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Fatigue and AnemiaFatigue and Anemia
           
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severe fatigue, concerned
Feb 15, 2004

Dear Dr. Bob,

I have not felt well for the past few months and am suspicious of my status.

I have extremely severe fatigue and general malaise. Sometimes at home or at work I only want to sleep or not move much. My body is achy. My armpits and groin have shooting pain, and my lymph nodes (especially in my neck) are swollen, but from what I have read, lymph nodes swell and hurt for lots of reasons.

I have shortness of breath and am not as physically active as usual. Even going up or down one flight of stairs makes me short of breath. I have frequent chest pains. And my mouth has yellow patches and streaks which sting sometimes. It especially stings if I scrape the patches off. Is this thrush? My appetite has also taken a dive and I am beginning to lose weight.

My concentration has been poor and my short term memory is not very good lately. I will start something or hear something and a second later forget it entirely. At work, I constantly make lists and notes so I can remind myself, but I am still missing things, which is very frustrating and not typical for me.

My sex drive has dwindled and I have no energy even when I do feel the urge.

I want to go get tested but I am not sure if I should rather go directly to a specialist. It does feel like it is getting gradually worse. Many of these are symptomatic of depression, but I have not been very depressed in a long time. Lately I have been frustrated more than anything else as these things have become more noticeable.

I would appreciate your advice.

Steve

Response from Dr. Frascino

Hello Steve,

Since this is the Fatigue and Anemia Forum, I'll take that approach first.

I agree that many of your symptoms are suggestive of depression. Depression/stress/anxiety/"frustration" can be associated with symptoms ranging from the "physical" loss of energy, weight, appetite, sleep, and sex drive to "mood" symptoms agitation (frustration), irritability, and inability to concentrate. You mention you have "not been very depressed in a long time," which would indicate that at some time in the past, you were indeed "very depressed." I absolutely feel you should explore the possibility that this could once again be all or part of your current problem.

What about anemia? That, too, can have many symptoms, including fatigue, exercise intolerance, shortness of breath, decreased sex drive, and inability to concentrate. Anemia is easy to diagnose with a simple blood test the hemoglobin level. The normal range for men is 14-18 g/dL.

Last, what about HIV? Check the Safe Sex/HIV Prevention Forum for detailed information on these concerns. If you've placed yourself at risk for HIV, then you'll need an HIV test at three months or longer from your last exposure. Should you see an HIV specialist? No, I don't feel it's necessary. Statistically, and looking at your symptom complex, I doubt HIV is your problem. However, since I know nothing of your potential exposures, I would still strongly advise an HIV test, if you've placed yourself at risk. If you do test positive, then yes, an HIV/AIDS specialist would be essential. Positive or negative, I do feel you would benefit from some counseling.

Good luck.

Dr. Bob


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