I have been pummelled lately with the adage that when you have cancer, your whole family does to and everyone that cares about you. At first I was like NO WAY! and THAT’S RIDICULOUS! No one else has tumors all over their body! No one else is getting poison shoved into their veins. C’MON! And then, I took a minute and got over myself and realized that that is not what that statement means. It doesn’t mean that everybody else is going through all the physical aspects of the cancer. It means that they are on their own emotional journey because the cancer is affecting someone they care about and they feel kind of helpless about it. They are having their own whirlwind of thoughts and feelings all the time as well. They have sorrow and sadness and anger all at the same time too. They need counselling too. The anger to me is actually sadder than the plain old sadness. I notice with my own family that I get caught in the crossfire of all of those feeling more than I care to. It is strange though, because, even though I get a lot of anger directed toward me, it doesn’t mean that they are actually angry at me. The way they describe it is that they are angry about what is happening to me and they don’t know how to express it. Well, combine that type of misdirected miscommunication with a dose of my current oversensitivity( and me being off prozac to boot) and we have a real mess on our hands at times. Suffice it to say, we are keeping the therapy offices busy right now and it still doesn’t always work out the best. It is a work in progress to be sure. Having said that, now that I have a better understanding of what that statement means, I can make better attempts at not taking their emotions personally. So maybe, if they can try a little harder not to misdirect and I can try a little harder to understand that they are going through stuff too, we can do a little better together.
Hey everybody. Show of hands…who seems to be tired all the time lately? I bet there is a ton of you. No matter how much sleep you get, no matter how well you eat, no matter how much caffeine you drink, that thick blanket of fatigue just never leaves lately. But why? My guess is that this persistent exhaustion isn’t actually just physical, it’s emotional as well. I mean sure, I am one of the believers that constant mask wearing puts you at risk for CO2 retention and respiratory acidosis, which can cause fatigue, but I know that is not the whole story.
So, why are we so exhausted? There are ten basic causes for fatigue that are the most common. Some of them we do to ourselves and some of them we have no control over. Let’s review.
The first one is poor diet. If you eat a diet full of refined sugars and carbs, you will be totally wiped out because all you get from that is short energy bursts followed by crashes. Likewise, if you are trying to diet and you are not actually getting enough calories to keep your body going, you will simultaneously just drain your own energy reserves throughout the day. On the other hand, if you eat a well balanced diet with no meal skipping, you will stay fueled the whole day!
The second one is using electronics before bed. I am totally guilty of this one. I mean, who is not filling their heads with the latest anxiety-causing social media right before they want to go to sleep? Sometimes it is the only time that we feel like we can “catch up” on the world right? Did you know that using electronics before bed turns up your fight or flight response which increases your pulse and blood pressure for several hours? It also decreases your melatonin levels. Both of those things are sure to keep you up longer. Ideally, you should aim to “unplug” at least three hours before bed time to give yourself a fighting chance.
The third one is sleep apnea. Sleep apnea happens when you literally stop breathing multiple times during the night, even if you don’t know that you’re doing it. This happens because your airways close while you are sleeping because of extra soft tissue. Not sure if this applies to you? Ask your bed buddy, if you have one, if you are keeping them up at night with your intense snoring. If the answer is yes, talk to your doctor about it and get treated.
The fourth one is anemia. If you are anemic with low hemoglobin, your red blood cell count is low and they are not getting enough oxygen and therefore you are tired all the time. The most common cause of anemia for women would be iron deficiency from menstrual blood loss. Some symptoms of anemia might be skin pallor, elevated pulse, fatigue or weakness. If you think you are anemic, talk to your doctor before self treating.
The fifth one is diabetes that is undiagnosed or poorly controlled. Diabetes causes excess sugars to stay in the bloodstream instead of going into the muscle where they can be used for fuel. As a result, you stay fatigued all the time. Some symptoms of diabetes could be frequent urination, excess hunger, excess thirst, and fatigue. If you think you might have diabetes talk to your doctor.
The sixth one is dehydration. We are all racing around lately without stopping just to try and keep up with the world around us. One sign of dehydration could be darkening of your urine when you go to the bathroom. If you notice, start increasing your fluids and see if it changes. We need to take the time to drink water frequently throughout the day. Experts say that we should aim for at least 3.7 liters(15.5 cups) a day for men and 2.7 liters( 11.5 cups) per day for women. How many of us are even close to that? I better get drinkin!
The seventh one is too much caffeine intake. I think that the world in general is guilty of this nowadays. There is no dietary recommendation for caffeine. It can be found in some medications, chocolate, caffeinated teas and sodas, and energy drinks. While caffeine can give you a temporary boost, it doesn’t last. How much caffeine is too much depends on the person. The effects of too much caffeine include increased blood pressure, elevated heart rate, premature heart contractions, and headaches. With caffeine, it really is a vicious cycle. You start drinking caffeine because you are tired. The caffeine then makes your body race and you get more fatigued. Then you find yourself “needing” more caffeine. Then when you try to wean yourself off of caffeine, you can get ridiculous headaches as it washes out of your system. In an ideal world, I would say don’t even try it in the first place. Mind you, I am saying this as I am sipping my dollar sized McDonald’s coffee.
The eight one is a chronic infection of some kind, most commonly a bladder infection. If you have been recently treated for a bladder infection and have no other symptoms except a lingering fatigue, go back to your doctor and get rechecked. You could have some infection left over.
