Why am I exhausted ALL the time! Update Post 98

[Ursula J]

I’m tired. Maybe it’s my job, or maybe I’m just getting old. I don’t know. I’ve scheduled a doctor’s appointment for my annual physical in mid April. I want to make a list of possible reasons for my exhaustion that I need to get checked out.

This is my list so far:
Check iron - I’ve had low iron in the past and have been on daily slow release iron pills for the past 10 years.
Check thyroid - I’ve been hypothyroid for the past 23 years and take daily meds. Maybe they need adjusting.
Sleep study - I had multiple knee surgeries over the past 2 years, and the anesthesiologist mentioned that I’m at risk for sleep apnea.
Heart monitor - I have an irregular heartbeat like my dad does. His eventually turned into A-Fib. I want to get this checked.

Is there any other medical thing I should get checked?

Some backstory - I’m a 56 year old middle school teacher. I know all teachers are tired after the last two years. I’m thinking of quitting and finding another type of job. My 7th and 8th graders are ok but the 6th graders are a handful. Dealing with them wipes me out. Plus with teaching classes you are “on” all day. There is no sitting quietly in your cubicle and getting your work done. I have to do all the grading, lesson planning, and paperwork after working a full day in the classroom. But I want to make sure there is not a physical reason for my exhaustion before I bail on teaching.

My heath is good (although I need to lose some weight), but I’ve had a rough couple of years with surgeries. I had double knee replacement in July 2020 due to bone on bone and terrible arthritis in both knees. It was very difficult; however, I was doing ok until Jan 2021 when I got a mild case of covid. Then in Feb 2021, my surgeon discovered my right knee implant and tibia bone were infected. I missed 6 months of work, had 2 additional surgeries, 3 hospitalizations (one because I had a terrible reaction to the IV antibiotic I was on), 8 weeks with a picc line and IV antibiotics. It was an ordeal. I did the knee replacements so I could move without pain and get my active life back. But now I’m too tired after work to live it!

Mrs. Ciz, I'm also in the land of the perpetually exhausted. I'm 47, mother of a 15 year old, wife of a cancer survivor who is taking classes and working full time, child of parents with health problems who live 5 hours away, a full-time community college prof...what else? Oh, I've had depression, anxiety, and insomnia off and on throughout my life. Over the last year, a new team (therapist/psychiatric n.p.) have been amazing in helping me find answers to all the tests you mention and then some.
Answer: I'm fine. I used to be anemic but am not now. My thyroid, D, B12, iron, etc. are all normal. No autoimmune disorders. I'm at a healthy weight and exercise regularly. I'm vegetarian. With every test, I almost hoped for something wrong because then it would mean I could just take a medicine and feel better. The hard part was coming to terms with what I wrote above: I have a lot of things pulling on me, and I'm just one person. I'm tired because--gasp--this life is tiring. I'm trying to give myself some grace, lean on God a bit more (that's just me, I don't preach to anyone), and just admit that some days I will be doing nothing but waiting for the day to finish. Women in particular have a tendency to be all things to all people. We overextend. Maybe what's happening is your body telling you it's a time of rest, maybe even just a short time when you need to listen to yourself and take it easy.
I agree with getting all the tests, and I hope that there are easy answers for you, truly. But if not--if you end up where I am--just know you're not alone.
Honestly, my great joy is planning (imaginary, for now) WDW trips and trying to sock away money to make them real! xoxo, UrsulaJ

 

[DLgal]

