Claudia Machado Cooke, MD, FACP, MPH  |  Health Through Understanding

Fatigue

By current estimates, up to 33% of people seeking attention in primary care clinics report significant fatigue. The doctor must distinguish between recent fatigue, prolonged fatigue (greater than one month duration), chronic fatigue (greater than six months duration), and chronic fatigue syndrome, the latter two not necessarily being the same.

The possible causes for fatigue run the gamut of the differential diagnosis, whether infectious, immune or autoimmune, nutritional, endocrine, or medication-related causes. The detailed history of the fatigue, its context, accompaniments, pattern over time, is critical to unlocking the mystery.

In addition to a careful history, physical examination, and lab tests, more detailed nutritional assessment and environmental considerations may offer clues, along with specialized lab evaluation and special studies. The therapy is determined by the cause. However, nutritional optimization, graded exercise and energetic exercises, tonic herbs, and acupuncture may all play a part in your return to vitality.