The ninth one is thyroid issues. The thyroid is that little gland in your neck that literally has it’s fingers in multiple body functions, not the least of which, your metabolism. If your thyroid is underactive(hypothyroid), that could slow your metabolism and make you feel really sluggish. It could also affect your skin and make it difficult for you to lose weight. If your thyroid is really underactive, you might even notice a bulge in your neck and have trouble swallowing. If you think you have thyroid issues, call your doctor and get checked.
Last, but definitely not least, depression and stress are a major cause of fatigue. At least 25% of people suffering from depression report fatigue and a loss of appetite, in addition to the classic depressed mood that we think of. This is the one that I think is really affecting all of us right now with the the state of the world like it is. Depression causes feelings of sadness, anxiety or hopelessness for an extended period of time. People who are depressed often have sleep problems, which only add to the fatigue. Stress stimulates our flight or fight response which overtaxes our metabolism and can leave us feeling worn out and tired. Who doesn’t feel all of those things right now? The world is just not the same. We feel out of control. We feel like the joy has been sapped out of all our favorite things. We are spending a lot of energy looking for someone to blame for how things are instead of using our energy to deal with it. In my practice alone, the percentage of patients that I am helping with depression has risen 75%. This is a real problem and we need help.
So, we have talked about the causes. For the first nine, the strategy is fairly obvious: treat the underlying condition and the symptoms should resolve. Correct the lifestyle slip ups and the symptoms should get better. The last one, depression and stress, is a much harder mountain to climb. There is no one strategy that works for everyone because it is not a straightforward issue. You know what my first suggestion is going to be: talk to your doctor! Clue them in to what is going on with you and maybe they can help. Talk to your family and your friends. Maybe they are feeling the same way! Support each other the best we can! Seek counselling and therapy. I know that I personally have a list of counsellors ready to help at my office at any one time. Don’t try to tackle it all on your own! There is no harm, no foul, and no defeat in seeking help. The real battle is lost when you don’t take advantage of the resources around you and something terrible happens. Then the consequences spread like ripples on a pond, not only affecting you, but everyone you care about as well. Make sure you take the time to realize your own importance, especially now. No one can do that for you. I will make you a promise right now, we doctors are here for you.. We understand and we are tired too, but we will always be here.
Remember how “they” always told us that high school and college were some of the best years of our lives? That these were the times to be free, live it up and soak up as much of life as we could? It always seemed like nothing would ever compare to our teen years and that they would be something we could look back on fondly for the rest of our lives. Well, that kind of thinking may have worked for other generations, but I am willing to bet that today’s teens just don’t see it that way.
Take a look around. Today’s teenagers face unprecedented obstacles that are unique to them. They have had regular school interactions ripped away. They have had to miss out on many important last firsts like their last sporting event, or prom, or even walking in a graduation ceremony. I realize that there are those of you out there puffing your chests as we speak stating that the challenges facing today’s teens are nothing like what you had to face. For example, some of you had to face the possibility of going off to war after high school. This cannot possibly be compared to missing prom or graduation. I get it, but, before you get all upset and entitled, who was trying to? Was anyone really trying to suggest that missing prom and being drafted were comparable? I really don’t think so. As I mentioned, this generation of teenagers is facing a different level of challenges that are unique to them. It is not an implied competition between current and past obstacles. No is better or worse off than anyone else. The situations are just different. Let these kids have their pain and attempt to deal with it the best that they can. Even if you chose not to embrace it, these kids are, in fact, in pain and this pain is very real to them.
I see examples of this every day. A few weeks ago, I had a group of my daughter’s friends over (under five kids and no hugging or snuggling allowed) and just observed. First of all, it was the first time some of them had really seen anyone else, much less each other. There were tears and rambling speeches about how much they had missed each other. Their conversations were particularly intense and loaded, as if they were trying to communicate as much as possible in the shortest amount of time, just in case the opportunity never presented itself again. There was a deep sadness and angst that pervaded their conversations. Instead of talking about gossip, boys and gum, they talked about their anxiety, their tics, their medications. They talked about how toxic school was. They spoke of parents as enemies of ideas. It was all so negative. They had spent so much time with their own thoughts with no one to bounce them off of that they had developed whole conspiracy theories about school and all of their relationships. It was as if their faith in any sort of return to normality had been destroyed and they developed a series of psychological walls to convince themselves that normality was truly overrated anyway and that there was really nothing to miss in the first place. I sat back and listened with my heart heavy. I wanted to interject and grab them all and hug them ( not very COVID PC) and remind them that it will all be ok at some point. Still, I didn’t make the gesture for two reasons: 1) I didn’t want to interrupt. These were the wild thoughts that they literally and physically needed to get off their chests. and 2) I wasn’t entirely sure myself that things would be ok eventually and I didn’t know what further harm I could cause by raising false hope.
As I said, these kids are in pain and they need help. Now more than ever they need us to listen and provide counsel and a sounding board. They need some kind of structure to cling to and see their way through life. I know that we all have our own frustrations right now economically, physically and emotionally as well, but we have to suck it up somewhat as adults. These kids haven’t had enough life experience or tools to effectively deal with all of the change happening around them just yet. Whether they want to accept it or we want to admit it, they need us more than ever right now. All of our roles have changed. We are no longer just parents or just teachers or even just friends for them. We are sometimes their only consistent connection to the world at the moment. We all need to be a little understanding and work a little harder to make sure that that connection is a healthy one. Otherwise, who knows what the future will hold for them….or us.