Mrs. Ciz, I'm also in the land of the perpetually exhausted. I'm 47, mother of a 15 year old, wife of a cancer survivor who is taking classes and working full time, child of parents with health problems who live 5 hours away, a full-time community college prof...what else? Oh, I've had depression, anxiety, and insomnia off and on throughout my life. Over the last year, a new team (therapist/psychiatric n.p.) have been amazing in helping me find answers to all the tests you mention and then some.
Answer: I'm fine. I used to be anemic but am not now. My thyroid, D, B12, iron, etc. are all normal. No autoimmune disorders. I'm at a healthy weight and exercise regularly. I'm vegetarian. With every test, I almost hoped for something wrong because then it would mean I could just take a medicine and feel better. The hard part was coming to terms with what I wrote above: I have a lot of things pulling on me, and I'm just one person. I'm tired because--gasp--this life is tiring. I'm trying to give myself some grace, lean on God a bit more (that's just me, I don't preach to anyone), and just admit that some days I will be doing nothing but waiting for the day to finish. Women in particular have a tendency to be all things to all people. We overextend. Maybe what's happening is your body telling you it's a time of rest, maybe even just a short time when you need to listen to yourself and take it easy.
I agree with getting all the tests, and I hope that there are easy answers for you, truly. But if not--if you end up where I am--just know you're not alone.
Honestly, my great joy is planning (imaginary, for now) WDW trips and trying to sock away money to make them real! xoxo, UrsulaJ

This reminds me of that saying "when you hear hoof beats, think horses, not zebras."

The most obvious answer is usually the right one.

 

[Mrs. Ciz]

Second the sleep study! Had no idea I had it. Dr said it causes everything else to not be balanced. Check your B vitamins. Also see if you can get a SIBO test done (gut bacteria). My daughter had that test done and it was very high. It can cause you not to absorb vitamins and minerals, which you mentioned low iron. She went through treatment and is a lot better. Hopefully you get answers and feel better soon!!

You have a well thought out list
I second the B vitamins
B12 can really play havoc with you. I had nearly zero levels years back, diagnosed with pernicious anemia. I self inject now.
I hope you find your answer, and get feeling better. ❤

Vitamin D is another one to check, especially this time of year when we're emerging from winter.

I feel you with the fatigue. I'm in a place where I'm not sleeping well at all. Unfortunately, my sleep cycle is out of whack and hard to get back on track

Have them also check your Vitamin D levels. Low levels will cause fatigue.

Sounds like you are on the right track. Have all the bloodwork done - sometimes you have to request Vitamin D because insurance won't cover a regular screening of it.

Sleep is probably a bit factor - you may think you are sleeping, but you may not be getting restorative sleep.

I have little kids and I'm constantly interrupted at night. I mean it might be once, but it disrupts the rest of the night.

Vitamin D and B12 levels are good to check. B12 and iron are tied together somehow; I think B12 levels might be essential to your body's ability to uptake iron or something to that effect. You can generally take a reasonable dose of both of these without any concern. I have a B12 spray I dose with once every 2-3 days. I take 4000 IUs of D3 a day. I get my levels tested annually.

I take daily thyroid replacement, and my uptake was not adequate on Synthroid alone. They had to add liothyronine for me to feel optimal. Consider asking about that if you haven't already. Also make sure you're taking your Synthroid on an empty stomach and waiting at least 30 min before eating anything, preferably closer to an hour. I have the best results taking my thyroid meds first thing in the morning when I wake up.

I had sleep apnea but lost some weight and it resolved. My signs of it when I did have it were: 1) irresistible sugar cravings in the afternoon, 2) being able to insta-nap in the afternoon (could fall asleep in minutes, anywhere), and 3) getting up to use the loo multiple times a night. I didn't really have to go - but apparently people with sleep apnea are waking up from hypoxia, and then their body is like 'oh hey, I'm awake, better go while I can'. So without apnea, you'd be sleeping most of the way through the night without needing to go.

I know it stinks to be tired all the time. Middle school is the worst age for behavior, too, in my experience, so no wonder you're exhausted, even just from that alone. Good luck with your results!

I will have my doctor check my Vitamin B levels. She has checked my Vitamin D levels in the past and found them low, so now I take a women's multivitamin and a Vitamin D supplment every day. I'll have her check that again too. Thank you for the info!

 

[Mrs. Ciz]

Has your A1C been checked recently?

Can you pinpoint when the fatigue started?

I looked back though my test results on MYCHART, and I don't see an A1C test anytime recently. I've had fasting glucose tests done every year for years and before every surgery the past 2 years. It is always solidly in the normal range.

 

[NeedMoreMickey]

After your doctor runs the usually blood test and if nothing shows up don't be afraid to ask for more test. I had both my knees replaced when I was 45 because the arthritis was so bad, about 3 years later I was diagnosed with Rheumatoid Arthritis. At first I didn't have any big issues but I've noticed in the last 2 years I'll have weekends where I crash on the sofa most of the weekend. There are a few auto immune diseases that will cause fatigue. Whatever is causing your fatigue the sooner you figure it out the sooner you will start to feel better.

