causes.
There are a variety of different sleep disorders that can contribute to tiredness, and many can result in severe fatigue if they are left unaddressed for prolonged periods of time. Most people are unaware of just how common conditions like sleep apnea really are, and assume that if they’re getting seven or eight hours of sleep each night then they should be well-rested. Your doctor will ask questions to assess the possibility that one of these sleep disorders could be a contributing factor in your reported fatigue.
The doctor will also question you about issues related to stress. Often times, increased levels of stress can lead to severe and even chronic fatigue – especially if the stressors that are affecting you become an ongoing concern. The attempt to identify your areas of stress will involve a wide-ranging group of question that will probe issues like your relationships, your job satisfaction, your home life, and any traumatic events that may have occurred in the recent past.
Your doctor will also need to ask questions to evaluate your emotional and mental state. Part of this is a continuation of the stress evaluation, but it also goes much deeper than that. Unhappiness, anxiety, and depression can all be factors that make you tired. Keep in mind that this is not to infer that your fatigue is “all in your head.” Rather, it is an attempt to identify emotional or psychological concerns that could be affecting your physical being and draining your energy levels.
Some patients become resentful over the psychological questioning, but there’s really nothing unusual about it. The studies indicate that one-fourth of all fatigue patients are suffering from some sort of depression. Others are enduring various forms of anxiety and even various forms of somatization. It is important to identify these issues if they exist, since they are generally treatable psychological issues that cause you physical discomfort when they are not properly managed.
Stage 2: A Thorough Physical Examination
The physical examination has two main purposes. The first is to reassure you that the doctor actually takes your concerns seriously. He or she does, of course, but without an actual examination many patients would assume otherwise! The second purpose is to identify any medical conditions that may be at the root of your lack of energy. This is important because many of the less common reasons for fatigue are often unable to be detected using normal laboratory tests.
In addition to assessing your general quality of health, your doctor will be looking for signs and symptoms that include:
- Actual signs of physical weakness. This can indicate the presence of a neuromuscular disease, or other serious medical condition.
- Problems with gait, reflexes, or vision. These can sometimes be clues that an autoimmune disorder such as multiple sclerosis is present.
- Evidence that you are experiencing swelling or pain in your joints. Such symptoms can indicate various forms of arthritis.
- Signs of malnutrition, especially in children and adolescents.
- Symptoms that might indicate anemia. This is especially important in women, who also tend to comprise the largest group of people presenting with fatigue symptoms.
- Physical signs of diabetes, such as light sensitivity.
- Vital signs are checked for the obvious reasons. In addition to blood pressure and pulse, your doctor will listen to your heart and lungs, as well as the abdomen. High blood pressure, low blood pressure, and other conditions involving the circulatory and respiratory systems are more readily identified with these simple exams.
Red Flag Concerns
There are also a number of symptoms that, when detected, should serve as a red flag for additional testing and investigation. These include the following:
- Indications that a malignancy is present - hardened lymph nodes, rectal bleeding, lumps in the breasts or testicles, or bleeding after menopause
- Any sort of fever
- Weight loss that has no obvious explanation
- Signs of heart disease
- Difficulty swallowing
- Recent respiratory difficulties and shortness of breath
- New neurological issues
- Signs of rheumatic difficulties
Stage 3: Lab Tests and Other Exams
Laboratory testing is the last part of the process, and is generally tailored in accord with the physician’s best assessment of the patient’s symptoms. It is rare that a physician performs every possible test, since most can be ruled out as unnecessary due to variations in both risk factors and existing symptoms. There are, however a number of tests that can be used, depending on the patient.
Blood tests are commonly among the first tests conducted. These tests can help to identify possible abnormalities in the blood that could be contributing to a lack of energy, as well as anemia, infections, and problems with the patient’s nutritional plan. A complete blood count can also be ordered to determine the number of blood cells present and their health.
Blood Glucose Testing
Doctors typically check the glucose levels in the blood to determine whether diabetes might be an issue. Often times, diabetic fatigue can be readily addressed once it is identified.
This test examines the quantity and quality of various substances that exist in your blood. The levels of potassium, sodium, bicarbonate, glucose, chloride, CUN, and creatinine are all evaluated using this diagnostic tool. Each can impact the amount of energy your body is able to use.
Since thyroid issues are often a contributing cause in fatigue cases, this test can be useful for identifying any issues with that important gland.
Urine testing is important for identifying some infections, as well as problem with the liver or potential diabetes. It can also provide clues about your general state of health that might be helpful in identifying the issues causing your fatigue.
CT Scan, Chest X-Ray, and Electrocardiogram
These three tests can identify issues with the brain, tumors or infections in the chest, and the overall performance of the heart. Any problems in any of those areas can result in health complications that can sap your energy and leave you feeling fatigued.
There are also tests that are even more tailored to existing risk factors, such as the HIV test, a pregnancy test, or tests to determine whether the patient has diseases such as lupus or lime disease. When rheumatic symptoms are present, your doctor can also test for the rheumatoid factor. Finally, skin tests for tuberculosis, and tests for hepatitis can be performed when the symptoms or patient history suggest that those conditions could be issues for the patient.
A Final Word
Fatigue is an affliction that not only affects many millions of people around the world, but also seems to be growing in prevalence with each passing year. Medical science has come a long way in the last three decades, and more doctors than ever before treat the issue of fatigue with the seriousness it merits. Because of that, you should never try to just endure your fatigue on your own, or assume that you know how to treat it. Your first option when fatigue lingers for weeks or months should be to consult with your physician and let him or her work with you to diagnose the real cause of your tiredness. That’s the best first step toward regaining your energy levels and your quality of life.
You might also be interested in:
- Be Alert for Red Flags in Fatigue. http://www.nps.org.au/topics/signs-and-symptoms/fatigue/for-health-professionals/investigating-fatigue/red-flags
- Chronic Fatigue Syndrome - Exams and Tests. http://www.webmd.com/chronic-fatigue-syndrome/chronic-fatigue-syndrome-exams-and-tests
- Fatigue Diagnosis. http://www.emedicinehealth.com/fatigue/page5_em.htm
- Fatigue: a practical approach to diagnosis in primary care. http://www.cmaj.ca/content/174/6/765.full
- Fatigue: An Overview. http://www.aafp.org/afp/2008/1115/p1173.html