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Fatigue and AnemiaFatigue and Anemia
           
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TIred...so tired of being tired
Jan 31, 2003

Hi Dr. Bob. I have been reading yor comments and I must say, I am impressed..who would have thought that a smart ass answer could make someone so darn endearing! Ok..enough of the mushy stuff! I am tired...headachy, sleepy..can't seem to get enough sleep. SInce being diagnosed a little over a year ago, this is the worst i have felt. I am on 30mgs of Prozac..so depression is not an issue. I am on zerit, ziegen, and epivir..viral load is undetectable and t cells are moving up..over 300 now. So now that you have all the facts..fix me! Ok..I am not expecting a miracle, but I would like some kind words. IS there hope? Will I ever get untired. I am jsut over it! It has affected my work. I do renovations (I know, butch, huh) and I have been sleeping through work..I am trying to listen to my body and let it make the decisions for me. I figure it has a better sence of what it needs than I do. But I tell you..my body is starting to really p*ss me off..yikes! I am hoping for some advice on what I can do for me...hell, i donl't even care about sex anymore..ok, not much anyway..ok..maybe a little..ok..when there is no headache, then I am up and ready to go....Anyway..thanks for your comments and I hope you got some encouraging words for me. So many things are going well for me..but this exhaustion is ruining all of it!! take care and thanks for the smiles..I need those..Tommy ZZZZZZZZZZZZ!

Response from Dr. Frascino

Hey Tommy ZZZZZZ,

Thanks for the "mushy stuff!"

Fatigue! Total bummer, isn't it? First words of encouragement are that you are not alone! It's the most common complaint of all us HIVers! Often times, we mention this to our doctors and are told, "everything checks out OK." And yet, we feel like hibernation is our only option. I was recently talking to a group of HIV specialists about how to accurately diagnose and treat HIV-related fatigue. One of the specialists raised his hand and said, "I'm tired of my patients always complaining about being tired. It's just part of the disease." This type of misguided and uninformed attitude among doctors is unfortunately all too common. HIV docs are indeed often overworked and, as a result of time constraints, forced to focus on what they consider to be our most important problems - CD4 counts, viral load, resistance tests, fighting with HMO's, etc., etc., etc. Fatigue often doesn't even come across their radar screen as something that needs to be addressed. If they do even hear our question about being tired, the only advice they offer is often to point us in the direction of the nearest Starbucks. Now I'm not at all opposed to Starbucks; in fact, at this very moment, I'm sitting in a Starbucks (with another one visible kitty corner across the intersection!), enjoying a Caramel Macchiato! This, although enjoyable, is not the answer to most of our fatigue problems. So we need to be pro-active with our HIV doctors and demand, if necessary, that they take our fatigue complaints seriously! Start by having them address the following list of common causes of fatigue.

Common causes of fatigue in the setting of HIV disease include:

1. Inadequate attention to rest, sleep, diet, and/or exercise. Getting adequate amounts of sleep and exercise, and eating well-balanced meals, are often difficult. An HIV-knowledgeable nutritionist can be helpful in assessing the adequacy of your diet. Exercise is critical to maintain health, energy, and most importantly, helps us look better naked. 2. Psychological causes. Stress, anxiety, and depression are incredibly common. In addition to being associated with fatigue, they can also cause sleep disturbances, difficulty concentrating, and other problems like decreased libido. You are on Prozac, but is it working? Is the dose correct? Prozac, in and of itself, can cause fatigue! Check with your psychiatrist or HIV specialist. You might try another antidepressant in a different class. 3. Infections. Many infections, from severe HIV-related opportunistic infections to more common infections (like sinusitis), can cause fatigue. Your CD4's are 300+, which takes you out of the range of many severe OI's, but you should be thoroughly examined for low-grade chronic infections. 4. Hormonal problems. Hypogonadism - decreased testosterone production - is another extremely common and often under-diagnosed problem in us "virally enhanced" folks. A simple blood test will let you know if there is a problem. Treatment is easy with a topical testosterone patch or gel. Other hormonal problems, such as adrenal insufficiency or low thyroid hormone production, should also be checked out. 5. Medication side effects. Almost all our HIV meds can cause fatigue. I've seen some incapacitating fatigue related to Ziagen (Abacavir). With an undetectable viral load, it is quite safe to switch from one potent, highly active antiretroviral combination to another. Presently, you are on 3 nukes, so you most likely have many potential options open to you. Also, non-HIV medications (such as Prozac, other antidepressants, allergy medications, etc.) and over-the-counter herbal products can cause fatigue. Check these out as well. 6. Anemia. Another energy zapper that often goes undiagnosed and untreated is anemia. Check your lab report. Have your hemoglobin levels been heading south? Normal range for men is 14-18 g/dL.

Check these things out first, sleepy Tommy boy, and report back if you are still feeling wiped out. Remember, fatigue in the setting of HIV disease is often multifactorial. This means that often there are multiple causes acting simultaneously to zap our zip. It may take some detective work to figure it all out, but it's worth the effort!

So, Tommy, you really do renovations? Yes, very butch! I've recently had my home remodeled, and not infrequently would make a surprise visit to the worksite and find one of the workmen sound asleep. Luckily, that group just needed triple espressos (and an occasional kick in the ass) to re-energize, as opposed to an entire fatigue workup. Tommy, I'm quite confident your energy levels will indeed improve, and when they do, would you please stop by here and finish up my renovations?

How will you know when you're back to normal? That's easy. You'll feel like having sex even when you have a headache!

Get better soon, sleepy boy. Write back if you're still having troubles, or to let me know when you'll be by to work on my house!

Dr. Bob


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