 

[Pea-n-Me]

I looked back though my test results on MYCHART, and I don't see an A1C test anytime recently. I've had fasting glucose tests done every year for years and before every surgery the past 2 years. It is always solidly in the normal range.

I‘d imagine they’ll run it as part of a comprehensive exam if you present with complaints of fatigue.

When did the fatigue start?

 

[Mrs. Ciz]

It's probably your thyroid. When I accidentally screw up on my meds, I'm exhausted for days until my meds are back on track.

I also had to have them adjusted when I gained some pandemic weight. Now that I lost most of it, I had to adjust the meds back down.

Do you know you shouldn't take iron or calcium supplements within 4 hours of taking thyroid meds?

I'm due for my annual thyroid test. That's part of the reason I made the appointment, so I'll definitly get that checked. I usually go to my GP for the thyroid stuff. Early on, I went to a specialist to see what kind of hypothyroid condition I had. He ran some specialty tests, tweaked my meds (to see if name brand worked better than generic - there was no difference) but never found anything unusual. My throid was damaged during my 2nd pregnancy and has never functioned at full capacity since then. I currently take 150 mcg of generic Synthroid.

I usually take my thyroid meds right when I wake up and take my iron, multivitamin and Vitamin D a couple of hours later. It looks like I should space them out even more. I'll start taking my supplements at lunch time instead.

 

[ddkkanders]

Explore a gluten free diet as it can be linked to autoimmune issues. I have hashimotos hypothyroidism and it changed my life going GF. I too was completely exhausted all the time with severe brain fog and headaches. All of that went away by eliminating gluten. I would also take a daily probiotic to get your gut health back on track after all your antibiotics from your infection. Sleep study is also important to eliminate sleep apnea as a possible cause. Best of luck on your quest to feeling back to your old self.

Don’t start a gluten free diet without being checked for celiac disease first. You start with a blood test and confirm with an endoscopy. The blood test will not be accurate if you are not consuming gluten. Celiac disease is an autoimmune disease that damages the small intestine which causes issues absorbing nutrients and could lead to deficiencies. It could explain your fatigue. Good luck and hope you find the cause.

 

[Mrs. Ciz]

I‘d imagine they’ll run it as part of a comprehensive exam if you present with complaints of fatigue.

When did the fatigue start?

Shoot, I meant to answer that part of your question too. I was exhausted when my second child was born but thought, "I'm a new mom with 2 kids. Of course I'm exhausted." But then the doctor discovered my thyroid wasn't working properly. I expected the medication to work miricles. It didn't. I even went to a thyroid specialist, but I never felt like I ever got full energy back after that. Then in 2015, I went from subbing to teaching 3/4 time (now I teach full time). I was exhausted, but I was doing something new, having to plan everything from scratch, wasn't used to consistenly working all those hours. I figured that's why I was so tired. Turns out I was severely anemic - like almost needed a blood transfusion anemic. I am a power through it type person, so I just kept going. After getting on slow release iron, which I still take, I felt a little better, but I never bounced all the way back. I was also dealing with the knee pain (from a series of running injuries over the years), then the knee replacements, infection, additional surgeries and the sleep deprivation that goes along with all that. I took Trazodone for almost 1.5 years starting in Fall 2020 because my sleep cycle was totally destroyed by all the surgeries. I feel like I am sleeping much better now, so I quit taking it in October ish. Sooooooo... to answer your question, it was not one particular point in time. I just keep getting more exhausted as life goes on.

 

[Mrs. Ciz]

Explore a gluten free diet as it can be linked to autoimmune issues. I have hashimotos hypothyroidism and it changed my life going GF. I too was completely exhausted all the time with severe brain fog and headaches. All of that went away by eliminating gluten. I would also take a daily probiotic to get your gut health back on track after all your antibiotics from your infection. Sleep study is also important to eliminate sleep apnea as a possible cause. Best of luck on your quest to feeling back to your old self.

