How to find the root cause of extreme fatigue?

Question

Hi doctor,

I am a 31-year-old male. I am managing an IT company. I have suffered from periods of extreme fatigue for the past one and a half years. The first period of fatigue was one and a half years ago, and it lasted for around 18 days. Then I felt fine for the next five months. From then till today, I have had one to two weeks of fatigue followed by one to two weeks of fine feeling. During these fatigue periods, I sleep an average of one extra hour each night. I get very little work done. I do not have the energy to exercise (which I have always enjoyed). I have no physical or mental energy and brain fog. This is something I have never experienced before. I have attached the blood test results. Abdominal ultrasound and chest X-ray were also done with normal results. My weight is normal, and I eat a healthy, varied diet. I supplement with fish oils. I do not work very much, and I do not feel stressed. My blood pressure is normal. Physical examination was done at the doctor’s office. The two doctors I have seen cannot find any problem, but something is clearly wrong with me. What do you suggest I do next to find the root cause?

Answer 1

Hi,

Welcome to icliniq.com.

You pointed out that you never had a period of fatigue problems before. Can you try to recall what happened during that period (before one and a half years)? Was there any excess stress situation or anxiety problems? As you are healthy and doing physical exercise, it means that physically you are perfect. We need to address the psychological aspect. This is not yet a psychiatric disorder, but a psychological disorder. When did you come to this place for work? Do you like the job and atmosphere? Do you like the work culture, subordinates and colleagues? What about your family? Do you miss your family? How is your sexual satisfaction?

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I went through your details and blood reports (attachment removed to protect patient identity). IgM antibodies are the type that form when an infection occurs for the first time. High levels of IgM can mean a new infection is present. But other tests indicate you do not have any of these problems. High levels of IgM appear in cases like macroglobulinemia, early viral hepatitis, mononucleosis, rheumatoid arthritis, and kidney damage (nephrotic syndrome). IgM also gets elevated in case of parasite infection. High levels of IgA indicate monoclonal gammopathy of unknown significance (MGUS) or multiple myeloma. Levels of IgA also appear high in some autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), and in liver diseases, such as cirrhosis and chronic hepatitis. But other tests indicate that you do not have any of these problems. Ferritin reading is normal. The most common causes of elevated ferritin levels are likely obesity, inflammation, and daily alcohol consumption. Morning cortisol level is high at 86. Morning cortisol level is always high. When the cortisol was measured at other times of the day, the results were normal. Therefore, there is nothing to worry about in that aspect, too.

All the other laboratory test reports say that there is nothing wrong with you. Therefore, the two doctors you consulted said that there is nothing wrong. I think you should leave the symptoms there and convince yourself that you are fine. You are a healthy person. You told me that you do not have any mental or psychological stress. But I strongly suspect that you have hypochondriasis (worrying about health and serious illness). Hypochondriasis is health anxiety. You are anxious about your health. Health anxiety can cause symptoms such as tiredness, lack of energy, brain fog (confusion), etc. Health anxiety symptoms will not have any physiological, anatomical, or organic causes with regard to the symptoms. The treatment for health anxiety is psychotherapy. The first step is to believe the doctors who treated you. Second is to ignore the symptoms because there are no underlying reasons. They are just your imagination. Lead your life as if you were doing before.

Convince yourself that you are perfect. Engage in physical, entertaining, hobby-rich, social, and family activities that keep you engaged, and you think less about health. Eat a balanced and healthy diet. As in your place, the climate is hot and humid, you are bound to have lethargy, tiredness, and brain fog. Do not connect these issues with what you had earlier. Drink a lot of water and eat fruits and vegetables. I suggest two tender coconut waters per day for 10 days.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.