My younger brother develloped a gluten allergy in his 40s. I'll look into this. I am back on intermittent fasting and a low carb diet. It's the best thing for me for weight control.

 

[Mrs. Ciz]

You will love it got mine two and a half weeks ago. Before that I was just a app user for a month and a half.

Did you order just the bike or did you get a package. I'm trying to figure out what I need - ear phones, special shoes, mat and bike?

 

[Mrs. Ciz]

To me the most obvious question is "have you passed menopause"? For me, during the process the only major symptom I had was something they called "crashing fatigue" and it was alarming. Eventually, the severe spells abated but I never have returned to my previous level of energy or stamina, either physically or mentally.

I have never heard of this. I am fully passed menopause as of last month. It's been a year. I had been on the cusp for about 4 -5 years with 1 or 2 periods a year. I get/got the occassional hot flash, but nothing really bad. I did get anxiety for the first time in my life. I could not figure out why I was having the "fight or flight"/ butterflies in the stomach /adrenaline dumps at such random times. Finally I talked to my gynocologist, and she said anxiety is a not often talked about symptom of menopause. These symptoms are pretty much gone now.

 

[Southernmiss]

I'm due for my annual thyroid test. That's part of the reason I made the appointment, so I'll definitly get that checked. I usually go to my GP for the thyroid stuff. Early on, I went to a specialist to see what kind of hypothyroid condition I had. He ran some specialty tests, tweeked my meds (to see if name brand worked better than generic - there was no difference) but never found anything unusual. My throid was damaged during my 2nd pregnancy and has never functioned at full capacity since then. I currently take 150 mcg of generic Synthroid.

I usually take my thyroid meds right when I wake up and take my iron, multivitamin and Vitamin D a couple of hours later. It looks like I should space them out even more. I'll start taking my supplements at lunch time instead.

About the thyroid...

My endocrinologist told me always go with name brand Synthroid as there can be differences at the plant where generics are made.

Also, there are several thyroid hormones, and Synthroid does not replace them all.

I see a chiropractor who sells pharmaceutical grade supplements. She has a product called GTA which I take in conjunction with my Synthroid that replaces the other hormones. Taking this had helped me much more than anything ever did.

My physician understands that I need this extra supplement to feel my best and agrees with me taking it.

Look also at Izabella Wentz. She is a pharmacist who did a deep dive into her own thyroid disorder and has a Facebook page, website, and many books on thyroid.

 

[Mrs. Ciz]

Have you had COVID?

I had it last month, and I'm still exhausted from it. I read that the fatigue can last up to 3 months afterwards. And for some people it can last much longer. I'm finding doing 30 minutes of moderate cardio a day is helping.

If you're taking antacids, I'd get your b-12 checked out. Mine was low when I was taking antacids for GERD. When I got off those meds, it returned to normal levels.

You might have an infection from the knee replacement surgery.

What's your caffeine intake like? When I cut out caffeine, I was exhausted for about two weeks.

Finally, are there any meds that you're taking that would make you fatigued?

Let the doctors sort it out. If they don't, find different doctors.

Is it possible you have had Covid again? I had what I thought was a "mild" case of Covid (until the test was positive I thought I had a slight cold) earlier this year. Following that, I was fatigued for over a month. I was so tired I did not think I could ever catch up on my rest. I was seriously dragging. Then the weirdest thing happened, I woke up one morning and felt like I was back to normal again.

I had covid 18 months ago in January 2020. I don't think I've had it a second time. My exhaustion predates covid though. Yes, I do take Pepcid. I will make sure to have my B12 checked. I hope to God the knee implant and tibia bone infection has not returned, but this is on my list to check because I'm having shin pain in that leg. The revision implant stem is much longer that the original implant stem. It goes down into my shin area. The original infection was in the hole they drilled into my tibia for the short implant stem. I'm super paranoid that it may come back.

 

[Mrs. Ciz]

I get tired if my B-12 and Vitamin D levels get low. I think that is common as we age, because absorption becomes an issue.
Other than that, make sure you are up-to-date with your lady health screenings -- mammograms and PAP smears. Maybe those fell through the cracks as you dealt with the other surgeries.

They did fall through the cracks for a year or so, but I started everything back up a few months ago before my deductible reset. The only thing I still have to do is the colonoscopy. Ugh.

 

[ronandannette]

I have never heard of this. I am fully passed menopause as of last month. It's been a year. I had been on the cusp for about 4 -5 years with 1 or 2 periods a year. I get/got the occassional hot flash, but nothing really bad. I did get anxiety for the first time in my life. I could not figure out why I was having the "fight or flight"/ butterflies in the stomach /adrenaline dumps at such random times. Finally I talked to my gynocologist, and she said anxiety is a not often talked about symptom of menopause. These symptoms are pretty much gone now.

https://www.womenshealthnetwork.com...3,Be rigid with your pre-sleep routine. More

I got off pretty light with most of the troublesome symptoms others report but boy, that Crashing Fatigue was horrible. And yeah, I've just resigned myself to the permanent reduction in my get-up-and-go.

 

[Christine]

https://www.womenshealthnetwork.com/menopause-and-perimenopause/crashing-fatigue-in-menopause/#:~:text= The solution to crashing fatigue in 3,Be rigid with your pre-sleep routine. More

I got off pretty light with most of the troublesome symptoms others report but boy, that Crashing Fatigue was horrible. And yeah, I've just resigned myself to the permanent reduction in my get-up-and-go.

Just adding on to this (sort of), but menopause for me was the time that I *stopped* feeling tired. I had heavy-ish periods all my life and was consistently depleted of enough iron stores. Once my periods stopped, that all corrected itself pretty quickly and I"m so much better in that regard. The downside is that I have not had a good night's sleep since menopause. I wake nearly every few hours. I can't even remember when I slept through. It's not sleep apnea and is purely hormone related I guess. HRT/estrogen cures it, but I'm not doing that.

 

[Mrs. Ciz]

Sleep study should be your first step.

My husband has spent the last few years being chronically tired during the day. It got so bad he would fall asleep while driving briefly. He finally had a sleep study done (military medicine moves slowly) and he has severe apnea, with an average of 40 apnic episodes per hour. His body never gets into Delta wave sleep (the restful, regenerative type). He will get his CPAP next week.

The sleep doctor told him it is NOT normal for any adult his age (early 40s) to *need* a nap during the day and he *should* feel rested after 7 hours of sleep. While he can make it through the workday with lots of coffee, he naps every weekend, for several hours.

He had been medically worked up for everything else, and the sleep study was last on the list. It should have been first.

I know it sounds crazy for me to say that I hope I have sleep apnea, but I kind of hope I do because it is a defined problem with an easy fix that is life changing.

 

[TwoMisfits]

Another thing to check - fatigue is also a big warning sign for cancer, especially blood cancer. So, make sure they run a full CBC, which will give you the info to know if you have "warning" signs to warrant further checks for blood cancer.

In fact, the problem tends to be that fatigue is a big 1st symptom for a ton of things (as you can see on this thread), so getting a bunch of blood work done is always a helpful 1st step to try to "check the obvious stuff" 1st...

 

[Imzadi]

I take daily thyroid replacement, and my uptake was not adequate on Synthroid alone. They had to add liothyronine for me to feel optimal. Consider asking about that if you haven't already. Also make sure you're taking your Synthroid on an empty stomach and waiting at least 30 min before eating anything, preferably closer to an hour. I have the best results taking my thyroid meds first thing in the morning when I wake up.

I take Liothyronine (Cytomel) too. My T3 hormone was way too low. I could barely get out of bed for years, until a specialist corrected this after a full thyroid blood panel - and someone who knows how to accurately read the T3, Reverse T3 and Free T3 results. Synthroid contains T4 ONLY. It does nothing to replace missing T3. I have mine specially compounded with a slow release formula at a compounding pharmacy, so it lasts longer. And instead of Synthroid, I take Armour Thyroid, as it contains both T4 and some T3.

Even so, I take the two thyroid meds at separate times, about 4 hours apart, along with a natural adrenal supplement, again at a different time. All three of these spaced out throughout the day are what keeps my energy up all day. I can NOT take them all together, even if I was ordered to, as they would cause heart arrhythmia.

Four hours after my last dose, I take calcium or iron.